本文選題：腦梗死 + 穿支動脈�。� 參考：《河北北方學(xué)院》2017年碩士論文

【摘要】：本研究主要探索不同部位急性穿支動脈腦梗死合并腦微出血患病率,危險因素及臨床變化。本研究通過收集邯鄲市中心醫(yī)院急性穿支動脈腦梗死住院患者,結(jié)合頭顱核磁彌散加權(quán)成像(Diffusion Weighted Imaging,DWI)和磁敏感加權(quán)成像(Susceptibility Weighted Imaging,SWI)序列檢查結(jié)果,篩選出基底節(jié)-丘腦和腦干急性穿支動脈腦梗死合并腦微出血(Cerebral Microbleeds,CMBs)患者作為研究對象,記錄研究對象臨床基本信息、相關(guān)危險因素及神經(jīng)功能評分(National Institutes of Health Stroke Scale,NIHSS)。將研究對象按新發(fā)梗死位置分為:基底節(jié)-丘腦梗死組和腦干梗死兩組。依據(jù)MARS(Microbleed Anatomical Rating Scale,MARS)表格[1](見圖1)分見別記錄研究對象責(zé)任病灶相關(guān)部位CMBs數(shù)量:基底節(jié)-丘腦梗死患者記錄病灶同側(cè)大腦半球CMBs數(shù)量及腦干CMBs數(shù)量;腦干梗死患者記錄腦干CMBs數(shù)量及雙側(cè)大腦半球CMBs數(shù)量。統(tǒng)計(jì)分析不同部位急性穿支動脈腦梗死中腦微出血患病率,危險因素及NIHSS評分變化。本次研究連續(xù)納入急性穿支動脈腦梗死患者214例,符合條件的急性穿支動脈腦梗死患者198例,其中6例資料不完善,10例為非基底節(jié)-丘腦、腦干急性穿支動脈腦梗死患者。最終共有198例急性穿支動脈腦梗死患者入組進(jìn)入統(tǒng)計(jì)分析。198例基底節(jié)-丘腦或腦干急性穿支動脈腦梗死患者中伴有CMBs(陽性組)103例,不伴有CMBs(陰性組)95例,陽性組高血壓發(fā)病率80.6%,顯著高于陰性組63.2%(χ2=4.51,P=0.03),余相關(guān)危險因素?zé)o統(tǒng)計(jì)學(xué)差異�；坠�(jié)-丘腦梗死患者合并有腦微出血67例,腦干梗死患者合并有腦微出血36例�；坠�(jié)-丘腦梗死合并CMBs患者中高血壓發(fā)病率為86.6%,高于腦干梗死合并CMBs患者中高血壓發(fā)病率69.4%(χ2=4.39,P=0.04)�；坠�(jié)-丘腦梗死組中梗死同側(cè)大腦半球CMBs數(shù)量為280個(4.2±4.8),顯著高于腦干梗死組雙側(cè)大腦半球CMBs數(shù)量23個(0.64±3.2)(t=5.18,P=0.00)。腦干梗死組腦干CMBs數(shù)量為174(4.8±3.2),高于基底節(jié)-丘腦梗死組腦干CMBs數(shù)量62(0.93±1.2),(t=8.8,P=0.00)。NIHSS評分與CMBs相關(guān)性分析顯示:急性穿支動脈腦梗死合并CMBs患者入院時NIHSS評分與責(zé)任病灶伴隨CMBs數(shù)量無明顯相關(guān)性(r=0.091,P=0.363),3月后神經(jīng)功能改善程度與責(zé)任病灶伴隨CMBs數(shù)量呈負(fù)相關(guān),相關(guān)系數(shù)(r=0.381,P=0.001)。急性穿支動脈腦梗死患者CMBs患病率較高,高血壓對基底節(jié)-丘腦梗死伴CMBs生成有重要作用。入院時NIHSS評分與責(zé)任病灶區(qū)CMBs數(shù)量無關(guān),但3月后神經(jīng)功能改善程度與責(zé)任病灶梗死區(qū)CMBs數(shù)量有一定相關(guān)性,責(zé)任病灶伴隨CMBs越多,神經(jīng)功能恢復(fù)越差。及時行SWI掃描,對急性穿支動脈腦梗死合并CMBs患者預(yù)后評估及二級預(yù)防有重要臨床意義。
[Abstract]:This study was to investigate the prevalence, risk factors and clinical changes of acute perforating artery cerebral infarction with cerebral microhemorrhage in different locations. In this study, we collected the results of brain diffusion weighted imaging (DWI) and magnetic sensitivity weighted imaging (WSI) sequences in patients with acute perforating artery cerebral infarction (ACI) in Handan Central Hospital. Patients with acute perforating artery infarction of basal ganglia thalamus and brain stem with cerebral microhemorrhage (Cerebral microbleeds) were selected as study subjects. The basic clinical information, related risk factors and neurological function scores were recorded. The subjects were divided into basal ganglia-thalamic infarction group and brainstem infarction group according to the location of new infarction. According to the MARSS-microbleed Anatomical scaling scale table [1] (see figure 1), the number of CMBs related to the responsible lesion was recorded: the number of ipsilateral cerebral hemispheres and the number of brainstem CMBs were recorded in patients with basal ganglia and thalamic infarction. The number of cerebral stem CMBs and the number of bilateral cerebral hemispheres were recorded in patients with brainstem infarction. The prevalence, risk factors and NIHSS score of cerebral