本文選題：青年卒中 + 卵圓孔未閉��； 參考：《山東大學》2016年碩士論文

【摘要】：目的一、探討合并心臟卵圓孔未閉的青年卒中患者的臨床特征；二、明確卵圓孔未閉在青年卒中發(fā)病病因的地位；三、避免在臨床工作中對合并卵圓孔未閉的青年卒中患者漏診,提升診斷的準確性和治療效果。方法回顧性研究2014年8月至2015年12月山東大學齊魯醫(yī)院神經(jīng)內(nèi)科收治的青年腦卒中患者,篩選出合并心臟卵圓孔未閉的青年卒中患者7例,收集患者的臨床資料,行體格檢查及神經(jīng)系統(tǒng)查體,分析此7例青年卒中患者的臨床特征,包括發(fā)病誘因、起病方式、臨床表現(xiàn)、實驗室及影像學檢查、治療方法及預后情況；結(jié)合國內(nèi)外相關(guān)文獻,對青年卒中合并卵圓孔未閉的患者的誘因、發(fā)病機制、臨床特點、診斷及治療等進行系統(tǒng)討論。結(jié)果1.病例一般情況：本研究7例病例,男性6例(86%),女性1例(14%),年齡在16歲～45歲之間,平均年齡35歲。2.發(fā)病誘因及基礎(chǔ)疾�。�7例(100%)患者均為急性起病。3例(43%)起病前處于安靜狀態(tài)未發(fā)現(xiàn)明顯誘因,3例(43%)患者發(fā)病于活動后,1例發(fā)病于睡眠狀態(tài)中。高血壓病史1例,偏頭痛史1例,吸煙史1例。3.臨床表現(xiàn)及NIHSS評分：3例(43%)表現(xiàn)為頭暈伴惡心嘔吐,5例(71%)有言語不清、口角歪斜,5例(71%)有肢體乏力麻木癥狀。7例患者的NIHSS評分依次為12分、5分、3分、3分、3分、2分、2分,1例因插胃管12分。4.輔助檢查：常規(guī)血液檢驗：7例(100%)患者的TC、TG及HDL基本正常,2例(29%)患者LDL略高于標準值。4例(57%)HCY較高,屬于高同型半胱氨酸血癥范疇。2例(29%)患者D-D較高,其余均在標準范圍內(nèi)。7例(100%)患者的HB基本正常,但都處于上限。其余血常規(guī)、血沉、凝血系列、肝腎功、血生化、腫瘤標記物、風濕系列等未見明顯異常。影像學檢查：7例患者行顱腦磁共振,2例(29%)表現(xiàn)為基底節(jié)區(qū)片狀梗死灶,2例(29%)梗死灶位于延髓,3例(43%)表現(xiàn)為多發(fā)部位腦梗死。7例(100%)患者均行經(jīng)顱多普勒超聲發(fā)泡試驗,結(jié)果均為陽性。5例(71%)行經(jīng)食道心臟超聲,其中4例提示存在卵圓孔未閉,1例未見明顯異常；2例(29%)患者行經(jīng)胸超聲心動圖,提示存在右向左的分流,即卵圓孔未閉。5.治療及預后：7例(100%)患者均給予抗血小板、促進循環(huán)及腦細胞代謝等藥物治療,行經(jīng)皮卵圓孔未閉封堵術(shù),術(shù)后患者恢復良好。7例患者(100%)院外均口服藥物治療,隨訪3個月至6個月,均未再發(fā)生腦卒中,且無明顯后遺癥。結(jié)論1.合并卵圓孔未閉的青年卒中起病形式多種多樣,與其他原因所致卒中無區(qū)別,前后循環(huán)的癥狀均可作為首發(fā)癥狀；2.合并卵圓孔未閉的青年卒中臨床特點較其他原因所致的卒中,輕型卒中較多見；3.患者的顱腦磁共振可表現(xiàn)為多發(fā)片狀梗死灶,也可表現(xiàn)為僅累及單側(cè)血管的單個病灶；4.對于45歲以下原因不明的青年缺血性腦卒中患者,進行發(fā)病危險因素篩查時,除常規(guī)血液及影像學檢查外,應把TCD發(fā)泡試驗、經(jīng)食道心臟超聲及聲學造影作為常規(guī)檢查；5.卵圓孔未閉所致腦卒中行經(jīng)皮封堵是目前較常用的安全、有效的治療方法。意義青年卒中的患病率較前有所增長,對家庭社會的影響不容忽視,其危險因素多種多樣,早期診斷、早期干預尤為重要。在臨床工作中,對于青年卒中的病因診斷,應考慮到卵圓孔未閉的情況,注意篩查避免漏診誤診。對于病因明確合并卵圓孔未閉的青年卒中,可采取封堵治療,較其他原因?qū)е碌淖渲锌芍斡翌A后好。
[Abstract]:Objective: To explore the clinical characteristics of young stroke patients with closed oval foramen of the heart. Two, clear the position of the oval hole in the etiology of young stroke; three, to avoid the missed diagnosis of the young stroke patients with oval foramen in clinical work, to improve the accuracy and effect of diagnosis in August 2014. Methods a retrospective study was conducted in August 2014. To the young stroke patients admitted in the Department of Neurology of Qilu Hospital of Shandong University in December 2015, 7 young stroke patients with oval foramen of heart were selected. The clinical data of the patients were collected, the physical examination and the examination of the nervous system were used to analyze the characteristics of the 7 young stroke patients, including the causes of the disease, the way of the onset and the clinical table. Present, laboratory and imaging examination, treatment methods and prognosis; combined with domestic and foreign related literature, the inducement, pathogenesis, clinical characteristics, diagnosis and treatment of young patients with Apoplexy with oval foramen were discussed systematically. Results 1. cases general case: 7 cases in this study, 6 men (86%), 1 women (14%), and 1 age. Between 6 and 45 years old, the average age 35 year old.2. causes and basic diseases: 7 cases (100%) were all.3 cases (43%) in the acute onset (43%) in the quiet state before the onset of no obvious inducement, 3 cases (43%) after the onset of activity, 1 cases in the sleep state. 