發(fā)布時(shí)間：2018-05-27 17:07

  本文選題：缺血性腦血管病 + 介入��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：腦血管病在我國(guó)是一種發(fā)病率高、致殘率、致死率均較高的一種疾病,常見(jiàn)于中老年人發(fā)病,給國(guó)家和家庭造成沉重的經(jīng)濟(jì)負(fù)擔(dān)和護(hù)理負(fù)擔(dān),該病包括:出血性和缺血性腦血管病兩大類。近些年,我國(guó)因該病導(dǎo)致的經(jīng)濟(jì)支出費(fèi)用將近200億元人民幣,同時(shí)也給患者家庭帶來(lái)了沉重的醫(yī)療、護(hù)理及經(jīng)濟(jì)負(fù)擔(dān),已經(jīng)成為一個(gè)重要的公共衛(wèi)生問(wèn)題。目前腦血管病的臨床治療方法并不是很多,大致分為藥物治療、康復(fù)治療、外科治療和介入治療。隨著影像學(xué)及藥學(xué)、材料的進(jìn)步,缺血性腦血管病的介入治療發(fā)展迅速,技術(shù)不斷更新發(fā)展,應(yīng)用更加廣泛。血管內(nèi)介入治療是治療缺血性腦病的有效方法,本文現(xiàn)對(duì)血管內(nèi)介入在治療缺血性腦病、診斷血管變異的進(jìn)展進(jìn)行進(jìn)一步探討。目的:缺血性腦血管病的發(fā)病率逐年升高,顱內(nèi)外動(dòng)脈狹窄是其發(fā)病的最主要原因,傳統(tǒng)的治療主要包括藥物治療、外科治療、康復(fù)治療等,但仍不能有效避免缺血性腦病造成的高致死率和致殘率。隨著介入技術(shù)的發(fā)展和普及,血管介入尤其是支架成形術(shù)被廣泛應(yīng)用于顱內(nèi)外動(dòng)脈嚴(yán)重狹窄所致的缺血性腦血管疾病。血管內(nèi)介入治療作為微創(chuàng)手術(shù),對(duì)腦組織損傷小、操作相對(duì)簡(jiǎn)單、成功率高,改善缺血腦組織的血液供應(yīng),從而受到國(guó)內(nèi)外學(xué)者的廣泛關(guān)注。近年來(lái),血管變異與缺血性腦血管病的關(guān)系逐漸受到重視。Willis環(huán)常發(fā)生結(jié)構(gòu)或血流動(dòng)力學(xué)變異,其不完整性以及復(fù)雜的吻合支等在缺血性腦病的發(fā)生發(fā)展中起到了至關(guān)重要的作用。觀察血管介入治療缺血性腦病的近期、遠(yuǎn)期療效以及并發(fā)癥發(fā)生情況,探討willis動(dòng)脈環(huán)的血管變異在缺血性腦血管發(fā)生發(fā)展中的作用,為有針對(duì)性的制定缺血性腦病個(gè)體化方案提供一定的臨床依據(jù)。方法:本研究為前瞻性臨床治療療效的觀察研究在石家莊市第一醫(yī)院(中心院區(qū))神經(jīng)內(nèi)科選取2012年2月到2015年2月收住院的缺血性腦血管病患者175例為此研究的研究對(duì)象。男性88例,女性87例,年齡在43-85歲之間,平均年齡(69.2±3.2)歲,其中腦梗死97例(大腦半球梗死者54例,小腦梗死23例,多部位腦梗死者20例),短暫性腦缺血發(fā)作者78例。所有患者及家屬均知情同意本研究。該研究由石家莊市第一醫(yī)院及石家莊市中心醫(yī)院倫理委員會(huì)審批通過(guò)并監(jiān)督管理,將入院患者進(jìn)行常規(guī)血管內(nèi)介入診斷及治療術(shù)前準(zhǔn)備,然后行血管內(nèi)介入治療,植入支架,并行升主動(dòng)脈造影+雙側(cè)腦血管造影+雙側(cè)頸動(dòng)脈選擇性造影。記錄術(shù)后即刻血管造影結(jié)果、并發(fā)癥發(fā)生情況、隨訪結(jié)果以及血管變異結(jié)果,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:所有患者共181支血管均順利植入支架,介入手術(shù)成功率為100%。介入術(shù)后即刻造影顯示,整體狹窄情況較術(shù)前明顯改善,差異具有統(tǒng)計(jì)學(xué)差異(P0.05)。分別有10例患者術(shù)中術(shù)后發(fā)生心率下降和血壓下降,4例患者出現(xiàn)穿刺部位出血和血腫,3例患者術(shù)后有短暫性腦缺血發(fā)作,發(fā)生并發(fā)癥的總數(shù)為17例,總發(fā)生率為9.7%。對(duì)所有患者隨訪12個(gè)月,分別在術(shù)后3個(gè)月、6個(gè)月、12個(gè)月測(cè)量患者手術(shù)血管狹窄情況,總血管再狹窄率為4.9%,在隨訪期間,死亡1例,發(fā)生腦梗死者5例,短暫性腦缺血發(fā)作者4例。所有研究對(duì)象中呈現(xiàn)A1優(yōu)勢(shì)征的有60例,頸動(dòng)脈供血型有11例,混合供血型共14例,總的willis環(huán)不完整血管變異率為48.6%。結(jié)論:1對(duì)于有顱內(nèi)外血管狹窄的缺血性腦病患者,介入治療成功率高,療效好,安全性高,介入治療后動(dòng)脈狹窄情況明顯改善。2在缺血性腦血管病患者中,Willis環(huán)不完整的患者比例較高,血管變異引起的血流動(dòng)力學(xué)代償異常,在缺血性腦血管病患者發(fā)病時(shí)起到重要的作用。
[Abstract]:Cerebrovascular disease is a kind of disease with high incidence, high disability rate and high mortality rate in China. It is common in the middle and old people, causing heavy economic burden and nursing burden to the state and family. This disease includes two major categories: hemorrhagic and ischemic cerebrovascular diseases. In recent years, the cost of economic expenditure caused by this disease in China is nearly 20 billion yuan. The RMB, at the same time, has brought heavy medical care, nursing and economic burden to the family. It has become an important public health problem. At present, the clinical treatment methods of cerebrovascular disease are not much, including drug treatment, rehabilitation, surgical treatment and interventional therapy. With the progress of imaging and pharmacy, progress of materials, ischemia The interventional therapy of cerebrovascular disease has developed rapidly, the technology is constantly updated and developed, and its application is more extensive. Intravascular interventional therapy is an effective method for the treatment of ischemic encephalopathy. The progress of intravascular interventional therapy in the treatment of ischemic encephalopathy and diagnosis of vascular variation is further discussed. Intracranial and extracranial artery stenosis is the most important cause of its disease. Traditional treatment mainly includes drug treatment, surgical treatment, rehabilitation therapy, but it still can not effectively avoid the high mortality and disability rate caused by ischemic