本文選題：分水嶺腦梗死 + 臨床特征　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分水嶺腦梗死(cerebral watershed infarction,CWI)是缺血性腦血管病一種特殊類(lèi)型,且發(fā)病率較高。但是目前仍有少數(shù)臨床醫(yī)師認(rèn)為CWI患者臨床癥狀輕、預(yù)后好,而忽略了CWI高復(fù)發(fā)率及高致殘率的特征。本研究通過(guò)觀察CWI的臨床特征及引起CWI復(fù)發(fā)的相關(guān)因素,為CWI的治療及預(yù)防提供依據(jù)。方法:收集2015年5月至2016年5月于大連市中心醫(yī)院神經(jīng)內(nèi)二科入院治療的143例分水嶺腦梗死患者,結(jié)合患者頭部核磁共振(MRI)和彌散加權(quán)成像(DWI)的影像學(xué)表現(xiàn),分為皮質(zhì)型分水嶺腦梗死(CWSI)、內(nèi)分水嶺腦梗死(IWSI)兩組。記錄入組患者年齡、性別、糖尿病、高血壓病、冠心病、卒中史、吸煙史、飲酒史、入院后連續(xù)7天的血壓、實(shí)驗(yàn)室化驗(yàn)結(jié)果。所有入組患者均行頸動(dòng)脈超聲檢查、磁共振血管成像檢查、心臟超聲檢查、24小時(shí)動(dòng)態(tài)心電圖檢查。于入院第1天和第7天進(jìn)行NIHSS評(píng)分、修正Rankin評(píng)分,并記錄住院天數(shù)及治療方案。在6個(gè)月面對(duì)面隨訪或電話隨訪時(shí),記錄患者是否再發(fā)腦梗死,血壓控制情況、目前用藥、是否行血管內(nèi)支架手術(shù)、康復(fù)鍛煉情況、NIHSS評(píng)分、mRS評(píng)分等。結(jié)果:1.入院第1天CWSI的NIHSS評(píng)分為3.61±2.14,IWSI的NIHSS評(píng)分為4.72±2.20,二者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),入院第7天CWSI的NIHSS評(píng)分為2.60±2.19,第7天IWSI的NIHSS評(píng)分為3.57±2.44,二者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組CWI患者入院第1天、第7天的NIHSS評(píng)分比較差異均有統(tǒng)計(jì)學(xué)意義;IWSI患者的NIHSS評(píng)分比CWSI患者的更高,住院天數(shù)更長(zhǎng)。2.入院7天后,CWSI患者中病情好轉(zhuǎn)的有25例(43.86%),IWSI患者中有14例(16.28%),二者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);CWSI患者中出現(xiàn)病情惡化的有7例(12.3%),IWSI患者中有23例(26.7%),二者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。CWSI患者更易出現(xiàn)病情好轉(zhuǎn),而IWSI患者更易出現(xiàn)病情惡化。3.入選的143例分水嶺腦梗死患者隨訪6個(gè)月,CWSI患者的mRS評(píng)分為1.72±1.45,IWSI患者的mRS評(píng)分為2.51±1.61,二者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。發(fā)病6個(gè)月內(nèi),IWSI患者比CWSI患者預(yù)后差,生活質(zhì)量差。4.143例分水嶺腦梗死患者中,有31人卒中復(fù)發(fā)(同側(cè)28例,對(duì)側(cè)2例,小腦1例),復(fù)發(fā)率為21.7%。無(wú)死亡病例。5.入院7天平均血壓140/90mmHg、不穩(wěn)定斑塊、頸動(dòng)脈狹窄程度≥70%與CWI的復(fù)發(fā)顯著正相關(guān)(p分別為0.003、0.000、0.000);擴(kuò)容及支架植入治療與CWI的復(fù)發(fā)顯著負(fù)相關(guān)(p分別為0.010及0.022)。多因素Logistic回歸分析顯示入院7天平均血壓140/90mmHg(OR=5.153,P=0.006,95%CI 1.558~16.719)、不穩(wěn)定斑塊(OR=8.363,P0.001,95%CI 3.468~20.172)、頸動(dòng)脈狹窄程度≥70%(OR=7.512,P0.001,95%CI 3.040~18.564)是CWI復(fù)發(fā)的危險(xiǎn)因素;而擴(kuò)容治療(OR=0.105,p=0.030,95%CI 0.014~0.806)及支架植入治療(OR=0.129,p=0.050,95%CI 0.017~0.100)是CWI復(fù)發(fā)的保護(hù)因素。結(jié)論:1.發(fā)病1周內(nèi),IWSI患者比CWSI患者更易出現(xiàn)病情惡化。2.發(fā)病6個(gè)月的預(yù)后,IWSI患者比CWSI患者差。3.入院7天平均血壓140/90mmHg、不穩(wěn)定斑塊、頸動(dòng)脈狹窄程度≥70%是分水嶺腦梗死復(fù)發(fā)的危險(xiǎn)因素;頸動(dòng)脈支架植入治療及擴(kuò)容治療則可有效預(yù)防復(fù)發(fā)。
[Abstract]:Objective: cerebral watershed infarction (CWI) is a special type of ischemic cerebrovascular disease and has a high incidence. But at present, a few clinicians still think that the clinical symptoms of CWI patients are light and the prognosis is good, but the high recurrence rate of CWI and the high rate of disability are neglected. The clinical features and causes of CWI are observed and caused by the observation of the clinical characteristics and causes of CWI. The related factors of CWI recurrence were provided for the treatment and prevention of CWI. Methods: from May 2015 to May 2016, 143 patients with watershed cerebral infarction treated in two families of nerve in Dalian central hospital were divided into cortical watershed cerebral infarction (MRI) and diffusion weighted imaging (DWI). CWSI), two groups of internal watershed cerebral infarction (IWSI). The age, sex, diabetes, hypertension, coronary heart disease, stroke history, smoking history, drinking history, 7 days of blood pressure after admission, and