应用超声造影技术比较联用阿托伐他

发布时间：2018-03-21 09:14

本文选题：缺血性脑血管病　切入点：颈动脉斑块　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过应用颈动脉斑块的超声造影(contrast-enhanced ultrasonography,CEUS)检查技术,观察并比较联合应用阿托伐他汀与普罗布考和单独应用阿托伐他汀两种治疗方法对缺血性脑血管病(ischemic cerebrovasular disease,ICVD)患者颈动脉斑块稳定性的影响,并观察比较两种治疗方法对患者ICVD复发率、临床症状的改善及其生活自理能力方面的影响,从而综合评价对比两种治疗方法的临床疗效;通过分析比较超声造影与常规超声对颈动脉斑块的探查结果,比较两种检查技术的优劣。方法:筛选并收集2015年7月-2016年12月于河北医科大学第二医院神经内科住院的ICVD患者,共68例,入组患者治疗前均通过头颅核磁共振技术(magnetic resonance imaging,MRI)证实为缺血性脑血管病,且均进行了颈动脉常规超声及超声造影检查,行超声造影检查前被检查者均无严重心肺疾病及其他造影禁忌证且签署超声造影知情同意书。符合入组标准的患者应用掷硬币法随机分为A、B两组,A组33例,B组35例,A组治疗采用联合应用阿托伐他汀与普罗布考(阿托伐他汀钙片20mg 1/日、普罗布考片0.25g早、晚餐时服用2/日)及其他ICVD的常规治疗,B组治疗采用单独应用阿托伐他汀(阿托伐他汀钙片20mg 1/日)及其他ICVD的常规治疗。4个月后对A、B两组病例复查颈动脉超声造影并进行随访记录,观察并对比A、B两组患者治疗前后颈动脉斑块稳定性的变化、NIHSS评分的变化以及ICVD的复发率。收集治疗前A、B两组患者颈动脉常规超声及超声造影检查图像,对比并分析总结两种检查方法的特点。结果:1斑块稳定性比较经治疗4个月后,比较两组患者治疗前后的颈动脉斑块稳定性等级好转情况,A、B两组患者颈动脉斑块稳定性等级均显著好转,与B组相比,A组患者颈动脉斑块稳定性等级显著好转,差异有统计学意义。2 NIHSS评分比较经4个月治疗后,比较两组患者治疗前后的NIHSS评分变化情况,A、B两组NIHSS评分水平均显著降低,但两组间差异无统计学意义。3 ICVD复发率比较治疗4个月后,A组30例患者中有1例复发;B组30例患者中有5例复发;A、B两组患者ICVD复发率的差异有统计学意义,A组患者较B组患者的ICVD复发率低。4颈动脉常规超声及超声造影检查对比在入组的60例患者中,存在8例患者超声造影证实斑块分级仅为Ⅰ级但常规超声提示为低回声;5例患者超声造影证实斑块分级为Ⅲ-Ⅳ级但常规超声提示高回声;4例患者的超声造影图像显示出常规超声未能清晰探及的位于颈内动脉外侧壁的斑块。结论:对于存在颈动脉斑块的缺血性脑血管病患者,在稳定颈动脉斑块、改善临床症状及其生活自理能力和降低缺血性脑血管病的复发率方面,联合应用阿托伐他汀与普罗布考疗效优于单独应用阿托伐他汀;颈动脉超声造影技术在诊断颈动脉粥样硬化斑块,尤其是在发现颈动脉外侧壁斑块、观察斑块内新生血管及评估斑块稳定性方面优于常规超声技术。
[Abstract]:Objective: through the application of contrast-enhanced ultrasound of carotid plaque (contrast-enhanced ultrasonography CEUS) technique, were observed and compared with atorvastatin and probucol atorvastatin alone and two kinds of treatment of ischemic cerebrovascular disease (ischemic cerebrovasular disease, ICVD) influence the stability of carotid plaque in patients, and compare the two methods to treat patients with ICVD recurrence rate of the observation, the improvement of self-care ability to influence life and clinical symptoms, clinical curative effect and comprehensive evaluation comparison of two treatment methods; through the analysis and comparison of the exploration results of contrast-enhanced ultrasound and conventional ultrasound on carotid artery plaque, comparison of two kinds of inspection technical merits. Method: screening and collection of July 2015 -2016 in December to ICVD patients in the Department of Neurology, the second hospital of Hebei Medical University, a total of 68 cases, the patients before the treatment by Cranial magnetic resonance technology (magnetic resonance imaging, MRI) confirmed ischemic cerebrovascular disease, and underwent carotid artery ultrasound and contrast-enhanced ultrasound, contrast-enhanced ultrasound examination before the patients have no serious heart and lung disease and other contraindications contrast ultrasound contrast and signed informed consent. Eligible patients application of coin were randomly divided into A, B two groups, A group of 33 cases, 35 cases of B group, A group treated with atorvastatin and probucol (1/, Atorvastatin Calcium Tablets 20mg, Probucol Tablets 0.25g early dinner taking 2/ day) and other conventional treatment ICVD, treatment group B used alone atorvastatin (Atorvastatin Calcium Tablets 20mg 1/) and other conventional treatment.4 ICVD months after the A, B group two cases of internal carotid artery ultrasonography and follow-up records, observation and comparison of A, B before and after treatment in two groups of carotid artery Changes in the stability of artery plaque, the change of NIHSS score and the recurrence rate of ICVD. A B collected before treatment, two groups of patients with carotid artery ultrasound and contrast-enhanced ultrasound image characteristics, contrast and analyze the two methods. Results: compared with 1 plaques after 4 months of therapy, the stability of carotid plaque grade two groups were compared before and after treatment of the situation improved, A, B two groups of patients with carotid artery plaque stability grade were significantly improved, compared with the B group, A group of patients with carotid artery plaque stability grade improved significantly, there were statistically significant differences in.2 NIHSS score 4 months after treatment, NIHSS score changes were compared before and after two. Groups A, B and NIHSS scores of the two groups were significantly decreased, but the difference between the two groups was not statistically significant.3 ICVD to compare the recurrence rate after 4 months of treatment, 1 cases recurred in 30 patients in the A group; B group of 30 patients in 5 cases Recurrence; A, the difference was statistically significant in two groups of B patients with ICVD recurrence rate, patients in the A group compared with B group, ICVD in patients with low recurrence rate.4 of carotid artery ultrasound angiography in 60 patients, 8 patients had confirmed ultrasound plaque classification only grade but regular ultrasound showed hypoechoic; 5 cases were confirmed as ultrasound contrast plaque grade III - IV but conventional ultrasound showed high echo; 4 cases of patients with contrast-enhanced ultrasonography showed conventional ultrasound probe and failed to clear in the lateral wall of the carotid artery plaque. Conclusion: in the presence of carotid plaque in patients with ischemic cerebrovascular disease in the stable, carotid artery plaque, improve clinical symptoms and self-care ability and reduce the recurrence rate of ischemic cerebrovascular disease, combined with atorvastatin and probucol curative effect is better than the single application of carotid artery ultrasound made Ato Vatatin; It is superior to conventional ultrasound in the diagnosis of carotid atherosclerotic plaques, especially in finding the lateral wall plaque of carotid artery, observing the neovascularization in plaques and evaluating the stability of plaques.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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