本文選題：腦梗死 + 肢體缺血后處理　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景腦梗死是世界上導(dǎo)致人類死亡和殘疾的主要原因。理論上,溶栓理應(yīng)成為腦梗死的最佳治療方案,但結(jié)果并沒有人們預(yù)期的那么好。因此要求我們必須探索出新的治療方法,國(guó)內(nèi)外的研究者把注意力轉(zhuǎn)移到了內(nèi)源性保護(hù)的研究上,如缺血處理。國(guó)外的許多基礎(chǔ)和臨床實(shí)驗(yàn)已經(jīng)證實(shí)了肢體缺血后處理具有神經(jīng)保護(hù)的作用。目前尚無肢體缺血后處理治療急性腦梗死的臨床報(bào)道。本研究分以下兩部分探討肢體缺血后處理對(duì)急性腦梗死的保護(hù)作用及其可能機(jī)制。第一部分肢體缺血后處理對(duì)急性腦梗死的保護(hù)作用目的探討肢體缺血后處理治療急性腦梗死的臨床療效方法選擇2015年3月~2016年6月在河南省人民醫(yī)院神經(jīng)內(nèi)科一病區(qū)住院治療的經(jīng)磁共振DWI序列明確診斷為急性腦梗死(發(fā)病72小時(shí)內(nèi))且未進(jìn)行溶栓治療的158例患者作為研究對(duì)象,按照患者入院的先后順序,將患者隨機(jī)分為治療組(肢體缺血后處理組)和對(duì)照組。入組的所有患者都會(huì)給予常規(guī)治療。治療組在常規(guī)治療的同時(shí),又給予了肢體缺血后處理治療。比較入院時(shí)、病程14天和病程3個(gè)月時(shí)的美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS);入院時(shí)和病程3個(gè)月時(shí)的改良Rankin量表(m RS);病程14天時(shí)兩組患者的臨床療效。結(jié)果1.兩組患者NIHSS評(píng)分在入院時(shí)和病程14天時(shí)差異無統(tǒng)計(jì)學(xué)意義(P0.05),而在病程3個(gè)月時(shí)差異有統(tǒng)計(jì)學(xué)意義(P0.05);2.病程3個(gè)月時(shí),肢體缺血后處理組的m RS評(píng)分較對(duì)照組下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05);3.病程14天時(shí),肢體缺血后處理組治療急性腦梗死的總有效率(95.9%)高于對(duì)照組(79.0%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.肢體缺血后處理可以改善急性腦梗死患者的NIHSS評(píng)分及m RS評(píng)分2.肢體缺血后處理治療可以提高急性腦梗死患者的臨床療效第二部分肢體缺血后處理對(duì)急性腦梗死患者的腦梗死體積及腦灌注的影響目的探討肢體缺血后處理對(duì)急性腦梗死患者的腦梗死體積及腦灌注的影響方法選擇2015年3月~2016年6月在河南省人民醫(yī)院神經(jīng)內(nèi)科一病區(qū)住院治療并完成了整個(gè)肢體缺血后處理治療周期并按時(shí)隨訪的136例急性腦梗死患者作為研究對(duì)象。由專人收集入組患者的相關(guān)資料。采用Siemens Trio Tim 3.0T超導(dǎo)型全身磁共振掃描儀對(duì)患者進(jìn)行掃描。所有入組患者均在入院時(shí)(發(fā)病72小時(shí)內(nèi))、病程14天、病程1個(gè)月、病程3個(gè)月時(shí)完成磁共振的相關(guān)檢查。比較入院時(shí)、病程14天時(shí)、病程1個(gè)月時(shí)和病程3個(gè)月時(shí)的腦梗死體積;入院時(shí)、病程14天和病程3個(gè)月時(shí)的相對(duì)PWI參數(shù)。結(jié)果1.在病程1個(gè)月和3個(gè)月時(shí),肢體缺血后處理組的梗死體積較對(duì)照組分別減小36%和34%的梗死體積(P0.05)。2.肢體缺血后處理組和對(duì)照組患者rr CBV、rr CBF、r MTT及r TTP在入院時(shí)和病程14天時(shí)差異無統(tǒng)計(jì)學(xué)意義,在病程3個(gè)月時(shí)差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.肢體缺血后處理可以減小急性腦梗死患者的腦梗死體積。2.肢體缺血后處理可以改善急性腦梗死患者的腦灌注。
[Abstract]:Background cerebral infarction is the major cause of human death and disability in the world. Thrombolytic therapy should theoretically be the best treatment for cerebral infarction, but the results are not as good as expected. Therefore, we need to explore new treatments, and researchers at home and abroad have shifted their attention to endogenous protection research. Such as ischemic treatment. Many foreign basic and clinical trials have confirmed the role of neuroprotection in limb ischemic postconditioning. There is no clinical report on the treatment of acute cerebral infarction after limb ischemia. This study is divided into two parts to discuss the protective effect of limb ischemic postconditioning on acute cerebral infarction and its possible mechanism. Part of the protective effect of ischemic postconditioning on acute cerebral infarction in order to explore the clinical efficacy of ischemic postconditioning in the treatment of acute cerebral infarction. In June ~2016 March 2015, the diagnosis of acute cerebral infarction (72 hours within the onset of acute cerebral infarction) was confirmed by the DWI sequence of magnetic resonance (MRI) in a hospital in the Department of Neurology, Henan Province People's Hospital. 