本文選題：老年 + 腦血管病�。� 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 應(yīng)用數(shù)字減影腦血管造影(Digital Subtraction Angiography，DSA)技術(shù)，研究65歲以上腦卒中人群腦血管病變的特點及分布情況，并分析腦血管病危險因素對腦血管的影響。 資料與方法： 回顧研究對象2008年9月至2014年1月在中日聯(lián)誼醫(yī)院神經(jīng)內(nèi)二科住院的65歲以上已行DSA檢查腦卒中患者33例。并設(shè)同期年齡在25-45歲之間的青年腦卒中患者40例，作為對照組。 采用Seldinger技術(shù)及改良技術(shù)，通過股動脈穿刺、插管行全腦血管造影檢查，記錄顱內(nèi)、外動脈狹窄的部位、程度、側(cè)枝循環(huán)及Willis環(huán)開放情況等，對血管病變類型、特點及分布情況進(jìn)行分析，并對腦血管病的危險因素（包括高血壓、糖尿病、卒中病史、吸煙、飲酒、高脂血癥）進(jìn)行記錄分析。研究65以上老年人群病因及血管病變特點及病因。使用SPSS17.0軟件，進(jìn)行數(shù)據(jù)錄入與統(tǒng)計，計數(shù)資料使用了卡方檢驗，計量資料使用方差分析。其中P0.05表示差異有統(tǒng)計學(xué)意義。 血管狹窄程度按NASCET標(biāo)準(zhǔn)分為4級①完全閉塞;②重度狹窄：狹窄程度在70%~99%;③中度狹窄：狹窄程度在50%~69%;④輕度狹窄或正常：指狹窄程度50%或無異常。以血管狹窄超過50%即認(rèn)為動脈病變。 結(jié)果： 1、33例65歲以上老年患者，最高81歲，最低65歲，平均年齡70.47±4.17歲，男：女為21:12=1.75:1。高血壓病17例，糖尿病4例，高血脂11例，吸煙6例，酗酒2例，卒中病史12例，其中2項以上18例。 2、老年組DSA檢查見28例出現(xiàn)血管病變，血管病變49處，2處以上病變14例，其中血管閉塞17處，重度狹窄15處，中度狹窄9處，輕度7處，動脈瘤1處。其中發(fā)現(xiàn)了19處側(cè)枝循環(huán)血管開放，一級側(cè)枝循環(huán)（Willis環(huán)）開放共13處：前交通動脈共6處，后交通動脈共7處，二級側(cè)枝循環(huán)開放共6處：發(fā)現(xiàn)前軟腦膜吻合動脈開放2例，后軟腦膜吻合動脈開放2例，眼動脈開放1例，穿支動脈開放1例。 3、40例對照組青年患者，最高45歲，最低28歲，平均年齡39.67±4.26歲，男：女為29:11=2.64:1。高血壓病21例，糖尿病4例，高血脂14例，吸煙19例，酗酒11例，卒中病史5例，其中2項以上20例。 4、青年組DSA檢查見28例出現(xiàn)血管病變，血管病變36處，2處以上病變7例，其中血管閉塞16處，重度狹窄4處，中度狹窄7處，輕度9處，動脈瘤1處，煙霧病2處。其中可見16處側(cè)枝循環(huán)開放，一級側(cè)枝循環(huán)（Willis環(huán)）開放11處：前交通動脈6處，后交通動脈5處，二級側(cè)枝循環(huán)開放5處：前軟腦膜吻合支開2例，后軟腦膜吻合支開放2例，眼動脈開放1例。 結(jié)論： 1、65歲以上老年組中，危險因素排序依次為高血壓病17（51.5%）、卒中病史12（36.4%）、高脂血癥11（33.3%）、吸煙6（18.2%）、糖尿病4（12.1%）、酗酒2（6.1%）。青年對照組中，危險因素排序依次為高血壓病21（52.5%）、吸煙19（47.5%）、高血脂14（35%）、酗酒11（27.5%）、卒中病史5（12.5%）、糖尿病4（10%）。占前3位的發(fā)病危險因素分別為：老年組的高血壓、腦卒中史及高血脂，青年組的高血壓、吸煙及高血脂。高血壓和高血脂為兩組共同主要危險因素。老年的卒中病史及青年的吸煙、酗酒為各自重要危險因素。 2、老年組血管病變率28/33=84.8%，青年組血管病變率28/40=70%。單一血管病變發(fā)生率，老年組為14/28=50%，青年組為21/28=75%。其中2處以上血管的病變比例也有區(qū)別，，老年組為14/28=50%，青年組為7/28=25%。顱內(nèi)外血管的病變比例，老年組為10/39=0.26：1，青年組為30/6=5：1。老年組血管病變率高于青年組，老年組2處以上病變多見，青年組單一血管病變多見，老年組顱外血管病變發(fā)生率較高，青年組顱內(nèi)血管病變發(fā)生率較高(P0.05)。重度狹窄及血管閉塞比例，老年組：青年組=65.3%：55.6%。 3、側(cè)枝循環(huán)開放情況，老年組11例（33.3%）一級側(cè)枝循環(huán)開放，共13處，5例（15.2%）二級側(cè)枝循環(huán)6處，青年組8例（20%）一級側(cè)枝循環(huán)開放，共11處，3例（7.5%）二級側(cè)枝循環(huán)5處。兩組側(cè)枝循環(huán)開放情況相當(dāng)。
[Abstract]:Objective:
Digital Subtraction Angiography (DSA) technique was used to study the characteristics and distribution of cerebrovascular disease in patients with cerebral apoplexy over 65 years of age, and to analyze the effect of risk factors of cerebrovascular disease on cerebral vessels.
