羥乙基淀粉治療分水嶺腦梗死臨床療效研究
發(fā)布時間：2018-12-09 18:30
【摘要】：目的研究擴容藥物羥乙基淀粉(HES)對分水嶺腦梗死(CWI)在臨床中的治療效果,分析HES對不同類型CWI患者的臨床療效差異及不同類型CWI與顱內外血管狹窄的關系,為臨床工作中的個體化治療尋找依據。方法選擇2010年10月-2016年05月住院的CWI患者93例,所有研究對象符合第四屆腦血管病學術會議的腦血管病診斷標準。入組者為發(fā)病24小時內經顱腦磁共振(MRI)常規(guī)檢查聯合擴散加權成像(DWI)檢查技術確診為CWI患者,存在與梗死灶明確相關的臨床癥狀和體征,初次發(fā)病者以及既往有腦梗死病史但未存留顯著神經系統受損表現者,排除全身低灌注、心源性栓塞、自身免疫相關性疾病、腦出血、腫瘤及對羥乙基淀粉過敏患者,所有患者完善頸內動脈顱外段(internal carotid artery,ICA)彩超和顱內血管磁共振3D TOF血管造影(MRA)成像檢查。將分水嶺腦梗死的患者93例隨機分為兩組,試驗組為50例和對照組43例。試驗組患者給予抗血小板、腦細胞保護等一般治療+6%中分子羥乙基淀粉注射液130/0.4 500ml ivdrip qdx14天擴容治療,對照組給予上述一般治療。采用NIHSS評分評估患者入院時、入院第七天、入院第十四天的神經功能缺損程度。結果1.兩組患者年齡、性別、CWI類型、高血壓、冠心病、糖尿病、高脂血癥、吸煙史、飲酒史比較并無統計學意義(P0.05)。2.兩組患者入院時比較NIHSS評分無統計學差異(P0.05),治療第7天、治療第14天NIHSS評分兩組患者均較入院時有顯著好轉,分別與入院時比較有統計學意義(P0.05),同時,試驗組與同期對照組比較有統計學意義(P0.05)。兩組治療第7天、第14天療效比較差異有統計學意義(P0.05)。試驗組中兩種類型CWI患者神經功能恢復有統計學差異(P0.05),HES擴容治療對皮質下分水嶺腦梗死(IWSI)效果優(yōu)于皮質分水嶺腦梗死(CWSI)。3.不同類型CWI病灶側血管的狹窄檢出率不同,CWSI多伴有同側相應頸內動脈(ICA)狹窄(OR值為0.019;95%CI為0.003~0.227;P=0.016);IWSI多伴有同側大腦中動脈(MCA)狹窄(OR值為39.271;95%CI為3.179~399.818;P=0.021)。結論1.HES擴容治療CWI療效顯著,患者的神經功能受損癥狀得到改善。HES擴容治療對IWSI神經功能恢復效果優(yōu)于CWSI。2.顱內外大血管病變與CWI的發(fā)生有重要關系,病灶側血管ICA、MCA病變的發(fā)生比例依CWI類型不同亦有差別。CWSI多伴有病灶側ICA狹窄;IWSI多伴有病灶側MCA狹窄。
[Abstract]:Objective to study the therapeutic effect of dilatation drug hydroxyethyl starch (HES) on watershed cerebral infarction (CWI) in patients with cerebral infarction, and to analyze the difference of clinical efficacy of HES in patients with different types of CWI and the relationship between different types of CWI and intracranial and extracranial vascular stenosis. To find the basis for individualized treatment in clinical work. Methods 93 patients with CWI were selected from October 2010 to May 2016. All the subjects met the diagnostic criteria of cerebrovascular disease of the 4th Symposium on Cerebrovascular Disease. The patients in the group were diagnosed as CWI within 24 hours after the onset of the disease by conventional craniocerebral magnetic resonance (MRI) combined with diffusion weighted imaging (DWI), and there were clinical symptoms and signs related to the infarct foci. Patients with primary onset and previous history of cerebral infarction without significant neurological damage were excluded from systemic hypoperfusion, cardiogenic embolism, autoimmune related diseases, cerebral hemorrhage, tumors and hypersensitivity to hydroxyethyl starch. All the patients were examined by color Doppler ultrasonography and 3 D TOF angiography (MRA) of internal carotid artery extracranial segment. 93 patients with watershed cerebral infarction were randomly divided into two groups: the experimental group (n = 50) and the control group (n = 43). The patients in the experimental group were treated with anti-platelet and cerebral cell protection, and the patients in the control group were given the general treatment of 6% of hydroxyethyl starch injection (130 / 0.4 500ml ivdrip qdx14 / d). NIHSS score was used to assess the degree of neurological impairment at admission, on day 7 and day 14. Result 1. Age, sex, CWI type, hypertension, coronary heart disease, diabetes, hyperlipidemia, smoking history, drinking history were not statistically significant (P0.05). There was no significant difference in NIHSS scores between the two groups on admission (P0.05). On the 7th day and 14th day of treatment, the NIHSS scores of the two groups were significantly improved compared with the admission time (P0.05), at the same time, there was no significant difference between the two groups (P0.05). There was significant difference between the experimental group and the control group in the same period (P0.05). There was significant difference between the two groups on the 7th day and the 14th day (P0.05). There was significant difference in the recovery of nerve function between the two types of CWI patients in the trial group (P0.05). The effect of), HES expansion on subcortical watershed cerebral infarction (IWSI) was better than that of cortical watershed cerebral infarction (CWSI). 3. The positive rate of stenosis in different types of CWI lesions was different. CWSI was associated with ipsilateral (ICA) stenosis of the internal carotid artery (OR = 0.019 鹵95 CI = 0.003 鹵0.227). IWSI was associated with ipsilateral (MCA) stenosis of the middle cerebral artery (OR = 39.271, 95 CI = 3.179, 399.818, P = 0.021). Conclusion 1.HES dilatation is effective in the treatment of CWI, and the symptoms of nerve function impairment are improved. HES dilatation is superior to CWSI.2. in the recovery of IWSI nerve function. There was an important relationship between extracranial and extracranial macrovascular lesions and CWI, and the incidence of ICA,MCA in the lesion side was different according to the type of CWI. CWSI was associated with ICA stenosis on the lesion side and IWSI with MCA stenosis on the lesion side.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
