本文選題：椎-基底動(dòng)脈擴(kuò)張延長(zhǎng)癥 + 危險(xiǎn)因素��； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:椎-基底動(dòng)脈擴(kuò)張延長(zhǎng)癥(vertebrobasilar dolichoectasia,VBD)是指各種原因所致椎-基底動(dòng)脈明顯管腔擴(kuò)張,延長(zhǎng)移位�？傮w人群發(fā)生率低,但是卒中患者伴有VBD并不少見(jiàn),且VBD伴有卒中患者致殘率、死亡率較高,因此需要對(duì)其高度重視。本研究通過(guò)對(duì)VBD患者臨床特點(diǎn)研究,加深對(duì)VBD的認(rèn)識(shí),提高VBD的早期診斷,減少漏診、誤診率,控制可干預(yù)的危險(xiǎn)因素,推遲并發(fā)癥的發(fā)生。方法:1病例來(lái)源及分組選取自2014年6月至2014年10月在河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科住院的經(jīng)頭顱CTA或核磁確診為VBD合并腦梗死患者共40例,作為病例組,即VBD組。同期住院有其他明確病因而非VBD所致腦梗死患者50例,作為對(duì)照組。所有病例均符合1995年第四次全國(guó)腦血管疾病學(xué)術(shù)會(huì)議制定的各類(lèi)腦血管疾病診斷要點(diǎn),并于發(fā)病一周內(nèi)入院。所有病例均排除風(fēng)濕性心臟病、房顫、惡性腫瘤、全身嚴(yán)重感染、自身免疫性疾病、血液系統(tǒng)疾病以及肝、腎或心功能衰竭等。VBD的診斷標(biāo)準(zhǔn),根據(jù)Smoker等[5]提出的VBD的CT診斷標(biāo)準(zhǔn)或Giang等[6]提出的MRI、MRA診斷標(biāo)準(zhǔn)。2記錄所有病例一般資料(性別、年齡、既往病史、吸煙史、飲酒史)、實(shí)驗(yàn)室指標(biāo)(血脂、同型半胱氨酸)、神經(jīng)功能缺損程度及改善情況、臨床表現(xiàn)、梗死部位、影像學(xué)特點(diǎn)以及最終治療效果的比較,應(yīng)用SPSS13.0軟件對(duì)資料進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用χ2檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1一般資料分析1.1性別及年齡病例組40例患者中,男性30例(75%),女10例(25%),平均年齡62.32±10.98歲,對(duì)照組50例患者中,男35例(70%),女15例(30%),平均年齡60.94±11.94歲,兩組比較性別構(gòu)成,年齡分布,無(wú)明顯差異(P0.05)。1.2危險(xiǎn)因素兩組比較,高血壓、糖尿病、冠心病、腦梗死、腦出血及吸煙飲酒史沒(méi)有明顯差異(P0.05);后循環(huán)TIA發(fā)作情況比較,兩組之間沒(méi)有差異(P0.05)�；颊呷朐簳r(shí)均測(cè)定同型半胱氨酸,兩組之間比較有統(tǒng)計(jì)學(xué)差異(P=0.01)。2臨床特點(diǎn)2.1病例類(lèi)型:病例組40例患者中,前循環(huán)梗死18例(45%),后循環(huán)梗死22例(55%);對(duì)照組50例患者中前循環(huán)梗死36例(72%),后循環(huán)梗死14例(28%),兩組比較,后循環(huán)梗死有顯著性差異(P0.05),提示VBD組患者更易發(fā)生后循環(huán)缺血。2.2臨床表現(xiàn):病例組40例患者中,肢體無(wú)力19例(47.5%),頭暈15例(37.5%),后循環(huán)TIA病史者10例(25%),言語(yǔ)不清9例(22.5%),偏身感覺(jué)障礙4例(10%),頭痛4例(10%),中樞性面癱4例(10%),復(fù)視3例(7.5%),飲水嗆咳2例(5%),三叉神經(jīng)痛1例(2.5%),偏盲1例(2.5)。VBD組40例患者中屬于輕度神經(jīng)功能障礙(NIHSS4)者16例(40%),屬于中度神經(jīng)功能障礙者(NIHSS 4~15分)24例(60%),無(wú)重度神經(jīng)功能障礙者(NIHSS15)。3影像學(xué)特征3.1梗死部位:VBD組內(nèi)后循環(huán)梗死患者梗死部位分布情況:腦干16例(中腦1例,橋腦13例,延髓2例),小腦3例,枕葉2例,顳葉1例。提示VBD最易引起腦干梗死,且以橋腦為主。3.2椎-基底動(dòng)脈受累情況及腦干受壓情況:7例(17.5%)只累及基底動(dòng)脈,13例(32.5%)累及雙側(cè)椎動(dòng)脈,5例(12.5%)累及基底動(dòng)脈及雙側(cè)椎動(dòng)脈,12例(30%)累及基底動(dòng)脈及單側(cè)椎動(dòng)脈,3例(7.5%)累及單側(cè)椎動(dòng)脈。17例患者存在不同程度腦干受壓。4其他輔助檢查VBD組與非VBD組在頸動(dòng)脈彩超及心臟彩超對(duì)照無(wú)統(tǒng)計(jì)學(xué)差異(P值均0.05)。5 VBD組治療:40例患者均按急性缺血性腦血管病給予抗血小板聚集、活血化瘀、神經(jīng)保護(hù)等治療,部分患者還給予了抗凝、擴(kuò)容、脫水等治療。6神經(jīng)功能改善情況:病例組患者,基本治愈2例,顯著進(jìn)步2例,進(jìn)步2例,無(wú)效34例,惡化0例,總有效率為15%。對(duì)照組患者,基本治愈4例,顯著進(jìn)步7例,進(jìn)步8例,無(wú)效21例,惡化0例,總有效率為38%。兩組比較有顯著差異(P0.05)。提示VBD合并腦梗死患者治療效果差,病情不易改善。結(jié)論:1 VBD組與非VBD組相比,在發(fā)病年齡,性別構(gòu)成,血脂,血壓,血糖,既往腦梗死,腦出血,病前TIA,發(fā)病時(shí)神經(jīng)功能缺損程度沒(méi)有明顯差異。2 VBD組與非VBD組相比,高同型半胱氨酸血癥發(fā)生率明顯高,高同型半胱氨酸血癥可能是VBD的危險(xiǎn)因素。3 VBD組與非VBD組相比,VBD組后循環(huán)梗死發(fā)生率明顯高于非VBD組,VBD是后循環(huán)缺血的危險(xiǎn)因素。4 VBD組患者臨床表現(xiàn)多樣,無(wú)特異性。5在療效方面,VBD組神經(jīng)功能缺損恢復(fù)情況較非VBD組差,臨床癥狀改善上也較非VBD組差,VBD合并腦梗死患者臨床治療效果差。
