本文選題：腦梗死 + 復發(fā)��； 參考：《山東大學》2017年碩士論文

【摘要】：背景與目的:腦梗死是嚴重危害人類健康的疾病之一,具有高致殘率、高死亡率和高復發(fā)率的特點,復發(fā)后的死亡率、致殘率均高于初發(fā),給社會和許多家庭造成了沉重的負擔。關于腦梗死復發(fā)的研究仍是醫(yī)學界的熱點,但是對導致復發(fā)的危險因素的確定、預測復發(fā)的多種量表的效度、藥物及顱內(nèi)外支架的預防效果等都存在一定爭議。本研究的目的就是分析住院治療的復發(fā)性腦梗死患者與未復發(fā)患者的臨床和影像學有何差異,尋找導致腦梗死復發(fā)的主要危險因素及預測指標,以便篩選出具有復發(fā)傾向的對象,以加強對他們的健康宣教及針對性治療,達到降低腦梗死復發(fā)的目標。方法:本研究收集自2014年12月至2015年12月在我院神經(jīng)內(nèi)科住院治療的初次發(fā)病的急性腦梗死患者,初次篩選后按照流程進行相應的檢查及治療,出院后進行常規(guī)二級預防治療,經(jīng)電話隨訪或門診復診1年,最后篩選出226名患者進行研究分析。根據(jù)患者是否復發(fā)分為復發(fā)組21例及非復發(fā)組205例,使用SPSS 18.0統(tǒng)計軟件對兩組患者的臨床和影像進行分析。結(jié)果:(1)1年內(nèi)226名患者有21例復發(fā),復發(fā)率為9.29%。(2)高血壓病、糖尿病在復發(fā)組的比率明顯高于非復發(fā)組,且差異有統(tǒng)計學意義(p0.05);兩組性別、年齡、吸煙史、體重指數(shù)、高脂血癥及心臟病等方面無統(tǒng)計學差異(P0.05)。(3)對兩組M-TOAST分型分別進行總體和各亞型之間對比發(fā)現(xiàn),動脈粥樣硬化血栓形成(AT型)在復發(fā)組所占比率(66.67%)明顯高于非復發(fā)組(43.41%),差異有統(tǒng)計學意義(P0.05)。(4)對兩組ESSEN評分進行對比,復發(fā)組中ESSEN評分高危及以上患者比率(71.43%)明顯高于非復發(fā)組(34.63%),且差異有統(tǒng)計學意義(p0.05)。(5)兩組影像學資料對比:不穩(wěn)定斑塊在復發(fā)組所占比率(71.43%)明顯高于非復發(fā)組(34.15%),顱內(nèi)或顱外血管狹窄在復發(fā)組所占比率明顯高于非復發(fā)組,且差異有統(tǒng)計學意義(P0.05)。結(jié)論:(1)本研究中初發(fā)腦梗死1年內(nèi)的復發(fā)率為9.29%。(2)高血壓病、糖尿病是腦梗死復發(fā)的主要危險因素。(3)有頸部不穩(wěn)定斑塊或顱內(nèi)外血管狹窄患者的復發(fā)率明顯增高。(4)M-T0AST分型中AT型患者復發(fā)率高,與本研究中存在頸部不穩(wěn)定斑塊或顱內(nèi)外血管狹窄患者的復發(fā)率明顯增高一致。(5)ESSEN評分能預測腦梗死復發(fā)的風險,但ESSEN評分未包含不穩(wěn)定斑塊及顱內(nèi)外血管狹窄等影像學特征,可能會影響其預測的效度。
[Abstract]:Background & objective: cerebral infarction is one of the most serious diseases that endanger human health. It has the characteristics of high disability rate, high mortality rate and high recurrence rate. It places a heavy burden on society and many families. The research on the recurrence of cerebral infarction is still a hot topic in the medical field. However, the determination of the risk factors leading to recurrence, the validity of multiple scales for predicting recurrence, and the preventive effects of drugs and extracranial stents are still controversial. The purpose of this study was to analyze the clinical and imaging differences between patients with recurrent cerebral infarction and those without recurrence, and to find out the main risk factors and predictors of recurrent cerebral infarction. In order to select the target with recurrence tendency, to strengthen their health education and targeted treatment, to achieve the goal of reducing the recurrence of cerebral infarction. Methods: from December 2014 to December 2015, patients with primary acute cerebral infarction who were hospitalized in Department of Neurology in our hospital were examined and treated according to the procedure of primary screening, and the patients were treated with routine secondary preventive therapy after discharge. 226 patients were selected and analyzed by telephone follow-up or outpatient follow-up for 1 year. The patients were divided into recurrent group (21 cases) and non-recurrent group (205 cases) according to whether they recurred or not. The clinical and imaging data of the two groups were analyzed by SPSS 18.0 software. Results: (1) there were 21 cases of recurrence in 226 patients within one year, the recurrence rate was 9.29. (2) the rate of hypertension and diabetes mellitus in recurrent group was significantly higher than that in non-recurrence group (p0.05), the sex, age, smoking history, body mass index of the two groups were significantly higher than those of non-recurrence group (p0.05). There was no statistical difference in hyperlipidemia and heart disease (P0.05). (3). The percentage of atherosclerotic thrombosis (AT type) in recurrent group (66.67%) was significantly higher than that in non-recurrent group (43.41%). The difference was statistically significant (P0.05). (4). The ratio of high risk and above Essen score in recurrent group (71.43%) was significantly higher than that in non-recurrent group (34.63%), and the difference was statistically significant (p0.05). (5). The ratio of unstable plaque in recurrent group (71.43%) was significantly higher than that in non-recurrent group (34.15%). The proportion of internal or extracranial vascular stenosis in recurrent group was significantly higher than that in non-recurrent group. The difference was statistically significant (P0.05). Conclusion: (1) the recurrence rate of primary cerebral infarction in this study is 9.290.The second is hypertension. Diabetes mellitus was the main risk factor for recurrence of cerebral infarction. (3) the recurrence rate of patients with unstable plaque of neck or intracranial and external vascular stenosis was significantly higher. (4) the recurrence rate of AT type patients in M-T0AST classification was high. In this study, the recurrence rate of patients with cervical unstable plaque or intracranial and extracranial vascular stenosis was significantly higher. (5) ESSEN score could predict the risk of cerebral infarction recurrence, but ESSEN score did not contain the imaging features of unstable plaque and intracranial and extracranial vascular stenosis. It may affect the validity of its prediction.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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