早期DTT在高血压基底节区脑出血预后评估中的价值

发布时间：2018-03-05 05:20

本文选题：高血压脑出血　切入点：基底节　出处：《扬州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的本研究通过DTT (Diffusion Tensor Tractography,弥散张量纤维束成像)重建双侧CST(Cortico Spinal Tract,皮质脊髓束)3D图像,显示高血压基底节区脑出血后神经纤维束的损伤情况,通过分析不同程度损伤和肢体远期肌力恢复之间的关系,探讨DTT技术在高血压基底节区脑出血预后评估中的价值。方法对25例采用保守治疗的单侧高血压基底节区脑出血病例,在入院时、出院时以及出院3个月三个不同时间段进行量表评估。根据CST损伤分级将其分为四组：CST1级；CST2级；CST3级；CST4级。评估指标为：肌力、改良Rankin评分及FMA (Fugl-Meyer Assessment,Fugl-Meyer运动)评分。结果采用SPSS19.0软件进行多样本均数间两两比较的q检验,以P0.05作为显著性差异指标。结果 1、肌力根据CST损伤分级的结果,对25例患者出血对侧肢体的肌力进行统计学分析,具有显著差异。同一分级的患者3次肌力评估时,其结果较前一次均有不同程度提升,下肢肌力恢复较上肢好。结果发现CST损伤分级与肢体功能障碍成正相关,CST损伤分级越低的患者,其肌力远期恢复结果较为理想,即CST1CST2CST3CST4.且CST1级和CST2级的患者其出院3个月后肌力基本恢复正常,而CST4级的患者,预后较差。 2、Rankin评分同一分级的患者在三个不同时间段内行Rankin评分时发现,其每一次评分较前都有不同,即入院时评分最高,而出院3个月时评分最低。对分级的四组数据在出院3个月进行检验时发现：CST1与CST2其两组间在统计学方面无明显差异(P0.05),而其他各组间相互比较其P值均0.05,具有统计学意义。因此CST3级和CST4级的患者,由于其远期评分高于CST1级和CST2级的患者,结果肢体功能恢复情况差于CST1级与CST2级的患者。 3、FMA评分对出血对侧肢体的运动功能进行FMA评分,其总分为100分,与健侧相比。结果发现每一组患者不同三个时间段内的FMA评分逐步提高。出院三个月CST1-2级的患者FMA评分均基本满分,而CST4级的患者,评分与其它三组相比,其评分最低,且各组间相互比较,其p值均0.05,具有明显差异,远期运动功能评分CST1、CST2、CST3、CST4。结论早期DTT可了解血肿对CST的破坏程度,并可预测患者远期肢体功能恢复。不同分级CST患者远期肢体功能的恢复情况与CST分级的结果高度相符。对患者的预后评估提供了较为可靠的影像依据,且此项检查无创、价廉,具有良好的社会和经济效益。
[Abstract]:objective
The study by DTT (Diffusion Tensor Tractography, diffusion tensor imaging (CST) reconstruction of bilateral Cortico Spinal Tract, 3D image display, corticospinal tract) injury of nerve fiber bundles in hypertensive cerebral hemorrhage in basal ganglia, by analyzing the relationship between the different degree of injury and limb muscle strength recovery forward, discusses the DTT technology in prognosis the assessment value of hypertensive cerebral hemorrhage in basal ganglia.
Method
Of 25 cases with conservative treatment of unilateral intracerebral hemorrhage on admission, discharge and 3 months after discharge in three different time scale assessment. According to the CST classification of injury will be divided into four groups: CST1; CST2; CST3; assessment indicators: CST4 level. Muscle strength, the modified Rankin score and FMA (Fugl-Meyer Assessment, Fugl-Meyer motion) score. Results by using SPSS19.0 software Q test for multi sample mean comparison between the 22, with P0.05 as the significant difference between the indicators.
Result
1, muscle strength
According to the classification results of CST damage, 25 cases of hemorrhage in patients with contralateral limb muscle strength were analyzed, with significant difference. The same grade of patients 3 times strength assessment, the results of previous times have varying degrees of improvement, lower limb muscle strength recovery is good. The upper limb CST injury grading and limb dysfunction is related to CST classification patients with lower strength, long-term recovery of the ideal result, namely CST1CST2CST3CST4. and CST1 level and CST2 level in patients with muscle discharge returned to normal after 3 months, while the CST4 level in patients with poor prognosis.
2, Rankin score
The same grade were found in three different time periods within the Rankin score, the score before each time are different, which was the highest score, and 3 months after discharge. The lowest score of the four sets of data for classification in 3 months after inspection found: CST1 and CST2 two between the groups there is no significant difference in Statistics (P0.05), and other groups were compared between the P value was 0.05, with statistical significance. The CST3 level and CST4 level of patients, because of its long-term score is higher than that of CST1 and CST2 patients, the recovery of limb function difference in CST1 level and CST2 level of patients.
3, FMA score
The bleeding on motor function of limbs were FMA score, the total score of 100 points, compared with the contralateral side. Results showed that each group of three patients with different time period FMA score gradually increased. Three months CST1-2 patients FMA scores were the basic score, and CST4 patients compared with the score the other three groups, the lowest score, and between groups were compared with each other, the p value was 0.05, with obvious difference, forward movement function score of CST1, CST2, CST3, CST4.
conclusion
Early DTT can understand the damage degree of hematoma on CST, and it can predict the long-term recovery of limb function in patients with different grade. Function of limbs long-term rehabilitation of CST patients with CST. The results of the classification of highly consistent provides reliable imaging basis for prognosis evaluation of the patients, and the examination is non-invasive, cheap, good the social and economic benefits.

【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

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