[Abstract]:Objective: vertebrobasilar dolichoectasia (VBD) refers to a variety of causes of the vertebrobasilar artery dilation and prolonged transposition. The overall population rate is low, but the incidence of VBD in stroke patients is not uncommon, and the mortality rate of VBD with stroke patients is high. Therefore, it is necessary to attach great importance to it. Through the study of the clinical characteristics of VBD patients, we can deepen the understanding of VBD, improve the early diagnosis of VBD, reduce the misdiagnosis, the rate of misdiagnosis, control the risk factors that can be intervened, and postpone the occurrence of complications. Methods: the 1 cases sources and groups were selected from June 2014 to October 2014 in the neurology department of the second hospital of Hebei Medical University. 40 cases of VBD combined with cerebral infarction were diagnosed by NMR as case group, that is group VBD. In the same period, 50 patients with other definite diseases and non VBD caused cerebral infarction were used as the control group. All cases were in line with the diagnosis points of various cerebrovascular diseases in the fourth national cerebral vascular Disease Conference in 1995 and hospitalized within one week of the onset of disease. All cases exclude rheumatic heart disease, atrial fibrillation, malignant tumor, systemic severe infection, autoimmune disease, blood system disease, and liver, kidney or heart failure, such as.VBD diagnostic criteria based on the CT diagnostic criteria of VBD or Giang such as Giang and [6], and MRA diagnostic standard.2 to record the general data of all cases (sex). Different age, past medical history, smoking history, drinking history), laboratory index (blood lipid, homocysteine), the degree and improvement of nerve function defect, clinical manifestation, infarct location, imaging characteristics and final therapeutic effect, SPSS13.0 software was used to analyze the data, the measurement data were t test, and the count data were used chi 2 The difference was statistically significant. Results: 1 general data: 1 general data analysis of 40 cases of 1.1 sex and age cases, male 30 (75%), 10 women (25%), average age 62.32 + 10.98 years, 50 patients in the control group, 35 (70%), female 15 (30%), average age and age, the group compared sex composition, age distribution, no significant difference There was no significant difference in the two groups of P0.05.1.2 risk factors. There was no significant difference in hypertension, diabetes, coronary heart disease, cerebral infarction, cerebral hemorrhage and smoking and drinking history (P0.05). There was no difference between the two groups (P0.05) in the case of TIA seizures in the posterior circulation (P0.05). There was a statistically significant difference between the two groups (P=0.01) the clinical characteristics of.2 2.1. Case type: among 40 cases of case group, 18 cases of anterior circulation infarction (45%), 22 cases of posterior circulation infarction (55%), 36 cases of anterior circulation infarction (72%) in 50 cases of control group, 14 cases of posterior circulation infarction (28%), and significant difference in posterior circulation infarction (P0.05) in the two group (P0.05), suggesting that patients in group VBD were more likely to have clinical manifestations of posterior circulation ischemia.2.2: case group 40 patients Among them, there were 19 cases of limb weakness (47.5%), 15 cases of dizziness (37.5%), 10 cases of posterior circulation TIA (25%), 9 cases (10%), 4 cases