本文選題：急性腦梗塞 + 臨床特點��； 參考：《吉林大學》2015年碩士論文

【摘要】：臨床觀察發(fā)現(xiàn)短時間癥狀緩解的腦梗塞患者比例正逐漸增加。對于這部分患者性別、年齡、危險因素、血管狹窄情況、影像學改變及治療方面等臨床特點，目前尚未完全闡明。通過探討此類腦梗塞的發(fā)病特點及可能影響病情進展的危險因素，實施能夠加強神經(jīng)功能恢復(fù)的臨床干預(yù)手段，并通過改善相關(guān)危險因素，能有效防止這部分患者發(fā)展成為進展性腦卒中。 研究目的 觀察腦梗塞患者短時間內(nèi)緩解的臨床特點，探討可能影響腦梗塞癥狀緩解的危險因素。 研究對象與方法 回顧性分析2013年7月至2014年9月在吉林大學第一醫(yī)院及二部神經(jīng)內(nèi)科住院治療的首次發(fā)病的急性腦梗塞患者的臨床資料。所有患者發(fā)病時間≤24h；治療前有明確的神經(jīng)功能缺損體征，腦功能損害體征持續(xù)時間超過1h；將5d內(nèi)美國國立衛(wèi)生院卒中量表（National Institute ofHealth stroke scale, NIHSS）評分降低7分及以上的患者納入緩解組，共64例；將NIHSS評分降低小于7分的患者納入未緩解組，共72例。對比兩組患者性別、年齡、NIHSS評分、吸煙、飲酒、高血壓、糖尿病、冠心病、血糖、血脂、纖維蛋白原、血管狹窄、梗塞類型、病灶周圍水腫、治療用藥及治療效率。 研究結(jié)果 1.入院后5d緩解組NIHSS評分均明顯小于入院時（P＜0.01），未緩解組入院后5d NIHSS評分與入院時無差異；緩解組入院時NIHSS評分均明顯低于未緩解組，有顯著統(tǒng)計學差異（P＜0.01）。 2.緩解組男性比例為88%，未緩解組男性比例56%，緩解組男性比例明顯高于未緩解組（P＜0.01）。 3.緩解組有糖尿病史18例，高血糖21例，吸煙史23例，未緩解組糖尿病史43例，高血糖49例，吸煙史39例。緩解組有糖尿病、高血糖患者明顯少于未緩解組，差異有顯著性（P＜0.01）；對比兩組有吸煙史患者，有統(tǒng)計學差異（P＜0.05）。 4.緩解組總血管狹窄率為27%，未緩解組為54%，緩解組總血管狹窄率明顯低于未緩解組，具有統(tǒng)計學差異（P＜0.01）；緩解組以相應(yīng)支配區(qū)單支血管狹窄為主，未緩解組以多支血管狹窄為主，具有統(tǒng)計學差異（P＜0.01）。緩解組以頸內(nèi)動脈系統(tǒng)血管狹窄為主，未緩解組以椎-基底動脈系統(tǒng)狹窄為主，有統(tǒng)計學差異（P＜0.05）。 5.緩解組中頭部MRI顯示病灶周圍腦組織明顯水腫者9例，前循環(huán)梗塞56例，后循環(huán)梗塞8例，未緩解組中頭部MRI顯示病灶周圍腦組織明顯水腫者29例，前循環(huán)梗塞46例，后循環(huán)梗塞26例，兩組患者病灶周圍水腫情況、梗塞類型均有統(tǒng)計學差異。 6.緩解組中應(yīng)用尤瑞克林23例，未緩解組為10例，，對比兩組應(yīng)用尤瑞克林有統(tǒng)計學差異（P＜0.01）。 7.兩組患者14d的NIHSS評分均明顯低于入院時（P＜0.01）；治療14d后緩解組的顯著有效率及總有效率均高于未緩解組（P＜0.01）。 研究結(jié)論 短時間內(nèi)癥狀緩解的腦梗塞的臨床特點： 1.入院時臨床癥狀相對較輕； 2.男性比例高于女性； 3.既往有糖尿病史、吸煙史患者比例少，入院監(jiān)測有高血糖患者少； 4.相應(yīng)支配區(qū)血管狹窄率低，以單支血管病變?yōu)橹鳎?5.梗塞類型以前循環(huán)為主，在MRI DWI像上以皮層改變?yōu)橹鳎X組織水腫程度輕； 6.尤瑞克林可明顯促進臨床癥狀的改善； 7.預(yù)后良好。
[Abstract]:Clinical observations have found that the proportion of patients with short term symptoms of cerebral infarction is increasing gradually. The clinical features such as sex, age, risk factors, vascular stenosis, imaging changes, and treatment are not fully elucidated. The characteristics of this type of cerebral infarction and the risk factors that may affect the progression of the disease have been discussed. The implementation of clinical intervention to strengthen the recovery of nerve function and the improvement of related risk factors can effectively prevent the development of this part of the patient from becoming a progressive stroke.
