【摘要】：第一部分 頸動(dòng)脈斑塊的性質(zhì)與其社區(qū)高危人群常見危險(xiǎn)因素的關(guān)系 目的： 探討頸動(dòng)脈斑塊的性質(zhì)與其社區(qū)高危人群常見危險(xiǎn)因素之間的關(guān)系。 方法： 收集2008年1月至2012年8月查頸彩超的本地社區(qū)動(dòng)脈粥樣硬化高危人群的資料(共277例)，以單因素及多因素方法分析頸動(dòng)脈斑塊的性質(zhì)(扁平斑、軟斑、硬斑和潰瘍斑)與其常見危險(xiǎn)因素的關(guān)系。 結(jié)果： 單因素分析發(fā)現(xiàn)：頸動(dòng)脈的扁平斑和潰瘍斑的檢出率隨年齡增長呈增多趨勢；扁平斑80歲以上者明顯多于65歲以下者(P 0.01)，潰瘍斑80歲以上者明顯多于80歲以下者(P 0.05)。女性(P 0.01)及高血壓(P 0.05)患者的軟斑檢出率明顯減少。多因素分析發(fā)現(xiàn)：年齡不僅是影響頸動(dòng)脈斑塊形成(OR=1.098, P=0.000)，而且是影響扁平斑(OR潰瘍斑=1.048, P=0.011）和潰瘍斑(OR扁平斑=1.034,P=0.012)增多的主要危險(xiǎn)因素。 結(jié)論： 頸動(dòng)脈斑塊的性質(zhì)與高危人群的年齡、性別及高血壓相關(guān)；女性及高血壓患者頸動(dòng)脈軟斑相對較少，高齡患者扁平斑及潰瘍斑明顯增多。 第二部分 斑塊的性質(zhì)對頸動(dòng)脈支架植入術(shù)的影響 目的：探討斑塊的性質(zhì)對頸動(dòng)脈支架植入術(shù)的影響 資料方法： 收集從2012年1月到2014年1月在我院神經(jīng)內(nèi)科住院治療并且經(jīng)影像學(xué)及DSA檢查后證實(shí)符合頸動(dòng)脈支架植入治療共48例資料.所有患者資料按斑塊的性質(zhì)分為軟斑塊組23例，硬斑塊組16例，潰瘍斑塊組9例。觀察頸動(dòng)脈支架植入術(shù)（CAS）中血壓及心率的變化情況及術(shù)前、術(shù)后影像學(xué)的改變。 結(jié)果： 軟斑塊組球囊擴(kuò)張前的收縮壓（147.03±8.78vs133.53±10.92, t=9.98, P=0.000）及心率（81.09±7.08vs73.55±6.81, t=7.15, P=0.000）與球囊擴(kuò)張后相比均有明顯降低，達(dá)統(tǒng)計(jì)學(xué)差異，血氧飽和度在球囊擴(kuò)張前后無明顯差異；支架植入前后血壓、心率及均無明顯改變。 硬斑塊組收縮壓（152.67±9.67vs126.88±13.41, t=14.16, P=0.000）及舒張壓（80.01±8.61vs69.78±8.85, t=3.03, P=0.008）在球囊擴(kuò)張后均有明顯下降；心率在球囊擴(kuò)張前后亦有統(tǒng)計(jì)學(xué)差異（84.59±6.69vs70.82±7.21, t=9.72, P=0.000）；球囊擴(kuò)張前后血氧飽和度無明顯改變（t=1.89, P=0.07）。支架植入前后收縮壓（P=0.28）、舒張壓（P=0.13）改變無統(tǒng)計(jì)學(xué)意義，而支架植入前后心率有統(tǒng)計(jì)學(xué)意義（84.52±6.69vs79.23±7.21, t=3.95, P=0.001）。 潰瘍斑塊組心率在球囊擴(kuò)張前后有統(tǒng)計(jì)學(xué)意義（77.75±7.01vs74.51±8.73, t=5.8, P=0.001），而收縮壓（149.25±13.43vs146.01±9.51, t=1.38, P=0.38）、舒張壓（72.33±3.41vs70.22±6.31, t=1.99, P=0.28）及血氧飽和度（t=0.59, P=0.15）在球囊擴(kuò)張前后均無統(tǒng)計(jì)學(xué)意義。收縮壓（P=0.35）、舒張壓（P=0.81）及心率（P=0.35）及在支架植入前后均無統(tǒng)計(jì)學(xué)意義。 組間比較：三組中硬斑塊組在球囊擴(kuò)張時(shí)所需要的壓力（χ2=27.25, P=0.000）及擴(kuò)張次數(shù)（χ2=18.504, P=0.003）明顯多于軟斑組及潰瘍斑塊組，有統(tǒng)計(jì)學(xué)意義；硬斑塊組球囊擴(kuò)張前后收縮壓（F=35.86，P=0.000）、舒張壓(F=22.835,P=0.000)及心率（F=14.45，P=0.001）明顯高于軟班組和潰瘍斑塊組。軟斑組深穿支梗死占11.1%（2/18），皮質(zhì)梗死占89.8%（16/18）,硬斑塊出現(xiàn)深穿支梗死占66.7%（6/9），，皮質(zhì)梗死占33.3%（3/9），兩組相比具有統(tǒng)計(jì)學(xué)意義（χ2=6.417，P=0.011）。 