microhemorrhage in acute perforating artery cerebral infarction were analyzed statistically. In this study, 214 patients with acute perforating artery cerebral infarction and 198 patients with acute perforating artery cerebral infarction were included in this study. Among them, 6 patients with incomplete data were non-basal ganglia thalamus and 10 patients with acute perforating artery cerebral infarction in the brainstem. A total of 198 patients with acute perforating artery cerebral infarction entered the group. 198 patients with acute perforating artery cerebral infarction in basal ganglia thalamus or brain stem were accompanied with CMBs103 cases in positive group and 95 cases in negative group. The incidence of hypertension in the positive group was 80.6, which was significantly higher than that in the negative group (蠂 2, 4.51, P 0.03). There was no significant difference in the remaining risk factors. There were 67 cases of cerebral microhemorrhage in patients with basal ganglia-thalamic infarction and 36 cases of cerebral microhemorrhage in patients with brainstem infarction. The incidence of hypertension in patients with basal ganglia thalamic infarction and CMBs was 86.6, which was higher than that in brainstem infarction patients with CMBs. The number of CMBs in the ipsilateral cerebral hemispheres in the basal ganglia thalamic infarction group was 280 鹵4.2 鹵4.8, which was significantly higher than that in the bilateral cerebral hemispheres in the brainstem infarction group. The number of CMBs in the ipsilateral cerebral hemispheres was 0.64 鹵3.2. The number of brainstem CMBs in brainstem infarction group was 174V 4.8 鹵3.2g, which was higher than that in basal ganglia thalamic infarction group (620.93 鹵1.2). NIHSS score and CMBs correlation analysis showed that NIHSS score and responsible lesion were associated with CMBs at admission in patients with acute perforating artery cerebral infarction. There was no significant correlation between the amount of nerve function and the number of CMBs, but there was a negative correlation between the degree of improvement of nerve function and the number of CMBs associated with the responsible lesion after 3 months. The correlation coefficient is 0.381P0. 001g. The prevalence of CMBs in patients with acute perforating artery cerebral infarction is high. Hypertension plays an important role in the formation of CMBs in basal ganglia-thalamic infarction. The NIHSS score was not related to the number of CMBs in the responsible lesion area at admission, but there was a certain correlation between the degree of improvement of nerve function and the number of CMBs in the responsible infarct area after 3 months. The more the responsible lesion accompanied by CMBs, the worse the recovery of nerve function. SWI scan in time has important clinical significance for prognosis evaluation and secondary prevention in patients with acute perforating artery cerebral infarction complicated with CMBs.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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