本文選題：短暫性腦缺血發(fā)作 + 危險因素��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:短暫性腦缺血發(fā)作(transient ischemic attack,TIA)是腦梗死的危險因素之一,是神經(jīng)內(nèi)科的急癥之一。TIA患者90d內(nèi)進(jìn)展為腦梗死的風(fēng)險可達(dá)9%~17%,其中多數(shù)患者發(fā)生在TIA發(fā)病后最開始的2d內(nèi)。TIA的危險因素較多,有研究表明TIA患者進(jìn)展為腦卒中與癥狀持續(xù)時間、年齡、高血壓、糖尿病、血脂異常、腦血管病家族史等有關(guān)。研究發(fā)現(xiàn)我國TIA患者二級預(yù)防尚欠規(guī)范,且依從性差。因此,本研究意在探討TIA后長期內(nèi)各危險因素與繼發(fā)卒中的關(guān)系,觀察TIA后腦卒中及TIA復(fù)發(fā)的發(fā)生率,觀察患者TIA后二級預(yù)防依從性,從而為臨床治療和TIA預(yù)后提供依據(jù)。方法:選取147例TIA患者作為研究對象,詳細(xì)登記患者的年齡、性別、吸煙史、飲酒史、既往高血壓、冠心病、糖尿病病史及腦血管病家族史、臨床癥狀、持續(xù)時間、發(fā)作次數(shù)、實(shí)驗(yàn)室檢查結(jié)果、心電圖結(jié)果、頸部血管超聲檢查結(jié)果、醫(yī)學(xué)影像學(xué)檢查結(jié)果(頭CT或MRI)等基本資料,給予目前指南推薦規(guī)范治療,出院時根據(jù)患者情況給予指南推薦二級預(yù)防方案。分別于患者入選后1個月、3個月、1年、2年、3年、4年、5年以電話或門診復(fù)診的方式進(jìn)行隨訪,觀察患者的用藥情況、有無腦血管病事件的發(fā)生及發(fā)生時間。終點(diǎn)事件為出現(xiàn)新的腦血管病事件或患者因其他原因死亡。結(jié)果:研究期間共收集符合入組標(biāo)準(zhǔn)的147例患者,其中因心臟病原因死亡1例,CO中毒死亡1例,不明原因死亡1例,12例患者因電話變更失訪。對剩余132例患者進(jìn)行統(tǒng)計(jì)學(xué)資料分析,年齡22~78歲,平均58.63±11.52歲,男性95例(71.97%),女性37例(28.03%)。臨床表現(xiàn)為頸內(nèi)動脈系統(tǒng)癥狀患者97例(73.48%),其中表現(xiàn)為單個或單側(cè)肢體無力伴言語不清27例,單肢或偏側(cè)肢體無力37例,單純言語不清12例,肢體感覺異常(伴或不伴肢體無力)21例;椎-基底動脈系統(tǒng)癥狀患者35例,其中表現(xiàn)為眩暈者26例,視物不清11例,意識不清2例,跌倒發(fā)作1例。頸內(nèi)動脈系統(tǒng)TIA患者5年內(nèi)發(fā)生腦梗死者20例,占20.62%,椎-基底動脈系統(tǒng)患者5年內(nèi)發(fā)生腦梗死者1例,占2.86%,兩者差別有統(tǒng)計(jì)學(xué)意義(χ2=6.065,P0.05)。132例患者中2天、7天、1月、3月、1年、2年、3年、4年、5年進(jìn)展為腦梗死(cerebral infarction,CI)的分別為3例(2.27%)、5例(3.79%)、11例(8.33%)、12例(9.09%)、14例(10.61%)、16例(12.12%)、17例(12.88%)、19例(14.39%)、21例(15.91%),TIA反復(fù)發(fā)作的分別為21例(15.91%)、24例(18.18%)、30例(22.73%)、39例(29.55%)、43例(32.58%)、45例(34.09%)、46例(34.85%)、46例(34.85%)、49例(37.12%)。出院后1月、3月、1年、2年、3年、4年、5年二級預(yù)防應(yīng)用藥物的依從率:抗血小板藥物依從率90.1%、85.8%、80.5%、72.4%、65.3%、60.1%、55.7%,降壓藥物依從率91.8%、88.3%、81.6%、74.2%、67.7%、60.2%、57.8%,降糖藥物依從率94.2%、90.6%、86.5%、82.3%、79.1%、75.4%、72.2%,他汀類藥物依從率83.2%、70.6%、52.4%、46.3%、40.1%、35.2%、28.8%。藥物依從率隨時間延長而逐漸降低,以他汀類藥物依從性最差。出院患者口服抗血小板聚集藥物、降壓藥、降糖藥依從性與腦梗死發(fā)生有關(guān)系(P0.05),服藥依從性越高,腦梗死發(fā)生率越低。TIA不良預(yù)后危險因素的單因素分析結(jié)果顯示:年齡≥60歲、有腦血管病家族史、有高血壓、糖尿病病史、頸動脈狹窄率≥50%、不同頸動脈系統(tǒng)TIA是TIA患者5年內(nèi)發(fā)生腦梗死的有意義的危險因素(P0.05)。將上述各因素引入多因素Logistic回歸分析以控制混雜因素的影響,得出:高血壓、糖尿病、頸部血管狹窄、腦血管病家族病史為影響TIA不良預(yù)后的獨(dú)立危險因素。結(jié)論:1年齡≥60歲、有腦血管病家族史、有高血壓、糖尿病病史、頸部血管狹窄率≥50%、不同頸動脈系統(tǒng)TIA是TIA患者5年內(nèi)發(fā)生腦梗死的有意義的危險因素;其中高血壓病史、糖尿病病史、頸部血管狹窄率≥50%、腦血管病家族史是獨(dú)立危險因素;2 TIA后5年內(nèi)總梗死率隨時間延長逐漸增高,且前1個月內(nèi)增高較快,TIA進(jìn)展為腦卒中風(fēng)險較高;3 TIA后5年內(nèi)TIA復(fù)發(fā)率隨著時間的延長呈上升趨勢;4 TIA患者離院后服藥率隨時間延長而逐漸降低,以他汀類服藥率最低,藥物種類組間比較差別有意義。出院患者口服抗血小板聚集藥物、降壓藥、降糖藥依從性與腦梗死發(fā)生有關(guān)系(P0.05),依從性越高,腦梗死發(fā)生率越低。
