本文選題：頸內(nèi)動脈 + 側(cè)支循環(huán)��； 參考：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過對有癥狀的腦梗死患者行全腦血管造影術(shù)檢查，明確責(zé)任血管，選取單側(cè)頸內(nèi)動脈狹窄程度為重度及閉塞的患者，記錄其側(cè)支循環(huán)的種類及數(shù)量，比較不同側(cè)支循環(huán)條件下的腦梗死患者預(yù)后的差異。 方法：113例有癥狀的頸內(nèi)動脈重度狹窄或閉塞的急性腦梗死患者，均通過數(shù)字減影腦血管造影技術(shù)分析這些腦梗死患者側(cè)支代償情況，根據(jù)有無側(cè)支代償及代償?shù)念愋蛯⑵浞譃椋簾o側(cè)支代償組A、有側(cè)支代償組B；將B組分為僅有初級代償組C組、僅有次級代償組D、同時具有初級和次級代償組E；將E組中有初級側(cè)支代償組條件下，有軟腦膜動脈向前循環(huán)代償供血的患者納入組F、有頸外動脈向頸內(nèi)動脈代償供血的患者納入組G。均于發(fā)病后第7天、3月行美國國立衛(wèi)生研究院卒中量表評分（The National institutes of Health stroke scale，NIHSS）及發(fā)病后第7天、1年后行改良Rankin評分（Modified Rankin score，，mRs），分別計算3月與第7天NIHSS評分差及1年與第7天的mRs評分差，并分析側(cè)支循環(huán)對急性腦梗死患者預(yù)后的影響。采用SPSS17.0軟件統(tǒng)計以上數(shù)據(jù)資料。計量資料用（Mean±SD）表示。計數(shù)資料用One-sample kolmogorov-smirnov Test得知數(shù)據(jù)均不符合正態(tài)分布。故采用Mann-Whitney U Test檢驗，在a=0.05的檢驗水準上P0.05定義為有統(tǒng)計學(xué)意義。而E、C、D組間的比較采用Kruskal-Wallis H(K)檢驗，在a=0.05的檢驗水準上P0.05定義為有統(tǒng)計學(xué)意義。 結(jié)果：113例患者中，重度狹窄78（69.02%）例，閉塞35（30.98%）例。其中A組51（45.13%）例，B組62（54.87%）例。C組12（19.37%）例，D組13（20.96%）例，E組37（59.67%）例。F組34（91.89%）例，G組20（54.05%）例。A組與B組相比較：3月內(nèi)B組NIHSS評分較A組顯著降低（P0.05），1年后B組mRs評分較A組明顯降低（P0.05）。F組與G組相比較：3月內(nèi)F組NIHSS評分較G組無明顯差異（P0.05），1年后F組mRs評分較G組無明顯差異（P0.05）。E、C、D組相比較：3月內(nèi)3組NIHSS評分有統(tǒng)計學(xué)差異（P0.05），其中D組評分降低最不明顯。1年后3組mRs評分有統(tǒng)計學(xué)差異（P0.05），其中D組評分降低最不明顯。 結(jié)論：單側(cè)頸內(nèi)動脈重度狹窄或閉塞的急性腦梗死患者，有側(cè)支循環(huán)患者預(yù)后明顯優(yōu)于無側(cè)支循環(huán)者。有初級側(cè)支代償?shù)募毙阅X梗死患者中，大腦后動脈通過軟腦膜動脈向前循環(huán)代償及頸外動脈向頸內(nèi)動脈代償是次級側(cè)支代償?shù)闹饕緩�，而次級代償方式對預(yù)后的影響無差異。僅有初級代償及同時具有初級、次級代償預(yù)示預(yù)后良好，但僅有次級代償預(yù)示預(yù)后不良。
[Abstract]:Objective: to determine the responsible vessels and to record the type and number of collateral circulation in patients with unilateral internal carotid artery stenosis and occlusion by means of total cerebrovascular angiography in patients with symptomatic cerebral infarction.To compare the prognosis of patients with cerebral infarction under different collateral circulation.Methods 113 cases of acute cerebral infarction with severe stenosis or occlusion of internal carotid artery were analyzed by digital subtraction angiography.According to the types of collateral compensations and compensations, they were divided into two groups: group A without collateral compensation, group B with collateral compensation, group B with primary compensation group, group C with primary compensation group, group B with collateral compensation group B, group B with non-collateral compensation group, group B with collateral compensation group BOnly sub-compensatory group D, with both primary and secondary compensatory groups, and group E with primary collateral compensatory group,Patients with forward-circulatory compensatory blood supply of pial meningeal artery were included in group F, patients with compensatory blood supply from external carotid artery to internal carotid artery were included in group G.The National institutes of Health stroke scale (NIHSS) was given on the 7th day after onset and the modified Rankin score was given 1 year after onset. The difference of NIHSS scores between 3 months and 7 days and 1 year and 1 year after onset were calculated respectively.On the 7th day, the mRs score was poor,The influence of collateral circulation on prognosis of patients with acute cerebral infarction was analyzed.Use SPSS17.0 software to calculate the above data.The metrological data are expressed in the mean 鹵SDs.One-sample kolmogorov-smirnov Test showed that the data did not accord with normal distribution.Therefore, using Mann-Whitney U Test test, the test level of A0. 05 was defined as statistically significant.The comparison between the two groups was determined by Kruskal-Wallis test, which was defined as statistically significant on the test level of A0. 05.Results among the 113 cases, 78,69.02 had severe stenosis and 350.98 were occluded.Group A (51n 45.13)) group B (62n 54.87), group C (1219.37) group D (1320.96) and group E 3759.67) patients, group F 3491.89) group G 2054.05). Group A compared with group B. the NIHSS score of group B was significantly lower than that of group A within three months, and the mRs score of group B was significantly lower than that of group A (P 0.055.F) one year later, the score of mRs in group B was significantly lower than that in group A.Compared with group G, there was no significant difference in NIHSS score between group F and group G within 3 months, and there was no significant difference between group F and group G in mRs score after one year. There was a significant difference in NIHSS score among three groups within 3 months (P 0.05), among which the score of group D was the least significantly lower than that of group G (P 0.05).After 1 year, the mRs scores of the three groups were significantly different (P < 0.05).Conclusion: in patients with acute cerebral infarction with severe stenosis or occlusion of unilateral internal carotid artery, the prognosis of patients with collateral circulation is significantly better than that without collateral circulation.In the patients with acute cerebral infarction with primary collateral compensations, the posterior cerebral artery circulates compensation forward through the pial meningeal artery and the external carotid artery compensates to the internal carotid artery is the main way to compensate the secondary collateral branch, but the secondary compensatory mode has no difference on the prognosis.Only primary compensations and both primary and secondary compensations predict good prognosis, but only secondary compensations predict poor prognosis.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.33

