7例合并卵圆孔未闭的青年卒中临床特点分析

发布时间：2018-05-16 02:05

本文选题：青年卒中 + 卵圆孔未闭　；参考：《山东大学》2016年硕士论文

【摘要】：目的一、探讨合并心脏卵圆孔未闭的青年卒中患者的临床特征；二、明确卵圆孔未闭在青年卒中发病病因的地位；三、避免在临床工作中对合并卵圆孔未闭的青年卒中患者漏诊,提升诊断的准确性和治疗效果。方法回顾性研究2014年8月至2015年12月山东大学齐鲁医院神经内科收治的青年脑卒中患者,筛选出合并心脏卵圆孔未闭的青年卒中患者7例,收集患者的临床资料,行体格检查及神经系统查体,分析此7例青年卒中患者的临床特征,包括发病诱因、起病方式、临床表现、实验室及影像学检查、治疗方法及预后情况；结合国内外相关文献,对青年卒中合并卵圆孔未闭的患者的诱因、发病机制、临床特点、诊断及治疗等进行系统讨论。结果1.病例一般情况：本研究7例病例,男性6例(86%),女性1例(14%),年龄在16岁～45岁之间,平均年龄35岁。2.发病诱因及基础疾病：7例(100%)患者均为急性起病。3例(43%)起病前处于安静状态未发现明显诱因,3例(43%)患者发病于活动后,1例发病于睡眠状态中。高血压病史1例,偏头痛史1例,吸烟史1例。3.临床表现及NIHSS评分：3例(43%)表现为头晕伴恶心呕吐,5例(71%)有言语不清、口角歪斜,5例(71%)有肢体乏力麻木症状。7例患者的NIHSS评分依次为12分、5分、3分、3分、3分、2分、2分,1例因插胃管12分。4.辅助检查：常规血液检验：7例(100%)患者的TC、TG及HDL基本正常,2例(29%)患者LDL略高于标准值。4例(57%)HCY较高,属于高同型半胱氨酸血症范畴。2例(29%)患者D-D较高,其余均在标准范围内。7例(100%)患者的HB基本正常,但都处于上限。其余血常规、血沉、凝血系列、肝肾功、血生化、肿瘤标记物、风湿系列等未见明显异常。影像学检查：7例患者行颅脑磁共振,2例(29%)表现为基底节区片状梗死灶,2例(29%)梗死灶位于延髓,3例(43%)表现为多发部位脑梗死。7例(100%)患者均行经颅多普勒超声发泡试验,结果均为阳性。5例(71%)行经食道心脏超声,其中4例提示存在卵圆孔未闭,1例未见明显异常；2例(29%)患者行经胸超声心动图,提示存在右向左的分流,即卵圆孔未闭。5.治疗及预后：7例(100%)患者均给予抗血小板、促进循环及脑细胞代谢等药物治疗,行经皮卵圆孔未闭封堵术,术后患者恢复良好。7例患者(100%)院外均口服药物治疗,随访3个月至6个月,均未再发生脑卒中,且无明显后遗症。结论1.合并卵圆孔未闭的青年卒中起病形式多种多样,与其他原因所致卒中无区别,前后循环的症状均可作为首发症状；2.合并卵圆孔未闭的青年卒中临床特点较其他原因所致的卒中,轻型卒中较多见；3.患者的颅脑磁共振可表现为多发片状梗死灶,也可表现为仅累及单侧血管的单个病灶；4.对于45岁以下原因不明的青年缺血性脑卒中患者,进行发病危险因素筛查时,除常规血液及影像学检查外,应把TCD发泡试验、经食道心脏超声及声学造影作为常规检查；5.卵圆孔未闭所致脑卒中行经皮封堵是目前较常用的安全、有效的治疗方法。意义青年卒中的患病率较前有所增长,对家庭社会的影响不容忽视,其危险因素多种多样,早期诊断、早期干预尤为重要。在临床工作中,对于青年卒中的病因诊断,应考虑到卵圆孔未闭的情况,注意筛查避免漏诊误诊。对于病因明确合并卵圆孔未闭的青年卒中,可采取封堵治疗,较其他原因导致的卒中可治愈且预后好。
[Abstract]:Objective: To explore the clinical characteristics of young stroke patients with closed oval foramen of the heart. Two, clear the position of the oval hole in the etiology of young stroke; three, to avoid the missed diagnosis of the young stroke patients with oval foramen in clinical work, to improve the accuracy and effect of diagnosis in August 2014. Methods a retrospective study was conducted in August 2014. To the young stroke patients admitted in the Department of Neurology of Qilu Hospital of Shandong University in December 2015, 7 young stroke patients with oval foramen of heart were selected. The clinical data of the patients were collected, the physical examination and the examination of the nervous system were used to analyze the characteristics of the 7 young stroke patients, including the causes of the disease, the way of the onset and the clinical table. Present, laboratory and imaging examination, treatment methods and prognosis; combined with domestic and foreign related literature, the inducement, pathogenesis, clinical characteristics, diagnosis and treatment of young patients with Apoplexy with oval foramen were discussed systematically. Results 1. cases general case: 7 cases in this study, 6 men (86%), 1 women (14%), and 1 age. Between 6 and 45 years old, the average age 35 year old.2. causes and basic diseases: 7 cases (100%) were all.3 cases (43%) in the acute onset (43%) in the quiet state before the onset of no obvious inducement, 3 cases (43%) after the onset of activity, 1 cases in the sleep state. 