encephalopathy. With the development and popularization of interventional technique, vascular intervention, especially stenting is widely used in intracranial external movement. Intravascular interventional therapy, as a minimally invasive operation, has small damage to brain tissue, relatively simple operation, high success rate and improved blood supply of ischemic brain tissue, which has been widely concerned by scholars both at home and abroad. In recent years, the relationship between vascular change and ischemic cerebrovascular disease has been gradually paid attention to.Wi LLIS rings often have structural or hemodynamic variations, and their incompleteness and complex anastomotic branches play a vital role in the development of ischemic encephalopathy. To observe the recent, long-term effects and complications of vascular interventional therapy for ischemic encephalopathy, and to explore the vascular variation of the Willis artery ring in ischemic cerebral blood. The role of the tube in the development of the individualized ischemic encephalopathy provides a certain clinical basis. Methods: an observation study of the prospective clinical therapeutic effect in the first hospital of Shijiazhuang (Central Hospital) selected the patients with ischemic cerebrovascular disease in hospital from February 2012 to February 2015, 175 For this study, 88 males and 87 females, aged 43-85 years, average age (69.2 + 3.2) years, 97 cases of cerebral infarction (54 cases of cerebral hemisphere infarction, 23 cerebellar infarcts, 20 cases of cerebral infarction), 78 cases of transient ischemic hair, all patients and their families were informed consent of this study. The study was made by stone family. The first hospital of Zhuang City and the ethics committee of the Central Hospital of Shijiazhuang are approved and supervised. The hospitalized patients are prepared by routine intravascular interventional diagnosis and treatment, then intravascular interventional therapy, stent implantation, parallel ascending aorta angiography, bilateral cerebral vascular imaging and bilateral carotid selective angiography. The results of angiography, complications, follow-up and blood vessel variation, and statistical analysis. Results: all 181 vessels were successfully implanted into the stent. The success rate of the interventional procedure was immediately after 100%. intervention, and the overall stenosis was significantly improved than that before the operation. The difference was statistically significant (P0.05). There were 10 patients who had heart rate decline and blood pressure drop after operation, 4 patients had puncture site bleeding and hematoma, 3 patients had transient ischemic attack after operation, and the total number of complications was 17 cases. The total incidence rate was 9.7%. for all patients for 12 months, 3 months, 6 months and 12 months after operation respectively. The stenosis rate of the total vascular restenosis was 4.9%. During the follow-up period, there were 1 cases of death, 5 cases of cerebral infarction and 4 cases of transient ischemic hair. There were 60 cases of A1 dominance, 11 cases of carotid artery supply, 14 cases of mixed donor blood type, and the total Willis ring incomplete vascular variation rate was 48.6%. conclusion: 1 for craniofacial and inside and outside the skull Patients with ischemic encephalopathy with vascular stenosis have high success rate, good curative effect, high safety, and obviously improved.2 in patients with ischemic cerebrovascular disease after interventional therapy. The proportion of patients with incomplete Willis ring is higher, and the hemodynamic compensatory abnormalities caused by vascular variation are abnormal in patients with ischemic cerebrovascular disease. To an important role.
【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】：2017
【分類號(hào)】：R743.3

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