本文選題：出血性轉(zhuǎn)化 + 大腦中動(dòng)脈��； 參考：《揚(yáng)州大學(xué)》2014年碩士論文

【摘要】：[目的] 探討大腦中動(dòng)脈心源性栓塞后大面積腦梗死出血性轉(zhuǎn)化與各血壓參數(shù)之間的關(guān)系。 [方法] 回顧性分析了發(fā)病后24小時(shí)內(nèi)入院的單側(cè)大腦中動(dòng)脈心源性栓塞的大面積腦梗死患者,篩選了其中入院時(shí)頭顱CT或MR未發(fā)現(xiàn)出血性轉(zhuǎn)化的146例,根據(jù)其7天內(nèi)復(fù)查頭顱Computed Tomography (CT)或Magnatic Resonance (MR)結(jié)果,分為出血性轉(zhuǎn)化組(HT)和非出血性轉(zhuǎn)化組(non-HT),比較分析了兩組之間各血壓特異性參數(shù)的關(guān)系。血壓特異性參數(shù)包括：入院初始血壓(initial)、均值(mean)、最大值(max)、最小值(min)、極差(max-min)、SD、連續(xù)變異性參數(shù)(sv),連續(xù)變異性參數(shù)的最大值(svmax)。其中極差(max-min)、SD、連續(xù)變異性參數(shù)(sv),連續(xù)變異性參數(shù)的最大值(svmax)被定義為血壓變異性參數(shù)。最后單獨(dú)比較高血壓變異組與低血壓變異組之間出血性轉(zhuǎn)化的發(fā)生率。 [結(jié)果] 在427例入院的大面積腦梗死患者當(dāng)中,其中389例符合急性大腦中動(dòng)脈心源性栓塞診斷。在這些389患者當(dāng)中,321例患者在發(fā)病后24小時(shí)內(nèi)入院,然后因?yàn)橐韵略蚺懦艘恍┗颊撸?6例入院頭顱CT/MR即發(fā)現(xiàn)出血性轉(zhuǎn)化,22例既往有卒中病史并留有明顯后遺癥,57例在入院后72小時(shí)之內(nèi)死亡或自動(dòng)出院,19例入院7d內(nèi)未再有影像學(xué)檢查,45例患者進(jìn)行溶栓或伴隨其它嚴(yán)重器質(zhì)疾病等混雜因素,6例入院最初72小時(shí)之內(nèi)沒有連續(xù)血壓監(jiān)測(cè)。最終一共146例患者參與了我們的研究。7d內(nèi)復(fù)查頭顱CT/MR有77(77/146)例患者發(fā)生了出血性轉(zhuǎn)化,出血性轉(zhuǎn)化率為52.7%。 將所有血壓參數(shù)通過(guò)其四分位數(shù)分類,在這些血壓參數(shù)中,SBPmin、SBPmax-min、 SBPsv、SBPsvmax、DBPinitial、DBPsd、DBPmax、DBPmax-min、DBPsv、DBPsvmax獨(dú)立于患者年齡、入院時(shí)間、入院時(shí)NIHISS評(píng)分、充血性心力衰竭病史、抗血小板治療、初始血糖、PT、INR與大腦中動(dòng)脈心源性栓塞后大面積腦梗死的出血性轉(zhuǎn)化顯著相關(guān)(P0.05趨勢(shì)擬然比檢驗(yàn))。除SBPinitial, SBPmean, SBPsd, DBPmean及DBPsvmax外,其他血壓參數(shù)均與出血性轉(zhuǎn)化顯著相關(guān)。大部分血壓變異性參數(shù)中(SBPmax-min, SBPsd, SBPsvmax, DBPmax-min, DBPsd, DBPsv),血壓高變異組的出血性轉(zhuǎn)化率要顯著高于血壓低變異組。 [結(jié)論] 較高的血壓水平及變異性會(huì)增加大腦中動(dòng)脈心源性栓塞后大面積腦梗死出血性轉(zhuǎn)化的風(fēng)險(xiǎn),對(duì)于這類患者可能需要平穩(wěn)緩慢的降壓。
[Abstract]:[purpose] To investigate the relationship between hemorrhagic transformation of large area cerebral infarction and blood pressure parameters after middle cerebral artery cardiogenic embolization (MCAE). [methods] The large area cerebral infarction patients with unilateral middle cerebral artery cardiogenic embolism (MCAE) admitted within 24 hours after onset were retrospectively analyzed. 146 cases of cerebral infarction with no hemorrhagic transformation on CT or Mr were selected. The patients were divided into hemorrhagic transformation group (Computed Tomography) and non-hemorrhagic transformation group (non-HTT) according to the results of Computed Tomography or Magnatic Resonance within 7 days. The relationship of blood pressure specific parameters between the two groups was compared and analyzed. The blood pressure specific parameters include: initial blood pressure, mean value, maximum value, minimum value, SDV, continuous variability parameter, and the maximum value of the continuous variability parameter, which is the maximum value of the continuous variability parameter, and the maximum value of the continuous variability parameter is the maximum value of the continuous variability parameter. Among these parameters, the maximum value of the continuous variability parameter, is defined as the blood pressure variability parameter, and the maximum value of the continuous variability parameter (svmax) is defined as the blood pressure variability parameter. Finally, the incidence of hemorrhagic transformation between hypertension variant group and hypotension variant group was compared separately. [results] Of 427 patients with massive cerebral infarction, 389 were diagnosed as acute middle cerebral artery cardiogenic embolism. Of these 389 patients, 321 patients were admitted to hospital within 24 hours after the onset of the disease. Then some patients were excluded for the following reasons: 26 patients were admitted to CT/MR, 22 patients with hemorrhagic transformation had a history of stroke and 57 patients died within 72 hours after admission or 19 patients were discharged automatically for 7 days. No imaging examination was found in 45 patients with thrombolytic therapy or other serious organ diseases. No continuous blood pressure monitoring was observed in 6 patients within 72 hours of admission. A total of 146 patients took part in our study. Within 7 days, 77,77% of 14.6 patients had hemorrhagic transformation, and the hemorrhagic conversion rate was 52.7%. All blood pressure parameters were classified according to their quartiles, in which SBPmin-SBPmax-min, SBPsvsvmax-DBPinitialdsdsmax-DBPmax-min-DBPssv-DBPsvmax were independent of age, admission time, NIHISS score at admission, history of congestive heart failure, antiplatelet therapy. There was a significant correlation between PTT INR and hemorrhagic transformation of large area cerebral infarction after middle cerebral artery embolization (MCAE). With the exception of SBPinitial, SBPmean, SBPsd, DBPmean and DBPsvmax, blood pressure parameters were significantly correlated with hemorrhagic transformation. Among the most blood pressure variability parameters, SBPmax-min, SBPsd, SBPsvmax, DBPmax-min, DBPsd, DBPsvN, the hemorrhagic conversion rate of high blood pressure variation group was significantly higher than that of hypotension variant group. [conclusion] High blood pressure levels and variability may increase the risk of hemorrhagic transformation of large areas of cerebral infarction after middle cerebral artery cardiogenic embolization, which may require a steady and slow lowering of blood pressure.
【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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本文編號(hào)：1977821