血管内介入治疗急性基底动脉闭塞的预后及影响因素

发布时间：2018-05-02 03:48

本文选题：基底动脉闭塞 + 脑梗死　；参考：《南方医科大学》2017年硕士论文

【摘要】：第一章急性基底动脉闭塞所致脑梗死的起病特征与病变部位的相关性目的:急性基底动脉闭塞所致脑梗死临床症状、体征复杂,表现形式多样。本文旨在探讨急性基底动脉闭塞所致脑梗死的起病特征与病变部位的相关性。方法:收集53例急性基底动脉闭塞所致后循环梗死患者的临床资料,根据起病形式将患者分为急进型组及缓慢进展组,结合脑血管造影结果进行回顾性分析。结果:急进型组血管闭塞部位多位于基底动脉中段及上段,缓慢进展组则多为基底动脉下段,两组之间有显著统计学差异(P0.05)。Logistic回归分析结果显示,与基底动脉上段闭塞的患者相比,下段闭塞患者的起病方式更倾向于缓慢进展型(OR=14.77,95%CI:1.57-139.00,P=0.019)。结论:急性基底动脉闭塞所致脑梗死的起病特征与病变部位具有相关性,早期诊断、及时治疗有助于改善患者的临床预后。第二章急性基底动脉闭塞血管内治疗临床预后影响因素分析目的:急性基底动脉闭塞所致缺血性卒中具有高致死率、高致残率特点。本文旨在探讨基底动脉闭塞血管内治疗临床预后及影响因素。方法:本研究连续纳入2007年1月至2016年7月在南京军区南京总医院经全脑数字减影血管造影术(Digital subtraction angiography,DSA)确诊急性基底动脉闭塞并行血管内介入治疗的53例患者。术后3月随访时按生活自理程度,根据改良的Rankin评分(mRS)将患者分为两组;(1)良好预后组(mRS4分),(2)不良好预后组(mRS≥4分)。结果:应用多因素Logistic回归模型分析探讨影响基底动脉闭塞患者血管内治疗临床预后的因素。以P0.05为差异有显著统计学意义。Logistic回归分析结果显示,在校正了 NIHSS评分、ASITN_SIR评分、血管再通因素后,入院时低 NIHSS 评分(OR= 0.114,95%CI:0.019-0.689,P=0.018)、高 ASITN_SIR评分(OR = 0.035,95%CI:0.005-0.239,P=0.001)及有效血管再通(OR=0.113,95%CI:0.017-0.767,P=0.026)的患者预后良好(三者均P0.005);而高 NIHSS评分、低ASITN_SIR评分及血管再通不佳提示患者不良预后。结论:采用血管内介入治疗急性基底动脉闭塞的患者中,入院时低NIHSS评分、高ASTTN_SIR评分及有效血管再通者预后良好。
[Abstract]:Chapter 1 the correlation between the onset characteristics of cerebral infarction caused by acute basilar artery occlusion and the location of cerebral infarction objective: the clinical symptoms and signs of acute basilar artery occlusion are complicated and the manifestations are varied. The purpose of this study was to investigate the correlation between the onset and location of cerebral infarction caused by acute basilar artery occlusion. Methods: the clinical data of 53 patients with posterior circulation infarction caused by acute basilar artery occlusion were collected. Results: the location of vessel occlusion in the acute type group was mostly located in the middle and upper part of the basilar artery, while in the slow progress group, it was mostly in the lower part of the basilar artery. There was a significant difference between the two groups (P 0.05). The logistic regression analysis showed that there was a significant difference between the two groups. Compared with the patients with upper basilar artery occlusion, the patients with lower segment occlusion were more prone to the slow progression type ORA 14.77-95 CI: 1.57-139.00 P0. 019. Conclusion: the onset features of cerebral infarction caused by acute basilar artery occlusion are related to the location of the lesion. Early diagnosis and timely treatment are helpful to improve the clinical prognosis of patients with acute basilar artery occlusion. Chapter 2 Analysis of prognostic factors in patients with acute basilar artery occlusion objective: ischemic stroke caused by acute basilar artery occlusion is characterized by high mortality and high disability rate. The purpose of this study was to investigate the clinical prognosis and influencing factors of endovascular treatment of basilar artery occlusion. Methods: from January 2007 to July 2016, 53 patients with acute basilar artery occlusion diagnosed by digital subtraction angiography and endovascular therapy in Nanjing General Hospital of Nanjing military region were included in this study. At 3 months follow-up, patients were divided into two groups according to the degree of self-care, according to the modified Rankin score. The patients were divided into two groups. Results: multivariate Logistic regression model was used to analyze the prognostic factors in patients with basilar artery occlusion. Logistic regression analysis showed that after adjusting the NIHSS score with ASITNSIR score and vascular recanalization factor, On admission, the patients with low NIHSS score (OR = 0.11495 CI: 0.019-0.689), high ASITN_SIR score (OR = 0.035 卤95CI: 0.005-0.239P0.001) and effective vascular recanalization (OR0.11395 CIW 0.017-0.767P0.026) had a good prognosis (all P 0.005), while high NIHSS score, low ASITN_SIR score and poor vascular recanalization suggested a poor prognosis. Conclusion: the patients with acute basilar artery occlusion treated by endovascular intervention have a good prognosis with low NIHSS score, high ASTTN_SIR score and effective vascular recanalization.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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