結(jié)論： 軟斑塊組術(shù)中球囊擴(kuò)張時(shí)所需壓力比硬斑塊組小，次數(shù)比硬斑塊組少；球囊擴(kuò)張后收縮壓及心率有明顯下降，但支架植入前后兩者無明顯改變。 硬斑塊組術(shù)中球囊擴(kuò)張時(shí)需要壓力比軟斑塊組及潰瘍斑塊組大，次數(shù)比軟斑塊組及潰瘍斑塊組多；球囊擴(kuò)張前后血壓及心率有明顯改變；支架植入前后血壓無明顯變化，但心率有明顯改變。 潰瘍斑塊組術(shù)中球囊擴(kuò)張時(shí)需要壓力最低，次數(shù)比硬斑塊組少；球囊擴(kuò)張前后血壓，無明顯改變；而心率有明顯變化。支架植入前后血壓及心率均無明顯改變。 頸動(dòng)脈支架植入術(shù)后軟斑塊易導(dǎo)致皮質(zhì)梗死，而硬斑塊易導(dǎo)致深穿支梗死。
[Abstract]:Part one
The relationship between the nature of carotid plaques and the common risk factors of high-risk population in the community
Objective:
Objective to explore the relationship between the nature of carotid plaques and the common risk factors of high-risk population in the community.
Method:
Data (277 cases) were collected from the local community atherosclerosis high risk population from January 2008 to August 2012. The relationship between the characteristics of carotid plaque (flattened spots, soft spots, hard spots, and ulcer spots) with common risk factors was analyzed by single factor and multi factor method.
Result:
Single factor analysis showed that the detection rate of flattened plaques and ulceration spots increased with age; those with flat spots over 80 years of age were obviously more than those under the age of 65 (P 0.01), and those over 80 years old were significantly more than those under the age of 80 (P 0.05). The detection rate of soft spots in women (P 0.01) and high blood pressure (P 0.05) decreased significantly. It was found that age not only affects the formation of carotid plaque (OR=1.098, P=0.000), but also the main risk factor affecting the increase of the flat plaque (OR =1.048, P=0.011) and the ulcer plaque (OR flat plaque =1.034, P=0.012).
Conclusion:
The characteristics of carotid artery plaque are associated with age, sex and hypertension in high risk groups. There are relatively few carotid plaques in women and hypertensive patients, and there is a significant increase in flattened spots and ulcerative spots in older patients.
The second part
Effects of plaque characteristics on carotid artery stenting
Objective: To investigate the effects of plaque characteristics on carotid artery stenting.