本文編號：2369841
[Abstract]:Objective to study the therapeutic effect of dilatation drug hydroxyethyl starch (HES) on watershed cerebral infarction (CWI) in patients with cerebral infarction, and to analyze the difference of clinical efficacy of HES in patients with different types of CWI and the relationship between different types of CWI and intracranial and extracranial vascular stenosis. To find the basis for individualized treatment in clinical work. Methods 93 patients with CWI were selected from October 2010 to May 2016. All the subjects met the diagnostic criteria of cerebrovascular disease of the 4th Symposium on Cerebrovascular Disease. The patients in the group were diagnosed as CWI within 24 hours after the onset of the disease by conventional craniocerebral magnetic resonance (MRI) combined with diffusion weighted imaging (DWI), and there were clinical symptoms and signs related to the infarct foci. Patients with primary onset and previous history of cerebral infarction without significant neurological damage were excluded from systemic hypoperfusion, cardiogenic embolism, autoimmune related diseases, cerebral hemorrhage, tumors and hypersensitivity to hydroxyethyl starch. All the patients were examined by color Doppler ultrasonography and 3 D TOF angiography (MRA) of internal carotid artery extracranial segment. 93 patients with watershed cerebral infarction were randomly divided into two groups: the experimental group (n = 50) and the control group (n = 43). The patients in the experimental group were treated with anti-platelet and cerebral cell protection, and the patients in the control group were given the general treatment of 6% of hydroxyethyl starch injection (130 / 0.4 500ml ivdrip qdx14 / d). NIHSS score was used to assess the degree of neurological impairment at admission, on day 7 and day 14. Result 1. Age, sex, CWI type, hypertension, coronary heart disease, diabetes, hyperlipidemia, smoking history, drinking history were not statistically significant (P0.05). There was no significant difference in NIHSS scores between the two groups on admission (P0.05). On the 7th day and 14th day of treatment, the NIHSS scores of the two groups were significantly improved compared with the admission time (P0.05), at the same time, there was no significant difference between the two groups (P0.05). There was significant difference between the experimental group and the control group in the same period (P0.05). There was significant difference between the two groups on the 7th day and the 14th day (P0.05). There was significant difference in the recovery of nerve function between the two types of CWI patients in the trial group (P0.05). The effect of), HES expansion on subcortical watershed cerebral infarction (IWSI) was better than that of cortical watershed cerebral infarction (CWSI). 3. The positive rate of stenosis in different types of CWI lesions was different. CWSI was associated with ipsilateral (ICA) stenosis of the internal carotid artery (OR = 0.019 鹵95 CI = 0.003 鹵0.227). IWSI was associated with ipsilateral (MCA) stenosis of the middle cerebral artery (OR = 39.271, 95 CI = 3.179, 399.818, P = 0.021). Conclusion 1.HES dilatation is effective in the treatment of CWI, and the symptoms of nerve function impairment are improved. HES dilatation is superior to CWSI.2. in the recovery of IWSI nerve function. There was an important relationship between extracranial and extracranial macrovascular lesions and CWI, and the incidence of ICA,MCA in the lesion side was different according to the type of CWI. CWSI was associated with ICA stenosis on the lesion side and IWSI with MCA stenosis on the lesion side.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
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