of partial feeling disorder (10%), 4 (10%) headache, central facial paralysis, recurrent cough, trigeminal neuralgia and mild nerve work in group.VBD. There were 16 (40%) patients with disability (NIHSS4), 24 cases (60%) of moderate nerve dysfunction (NIHSS 4~15), and 3.1 infarct sites with.3 imaging features without severe neurological dysfunction (NIHSS15): the distribution of Infarct Sites in group VBD patients with posterior circulation infarction: 16 cases of brain stem (1 cases in the middle brain, 13 cases of pontine, 2 cases of medulla oblongata), 3 cases in cerebellum, 2 in occipital lobe and 1 in temporal lobe. It was suggested that VBD was the most likely cause of brain stem infarction, and the main.3.2 vertebral basilar artery involvement in the bridge brain and the pressure of the brain stem: 7 cases (17.5%) only involve the basilar artery, 13 cases (32.5%) involve bilateral vertebral artery, 5 cases (12.5%) involve the basilar artery and bilateral vertebral artery, 12 cases (30%) involve the basilar artery and the unilateral vertebral artery, 3 cases (7.5%) involve the unilateral vertebral artery. .17 patients had different degree of brain stem compression and.4 other auxiliary examination of VBD group and non VBD group in carotid artery color Doppler ultrasound and heart color ultrasound control no statistically significant difference (P value 0.05).5 VBD group treatment: 40 patients were treated with acute ischemic cerebrovascular disease to give anti platelet aggregation, blood activating and blood stasis, neuroprotection and other treatment, some patients also gave resistance. Coagulation, dilatation, dehydration and other treatment of.6 nerve function improvement: case group patients, basic cure 2 cases, significant progress in 2 cases, 2 cases, 34 cases, 0 cases of deterioration, the total effective rate is 15%. control group, the basic cure 4 cases, significant progress 7 cases, 8 cases, 21 cases, 0 cases, the total effective rate of group 38%. two is significant difference (P0.05). The treatment effect of VBD combined with cerebral infarction was poor and the condition was not easy to improve. Conclusion: 1 VBD group compared with non VBD group, the age of onset, sex composition, blood lipid, blood pressure, blood sugar, previous cerebral infarction, cerebral hemorrhage, TIA before the disease, there was no significant difference between.2 VBD and non VBD group, the incidence of hyperhomocysteinemia was compared with the non VBD group. Significantly higher, hyperhomocysteinemia may be a risk factor for VBD in the.3 VBD group and the non VBD group. The incidence of posterior circulation infarction in the VBD group was significantly higher than that in the non VBD group. VBD was a risk factor for the posterior circulation ischemia in the group.4 VBD, and there was no specific.5 in the curative effect, and the recovery of the neurological function in VBD group was worse than that of the non VBD group. The improvement of bed symptoms was also worse than that of non VBD group. The clinical efficacy of VBD combined with cerebral infarction was poor.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R743.3

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