分水岭脑梗死的临床特征及复发相关因素分析

发布时间：2018-05-17 02:09

本文选题：分水岭脑梗死 + 临床特征　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:分水岭脑梗死(cerebral watershed infarction,CWI)是缺血性脑血管病一种特殊类型,且发病率较高。但是目前仍有少数临床医师认为CWI患者临床症状轻、预后好,而忽略了CWI高复发率及高致残率的特征。本研究通过观察CWI的临床特征及引起CWI复发的相关因素,为CWI的治疗及预防提供依据。方法:收集2015年5月至2016年5月于大连市中心医院神经内二科入院治疗的143例分水岭脑梗死患者,结合患者头部核磁共振(MRI)和弥散加权成像(DWI)的影像学表现,分为皮质型分水岭脑梗死(CWSI)、内分水岭脑梗死(IWSI)两组。记录入组患者年龄、性别、糖尿病、高血压病、冠心病、卒中史、吸烟史、饮酒史、入院后连续7天的血压、实验室化验结果。所有入组患者均行颈动脉超声检查、磁共振血管成像检查、心脏超声检查、24小时动态心电图检查。于入院第1天和第7天进行NIHSS评分、修正Rankin评分,并记录住院天数及治疗方案。在6个月面对面随访或电话随访时,记录患者是否再发脑梗死,血压控制情况、目前用药、是否行血管内支架手术、康复锻炼情况、NIHSS评分、mRS评分等。结果:1.入院第1天CWSI的NIHSS评分为3.61±2.14,IWSI的NIHSS评分为4.72±2.20,二者比较差异有统计学意义(P0.05),入院第7天CWSI的NIHSS评分为2.60±2.19,第7天IWSI的NIHSS评分为3.57±2.44,二者比较差异有统计学意义(P0.05)。两组CWI患者入院第1天、第7天的NIHSS评分比较差异均有统计学意义;IWSI患者的NIHSS评分比CWSI患者的更高,住院天数更长。2.入院7天后,CWSI患者中病情好转的有25例(43.86%),IWSI患者中有14例(16.28%),二者比较差异有统计学意义(P0.05);CWSI患者中出现病情恶化的有7例(12.3%),IWSI患者中有23例(26.7%),二者比较差异有统计学意义(P0.05)。CWSI患者更易出现病情好转,而IWSI患者更易出现病情恶化。3.入选的143例分水岭脑梗死患者随访6个月,CWSI患者的mRS评分为1.72±1.45,IWSI患者的mRS评分为2.51±1.61,二者比较差异有统计学意义(P0.05)。发病6个月内,IWSI患者比CWSI患者预后差,生活质量差。4.143例分水岭脑梗死患者中,有31人卒中复发(同侧28例,对侧2例,小脑1例),复发率为21.7%。无死亡病例。5.入院7天平均血压140/90mmHg、不稳定斑块、颈动脉狭窄程度≥70%与CWI的复发显著正相关(p分别为0.003、0.000、0.000);扩容及支架植入治疗与CWI的复发显著负相关(p分别为0.010及0.022)。多因素Logistic回归分析显示入院7天平均血压140/90mmHg(OR=5.153,P=0.006,95%CI 1.558~16.719)、不稳定斑块(OR=8.363,P0.001,95%CI 3.468~20.172)、颈动脉狭窄程度≥70%(OR=7.512,P0.001,95%CI 3.040~18.564)是CWI复发的危险因素;而扩容治疗(OR=0.105,p=0.030,95%CI 0.014~0.806)及支架植入治疗(OR=0.129,p=0.050,95%CI 0.017~0.100)是CWI复发的保护因素。结论:1.发病1周内,IWSI患者比CWSI患者更易出现病情恶化。2.发病6个月的预后,IWSI患者比CWSI患者差。3.入院7天平均血压140/90mmHg、不稳定斑块、颈动脉狭窄程度≥70%是分水岭脑梗死复发的危险因素;颈动脉支架植入治疗及扩容治疗则可有效预防复发。
[Abstract]:Objective: cerebral watershed infarction (CWI) is a special type of ischemic cerebrovascular disease and has a high incidence. But at present, a few clinicians still think that the clinical symptoms of CWI patients are light and the prognosis is good, but the high recurrence rate of CWI and the high rate of disability are neglected. The clinical features and causes of CWI are observed and caused by the observation of the clinical characteristics and causes of CWI. The related factors of CWI recurrence were provided for the treatment and prevention of CWI. Methods: from May 2015 to May 2016, 143 patients with watershed cerebral infarction treated in two families of nerve in Dalian central hospital were divided into cortical watershed cerebral infarction (MRI) and diffusion weighted imaging (DWI). CWSI), two groups of internal watershed cerebral infarction (IWSI). The age, sex, diabetes, hypertension, coronary heart disease, stroke history, smoking history, drinking history, 7 days of blood pressure after admission, and laboratory test results were recorded. All the patients underwent carotid ultrasound examination, magnetic resonance angiography, cardiac ultrasound examination, and 24 hour dynamic electrocardiogram. The NIHSS score was performed on first and seventh days of admission. The Rankin score was corrected and the number of hospitalization