颈内动脉重度狭窄或闭塞的脑梗死患者侧支循环对预后的影响

发布时间：2018-04-15 06:16

本文选题：颈内动脉 + 侧支循环　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的：通过对有症状的脑梗死患者行全脑血管造影术检查，明确责任血管，选取单侧颈内动脉狭窄程度为重度及闭塞的患者，记录其侧支循环的种类及数量，比较不同侧支循环条件下的脑梗死患者预后的差异。方法：113例有症状的颈内动脉重度狭窄或闭塞的急性脑梗死患者，均通过数字减影脑血管造影技术分析这些脑梗死患者侧支代偿情况，根据有无侧支代偿及代偿的类型将其分为：无侧支代偿组A、有侧支代偿组B；将B组分为仅有初级代偿组C组、仅有次级代偿组D、同时具有初级和次级代偿组E；将E组中有初级侧支代偿组条件下，有软脑膜动脉向前循环代偿供血的患者纳入组F、有颈外动脉向颈内动脉代偿供血的患者纳入组G。均于发病后第7天、3月行美国国立卫生研究院卒中量表评分（The National institutes of Health stroke scale，NIHSS）及发病后第7天、1年后行改良Rankin评分（Modified Rankin score，，mRs），分别计算3月与第7天NIHSS评分差及1年与第7天的mRs评分差，并分析侧支循环对急性脑梗死患者预后的影响。采用SPSS17.0软件统计以上数据资料。计量资料用（Mean±SD）表示。计数资料用One-sample kolmogorov-smirnov Test得知数据均不符合正态分布。故采用Mann-Whitney U Test检验，在a=0.05的检验水准上P0.05定义为有统计学意义。而E、C、D组间的比较采用Kruskal-Wallis H(K)检验，在a=0.05的检验水准上P0.05定义为有统计学意义。结果：113例患者中，重度狭窄78（69.02%）例，闭塞35（30.98%）例。其中A组51（45.13%）例，B组62（54.87%）例。C组12（19.37%）例，D组13（20.96%）例，E组37（59.67%）例。F组34（91.89%）例，G组20（54.05%）例。A组与B组相比较：3月内B组NIHSS评分较A组显著降低（P0.05），1年后B组mRs评分较A组明显降低（P0.05）。F组与G组相比较：3月内F组NIHSS评分较G组无明显差异（P0.05），1年后F组mRs评分较G组无明显差异（P0.05）。E、C、D组相比较：3月内3组NIHSS评分有统计学差异（P0.05），其中D组评分降低最不明显。1年后3组mRs评分有统计学差异（P0.05），其中D组评分降低最不明显。结论：单侧颈内动脉重度狭窄或闭塞的急性脑梗死患者，有侧支循环患者预后明显优于无侧支循环者。有初级侧支代偿的急性脑梗死患者中，大脑后动脉通过软脑膜动脉向前循环代偿及颈外动脉向颈内动脉代偿是次级侧支代偿的主要途径，而次级代偿方式对预后的影响无差异。仅有初级代偿及同时具有初级、次级代偿预示预后良好，但仅有次级代偿预示预后不良。
[Abstract]:Objective: to determine the responsible vessels and to record the type and number of collateral circulation in patients with unilateral internal carotid artery stenosis and occlusion by means of total cerebrovascular angiography in patients with symptomatic cerebral infarction.To compare the prognosis of patients with cerebral infarction under different collateral circulation.Methods 113 cases of acute cerebral infarction with severe stenosis or occlusion of internal carotid artery were analyzed by digital subtraction angiography.According to the types of collateral compensations and compensations, they were divided into two groups: group A without collateral compensation, group B with collateral compensation, group B with primary compensation group, group C with primary compensation group, group B with collateral compensation group B, group B with non-collateral compensation group, group B with collateral compensation group BOnly sub-compensatory group D, with both primary and secondary compensatory groups, and group E with primary collateral compensatory group,Patients with forward-circulatory compensatory blood supply of pial meningeal artery were included in group F, patients with compensatory blood supply from external carotid artery to internal carotid artery were included in group G.The National institutes of Health stroke scale (NIHSS) was given on the 7th day after onset and the modified Rankin score was given 1 year after onset. The difference of NIHSS scores between 3 months and 7 days and 1 year and 1 year after onset were calculated respectively.On the 7th day, the mRs score was poor,The influence of collateral circulation on prognosis of patients with acute cerebral infarction was analyzed.Use SPSS17.0 software to calculate the above data.The metrological data are expressed in the mean 卤SDs.One-sample kolmogorov-smirnov Test showed that the data did not accord with normal distribution.Therefore, using Mann-Whitney U Test test, the test level of A0. 05 was defined as statistically significant.The comparison between the two groups was determined by Kruskal-Wallis test, which was defined as statistically significant on the test level of A0. 05.Results among the 113 cases, 78,69.02 had severe stenosis and 350.98 were occluded.Group A (51n 45.13)) group B (62n 54.87), group C (1219.37) group D (1320.96) and group E 3759.67) patients, group F 3491.89) group G 2054.05). Group A compared with group B. the NIHSS score of group B was significantly lower than that of group A within three months, and the mRs score of group B was significantly lower than that of group A (P 0.055.F) one year later, the score of mRs in group B was significantly lower than that in group A.Compared with group G, there was no significant difference in NIHSS score between group F and group G within 3 months, and there was no significant difference between group F and group G in mRs score after one year. There was a significant difference in NIHSS score among three groups within 3 months (P 0.05), among which the score of group D was the least significantly lower than that of group G (P 0.05).After 1 year, the mRs scores of the three groups were significantly different (P < 0.05).Conclusion: in patients with acute cerebral infarction with severe stenosis or occlusion of unilateral internal carotid artery, the prognosis of patients with collateral circulation is significantly better than that without collateral circulation.In the patients with acute cerebral infarction with primary collateral compensations, the posterior cerebral artery circulates compensation forward through the pial meningeal artery and the external carotid artery compensates to the internal carotid artery is the main way to compensate the secondary collateral branch, but the secondary compensatory mode has no difference on the prognosis.Only primary compensations and both primary and secondary compensations predict good prognosis, but only secondary compensations predict poor prognosis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.33

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