进展性卒中相关危险因素分析

发布时间：2018-03-24 02:39

本文选题：缺血性脑卒中　切入点：进展性卒中　出处：《吉林大学》2015年硕士论文

【摘要】：目的: 寻找进展性卒中相关危险因素，为其预防和治疗提供依据。方法: 收集吉林大学第二医院神经内科2013年12月—2014年6月住院治疗的176例急性脑卒中患者的临床资料，在患者入院时、病情变化时及发病7天时分别采用美国国立研究院卒中量表(NationalInstitutes of Stroke in progression Health Stroke Scale，NIHSS）对其进行评分，，根据评分是否增加3分或3分以上，分为进展性卒中（Strokein progression，SIP）组和非进展性卒中（Not stroke in progression，NSIP）组，其中SIP组52例，NSIP组124例，分析比较两组患者的一般资料(年龄、性别、吸烟、既往病史、卒中家族史)，入院后体温、血压及血压变化,生化指标(甘油三酯、总胆固醇、低密度脂蛋白胆固醇、尿酸、空腹血糖、纤维蛋白原、D-二聚体、血清同型半胱氨酸)及头颅电子计算机体层扫描（Computerized tomography，CT）、头部磁共振成像（Magnetic resonance imaging，MRI）、头颈部血管彩超、磁共振血管成像（Magnetic resonance angiograpgy，MRA）或CT血管成像（Computerized tomography angiograpgy，CTA）。应用SPSS19.0软件处理数据,计数资料的比较行χ2检验,计量资料行t检验,p0.05有统计学意义。结果: 1.共纳入缺血型脑卒中患者176例,其中SIP组52例，非SIP组124例。SIP的发生率为28.4%。 2.比较两组一般资料，在性别、年龄、吸烟史、脑血管病家族史方面结果显示差异均无统计学意义(P0.05)。而高血压、糖尿病病史在两组间比较差异有统计学意义(P0.05)。 3.比较两组患者的纤维蛋白原、D-二聚体、血同型半胱氨酸、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、尿酸，入院后血糖水平，结果显示，血糖升高在两组间比较差异有统计学意义(P0.05)，余因素比较差异均无统计学意义(P0.05)。 4.比较两组患者入院后发热及收缩压下降，差异均有统计学意义(P＜0.05)。 5.比较两组患者责任病灶，结果显示，分水岭梗塞（皮层及皮层下分水岭）及大面积梗塞在两组间相比差异有统计学意义(P0.05)。 6.比较两组患者血管方面检查，结果显示，责任血管闭塞、中重度狭窄及存在不稳定斑块在两组间差异均有统计学意义（P＜0.05）。 7.比较患者颈内动脉系统及椎基底动脉系统血管闭塞、中重度狭窄或存在不稳定斑块的情况，结果显示，两者比较差异有统计学意义(P＜0.05)。结论: 1.SIP的发生率为28.4%。 2.糖尿病病史以及入院后血糖升高、高血压病史以及入院后收缩压下降、卒中后发热均为SIP的危险因素。 3.大面积脑梗塞及分水岭梗塞均易发生SIP。 4.责任血管闭塞、中重度狭窄及存在不稳定斑块均为SIP重要预测因素。其中颈内动脉系统血管存在闭塞、中重度狭窄或不稳定斑块比椎基底动脉系统血管存在上述情况更易进展。
[Abstract]:Objective:. To search for risk factors related to progressive stroke and provide evidence for prevention and treatment. Methods:. To collect the clinical data of 176 patients with acute stroke hospitalized in Department of Neurology, second Hospital of Jilin University from December 2013 to June 2014. The patients were evaluated by the National Institutes of Stroke in progression Health Stroke scale NIHSS at the time of disease change and 7 days after onset, according to whether the score was increased by 3 points or more. The patients were divided into two groups: strokein progression sip group and non progressive stroke group (not stroke in progression group). There were 52 patients in SIP group and 124 patients in SIP group. The general data (age, sex, smoking, past medical history, family history of stroke, body temperature after admission) were analyzed and compared between the two groups. Blood pressure and changes in blood pressure, biochemical parameters (triglyceride, total cholesterol, low density lipoprotein cholesterol, uric acid, fasting blood glucose, fibrinogen D-dimer), Serum homocysteine) and computed tomography computed tomography (CTA), head magnetic resonance imaging, head and neck vascular color ultrasound, magnetic resonance angiograpgyography (MRAA) or computed tomography computed tomography (CTA). The count data were compared by 蠂 2 test, and measured data by t test (p 0.05) were statistically significant. Results:. 1. A total of 176 patients with ischemic stroke were included, including 52 cases in SIP group and 124 cases in non-#en1# group. The incidence rate of SIP was 28.4%. 2.Compared with the general data of the two groups, there was no significant difference in sex, age, smoking history, family history of cerebrovascular diseases, but there was significant difference in the history of hypertension and diabetes between the two groups (P 0.05). 3. The levels of fibrinogen D-dimer, homocysteine, triglyceride, total cholesterol, low density lipoprotein cholesterol, uric acid, blood glucose after admission were compared between the two groups. There was significant difference in blood glucose between the two groups (P 0.05), but there was no significant difference in the other factors between the two groups (P 0.05). 4. The difference of fever and systolic blood pressure between the two groups was statistically significant (P < 0.05). 5. The results showed that watershed infarction (cortical and subcortical watershed) and large area infarction were significantly different between the two groups (P 0.05). 6.Compared with the blood vessel examination of the two groups, the results showed that the responsible vessel occlusion, moderate and severe stenosis and the existence of unstable plaques were significantly different between the two groups (P < 0.05). 7. The internal carotid artery system and vertebrobasilar artery system were compared in the patients with occlusion, moderate and severe stenosis or unstable plaque. The results showed that there was significant difference between the two groups (P < 0.05). Conclusion:. The incidence of 1.SIP was 28. 4%. 2. Diabetes history, hyperglycemia after admission, hypertension, systolic blood pressure after admission and fever after stroke were all risk factors of SIP. 3. Large area cerebral infarction and watershed infarction are prone to SIPs. 4. Responsible vascular occlusion, moderate and severe stenosis and unstable plaque were important predictors of SIP. Moderate and severe stenosis or unstable plaques are more likely to progress than vertebrobasilar arteries.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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