days and treatment plans were recorded. In 6 months of face to face follow-up or telephone follow-up, the patients were recorded if cerebral infarction, blood pressure control, current medication, rehabilitation exercise, NIHSS score, and mRS score. Fruit: 1. the NIHSS score of CWSI was 3.61 + 2.14 on the first day admission, and the NIHSS score of IWSI was 4.72 + 2.20. The two groups had a statistically significant difference (P0.05). The NIHSS score of CWSI was 2.60 + 2.19 at seventh days in hospital, and NIHSS score of IWSI was 3.57 + 2.44, and the differences were statistically significant (P0.05). The difference in score was statistically significant; the NIHSS score of IWSI patients was higher than that of CWSI patients, and 7 days after hospitalization was longer.2., 25 cases (43.86%) were improved in CWSI patients, 14 in IWSI patients (16.28%), and the difference was statistically significant (P0.05), 7 cases (12.3%) in CWSI patients, IWSI patients. Among the 23 cases (26.7%), the two were more likely to have a statistically significant difference (P0.05).CWSI patients were more likely to have a better condition, while IWSI patients were more likely to appear in 143 cases of watershed cerebral infarction for 6 months, CWSI patients' mRS score was 1.72 + 1.45, mRS scores in IWSI patients were 2.51 + 1.61, two were statistically significant differences. P0.05. Within 6 months of onset, the prognosis of IWSI patients was worse than that of CWSI patients. Of the poor quality of life, 31 people had recurrent stroke (28 cases in the same side, 2 cases in the contralateral, 1 cerebellum), and the recurrence rate was the mean blood pressure 140/ 90mmHg, unstable plaque, the degree of carotid stenosis more than 70% and CWI in the 7 days of 21.7%. without death. Positive correlation (P was 0.003,0.000,0.000); dilatation and stent implantation were negatively correlated with the recurrence of CWI (P was 0.010 and 0.022 respectively). Multiple factor Logistic regression analysis showed the average blood pressure 140/90mmHg (OR=5.153, P=0.006,95%CI 1.558~16.719) for 7 days, unstable plaque (OR=8.363, P0.001,95%CI 3.468~20.172), carotid stenosis Degree more than 70% (OR=7.512, P0.001,95%CI 3.040~18.564) is a risk factor for CWI recurrence, while dilatation therapy (OR=0.105, p=0.030,95%CI 0.014~0.806) and stent implantation (OR=0.129, p=0.050,95%CI 0.017~0.100) are the protective factors for CWI recurrence. Conclusion: within 1 weeks of the 1. onset, IWSI patients are more likely to have a worsening condition for 6 months than those of the patients. The prognosis of IWSI patients was less than that of CWSI patients. The average blood pressure of.3. was 140/90mmHg for 7 days, the unstable plaque and the degree of carotid stenosis more than 70% were the risk factors for the recurrence of the watershed infarction, and the carotid artery stent implantation and dilatation treatment could effectively prevent the recurrence.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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