颈动脉血栓栓塞性脑梗死17例病例分析

发布时间：2018-02-05 23:51

本文关键词： 颈内动脉血栓 CTA 临床特点影像学特点　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨分析颈动脉血栓栓塞性脑梗死患者的病因、临床表现、影像学特征、治疗及预后,对临床治疗颈动脉血栓栓塞性脑梗死提供参考依据。方法：收集2014年12月至2015年12月就诊于浙江大学医学院附属第二医院神经内科的颈动脉血栓引起的脑卒中患者17例,进行回顾性分析,并对其危险因素、临床表现、治疗经过、预后等作详细描述。结果：(1)本组患者17例,均为男性,发病年龄43-83岁,平均年龄63岁。(2)本组患者发病原因有：颈内动脉血栓17例(左侧颈内动脉血栓8例,右侧颈内动脉血栓9例)。其中2例合并颈内动脉夹层,15例合并动脉粥样硬化斑块。(3)本组患者以意识不清起病1例,以肢体无力起病12例,以视野缺损起病1例,以单眼视力丧失起病1例,以头晕起病1例,以言语不清起病1例。(4)本组有6例患者接受低分子肝素抗凝治疗,2例患者接受了华法林抗凝治疗,1例患者接受了达比加群抗凝治疗,未接受抗凝治疗的患者其中5例接受阿司匹林+波利维抗血小板治疗,3例只接受了阿司匹林抗血小板治疗。(5)本组17例患者1-2周内病情均好转,部分恢复病前水平,5例复查颈部CTA示血栓消失,1例复查颈部CTA示颈内动脉闭塞。结论：颈内动脉血栓形成病因复杂,动脉粥样硬化斑块破裂是其常见病因,颈内动脉血栓CTA常表现为充盈缺损,“甜甜圈征”、“手指征”为其较为特征性表现。颈内动脉血栓形成的治疗方法有外科手术治疗和药物治疗,本研究提示药物治疗——抗凝治疗和抗血小板治疗是安全有效的,但仍需大样本的随机对照双盲临床试验进一步证实。
[Abstract]:Objective: To investigate the etiology of patients with carotid artery thromboembolic cerebral infarction, clinical manifestations, imaging features, treatment and prognosis, to provide reference for clinical treatment of carotid artery thromboembolic cerebral infarction. Methods: 17 patients with stroke caused by carotid artery thrombosis in the Department of Neurology, the Second Affiliated Hospital of Zhejiang University Medical College from December 2014 to December 2015 were reviewed. Analysis of the risk factors, clinical manifestations, treatment and prognosis are discussed in detail. Results: (1) 17 patients of the group were male, age of 43-83 years, the average age of 63 years. (2) in this group of patients the incidence reasons: internal carotid artery thrombosis in 17 cases (8 cases the left internal carotid artery thrombosis in 9 patients, right internal carotid artery thrombosis). 2 cases with internal carotid artery dissection, 15 cases with atherosclerotic plaque. (3) the patients with consciousness unclear onset in 1 cases, with no limb 12 cases of stress onset, 1 patients with visual field defect onset, 1 cases of monocular visual loss onset, 1 cases of dizziness onset, with slurred speech onset in 1 cases (4). There were 6 patients were treated with low molecular weight heparin anticoagulation therapy, 2 patients received warfarin therapy, 1 patients received as one group without anticoagulant therapy, patients receiving anticoagulant therapy in 5 patients receiving aspirin plus Polivy antiplatelet therapy, 3 patients only received aspirin antiplatelet therapy. (5) the group of 17 patients 1-2 weeks of illness were improved, partial recovery of disease before, 5 cases of cervical CTA showed thrombosis disappeared, 1 cases CTA showed cervical internal carotid artery occlusion. Conclusion: carotid artery thrombosis complicated cause of atherosclerotic plaque rupture is the most common cause of internal carotid artery thrombosis CTA showed filling defect, "donut sign", "finger syndrome" is a characteristic of the internal carotid. Surgical treatment and drug therapy are the treatment methods for arterial thrombosis. This study indicates that anticoagulation therapy and antiplatelet therapy are safe and effective, but large sample randomized controlled double-blind clinical trials are needed.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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