脑梗死出血性转化的发生时间及MRI分型

发布时间：2018-04-05 11:22

  本文选题：脑梗死　切入点：出血性转化　出处：《兰州大学》2014年硕士论文

【摘要】：目的 观察72例脑梗死患者发生出血性转化(HT)的时间,总结其发病时间规律性,为临床及时调整治疗方案提供依据；对72例HT患者在MRI上的表现特点进行归纳、总结,提出新的MRI分型。 材料和方法 1.本研究搜集HT病例72例(均未给予溶栓治疗),男性42人,女性30人,年龄30-82岁。其中栓塞性脑梗死患者22人,血栓形成性脑梗死50人。栓塞性、血栓形成性脑梗死的诊断由临床医师通过病史、心电图、心脏彩超、颈动脉彩超及经颅多普勒等检查作出。所有CT和MRI片由两名从事多年影像诊断的医师进行判断。 2.通过影像学资料及临床病程记录计算出栓塞性和血栓形成性脑梗死患者发生HT的时间,具体算法为：监测到出血的时间点减去出现脑梗死临床症状的时间,分别计算出栓塞性和血栓形成性脑梗死患者在发病1-3天、4-7天和7天以上发生HT的人数,采用SPSS17.0软件包对所测数据进行统计分析,P0.05认为有统计学意义。头颅CT平扫图像由德国西门子公司Siemens Sensation64层螺旋CT机进行扫描,MRI平扫及DWI图由美国GE公司产singa CV/I1.5T超导型MRI扫描仪扫描,结合临床及影像学检查作出HT诊断。通过观察所有病例MRI平扫及DWI图,记录不同发生部位、不同出血形态以及不同发生部位的出血形态的病例数,计算出其相应的发生率。最后,结合出血部位、出血形态、发生率提出新的MRI分型。 结果 脑梗死HT在发病后1周以内发生者67例,占93.1%,大于1周者5例,占6.9%。栓塞性脑梗死HT的发生时间早于血栓形成性脑梗死,前者为第1-3天,后者为第4-7天,两者间差异有统计学意义(P=0.017)。 HT仅发生于幕上最多(占84.7%),幕下次之(占12.5%),幕上幕下同时发生最少(占2.8%)。出血形态上,斑片样、斑点样最多见(55.3%),脑回样、线样出血次之(39.4%),血肿形成型最少(5.3%)。其中脑回样、线样出血最多见于脑叶(占89.2%),斑片样、斑点样出血最多见于基底节区(占48.2%)。 结论 栓塞性和血栓形成性脑梗死发生HT的高峰时间不同,栓塞性脑梗死HT的发生时间早于血栓形成性脑梗死。本研究提出脑梗死HT新的MRI分型：Ⅰ型：幕上非血肿型；Ⅱ型：幕下非血肿型；Ⅲ型：血肿形成型；Ⅳ型：混合(幕上及幕下)非血肿型。
[Abstract]:PurposeTo observe the time of hemorrhagic transformation (HTT) in 72 patients with cerebral infarction, to summarize the regularity of its onset time, to provide the basis for clinical timely adjustment of treatment scheme, to sum up the characteristics of 72 patients with HT on MRI.A new MRI typing was proposed.Materials and methods1.This study collected 72 cases of HT (all without thrombolytic therapy, 42 males and 30 females, aged 30-82 years).Among them, 22 patients with embolic cerebral infarction and 50 patients with thrombotic cerebral infarction.The diagnosis of embolic and thrombotic cerebral infarction was made by clinicians through history, electrocardiogram, echocardiography, carotid ultrasound and transcranial Doppler.All CT and MRI films were judged by two physicians who had been diagnosed for many years.2.The time of occurrence of HT in patients with embolic and thrombotic cerebral infarction was calculated by imaging data and clinical course records. The specific algorithm was: monitoring the time point of hemorrhage minus the time of occurrence of clinical symptoms of cerebral infarction.The number of patients with embolic and thrombotic cerebral infarction who developed HT on 1-3 days 4-7 days and more than 7 days were calculated respectively. The data were statistically analyzed by SPSS17.0 software package (P0.05).Cranial CT plain scan was performed by Siemens Sensation64 spiral CT machine of Siemens Company in Germany and DWI was scanned by singa CV/I1.5T superconducting MRI scanner produced by GE Company in USA. HT was diagnosed by clinical and imaging examination.By observing the MRI plain scan and DWI images of all cases, we recorded the number of cases with different occurrence sites, different haemorrhage patterns and different occurrence sites, and calculated the corresponding incidence rate.Finally, a new MRI classification was proposed based on the location, morphology and incidence of bleeding.ResultThere were 67 cases of HT within 1 week after the onset of cerebral infarction, accounting for 93.1%, and 5 cases more than 1 week, accounting for 6.9%.The time of occurrence of HT in embolic cerebral infarction was earlier than that in thrombotic cerebral infarction (1-3 days in the former and 4-7 days in the latter). The difference between the two groups was statistically significant.HT only occurred on the curtain (84.7%), the next one (12.5%), and the lower part of the curtain (2.8%) at the same time.In the form of hemorrhage, most of them were macular, speckle, gyrus, linear hemorrhage, hematoma formation, hematoma formation, and hematoma formation at least 5.3N, 55.3%, 55.3%, 39.4%, 55.3%, 55.3%, 55.3%, 39.4%, 55.3%, 55.3% respectively.Among them, linear hemorrhage was most common in the lobes (89.2%), mottle like, and mottled hemorrhage in the basal ganglia (48.2%).ConclusionThe peak time of HT in embolism cerebral infarction was different from that in thrombotic cerebral infarction, and the time of HT in embolism cerebral infarction was earlier than that in thrombotic cerebral infarction.In this study, a new MRI classification of HT in cerebral infarction was proposed: type 鈪，

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