research objective
Objective To observe the clinical characteristics of cerebral infarction patients in a short period of time, and explore the risk factors that may affect the symptoms of cerebral infarction.
Research objects and methods
A retrospective analysis of the clinical data of patients with acute cerebral infarction hospitalized in No.1 Hospital of Jilin University and two Department of Neurology from July 2013 to September 2014. The onset time of all patients was less than 24h; there was a clear neurological defect before treatment, and the duration of brain dysfunction syndrome lasted more than 1h; the US national state within 5D was national. The National Institute ofHealth Stroke Scale (NIHSS) score was reduced by 7 and more of the patients were included in the remission group, with a total of 64 cases. The NIHSS score was reduced to less than 7 in the group of 72. The sex, age, NIHSS score, smoking, drinking, hypertension, diabetes, coronary heart disease, blood sugar, blood lipid were compared in the two groups. Fibrinogen, vascular stenosis, type of infarction, edema around the lesion, treatment and treatment efficiency.
Research results
1. after admission, the NIHSS score of 5D remission group was significantly lower than that of admission (P < 0.01). The score of 5D NIHSS in the non remission group was not different from that of the admission group, and the NIHSS score in the remission group was significantly lower than that in the non remission group, and there was significant statistical difference (P < 0.01).
2. the proportion of males in the remission group was 88%, and the male in the non remission group was 56%. The male ratio in the remission group was significantly higher than that in the non remission group (P < 0.01).
3. in the remission group, there were 18 cases of diabetes, 21 cases of hyperglycemia, 23 cases of smoking history, 43 cases of diabetes in the non remission group, 49 cases of hyperglycemia and 39 cases of smoking history. The remission group had diabetes, and the patients with hyperglycemia were significantly less than those in the non remission group (P < 0.01); compared with the two groups with smoking history, there were statistical differences (P < 0.05).
The total vascular stenosis rate in the 4. remission group was 27%, the group in the non remission group was 54%, the total vascular stenosis rate in the remission group was significantly lower than that in the non remission group (P < 0.01). The remission group was dominated by the single vessel stenosis in the corresponding dominating area, and the group with multiple vascular stenosis was mainly in the non remission group (P < 0.01). The remission group was treated with the internal carotid artery system blood. Guan Xiazhai was the main group, and the non remission group was mainly vertebral basilar artery stenosis (P < 0.05).
5. in the remission group, the head MRI showed obvious edema around the lesion in 9 cases, anterior circulation infarction in 56 cases and posterior circulation infarction in 8 cases. The head MRI in the non remission group showed 29 cases of obvious edema around the focus of the focus, 46 cases of anterior circulation infarction, 26 cases of posterior circulation infarction, and two groups of patients with edema around the focus, and the types of infarction were statistically different.
6. in the remission group, 23 cases were treated with Yuri Klein, and 10 cases in the non remission group. The difference between the two groups was statistically significant (P < 0.01). The difference between the two groups was statistically significant (P < 0.01).
7. the NIHSS score of 14d in the two groups was significantly lower than that in the hospital (P < 0.01), and the significant effective rate and total effective rate of the remission group after the treatment of 14d were higher than those in the non remission group (P < 0.01).
research conclusion
Clinical characteristics of cerebral infarction with symptomatic relief in a short time:
1. the clinical symptoms were relatively mild at admission.
2. male ratio was higher than that of women.
3. the proportion of patients with diabetes history and smoking history was less.
4. the vascular stenosis rate in the corresponding control area was low, with single vessel disease as the main factor.
5. the type of infarction was mainly before circulation, and the cortical changes were the main causes on MRI DWI images.
6. Yuri klining can significantly improve the clinical symptoms.
7. the prognosis was good.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R743.3

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