颈动脉狭窄性短暂性脑缺血发作继发脑梗死相关危险因素与预后分析

发布时间：2018-03-22 12:00

  本文选题：短暂性脑缺血发作　切入点：颈动脉狭窄　出处：《新乡医学院》2014年硕士论文　论文类型：学位论文

【摘要】：背景短暂性脑缺血发作(transient ischemic attack, TIA)是指脑血管病变(颈动脉或椎-基底动脉系统发生短暂性血液供应不足),引起局灶性脑缺血导致突发的、短暂性、可逆性神经功能障碍,可能进展为完全性脑梗死,是继发脑卒中的常见预警信号。颈动脉粥样硬化狭窄是TIA和脑卒中常见病因。目的收集颈动脉狭窄性TIA患者的临床资料,并通过随访调查,以颈动脉狭窄性TIA患者进展为脑梗死或死亡为终点事件,通过队列研究,寻找出颈动脉狭窄性TIA患者进展为脑梗死的危险因素,提高对颈动脉狭窄性TIA进展为脑梗死的危险性及预后的认识,以便实施早期干预、制定有效治疗方案,系统性治疗,降低患者不良预后发生率。方法收集我院自2008年5月至2009年6月收治的126例经颈部血管彩超明确有颈动脉狭窄的TIA患者的临床资料,随访5年。以继发脑梗死或死亡为终点事件,分为继发脑梗死组与无继发脑梗死组,比较两组患者间的临床资料,包括一般常规资料：患者年龄、性别、既往糖尿病史、既往高血压病史、既往吸烟史(吸烟指数)；入院时常规生化指标：包括总淋巴细胞计数、血红蛋白、C-反应蛋白、纤维蛋白原、血小板计数、低密度脂蛋白胆固醇水平、肌酐水平、国际标准化比值；影像学资料：颈动脉狭窄程度,并采用ABCD2评估方法,对两组资料进行比较,寻找颈动脉狭窄性TIA进展为脑梗死的危险因素。同时选择同时期48例无TIA发作颈动脉狭窄性脑梗死患者,作为继发脑梗死组的另一对比组,比较两组间的临床资料,总结颈动脉狭窄性TIA继发脑梗死相关危险因素,对比两组间患者神经功能缺损程度及对应预后分级,探讨颈动脉狭窄性TIA后脑梗死患者的预后。结果对比两组资料,继发脑梗死组合并高血压病史15人(17.24%)较无继发脑梗死组5人(12.82%)高,p0.05,差异有统计学意义；继发脑梗死组合并糖尿病史12人(13.79%)较无继发脑梗死组3人(7.69%)高,p0.05,差异有统计学意义；继发脑梗死组平均吸烟指数400者31人(35.63%)较无继发脑梗死组10人(25.64%)高,p0.05,差异有统计学意义,继发脑梗死组发作60min者占30人(34.48%)较无继发脑梗死组7人(17.95%)高,有统计学差异。继发脑梗死组以及无继发脑梗死组在ABCD2平均评分分别为：5.00分、3.17分,两组x2检验,p0.05,差异有统计学意义。在常规生化指标上继发脑梗死组,患者的血小板计数、纤维蛋白原水平均较无继发脑梗死组高,两者比较,p0.05,两组在颈动脉狭窄程度上,继发脑梗死组重度和颈动脉闭塞比率比无继发脑梗死组高,两者比较,p0.05,有统计学差异。继发脑梗死组与无TIA脑梗死组在一般资料项目中,继发脑梗死组患者高血压病史比率、低密度脂蛋白水平较无TIA脑梗死组要低,p0.05,有统计学差异。继发脑梗死组与无TIA脑梗死组,两组GCS评分、神经功能缺损程度、预后分级上,继发脑梗死组重症病人要比无TIA脑梗死组多,p0.05,有统计学差异(p0.05)。结论TIA合并颈动脉狭窄继发脑梗死风险高,合并颈动脉狭窄TIA后脑梗死相关危险因素包括年龄60岁、高血压病、糖尿病、发病持续时间60min、吸烟指数400、血小板计数升高、低密度脂蛋白水平升高、纤维蛋白原水平升高以及颈动脉狭窄程度。颈动脉狭窄性TIA患者继发脑梗死预后差。
[Abstract]:The background of transient ischemic attack (transient ischemic, attack, TIA) is a cerebral vascular disease (carotid or vertebrobasilar transient blood supply), caused by focal cerebral ischemia leads to sudden, transient, reversible neurological dysfunction, may progress to complete cerebral infarction is a common early warning signal secondary stroke. Carotid artery stenosis is a common cause of stroke and TIA. The clinical data collection of patients with carotid artery stenosis of TIA, and through the follow-up survey, with the progress of TIA for patients with carotid artery stenosis cerebral infarction or death as the end point events, through the cohort study, find out the progress of patients with carotid artery stenosis TIA the risk factors of cerebral infarction, improve the carotid artery stenosis TIA progress to know the risk and prognosis of cerebral infarction, in order to implement the early intervention, to develop effective treatment programs, treatment system, Reduce the incidence of adverse prognosis. The neck vascular ultrasound methods in our hospital from May 2008 to June 2009 were 126 cases of clear clinical data of carotid artery stenosis in patients with TIA and followed up for 5 years. In the secondary cerebral infarction or death as the end point event, divided into cerebral infarction group and non cerebral infarction group. The clinical data were compared between the two groups among the patients, including general information: age, gender, history of diabetes, history of hypertension, history of smoking (smoking index); admission of conventional biochemical indicators include: total lymphocyte count, hemoglobin, C- reactive protein, fibrinogen, platelet count, the level of low density lipoprotein cholesterol, creatinine levels. The international normalized ratio; imaging data: the degree of carotid artery stenosis, and