Data method:
A total of 48 patients were collected from January 2012 to January 2014 in the neurology department of our hospital and confirmed by imaging and DSA examination. The data were divided into 23 cases in soft plaque group, 16 cases of hard plaque group and 9 cases of ulcer plaque group according to the nature of plaque. The blood pressure and blood pressure in carotid artery stent implantation (CAS) were observed. The change of heart rate and preoperative and postoperative imaging changes.
Result:
The systolic pressure (147.03 + 8.78vs133.53 + 10.92, t=9.98, P=0.000) and heart rate (81.09 + 7.08vs73.55 + 6.81, t=7.15, P=0.000) before balloon dilatation in soft plaque group were significantly lower than that of balloon dilatation. There was no significant difference between balloon dilatation and balloon dilatation. There was no significant difference in blood oxygen saturation before and after balloon dilatation; blood pressure and heart rate were not obvious before and after stent implantation. Change.
The systolic pressure (152.67 + 9.67vs126.88 + 13.41, t=14.16, P=0.000) and diastolic pressure (80.01 + 8.61vs69.78 + 8.85, t=3.03, P=0.008) in the hard plaque group decreased significantly after the balloon dilation, and the heart rate was also statistically different (84.59 + 6.69vs70.82 + 7.21, t=9.72, P=0.000) before and after the balloon dilation, and the oxygen saturation was not obvious before and after the balloon dilation. The changes (t=1.89, P=0.07). The systolic pressure (P=0.28) and diastolic pressure (P=0.13) before and after the stent implantation had no statistical significance, but the heart rate before and after the stent implantation was statistically significant (84.52 + 6.69vs79.23 + 7.21, t=3.95, P=0.001).
The heart rate of the ulcer plaque group was statistically significant before and after balloon dilatation (77.75 + 7.01vs74.51 + 8.73, t=5.8, P=0.001), while systolic pressure (149.25 + 13.43vs146.01 + 9.51, t=1.38, P=0.38), diastolic pressure (72.33 + 3.41vs70.22 + 6.31, t=1.99, P=0.28) and oxygen saturation (t=0.59, P=0.15) were not statistically significant before and after balloon dilatation. P=0.35), diastolic blood pressure (P=0.81) and heart rate (P=0.35) were not statistically significant before and after stent implantation.
Group comparison: the pressure (chi 2=27.25, P=0.000) and expansion times (x 2=18.504, P=0.003) in the three groups of hard plaque group were significantly more than that in the soft plaque group and the ulcer plaque group, with statistical significance. The systolic pressure (F=35.86, P=0.000), diastolic pressure (F=22.835, P=0.000) and heart rate (F=14.45, P=0.001) before and after balloon dilatation in the hard plaque group were statistically significant. It was significantly higher than the soft group and the ulcer plaque group. The deep perforating infarction in the soft spot group was 11.1% (2/18), the cortical infarct accounted for 89.8% (16/18), the deep perforating infarction of the hard plaque was 66.7% (6/9), the cortical infarct accounted for 33.3% (3/9), and the two groups were statistically significant (x 2=6.417, P= 0.011).
Conclusion:
The pressure of balloon dilatation in the soft plaque group was smaller than the hard plaque group, and the number of times was less than that in the hard plaque group. The systolic pressure and heart rate decreased significantly after the balloon dilation, but there was no significant change in the two groups before and after the stent implantation.
In the hard plaque group, the pressure of the balloon was larger than the soft plaque group and the ulcer plaque group. The number of times was more than the soft plaque group and the ulcer plaque group. The blood pressure and heart rate before and after the balloon dilation were obviously changed. The blood pressure before and after the stent implantation did not change obviously, but the heart rate was obviously changed.
In the ulcer plaque group, the balloon dilatation needs the lowest pressure, less times than the hard plaque group, and the blood pressure before and after the balloon dilatation does not change obviously, but the heart rate has obvious changes.
Soft plaque after carotid artery stent implantation can cause cortical infarction, while hard plaque can lead to deep perforating infarction.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.33

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