[Abstract]:Objective: transient ischemic attack (transient ischemic attack, TIA) is one of the risk factors for cerebral infarction. One of the acute symptoms of Neurology is one of the.TIA patients in.TIA. The risk of progression to cerebral infarction in 90d can reach 9%~17%, most of them occur at the beginning of TIA, and there are more risk factors for.TIA in 2D. There are studies showing that TIA patients are progressing. Stroke is associated with duration of symptoms, age, hypertension, diabetes, dyslipidemia, and family history of cerebrovascular disease. The study found that the two stage prevention of TIA patients in our country is still under standard and poor compliance. Therefore, this study aims to explore the relationship between the risk factors and secondary pawns in the long term after TIA, and to observe the incidence of stroke and the recurrence of TIA after TIA. The two levels of compliance after TIA were observed to provide basis for the clinical treatment and the prognosis of TIA. Methods: 147 cases of TIA patients were selected as the research object, and the age, sex, smoking history, drinking history, past hypertension, coronary heart disease, history of diabetes and the family history of cerebrovascular disease, clinical symptoms, duration, frequency of attack, and experiment were studied. The results of the room examination, the results of the electrocardiogram, the results of the cervical vascular ultrasound, the results of the medical imaging examination (head CT or MRI), were given the current guidelines for the recommended standard treatment, and the guidelines recommended two levels of prevention according to the patient's condition in the discharge. 1 months, 3 months, 1 years, 2 years, 3 years, 4 years, and 5 years by telephone or door respectively. The treatment of the patients was followed up to observe the situation of the patient's medication, the occurrence and time of the event of cerebrovascular disease. The end event was a new event of cerebrovascular disease or the death of the patient for other reasons. Results: during the study, 147 patients were collected in accordance with the standard of the group. Among them, 1 cases died of heart disease and 1 cases died of CO poisoning. 1 cases of unknown cause died and 12 patients were lost in the telephone. The remaining 132 cases were analyzed statistically. The average age was 22~78 years old, the average age was 58.63 + 11.52 years old, the male 95 cases (71.97%), and the female 37 cases (28.03%). The clinical manifestations were 97 cases (73.48%) of the internal carotid artery system symptoms, which showed single or unilateral limb weakness accompanied by speech indifference. In 27 cases, there were 37 cases of single or partial limb weakness, 12 cases of simple speech, 21 cases of abnormal limb sensation (with or without limb weakness), 35 cases of vertebral basilar artery system symptoms, including 26 cases of vertigo, 11 cases, 2 sense of consciousness, 1 cases of fall attack, and 20 cases of cerebral infarction within 5 years of internal carotid system TIA patients, occupied 20.. 