【參考文獻】

相關(guān)期刊論文 前10條

1 羅國君;杜玲;王云甫;何國厚;;頸動脈狹窄或閉塞后側(cè)支循環(huán)影響因素的探討[J];重慶醫(yī)學(xué);2009年20期

2 蔡俊穎;董強;付建輝;;腦動脈狹窄或閉塞后側(cè)支循環(huán)與卒中預(yù)后的關(guān)系[J];神經(jīng)損傷與功能重建;2007年03期

3 陳鋒,譚最;血管生成與動脈生成[J];國外醫(yī)學(xué).外科學(xué)分冊;2005年02期

4 白雪;王楓;劉會玲;林占峰;趙冬梅;;頸內(nèi)動脈嚴重狹窄或閉塞后顱內(nèi)血流變化的TCD分析[J];河北醫(yī)學(xué);2008年11期

5 高占東;;腦梗死患者腦血管病變及側(cè)支循環(huán)的研究[J];家庭醫(yī)藥(醫(yī)藥論壇);2010年03期

6 王雁;孫曉明;張晨;;缺血性腦卒中與側(cè)支循環(huán)[J];臨床神經(jīng)病學(xué)雜志;2011年02期

7 何潔;吉訓(xùn)明;張人玲;翟勇;關(guān)樂;許英路;;單側(cè)大腦中動脈狹窄或閉塞側(cè)支循環(huán)與腦缺血的關(guān)系[J];首都醫(yī)科大學(xué)學(xué)報;2008年01期

8 彭旭;趙偉佳;;頸內(nèi)動脈狹窄或閉塞的TCD、DSA對比研究[J];山東醫(yī)藥;2007年27期

9 劉靜穎;劉麗麗;周曉;;彩色多普勒在頸內(nèi)動脈狹窄診斷中的應(yīng)用[J];社區(qū)醫(yī)學(xué)雜志;2005年12期

10 李堯;龔浠平;王擁軍;李征;;頸動脈狹窄閉塞性病變時側(cè)支循環(huán)的開放特征[J];中國臨床康復(fù);2006年28期

本文編號：1752886