前循环梗死侧支循环形成与临床相关因素的分析

发布时间：2018-03-09 03:05

本文选题：前循环　切入点：脑梗死　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：应用数字减影血管造影技术对前循环系统血管病变所致脑梗死患者动脉狭窄的程度、分布特征、侧支循环建立情况进行评估，以及侧支循环与神经功能缺损的关系进行初步分析，旨在进一步探讨前循环系统狭窄或闭塞脑梗死患者侧支循环的形成与临床相关因素的关系。方法：选择2012年1月～2014年1月南昌大学第一附属医院收治的急性缺血性卒中并且有颈内动脉或者大脑中动脉病变的，准备进一步治疗（行动脉搭桥、颈内动脉支架或者颈内动脉剥脱）的112例患者作为研究对象。所有入组患者均完善一般资料的采集，完善头颅MRA及颈动脉彩超、DSA等影像学检查，完善血糖、血脂等生化检查，进行NIHSS评分，以有侧支循环52例患者为实验组，无侧支循环60例患者为对照组，比较两组之间的血管狭窄部位，狭窄程度、神经功能缺损程度，以及脑梗死危险因素对侧支循环建立的影响。使用SPSS19.0统计软件行数据录入及结果输出，以P0.05为差异有统计学意义。结果：①入选的112例患者中男性66例，女性46例，有侧支循环组男性32例，女性20例，无侧支循环组男性34例，女性26例，年龄最小37岁，最大80岁，平均年龄56.90±11.39，男女性别之间无统计学差别。②112例病例中，共检出病变血管130处，其中颅内血管病变86处，颅外血管病变44处，狭窄88处，闭塞42处，颈总动脉分布有15处，颈内动脉病变有48处，大脑中动脉有67处。52例建立侧支循环病例中，以前交通开放最多，有20例，后交通开放12例，前后交通均开放8例，眼动脉开放4例，软脑膜开放8例。③两组之间的狭窄程度及部位均有差别，P0.05，随着狭窄程度的增加，侧支循环增加。④两组之间的NIHSS评分比较，有侧支循环组NIHSS评分较无侧支循环组明显降低，有差异性，P0.05，侧支循环改善脑梗死临床症状。⑤对有意义的危险因素进行多因素Logistic回归分析，显示高血压促进侧支循环形成，，高血糖、高血脂、高同型半胱氨酸等均不利于侧支循环的形成。结论： 1、前循环梗死动脉病变好发于颅内段，且多见于大脑中动脉。 2、侧支循环开放与脑动脉狭窄程度相关，狭窄程度越重，侧支循环开放越充分。 3、侧支循环对缺血脑组织有保护作用，能改善脑梗死临床症状，减少梗死体积。 4、侧支循环形成时，首先开放的是初级侧支循环，以前交通开放为主。 5、侧支循环的形成受多因素的影响，高血压促进侧支循环的形成，而高血糖、吸烟、高血脂、高同型半胱氨酸等均不利于侧支循环的形成。
[Abstract]:Objective: to evaluate the degree, distribution and establishment of collateral circulation in patients with cerebral infarction caused by anterior circulatory system angiopathy by digital subtraction angiography. The relationship between collateral circulation and nerve function defect was analyzed in order to explore the relationship between collateral circulation and clinical factors in patients with anterior circulatory stenosis or occlusion. Methods: from January 2012 to January 2014, patients with acute ischemic stroke treated in the first affiliated Hospital of Nanchang University with lesions of internal carotid artery or middle cerebral artery were selected for further treatment. 112 patients with internal carotid artery stents or internal carotid artery exfoliation were studied. All the patients in the group improved the collection of general data, the imaging examination of head MRA and carotid artery color Doppler ultrasound, and the biochemical examination of blood glucose, blood lipid, etc. NIHSS score was performed in 52 patients with collateral circulation and 60 patients without collateral circulation as control group. And the influence of risk factors of cerebral infarction on the establishment of collateral circulation. Using SPSS19.0 statistical software data input and result output, P0.05 as the difference was statistically significant. Results among 112 patients, 66 were male, 46 were female, 32 were male and 20 female in collateral circulation group, 34 were male and 26 female in non-collateral circulation group, the youngest was 37 years old and the oldest was 80 years old. The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39.The mean age was 56.90 卤11.39@@. There were 48 lesions in the internal carotid artery, 67 in the middle cerebral artery and 52 in the establishment of collateral circulation. In the past, there were 20 cases of open communication, 12 cases of posterior communication, 8 cases of anterior and posterior communicating, 4 cases of open ophthalmic artery. There were significant differences in the degree and location of stenosis between the two groups (P 0.05). With the increase of the stenosis degree, the collateral circulation increased the NIHSS score between the two groups. The NIHSS score of the collateral circulation group was significantly lower than that of the non-collateral circulation group. Logistic regression analysis showed that hypertension promoted collateral circulation, hyperglycemia and hyperlipidemia. High homocysteine is not conducive to the formation of collateral circulation. Conclusion:. 1. Arteriopathy of anterior circulation infarction is more common in intracranial segment, and is more common in middle cerebral artery. 2. The opening of collateral circulation is related to the degree of cerebral artery stenosis. 3, collateral circulation has protective effect on ischemic brain tissue, can improve clinical symptoms of cerebral infarction and reduce infarct volume. 4. When collateral circulation was formed, primary collateral circulation was first opened, and traffic was mainly opened before. 5. The formation of collateral circulation was affected by many factors. Hypertension promoted the formation of collateral circulation, while hyperglycemia, smoking, hyperlipidemia and homocysteine were not conducive to the formation of collateral circulation.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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