1 cases of hypertension history, migraine history 1 cases, 6 cases of smoking history, 1 cases clinical manifestation and NIHSS Score: 3 cases (43%) showed dizziness with nausea and vomiting, 5 cases (71%) had poor speech, angular skew, 5 cases (71%) with numbness of limb weakness in.7 patients, the NIHSS score in turn was 12, 5, 3, 3, 3, 2, 2, and 1 cases were divided into.4. by inserting gastric tube: conventional blood test: TC, TG, and HDL were basically normal. Cases (29%) LDL was slightly higher than standard value.4 (57%) HCY,.2 cases of hyperhomocysteinemia (29%) patients with higher D-D, and the rest were basically normal in.7 cases (100%), but all were at upper limit. The remaining blood routine, erythrocyte sedimentation, blood coagulation series, liver and kidney work, blood biochemistry, tumor markers, rheumatic series and so on were not seen. Imaging examination: imaging examination: 7 patients underwent craniocerebral magnetic resonance, 2 (29%) showed basal ganglia infarction, 2 (29%) located in the medulla and 3 (43%) showed multiple cerebral infarction in.7 (100%) with transcranial Doppler ultrasonic foaming test. The results were all positive.5 cases (71%) transesophageal echocardiography, 4 cases were suggested. 1 cases had no obvious abnormality in 1 cases, and 2 cases (29%) underwent transthoracic echocardiography, suggesting the existence of right to left shunt, that is, the treatment and prognosis of the unclosed oval foramen, 7 cases (100%) were treated with antiplatelet, promoting circulation and brain cell metabolism, and underwent percutaneous patent foramen ovale closure, and the postoperative patients recovered well. .7 patients (100%) were treated with oral medication outside the hospital, followed up for 3 months to 6 months, no cerebral apoplexy was found and no significant sequelae were found. Conclusion there are various forms of stroke in young adults with 1. oval foramen, which are not different from other causes of stroke, and the anterior and posterior circulatory symptoms can be the first symptom; 2. with the closure of oval foramen. The clinical characteristics of apoplexy in the year were more common than those caused by other causes. The brain MRI in 3. patients could be seen as multiple flake infarcts and only single lesion involving unilateral vessels; 4. for young patients with unknown causes under 45 years of age, the screening of risk factors in young patients with unexplained reasons except routine was routine. The TCD foaming test, transesophageal echocardiography and acoustic contrast examination should be taken as routine examination, and transcutaneous closure of cerebral pawns caused by 5. oval foramen is a safe and effective treatment. The incidence of young stroke is longer than that before, and the impact on family society can not be ignored and its risk is not to be ignored. There are various factors, early diagnosis and early intervention are particularly important. In the clinical work, for the diagnosis of young stroke, we should take into account the absence of the oval hole, and pay attention to the screening to avoid misdiagnosis. The prognosis is good.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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