by ABCD2 evaluation method, to compare the two groups of data, looking for the progress of carotid artery stenosis TIA The risk factors of cerebral infarction. At the same time, select the same period in 48 cases of non TIA patients with carotid artery stenosis cerebral infarction, as a contrast group and cerebral infarction group, the clinical data were compared between the two groups, then the related risk of carotid artery stenosis of TIA cerebral infarction secondary factors, comparison between the two groups of patients with neurological impairment and prognosis of the corresponding classification to explore the prognosis of carotid artery stenosis, TIA of patients with cerebral infarction. Results compared with two groups of data, and a history of hypertension and cerebral infarction of 15 people (17.24%) with no secondary cerebral infarction group of 5 people (12.82%), P0.05, the difference was statistically significant; secondary cerebral infarction combined with diabetes history of 12 people (13.79%) with no secondary cerebral infarction a group of 3 people (7.69%), P0.05, the difference was statistically significant; cerebral infarction group average smoking index 400 31 people (35.63%) with no secondary cerebral infarction group of 10 people (25.64%), P0.05, there was statistically significant difference Yi, secondary cerebral infarction attack 60min accounted for 30 (34.48%) with no secondary cerebral infarction group of 7 people (17.95%), there was statistically significant difference. The secondary cerebral infarction group and no secondary cerebral infarction group in ABCD2 scores were 5 points, 3.17 points, two group x2 test, P0.05, the difference was statistically significant secondary. Cerebral infarction group in the conventional biochemical indicators, platelet count, fibrinogen and no secondary cerebral infarction was higher than the average, the comparison between the two, P0.05, two groups in the degree of carotid artery stenosis, cerebral infarction group and severe carotid artery occlusion ratio without cerebral infarction group, the comparison between the two, P0.05, there were significant differences in secondary. The cerebral infarction group and non cerebral infarction group TIA in the general information project, the group of patients with cerebral infarction secondary hypertension ratio, low density lipoprotein levels than those without TIA in cerebral infarction group to low P0.05, there were significant differences in cerebral infarction group and non T. IA of cerebral infarction group, GCS scores of the two groups, the degree of neurologic impairment and prognosis grading, secondary cerebral infarction group than patients without TIA in cerebral infarction group, there were significant differences (P0.05, P0.05). Conclusion TIA combined with carotid artery stenosis and cerebral infarction with high risk, the risk associated with carotid artery stenosis cerebral infarction TIA factors including age 60 years of age, hypertension, diabetes, disease duration 60min, smoking index 400, platelet count increased, elevated low-density lipoprotein levels, elevated levels of fibrinogen and carotid artery stenosis. The carotid artery stenosis of TIA patients with secondary cerebral infarction with poor prognosis.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3
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本文编号：1648553