羥乙基淀粉治療分水嶺腦梗死臨床療效研究
發(fā)布時(shí)間：2018-12-09 18:30
【摘要】：目的研究擴(kuò)容藥物羥乙基淀粉(HES)對(duì)分水嶺腦梗死(CWI)在臨床中的治療效果,分析HES對(duì)不同類型CWI患者的臨床療效差異及不同類型CWI與顱內(nèi)外血管狹窄的關(guān)系,為臨床工作中的個(gè)體化治療尋找依據(jù)。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(duì)象符合第四屆腦血管病學(xué)術(shù)會(huì)議的腦血管病診斷標(biāo)準(zhǔn)。入組者為發(fā)病24小時(shí)內(nèi)經(jīng)顱腦磁共振(MRI)常規(guī)檢查聯(lián)合擴(kuò)散加權(quán)成像(DWI)檢查技術(shù)確診為CWI患者,存在與梗死灶明確相關(guān)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(jīng)系統(tǒng)受損表現(xiàn)者,排除全身低灌注、心源性栓塞、自身免疫相關(guān)性疾病、腦出血、腫瘤及對(duì)羥乙基淀粉過(guò)敏患者,所有患者完善頸內(nèi)動(dòng)脈顱外段(internal carotid artery,ICA)彩超和顱內(nèi)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(jī)分為兩組,試驗(yàn)組為50例和對(duì)照組43例。試驗(yàn)組患者給予抗血小板、腦細(xì)胞保護(hù)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(kuò)容治療,對(duì)照組給予上述一般治療。采用NIHSS評(píng)分評(píng)估患者入院時(shí)、入院第七天、入院第十四天的神經(jīng)功能缺損程度。結(jié)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(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.兩組患者入院時(shí)比較NIHSS評(píng)分無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),治療第7天、治療第14天NIHSS評(píng)分兩組患者均較入院時(shí)有顯著好轉(zhuǎn),分別與入院時(shí)比較有統(tǒng)計(jì)學(xué)意義(P0.05),同時(shí),試驗(yàn)組與同期對(duì)照組比較有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組治療第7天、第14天療效比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。試驗(yàn)組中兩種類型CWI患者神經(jīng)功能恢復(fù)有統(tǒng)計(jì)學(xué)差異(P0.05),HES擴(kuò)容治療對(duì)皮質(zhì)下分水嶺腦梗死(IWSI)效果優(yōu)于皮質(zhì)分水嶺腦梗死(CWSI)。3.不同類型CWI病灶側(cè)血管的狹窄檢出率不同,CWSI多伴有同側(cè)相應(yīng)頸內(nèi)動(dòng)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(cè)大腦中動(dòng)脈(MCA)狹窄(OR值為39.271;95%CI為3.179~399.818;P=0.021)。結(jié)論1.HES擴(kuò)容治療CWI療效顯著,患者的神經(jīng)功能受損癥狀得到改善。HES擴(kuò)容治療對(duì)IWSI神經(jīng)功能恢復(fù)效果優(yōu)于CWSI。2.顱內(nèi)外大血管病變與CWI的發(fā)生有重要關(guān)系,病灶側(cè)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(cè)ICA狹窄;IWSI多伴有病灶側(cè)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(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
本文編號(hào)：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(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
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