Information and methods:
From September 2008 to January 2014, 33 cases of cerebral apoplexy were examined by DSA in two families in the neurology hospital of Sino Japanese Friendship Hospital from September 2008 to January 2014, and 40 cases of stroke patients aged 25-45 years old were set up as the control group.
Using the Seldinger technique and the improved technique, through the femoral artery puncture and the intubation of the whole brain angiography, the location of the intracranial and external artery stenosis, the degree, the collateral circulation and the opening of the Willis ring were recorded, and the types, characteristics and distribution of the vascular diseases were analyzed, and the risk factors of cerebrovascular disease (including hypertension, diabetes, pawns) were also analyzed. History, smoking, drinking and hyperlipidemia were recorded and analyzed. The etiology and angiopathy of more than 65 Elderly people were studied. SPSS17.0 software was used to carry out data entry and statistics. Counting data were used in Chi square test and measurement data were analyzed with variance. P0.05 indicated that the difference was statistically significant.
The degree of vascular stenosis was divided into 4 levels, complete occlusion according to NASCET standard, and severe stenosis: the degree of stenosis was 70%~99%; (3) moderate stenosis: the degree of stenosis was 50%~69%; (4) mild stenosis or normal: the degree of stenosis was 50% or no abnormal. Artery stenosis was considered to be more than 50%.
Result:
1,33 aged over 65 years old, the highest 81 years old, the lowest 65 years old, the average age of 70.47 + 4.17 years, male: female 21:12=1.75:1. hypertension, 17 cases, diabetes 4 cases, hyperlipidemia 11 cases, smoking 6 cases, 2 cases of alcoholism, 12 cases of stroke, among them 2 more 18 cases.
2, the DSA examination in the elderly group showed that 28 cases had vascular lesions, 49 vascular lesions and 14 cases above 2 lesions, including 17 vascular occlusion, 15 severe stenosis, 9 moderate stenosis, mild 7, and 1 aneurysms. Among them, 19 collateral circulation vessels were open and primary collateral circulation (Willis ring) was open to 13 places: anterior communicating artery 6, posterior traffic movement The total vein was 7, and the two grade collateral circulation opened in 6 places: 2 cases were open before the discovery of the pia anastomosis artery, 2 cases of posterior PIA anastomosis artery opening, 1 cases of open ophthalmic artery, and 1 perforator artery open cases.
3,40 cases of young patients in the control group, the highest 45 years old, the lowest 28 years old, the average age was 39.67 + 4.26 years old, male: women were 29:11=2.64:1. hypertension 21 cases, diabetes 4 cases, hyperlipidemia 14 cases, smoking 19 cases, alcoholism 11 cases, 5 cases of stroke disease history, of which 2 more 20 cases.
4, the DSA examination in the youth group showed 28 cases of vascular lesions, 36 vascular lesions and 7 cases above 2 lesions, including 16 vascular occlusion, 4 severe stenosis, 7 moderate stenosis, 9 mild, 1 aneurysms and 2 moyamoya disease. Among them, the circulation of collateral branches in the 16 places was open and the first grade collateral circulation (Willis ring) opened in 11: anterior communicating artery 6, posterior communicating artery There were 5 lateral collateral circulation at two levels: 2 cases of anterior PIA anastomosis, 2 cases of posterior PIA anastomosis and 1 cases of open ophthalmic artery.
Conclusion:
The order of risk factors was 17 (51.5%), 12 (36.4%) of stroke disease, 11 (33.3%) of hyperlipidemia, 6 (18.2%), 4 (12.1%) and 2 (6.1%). In the young control group, the order of risk factors was high blood pressure disease 21 (52.5%), high blood lipid, alcoholism, alcoholism and stroke history. .5%), diabetes 4 (10%). The risk factors for the first 3 were: hypertension in the elderly group, the history of stroke and hyperlipidemia, hypertension in the youth group, smoking and hyperlipidemia, hypertension and hyperlipidemia as the common risk factors in two groups. The history of stroke in the elderly and the smoking and drinking of young people were the major risk factors.
2, the rate of vascular lesions in the elderly group was 28/33=84.8%, the rate of 28/40=70%. single vascular lesion in the young group was 14/28=50%, the elderly group was 14/28=50%, and the proportion of the lesions in the young group was 2 and more. The elderly group was 14/28=50%, the young group was the 7/28=25%. lesion ratio of the external intracranial vessels, and the elderly group was 10/39=0.26:1, green. The rate of vascular lesions in the elderly group was higher than that of the young group, and more than 2 lesions in the elderly group were more common, the single vascular lesions in the young group were more common, the incidence of extracranial vascular lesions in the elderly group was higher, the incidence of intracranial vascular lesions in the young group was higher (P0.05). The proportion of severe stenosis and vascular closure was in the elderly group: the young group was =65.3%:55.6%.
3, the circulation of lateral branches was open, 11 cases (33.3%) in the elderly group were open, 13, 5 (15.2%), 6 of the grade two collateral circulation, 8 (20%) in the youth group (20%), 11, 3 (7.5%) collateral circulation.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743

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