急性脑梗死患者动态脑血流自动调节功能受损的相关危险因素研究

发布时间：2018-03-12 19:47

  本文选题：急性脑梗死　切入点：动态脑血流自动调节　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的:动态脑血流自动调节(dynamic cerebral autoregulation,dCA)是一种在血压在一定范围内快速变化时,大脑通过阻力血管收缩或舒张保持脑血流量相对稳定的内在机制。急性期脑梗死患者的dCA功能受损与患者不良预后密切相关,但dCA功能受损的相关影响因素尚不明确。该研究旨在探究急性脑梗死患者dCA功能受损的相关危险因素。方法:研究共纳入来自吉林大学第一医院脑卒中单元的急性单侧前循环脑梗死患者112例,同时纳入年龄、性别与患者组相匹配的健康人50例作为对照组。采用经颅多普勒超声(transcranial Doppler ultrasound,TCD)连续监测受试者的双侧大脑中动脉(middle cerebral artery,MCA)脑血流速度(cerebral blood flow velocity,CBFV),应用无创指尖血压连续监测法同步监测动脉血压(arterial blood pressure,ABP)。将采集的ABP和CBFV的原始数据应用传递函数(transfer function analysis,TFA)分析得出定量评估dCA的参数:增益(Gain)和相位差(Phase Difference,PD)。所有患者临床资料均来源于卒中单元患者数据库。对患者组的PD与临床因素进行线性回归分析,得到急性脑梗死患者dCA功能受损的相关危险因素。结果:1.患者组的平均年龄为52.18±11.41岁(27 77岁),其中女性15例(13.4%)。NIHSS评分≤3患者59例(52.7%),合并高血压病史患者57例(50.9%),合并糖尿病患者18例(16.1%),合并脑卒中病史的患者39例(34.8%),既往有吸烟史的患者73例(65.2%),合并患侧脑动脉狭窄患者69例(61.61%),合并健侧脑动脉轻度狭窄患者21例(18.75%)。2.患侧PD(38.14±18.97°)较健侧PD(43.13±15.78°)及健康对照组PD(57.17±13.45°)明显降低(p0.05),健侧PD亦明显低于健康对照组PD(p0.001)。3.经过线性回归分析得出,患侧MCA狭窄(p0.001)是患侧大脑半球dCA功能受损的独立危险因素,LDL-C水平升高是急性脑梗死患者双侧大脑半球dCA功能受损的独立危险因素(患侧:p=0.04;健侧:p=0.012)。4.患侧MCA狭窄与LDL-C水平无交互作用(p0.05)。5.在患侧MCA不同程度狭窄分组中,重度狭窄或闭塞组的患侧PD(29.20±16.50°)较轻度狭窄组患侧PD(46.53±16.94°39.91±22.44)明显降低(p0.001p=0.039),但较中度狭窄组患侧PD(35.11±17.21°)无显著差异(p0.05)。结论:(1)急性单侧前循环脑梗死患者,不论是否合并颅内动脉狭窄,动态脑血流自动调节功能均双侧受损,患侧受损程度较健侧严重。(2)患侧大脑中动脉狭窄是急性脑梗死患者患侧大脑半球动态脑血流自动调节功能受损的相关危险因素,当其重度狭窄或闭塞时,动态脑血流自动调节功能受损更严重。(3)低密度脂蛋白胆固醇升高是急性脑梗死患者双侧大脑半球动态脑血流自动调节功能受损的相关危险因素。
[Abstract]:Background & AIM: dynamic cerebral autoregulationdCAA is a kind of dynamic cerebral autoregulationdCAA which changes blood pressure rapidly in a certain range. The internal mechanism of the brain maintaining relatively stable cerebral blood flow through resistance vasoconstriction or relaxation. The impaired dCA function in patients with acute cerebral infarction is closely related to the poor prognosis of the patients. However, the factors related to the impairment of dCA function are not clear. The aim of this study was to investigate the risk factors of dCA dysfunction in patients with acute cerebral infarction. Methods: the study included acute stroke units from the first Hospital of Jilin University. 112 patients with unilateral anterior circulation cerebral infarction, At the same time, A total of 50 healthy subjects of gender matched with the patient group were used as control group. Transcranial Doppler ultrasound (TCD) was used to continuously monitor bilateral middle cerebral artery (MCA) cerebral blood flow velocity and cerebral blood flow velocityCBFV, and noninvasive fingertip blood pressure was used continuously. The method of monitoring arterial blood pressure was used to monitor arterial blood pressure simultaneously. The original data of ABP and CBFV were analyzed by transfer function analysis (TFAA). The parameters of quantitative evaluation of dCA were obtained: gain gain and phase difference phase difference. All the clinical data of patients were derived from apoplexy. Linear regression analysis of PD and clinical factors, Results 1. The average age of patients with acute cerebral infarction was 52.18 卤11.41 years old or 27 to 77 years old, including 15 women with a score of 13.40.NIHSS 鈮，

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