短时间内症状缓解的脑梗塞的临床特点

发布时间：2018-04-27 02:37

本文选题：急性脑梗塞 + 临床特点　；参考：《吉林大学》2015年硕士论文

【摘要】：临床观察发现短时间症状缓解的脑梗塞患者比例正逐渐增加。对于这部分患者性别、年龄、危险因素、血管狭窄情况、影像学改变及治疗方面等临床特点，目前尚未完全阐明。通过探讨此类脑梗塞的发病特点及可能影响病情进展的危险因素，实施能够加强神经功能恢复的临床干预手段，并通过改善相关危险因素，能有效防止这部分患者发展成为进展性脑卒中。研究目的观察脑梗塞患者短时间内缓解的临床特点，探讨可能影响脑梗塞症状缓解的危险因素。研究对象与方法回顾性分析2013年7月至2014年9月在吉林大学第一医院及二部神经内科住院治疗的首次发病的急性脑梗塞患者的临床资料。所有患者发病时间≤24h；治疗前有明确的神经功能缺损体征，脑功能损害体征持续时间超过1h；将5d内美国国立卫生院卒中量表（National Institute ofHealth stroke scale, NIHSS）评分降低7分及以上的患者纳入缓解组，共64例；将NIHSS评分降低小于7分的患者纳入未缓解组，共72例。对比两组患者性别、年龄、NIHSS评分、吸烟、饮酒、高血压、糖尿病、冠心病、血糖、血脂、纤维蛋白原、血管狭窄、梗塞类型、病灶周围水肿、治疗用药及治疗效率。研究结果 1.入院后5d缓解组NIHSS评分均明显小于入院时（P＜0.01），未缓解组入院后5d NIHSS评分与入院时无差异；缓解组入院时NIHSS评分均明显低于未缓解组，有显著统计学差异（P＜0.01）。 2.缓解组男性比例为88%，未缓解组男性比例56%，缓解组男性比例明显高于未缓解组（P＜0.01）。 3.缓解组有糖尿病史18例，高血糖21例，吸烟史23例，未缓解组糖尿病史43例，高血糖49例，吸烟史39例。缓解组有糖尿病、高血糖患者明显少于未缓解组，差异有显著性（P＜0.01）；对比两组有吸烟史患者，有统计学差异（P＜0.05）。 4.缓解组总血管狭窄率为27%，未缓解组为54%，缓解组总血管狭窄率明显低于未缓解组，具有统计学差异（P＜0.01）；缓解组以相应支配区单支血管狭窄为主，未缓解组以多支血管狭窄为主，具有统计学差异（P＜0.01）。缓解组以颈内动脉系统血管狭窄为主，未缓解组以椎-基底动脉系统狭窄为主，有统计学差异（P＜0.05）。 5.缓解组中头部MRI显示病灶周围脑组织明显水肿者9例，前循环梗塞56例，后循环梗塞8例，未缓解组中头部MRI显示病灶周围脑组织明显水肿者29例，前循环梗塞46例，后循环梗塞26例，两组患者病灶周围水肿情况、梗塞类型均有统计学差异。 6.缓解组中应用尤瑞克林23例，未缓解组为10例，，对比两组应用尤瑞克林有统计学差异（P＜0.01）。 7.两组患者14d的NIHSS评分均明显低于入院时（P＜0.01）；治疗14d后缓解组的显著有效率及总有效率均高于未缓解组（P＜0.01）。研究结论短时间内症状缓解的脑梗塞的临床特点： 1.入院时临床症状相对较轻； 2.男性比例高于女性； 3.既往有糖尿病史、吸烟史患者比例少，入院监测有高血糖患者少； 4.相应支配区血管狭窄率低，以单支血管病变为主； 5.梗塞类型以前循环为主，在MRI DWI像上以皮层改变为主，脑组织水肿程度轻； 6.尤瑞克林可明显促进临床症状的改善； 7.预后良好。
[Abstract]:Clinical observations have found that the proportion of patients with short term symptoms of cerebral infarction is increasing gradually. The clinical features such as sex, age, risk factors, vascular stenosis, imaging changes, and treatment are not fully elucidated. The characteristics of this type of cerebral infarction and the risk factors that may affect the progression of the disease have been discussed. The implementation of clinical intervention to strengthen the recovery of nerve function and the improvement of related risk factors can effectively prevent the development of this part of the patient from becoming a progressive stroke.
research objective
Objective To observe the clinical characteristics of cerebral infarction patients in a short period of time, and explore the risk factors that may affect the symptoms of cerebral infarction.
Research objects and methods
A retrospective analysis of the clinical data of patients with acute cerebral infarction hospitalized in No.1 Hospital of Jilin University and two Department of Neurology from July 2013 to September 2014. The onset time of all patients was less than 24h; there was a clear neurological defect before treatment, and the duration of brain dysfunction syndrome lasted more than 1h; the US national state within 5D was national. The National Institute ofHealth Stroke Scale (NIHSS) score was reduced by 7 and more of the patients were included in the remission group, with a total of 64 cases. The NIHSS score was reduced to less than 7 in the group of 72. The sex, age, NIHSS score, smoking, drinking, hypertension, diabetes, coronary heart disease, blood sugar, blood lipid were compared in the two groups. Fibrinogen, vascular stenosis, type of infarction, edema around the lesion, treatment and treatment efficiency.
Research results
