發(fā)布時間：2018-05-06 14:19

  本文選題：腦血管反應(yīng)性 + 后循環(huán)梗死��； 參考：《南京大學》2014年碩士論文

【摘要】：第一部分顱內(nèi)外大動脈無狹窄患者發(fā)生后循環(huán)梗死的血管反應(yīng)性評估研究目的：通過對顱內(nèi)外大動脈無明顯狹窄但發(fā)生后循環(huán)梗死的患者大腦中動脈血管反應(yīng)性(cerebrovascular reactivity in middle cerebral artery, MCVR)和椎動脈血管反應(yīng)性(cerebrovascular reactivity in vertebral artery, VCVR)的比較,探討CVR改變在預(yù)測后循環(huán)梗死中的作用。方法：選擇后循環(huán)梗死患者27例(PCI組),選擇同期健康體檢者25例(對照組)。采用經(jīng)顱多普勒超聲(transcranial doppler sonography, TCD)結(jié)合CO2吸入試驗檢測所有入選者的MCVR和VCVR。結(jié)果：與對照組比較,PCI組雙側(cè)MCVR明顯下降(左側(cè)：25.96±15.90% vs 34.63±8.60%,右側(cè)：26.40±14.54% vs 34.49±9.08%,P0.05)；而雙側(cè)VCVR較對照組雖也有所下降,但差異無統(tǒng)計學意義(P0.05)。多變量線性回歸分析顯示,糖尿病是MCVR受損的獨立危險因素(p=-0.116,P=0.035)。結(jié)論：對于顱內(nèi)外大動脈無明顯狹窄的PCI患者,MCVR顯著下降,VCVR受損則不明顯,MCVR或可作為腦大動脈無明顯狹窄者后循環(huán)梗死的預(yù)測指標。對于顱內(nèi)外大動脈無明顯狹窄的PCI患者,糖尿病是MCVR降低的獨立危險因素。第二部分椎動脈狹窄程度與腦血管反應(yīng)性的相關(guān)性研究研究目的：CVR是評估腦血管儲備能力的主要指標。以往關(guān)于MCVR與頸內(nèi)動脈(internal carotid artery, ICA)或大腦中動脈(middle cerebral artery, MCA)狹窄程度之間關(guān)系的研究較多,而針對VCVR與椎動脈(vertebral artery, VA)狹窄程度相關(guān)性的研究少見。本研究采用TCD結(jié)合C02吸入試驗探討VCVR與椎動脈狹窄之間的關(guān)系。方法：選擇2012年4月-2013年5月間在南京軍區(qū)南京總醫(yī)院神經(jīng)內(nèi)科住院治療、經(jīng)DSA證實一側(cè)VA狹窄而ICA和MCA無明顯狹窄的PCI患者30例；同期的住院病人中無顱內(nèi)外大血管狹窄的24例PCI患者作為對照組。利用TCD結(jié)合C02吸入試驗檢測所有入選患者的VCVR和MCVR。結(jié)果：VA狹窄側(cè)的VCVR較狹窄對側(cè)的明顯下降,差異有統(tǒng)計學意義(28.82±12.91% vs31.52±14.09%,P0.05),而VA狹窄同側(cè)和對側(cè)的MCVR無顯著統(tǒng)計學差異(27.07±15.77% vs 29.12±17.16%, P 0.05). VCVR下降程度與VA狹窄程度存在顯著相關(guān)性(correlation coefficient=-0.470, P 0.01).多重線性回歸分析顯示VA狹窄和糖尿病是VCVR下降的獨立危險因素(β=-0.432,P=0.009,p=-0.405,P=0.013)。結(jié)論：MCVR與VA狹窄之間無明顯相關(guān),而VCVR與VA狹窄程度有較好的負相關(guān)關(guān)系,提示前后循環(huán)間盡管存在Willis環(huán),其血流儲備仍相對獨立,在臨床及科研工作中應(yīng)充分考慮前后循環(huán)CVR的相對獨立性。第三部分椎動脈支架置入對后循環(huán)腦血管反應(yīng)性的影響研究目的：椎動脈支架置入術(shù)(vertebral artery stenting,VAS)已成為VA重度狹窄的重要治療手段,但無論是手術(shù)適應(yīng)癥的選擇還是術(shù)后療效的評估,目前僅局限于影像學狹窄程度和臨床癥狀的評估,缺乏手術(shù)前后后循環(huán)區(qū)域腦血流動力學變化的研究,本文探討VAS對VCVR的影響。方法：24例接受VAS治療的癥狀性VA狹窄患者作為手術(shù)組,同期住院的22例無VA狹窄或狹窄率50%的PCI患者作為對照組。采用TCD結(jié)合CO2吸入試驗觀察VAS前后的VCVR的變化。結(jié)果：手術(shù)組患者術(shù)前VA狹窄側(cè)和對側(cè)的VCVR與對照組相比均明顯下降(25.37±9.42%vs 31.51±10.59%,28.84±7.07% vs 35.98±15.48%,P0.05)；手術(shù)組患者術(shù)前VA狹窄側(cè)VCVR較對側(cè)亦明顯下降(25.37±9.42%vs 28.84±7.07%,P0.05)。VAS術(shù)后,雖然術(shù)側(cè)和對側(cè)VCVR均有所改善,但與術(shù)前相比無顯著統(tǒng)計學差異。結(jié)論：VAS是目前治療VA狹窄的重要手段,但術(shù)后短期內(nèi)后循環(huán)腦血流動力學并無明顯改善,VAS對后循環(huán)腦血流動力學的遠期影響有待于進一步的隨訪研究。
[Abstract]:Part 1 vascular reactivity assessment of posterior circulatory infarction in patients with intracranial and extracranial artery stenosis Objective: cerebrovascular reactivity in middle cerebral artery, MCVR, and vertebral artery vascular reactivity (c) in patients with no significant stenosis but posterior circulation infarction (c). The comparison of erebrovascular reactivity in vertebral artery, VCVR) to explore the role of CVR changes in the prediction of posterior circulation infarction. Methods: 27 patients with posterior circulation infarction (group PCI) were selected and 25 patients (control group) were selected at the same period of health examination. MCVR and VCVR. results of all the participants were measured: compared with the control group, the bilateral MCVR decreased significantly in the PCI group (left: 25.96 + 15.90% vs 34.63 + 8.60%, 26.40 + 14.54% vs 34.49 + 9.08%, P0.05), while bilateral VCVR was also lower than the control group, but the difference was not statistically significant (P0.05). It is an independent risk factor for MCVR damage (p=-0.116, P=0.035). Conclusion: for PCI patients with no obvious stenosis in the intracranial and external large arteries, MCVR is significantly decreased, VCVR is not impaired, MCVR or can be used as a predictor of posterior circulation infarction in patients with no obvious stenosis of the large cerebral arteries. For PCI patients with no obvious stenosis of the intracranial large artery, the diabetes is MCVR An independent risk factor for