62%, 1 cases of cerebral infarction died within 5 years of the vertebral basilar artery system, accounting for 2.86%. The difference was statistically significant (x 2=6.065, P0.05) for 2 days, 7 days, January, March, 1, 3, 4, 4, cerebral infarction, CI. Cases (12.12%), 17 cases (12.88%), 19 cases (14.39%), 21 cases (15.91%), 24 cases (18.18%), 30 cases (22.73%), 24 cases, March, year, year, year, year, year Drug compliance rate is 90.1%, 85.8%, 80.5%, 72.4%, 65.3%, 60.1%, 55.7%, and the compliance rate of antihypertensive drugs is 91.8%, 88.3%, 81.6%, 74.2%, 67.7%, 60.2%, 57.8%, and statins compliance rates gradually decrease with time. The adherence of statins was the worst. Oral antiplatelet aggregation drugs, antihypertensive drugs, compliance with hypoglycemic drugs were associated with cerebral infarction (P0.05), the higher the compliance of the drugs, the lower the incidence of cerebral infarction, the single factor analysis of the risk factors of poor prognosis of.TIA showed that age is more than 60 years old, there are family history of cerebrovascular disease, hypertension, sugar The history of urinary disease, the stenosis rate of carotid artery is more than 50%, different carotid system TIA is a significant risk factor (P0.05) for patients with TIA cerebral infarction within 5 years. Multiple factor Logistic regression analysis is introduced to control the influence of confounding factors, and it is concluded that hypertension, diabetes, cervical vascular stenosis, and the family history of cerebrovascular disease affect TIA The independent risk factors of bad prognosis. Conclusion: 1 age of age and more than 60 years old, there are family history of cerebrovascular disease, hypertension, diabetes history, cervical stenosis rate more than 50%, different carotid artery system TIA is a significant risk factor for cerebral infarction within 5 years of TIA patients, including hypertension, diabetes, neck stenosis rate more than 50%, cerebral blood The family history of tube disease was an independent risk factor; the total infarct rate increased gradually within 5 years after 2 TIA, and increased rapidly in the first 1 months, and the risk of stroke was higher in the first 1 months. The recurrence rate of TIA in the 5 year of 3 TIA increased with the prolongation of time; the rate of medication in 4 TIA patients gradually decreased with time and was taken with statins. The rate was the lowest, and the difference among the groups was significant. The oral antiplatelet aggregation drug, the antihypertensive drug, the compliance of the antihypertensive drugs and the occurrence of cerebral infarction were related to the occurrence of cerebral infarction (P0.05), the higher the compliance, the lower the incidence of cerebral infarction.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.31

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