脑微出血（CMBs）与缺血性卒中关系的探讨

发布时间：2018-01-23 19:41

本文关键词： 脑微出血缺血性脑卒中影像学　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过观察缺血性卒中与脑微出血的临床与影像学资料，研究并且找出脑微出血的相关危险因素、影像学方面的特征，为临床诊疗提供较为可行的依据与方案。方法：收集2012年11月至2013年11月我院神经内科住院的CMBs的病例30例，行颅脑CT、MRI及MRI的SWI序列,排除钙化、肿瘤等，统计脑微出血病人发病的部位、危险因素、数量等等资料，并加以统计学分析。结果： 1.高龄、高血压、脑梗死、高血脂、使用抗血小板聚集药物、抗凝药物、脑白质疏松等等为脑微出血患者的常见的危险因素。 2.研究证明脑微出血并不是完全无症状的，症状较轻或者无特异性，并且容易被忽略。它与患者认知缺陷存在相关性，与机能障碍有一定关联，当脑微出血患者数量增加时，其认知缺陷和机能障碍也变得越发严重；CMBs患者的主要临床症状完全依赖于它发生的数量多少、病灶大小和具体发病部位。 3. CMBs病灶病因不尽相同，但大部分于深部脑实质区，即双侧基底节，其余可见于皮质下区、皮质，再次分布于脑干、小脑，深部脑组织CMBs病灶数目显著多于皮质。 4.抗血小板聚集药物的使用者比未使用者，CMBs的检出数量明显增多。 5.本组30例患者有26例好转，4例发展为脑出血，1例死亡。结论： 1.高龄、高血脂、高血压病、应用抗血小板聚集药物及抗凝药物是脑微出血患者发病的重要危险因素。 2.脑微出血的存在要着潜在的危险性，CMBs早期无明显症状，CMBs数量随时间逐渐增多、出血量不断增大，并且持续多年，最终演变成脑出血。CMBs范围及数量的变化直接反映在小血管性病变风险性的层面，并说明这些参数为评估其继发ICH风险性的参考指标。 3.具有CMBs缺血性脑卒中患者在服用抗血小板聚集药物后发生脑出血的风险增加。 4.头部MRI的SWI序列是诊断CMBs最敏感、最准确的影像学方法。
[Abstract]:Objective: By observing the clinical and imaging data of ischemic stroke and cerebral microhemorrhage, we studied and found out the risk factors and imaging features of cerebral microhemorrhage. To provide a more feasible basis and plan for clinical diagnosis and treatment. Methods: From November 2012 to November 2013, 30 cases of CMBs in Department of Neurology in our hospital were collected. The SWI sequences of MRI and craniocerebral CT were performed to exclude calcification, tumor and so on. The location, risk factors, quantity and so on of patients with cerebral microhemorrhage were analyzed statistically. Results: 1. Old age, hypertension, cerebral infarction, hyperlipidemia, antiplatelet aggregation drugs, anticoagulants, leukoaraiosis were common risk factors in patients with cerebral microhemorrhage. 2. Studies have shown that cerebral microhemorrhage is not asymptomatic, mild or non-specific, and easily ignored. It is associated with cognitive impairment and dysfunction. As the number of patients with intracerebral microhemorrhage increased, their cognitive impairment and dysfunction became more and more serious. The main clinical symptoms of CMBs patients depend entirely on the number, size and location of the lesions. 3. The etiology of CMBs lesions is different, but most of them are located in the deep brain parenchyma, that is, bilateral basal ganglia, and the rest are found in the subcortical area, cortex, again distributed in the brain stem and cerebellum. The number of CMBs lesions in deep brain tissue was significantly more than that in cortex. 4. The number of anti-platelet aggregation drugs detected by users was significantly higher than that of non-users. 5. Among the 30 cases, 26 cases had improved and 4 cases had developed cerebral hemorrhage, 1 case died. Conclusion: 1. Advanced age, hyperlipidemia, hypertension, antiplatelet aggregation drugs and anticoagulants are important risk factors for cerebral microhemorrhage. 2. The presence of cerebral microhemorrhage (ICH) means that the number of CMBs without obvious symptoms in the early stage of CMBs increases gradually with time, and the amount of bleeding increases continuously, and it lasts for many years. The changes of the range and quantity of ICH. CMBs were directly reflected in the risk level of small vascular lesions, and these parameters were used as a reference index to evaluate the risk of ICH secondary to ICH. 3. Patients with CMBs ischemic stroke had an increased risk of cerebral hemorrhage after taking antiplatelet aggregation drugs. 4. SWI sequence of head MRI is the most sensitive and accurate imaging method for diagnosis of CMBs.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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