reduction. A study of correlation between the degree of vertebral artery stenosis and cerebrovascular reactivity in part second: Objective: CVR is the main index to evaluate the ability of cerebral vascular reserve. The relationship between MCVR and the stenosis degree of the internal carotid artery (internal carotid artery, ICA) or the middle cerebral artery (middle cerebral artery, MCA) There are more studies on the correlation between VCVR and the degree of vertebral artery (VA) stenosis. This study uses TCD combined with C02 inhalation to explore the relationship between VCVR and vertebral artery stenosis. Methods: in April 2012 -2013 year and May in the Department of Neurology in the General Hospital of Nanjing Military District, Nanjing general hospital, and DSA confirmed one side VA narrowness. 30 patients with narrow ICA and MCA without obvious stenosis; 24 cases of PCI patients without intracranial and internal large vascular stenosis in the same period of hospitalized patients were used as the control group. The VCVR and MCVR. results of all selected patients were detected by TCD combined with C02 inhalation test: the VA narrow side VCVR was significantly lower than that of the narrow side, the difference was statistically significant (28.82 + 12.91%). Vs31.52 + 14.09%, P0.05), but there was no significant statistical difference between VA stenosis at the ipsilateral and contralateral MCVR (27.07 + 15.77% vs 29.12 + 17.16%, P 0.05). The degree of VCVR decline was significantly correlated with the degree of VA stenosis (correlation coefficient=-0.470, P 0.01). Multiple linear regression analysis showed that VA stenosis and diabetes were independent risk factors Conclusion: (beta =-0.432, P=0.009, p=-0.405, P=0.013). Conclusion: there is no obvious correlation between MCVR and VA stenosis, and there is a better negative correlation between VCVR and VA stenosis. The blood flow reserve is still relatively independent, and the relative independence of the circulation CVR should be fully considered in clinical and scientific research. Third parts should be fully considered in clinical and scientific research. The effect of the stent placement on the reactivity of the cerebrovascular reactivity of the posterior circulation: vertebral artery stenting (VAS) has become an important treatment for severe VA stenosis. However, the selection of surgical indications and the evaluation of postoperative curative effect are limited to the degree of imaging stenosis and clinical symptoms. The study of cerebral hemodynamic changes in the posterior circulation region before and after operation was evaluated. The effect of VAS on VCVR was investigated. Methods: 24 patients with symptomatic VA stenosis treated with VAS were used as the operation group, and 22 cases of PCI patients who were hospitalized without VA stenosis or stenosis rate 50% were used as control group. TCD combined with CO2 inhalation test was used to observe before and after VAS. Results: the VA stenosis and the contralateral VCVR in the operation group were significantly lower than those in the control group (25.37 + 9.42%vs 31.51 + 10.59%, 28.84 + 7.07% vs 35.98 + 15.48%, P0.05). The VA narrowed side of the operation group was significantly lower than the contralateral side (25.37 + 9.42%vs 28.84 + VA, P0.05).VAS after operation, although the operation side and the right side were on the side. There is no significant difference in side VCVR, but there is no significant difference compared with preoperative. Conclusion: VAS is an important means for the treatment of VA stenosis, but the short term and posterior circulation cerebral hemodynamics after operation is not obviously improved. The long-term effect of VAS on the cerebral hemodynamics of the posterior circulation remains to be further followed up.

【學位授予單位】：南京大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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