158 patients who had not been treated with thrombolytic treatment were divided into the treatment group (limb ischemia post treatment group) and the control group according to the order of hospitalization. All the patients in the group were given routine treatment. The treatment group was given the limb ischemia treatment at the same time. The National Institutes of Health Stroke Scale (NIHSS) at 14 days and 3 months in the course of disease, the improved Rankin scale (m RS) at admission and the course of 3 months, and the clinical efficacy of two groups of patients at 14 days of disease. The NIHSS score in the 1. two groups was not statistically significant (P0.05) at the time of admission and the course of disease (P0.05), but there was a difference in the course of the disease for 3 months. Statistical significance (P0.05); 2. when the course of disease was 3 months, the m RS score of the limb ischemic post treatment group was lower than the control group, the difference was statistically significant (P0.05); the total effective rate of the limb ischemic post-treatment group (95.9%) was higher than the control group (95.9%) at 14 days (95.9%), the difference was statistically significant (P0.05). Conclusion 1. limb ischemia post treatment Improvement of NIHSS score and m RS score in patients with acute cerebral infarction 2. limb ischemic post-treatment can improve the clinical efficacy of acute cerebral infarction patients. The effect of second part of limb ischemic postconditioning on cerebral infarction volume and cerebral perfusion in patients with acute cerebral infarction The methods of influence of death volume and cerebral perfusion were selected and treated in the one area of Neurology in Henan Province People's Hospital in June ~2016 March 2015, and 136 patients with acute cerebral infarction completed the whole limb ischemic post treatment cycle and followed up on time as the research object. The related data of the patients were collected by the special person. Siemens Trio was used. The patients were scanned by the Tim 3.0T superconducting general magnetic resonance scanner. All the patients were enrolled in the hospital (within 72 hours of onset), the course of the disease was 14 days, the course of the disease was 1 months, and the related examination of magnetic resonance was completed at the course of 3 months. At the time of admission, the course of the disease was 14 days, the course of the disease was 1 and the course of the disease was 3 months, and the course of illness was 14 days when the hospital was admitted. Relative PWI parameters at 3 months. Results 1. at 1 months and 3 months in the course of disease, the infarct volume in the limb ischemic post treatment group decreased by 36% and 34% in the control group (P0.05), and the RR CBV, RR CBF, R MTT and R TTP were no significant difference between the admission and the course 14 days. The difference between 3 months was statistically significant (P0.05). Conclusion 1. limb ischemic post-treatment can reduce the volume of cerebral infarction in patients with acute cerebral infarction and the post-treatment of.2. limb ischemia can improve the cerebral perfusion in patients with acute cerebral infarction.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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