laboratory test results were recorded. All the patients underwent carotid ultrasound examination, magnetic resonance angiography, cardiac ultrasound examination, and 24 hour dynamic electrocardiogram. The NIHSS score was performed on first and seventh days of admission. The Rankin score was corrected and the number of hospitalization days and treatment plans were recorded. In 6 months of face to face follow-up or telephone follow-up, the patients were recorded if cerebral infarction, blood pressure control, current medication, rehabilitation exercise, NIHSS score, and mRS score. Fruit: 1. the NIHSS score of CWSI was 3.61 + 2.14 on the first day admission, and the NIHSS score of IWSI was 4.72 + 2.20. The two groups had a statistically significant difference (P0.05). The NIHSS score of CWSI was 2.60 + 2.19 at seventh days in hospital, and NIHSS score of IWSI was 3.57 + 2.44, and the differences were statistically significant (P0.05). The difference in score was statistically significant; the NIHSS score of IWSI patients was higher than that of CWSI patients, and 7 days after hospitalization was longer.2., 25 cases (43.86%) were improved in CWSI patients, 14 in IWSI patients (16.28%), and the difference was statistically significant (P0.05), 7 cases (12.3%) in CWSI patients, IWSI patients. Among the 23 cases (26.7%), the two were more likely to have a statistically significant difference (P0.05).CWSI patients were more likely to have a better condition, while IWSI patients were more likely to appear in 143 cases of watershed cerebral infarction for 6 months, CWSI patients' mRS score was 1.72 + 1.45, mRS scores in IWSI patients were 2.51 + 1.61, two were statistically significant differences. P0.05. Within 6 months of onset, the prognosis of IWSI patients was worse than that of CWSI patients. Of the poor quality of life, 31 people had recurrent stroke (28 cases in the same side, 2 cases in the contralateral, 1 cerebellum), and the recurrence rate was the mean blood pressure 140/ 90mmHg, unstable plaque, the degree of carotid stenosis more than 70% and CWI in the 7 days of 21.7%. without death. Positive correlation (P was 0.003,0.000,0.000); dilatation and stent implantation were negatively correlated with the recurrence of CWI (P was 0.010 and 0.022 respectively). Multiple factor Logistic regression analysis showed the average blood pressure 140/90mmHg (OR=5.153, P=0.006,95%CI 1.558~16.719) for 7 days, unstable plaque (OR=8.363, P0.001,95%CI 3.468~20.172), carotid stenosis Degree more than 70% (OR=7.512, P0.001,95%CI 3.040~18.564) is a risk factor for CWI recurrence, while dilatation therapy (OR=0.105, p=0.030,95%CI 0.014~0.806) and stent implantation (OR=0.129, p=0.050,95%CI 0.017~0.100) are the protective factors for CWI recurrence. Conclusion: within 1 weeks of the 1. onset, IWSI patients are more likely to have a worsening condition for 6 months than those of the patients. The prognosis of IWSI patients was less than that of CWSI patients. The average blood pressure of.3. was 140/90mmHg for 7 days, the unstable plaque and the degree of carotid stenosis more than 70% were the risk factors for the recurrence of the watershed infarction, and the carotid artery stent implantation and dilatation treatment could effectively prevent the recurrence.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.3

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本文編號(hào)：1899427