1. after admission, the NIHSS score of 5D remission group was significantly lower than that of admission (P < 0.01). The score of 5D NIHSS in the non remission group was not different from that of the admission group, and the NIHSS score in the remission group was significantly lower than that in the non remission group, and there was significant statistical difference (P < 0.01).
2. the proportion of males in the remission group was 88%, and the male in the non remission group was 56%. The male ratio in the remission group was significantly higher than that in the non remission group (P < 0.01).
3. in the remission group, there were 18 cases of diabetes, 21 cases of hyperglycemia, 23 cases of smoking history, 43 cases of diabetes in the non remission group, 49 cases of hyperglycemia and 39 cases of smoking history. The remission group had diabetes, and the patients with hyperglycemia were significantly less than those in the non remission group (P < 0.01); compared with the two groups with smoking history, there were statistical differences (P < 0.05).
The total vascular stenosis rate in the 4. remission group was 27%, the group in the non remission group was 54%, the total vascular stenosis rate in the remission group was significantly lower than that in the non remission group (P < 0.01). The remission group was dominated by the single vessel stenosis in the corresponding dominating area, and the group with multiple vascular stenosis was mainly in the non remission group (P < 0.01). The remission group was treated with the internal carotid artery system blood. Guan Xiazhai was the main group, and the non remission group was mainly vertebral basilar artery stenosis (P < 0.05).
5. in the remission group, the head MRI showed obvious edema around the lesion in 9 cases, anterior circulation infarction in 56 cases and posterior circulation infarction in 8 cases. The head MRI in the non remission group showed 29 cases of obvious edema around the focus of the focus, 46 cases of anterior circulation infarction, 26 cases of posterior circulation infarction, and two groups of patients with edema around the focus, and the types of infarction were statistically different.
6. in the remission group, 23 cases were treated with Yuri Klein, and 10 cases in the non remission group. The difference between the two groups was statistically significant (P < 0.01). The difference between the two groups was statistically significant (P < 0.01).
7. the NIHSS score of 14d in the two groups was significantly lower than that in the hospital (P < 0.01), and the significant effective rate and total effective rate of the remission group after the treatment of 14d were higher than those in the non remission group (P < 0.01).
research conclusion
Clinical characteristics of cerebral infarction with symptomatic relief in a short time:
1. the clinical symptoms were relatively mild at admission.
2. male ratio was higher than that of women.
3. the proportion of patients with diabetes history and smoking history was less.
4. the vascular stenosis rate in the corresponding control area was low, with single vessel disease as the main factor.
5. the type of infarction was mainly before circulation, and the cortical changes were the main causes on MRI DWI images.
6. Yuri klining can significantly improve the clinical symptoms.
7. the prognosis was good.

【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

【参考文献】