缺血性脑卒中患者认知功能障碍与病灶部位的相关性分析

发布时间：2018-04-04 21:14

  本文选题：缺血性脑损伤　切入点：脑卒中　出处：《天津医科大学》2014年硕士论文

【摘要】：目的缺血性脑卒中患者急性期多伴随认知、睡眠和自主神经功能状况紊乱及障碍,有关脑卒中损伤部位与此类并发症相关关系的研究较多,得出的结论也各不相同,主要研究有大脑半球对称性、损伤容积、损伤前界距额极距离、皮质或皮质下损伤、脑萎缩等诸多方面。大多数研究认为,脑卒中梗死灶部位与认知功能障碍存在一定内在联系。本研究旨在通过分析、比较缺血性脑卒中患者不同部位卒中后认知功能状况,探讨缺血性脑卒中急性期不同卒中部位与出现的认知功能障碍之间的关系,观察不同部位病变所致认知功能障碍的特点。 方法收集118例脑梗死患者资料,包括额叶17例,颞叶14例,顶叶13例,枕叶10例,基底节24例,丘脑19例,小脑11例,脑干10例。记录、统计并分析患者相关资料包括年龄、性别、受教育程度等。采用中文版蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)对118例脑梗死患者进行测试,由受过专业培训的神经心理测验员在安静的房间内对患者进行评分,所有测验均1次完成,将脑梗死患者的CT/MRI定位与MoCA的7个分项目,包括定向力(ORT)、视空间与执行功能(EF)、命名(NAM)、记忆(MEM,包括瞬时记忆及近记忆)、注意(ATT)、语言功能(LANG,包括复述与流畅性)、抽象概括(ABS)的测试结果进行相关分析。将上述测得数据应用SPSS17.0统计软件进行分析,计数资料应用卡方检验,计量资料应用t检验、方差分析,相关分析进行Logistic多因素逐步回归分析和Pearson相关系数检验。p0.05为差异有统计学意义。 结果(1)118例脑梗死患者资料与认知障碍统计分析结果提示患者脑梗死的年龄、性别及受教育年限比较无显著性差异；(2)额叶组及丘脑组认知障碍发生率最高,达90%以上；其次为颞叶组,将近80%以上；小脑组及脑干组最低,将近30%；经Logistic回归分析发现,额叶卒中与认知功能障碍的发生密切相关(P0.01),颞叶、顶叶、枕叶、基底节、丘脑卒中与认知功能障碍的发生相关(P0.05),小脑、桥脑卒中与认知功能障碍的发生无关(P0.05),不同部位脑梗死患者认知障碍发生率有显著性差异(p0.005)。(3)经Pearson相关系数检验分析基底节卒中MoCA各分测验均有损害,其中EF、MEM、LANG损害明显,额叶卒中ORT、EF、MEM、ATT有明显损害,顶叶卒中EF、NAM、MEM、ATT损害明显,颞叶卒中以EF、MEM、LANG损害为主,枕叶卒中主要损害EF,丘脑卒中MEM、LANG损害明显,小脑卒中可累及LANG,脑桥卒中可累及EF。 结论不同部位脑梗死患者急性期认知障碍的发生率及认知障碍功能损害的特点不同；不同认知功能障碍的发生与脑梗死的部位存在紧密相关性。
[Abstract]:Objective in the acute phase of ischemic stroke patients, cognitive, sleep and autonomic nervous function disorders and disorders are often associated. The relationship between the location of stroke injury and such complications has been studied and the conclusions are different.There are many aspects such as the symmetry of cerebral hemisphere, the volume of injury, the distance between anterior boundary of injury and frontal area, cortical or subcortical injury, brain atrophy and so on.Most studies suggest that there is an intrinsic relationship between the location of cerebral infarction and cognitive impairment.The purpose of this study was to compare the cognitive function of patients with ischemic stroke after stroke at different locations, and to explore the relationship between different stroke sites and cognitive dysfunction in acute stage of ischemic stroke.To observe the characteristics of cognitive dysfunction caused by different lesions.Methods 118 cases of cerebral infarction were collected, including 17 cases of frontal lobe, 14 cases of temporal lobe, 13 cases of parietal lobe, 10 cases of occipital lobe, 24 cases of basal ganglia, 19 cases of thalamus, 11 cases of cerebellum and 10 cases of brain stem.Record, statistics and analyze patient data including age, sex, education level, etc.The Chinese version of Montreal Cognitive Assessment scale (MoCAA) was used to test 118 patients with cerebral infarction. The patients were scored by trained neuropsychological examiners in a quiet room. All the tests were completed once.The CT/MRI of patients with cerebral infarction was located with 7 subitems of MoCA.It includes orientational force, visual space and executive function, visual space and executive function, Nam, memory, memory, including instantaneous memory and proximal memory, attention to ATT, language function, including repetition and fluency, abstract summary of ABS).The above measured data were analyzed by SPSS17.0 statistical software, the counting data were analyzed by chi-square test, the measurement data were analyzed by t test, and the analysis of variance was made.There were significant differences in Logistic stepwise regression analysis and Pearson correlation coefficient test (p0. 05).Results the data of 118 patients with cerebral infarction and the statistical analysis of cognitive impairment showed that there was no significant difference in age, sex and years of education in patients with cerebral infarction. (2) the incidence of cognitive impairment in frontal lobe group and thalamus group was the highest (over 90%).The second was temporal lobe group (nearly 80%), cerebellar group and brainstem group (nearly 30%). By Logistic regression analysis, it was found that frontal lobe stroke was closely related to cognitive dysfunction (P 0.01), temporal lobe, parietal lobe, occipital lobe, basal ganglia,Thalamic apoplexy is associated with cognitive impairment (P0.05), cerebellum, cerebellum, cerebellum, and cerebellum.There was significant difference in the incidence of cognitive impairment in patients with cerebral infarction at different locations (P < 0.05). The MoCA subtests of basal ganglia stroke were analyzed by Pearson correlation coefficient test.棰濆彾鍗掍腑ORT,EF,MEM,ATT鏈夋槑鏄炬崯瀹，

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