1 cases of hypertension history, migraine history 1 cases, 6 cases of smoking history, 1 cases clinical manifestation and NIHSS Score: 3 cases (43%) showed dizziness with nausea and vomiting, 5 cases (71%) had poor speech, angular skew, 5 cases (71%) with numbness of limb weakness in.7 patients, the NIHSS score in turn was 12, 5, 3, 3, 3, 2, 2, and 1 cases were divided into.4. by inserting gastric tube: conventional blood test: TC, TG, and HDL were basically normal. Cases (29%) LDL was slightly higher than standard value.4 (57%) HCY,.2 cases of hyperhomocysteinemia (29%) patients with higher D-D, and the rest were basically normal in.7 cases (100%), but all were at upper limit. The remaining blood routine, erythrocyte sedimentation, blood coagulation series, liver and kidney work, blood biochemistry, tumor markers, rheumatic series and so on were not seen. Imaging examination: imaging examination: 7 patients underwent craniocerebral magnetic resonance, 2 (29%) showed basal ganglia infarction, 2 (29%) located in the medulla and 3 (43%) showed multiple cerebral infarction in.7 (100%) with transcranial Doppler ultrasonic foaming test. The results were all positive.5 cases (71%) transesophageal echocardiography, 4 cases were suggested. 1 cases had no obvious abnormality in 1 cases, and 2 cases (29%) underwent transthoracic echocardiography, suggesting the existence of right to left shunt, that is, the treatment and prognosis of the unclosed oval foramen, 7 cases (100%) were treated with antiplatelet, promoting circulation and brain cell metabolism, and underwent percutaneous patent foramen ovale closure, and the postoperative patients recovered well. .7 patients (100%) were treated with oral medication outside the hospital, followed up for 3 months to 6 months, no cerebral apoplexy was found and no significant sequelae were found. Conclusion there are various forms of stroke in young adults with 1. oval foramen, which are not different from other causes of stroke, and the anterior and posterior circulatory symptoms can be the first symptom; 2. with the closure of oval foramen. The clinical characteristics of apoplexy in the year were more common than those caused by other causes. The brain MRI in 3. patients could be seen as multiple flake infarcts and only single lesion involving unilateral vessels; 4. for young patients with unknown causes under 45 years of age, the screening of risk factors in young patients with unexplained reasons except routine was routine. The TCD foaming test, transesophageal echocardiography and acoustic contrast examination should be taken as routine examination, and transcutaneous closure of cerebral pawns caused by 5. oval foramen is a safe and effective treatment. The incidence of young stroke is longer than that before, and the impact on family society can not be ignored and its risk is not to be ignored. There are various factors, early diagnosis and early intervention are particularly important. In the clinical work, for the diagnosis of young stroke, we should take into account the absence of the oval hole, and pay attention to the screening to avoid misdiagnosis. The prognosis is good.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R743.3

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