缺血性脑血管病患者介入治疗效果的临床研究

发布时间：2018-05-27 17:07

本文选题：缺血性脑血管病 + 介入　；参考：《河北医科大学》2017年硕士论文

【摘要】：脑血管病在我国是一种发病率高、致残率、致死率均较高的一种疾病,常见于中老年人发病,给国家和家庭造成沉重的经济负担和护理负担,该病包括:出血性和缺血性脑血管病两大类。近些年,我国因该病导致的经济支出费用将近200亿元人民币,同时也给患者家庭带来了沉重的医疗、护理及经济负担,已经成为一个重要的公共卫生问题。目前脑血管病的临床治疗方法并不是很多,大致分为药物治疗、康复治疗、外科治疗和介入治疗。随着影像学及药学、材料的进步,缺血性脑血管病的介入治疗发展迅速,技术不断更新发展,应用更加广泛。血管内介入治疗是治疗缺血性脑病的有效方法,本文现对血管内介入在治疗缺血性脑病、诊断血管变异的进展进行进一步探讨。目的:缺血性脑血管病的发病率逐年升高,颅内外动脉狭窄是其发病的最主要原因,传统的治疗主要包括药物治疗、外科治疗、康复治疗等,但仍不能有效避免缺血性脑病造成的高致死率和致残率。随着介入技术的发展和普及,血管介入尤其是支架成形术被广泛应用于颅内外动脉严重狭窄所致的缺血性脑血管疾病。血管内介入治疗作为微创手术,对脑组织损伤小、操作相对简单、成功率高,改善缺血脑组织的血液供应,从而受到国内外学者的广泛关注。近年来,血管变异与缺血性脑血管病的关系逐渐受到重视。Willis环常发生结构或血流动力学变异,其不完整性以及复杂的吻合支等在缺血性脑病的发生发展中起到了至关重要的作用。观察血管介入治疗缺血性脑病的近期、远期疗效以及并发症发生情况,探讨willis动脉环的血管变异在缺血性脑血管发生发展中的作用,为有针对性的制定缺血性脑病个体化方案提供一定的临床依据。方法:本研究为前瞻性临床治疗疗效的观察研究在石家庄市第一医院(中心院区)神经内科选取2012年2月到2015年2月收住院的缺血性脑血管病患者175例为此研究的研究对象。男性88例,女性87例,年龄在43-85岁之间,平均年龄(69.2±3.2)岁,其中脑梗死97例(大脑半球梗死者54例,小脑梗死23例,多部位脑梗死者20例),短暂性脑缺血发作者78例。所有患者及家属均知情同意本研究。该研究由石家庄市第一医院及石家庄市中心医院伦理委员会审批通过并监督管理,将入院患者进行常规血管内介入诊断及治疗术前准备,然后行血管内介入治疗,植入支架,并行升主动脉造影+双侧脑血管造影+双侧颈动脉选择性造影。记录术后即刻血管造影结果、并发症发生情况、随访结果以及血管变异结果,并进行统计学分析。结果:所有患者共181支血管均顺利植入支架,介入手术成功率为100%。介入术后即刻造影显示,整体狭窄情况较术前明显改善,差异具有统计学差异(P0.05)。分别有10例患者术中术后发生心率下降和血压下降,4例患者出现穿刺部位出血和血肿,3例患者术后有短暂性脑缺血发作,发生并发症的总数为17例,总发生率为9.7%。对所有患者随访12个月,分别在术后3个月、6个月、12个月测量患者手术血管狭窄情况,总血管再狭窄率为4.9%,在随访期间,死亡1例,发生脑梗死者5例,短暂性脑缺血发作者4例。所有研究对象中呈现A1优势征的有60例,颈动脉供血型有11例,混合供血型共14例,总的willis环不完整血管变异率为48.6%。结论:1对于有颅内外血管狭窄的缺血性脑病患者,介入治疗成功率高,疗效好,安全性高,介入治疗后动脉狭窄情况明显改善。2在缺血性脑血管病患者中,Willis环不完整的患者比例较高,血管变异引起的血流动力学代偿异常,在缺血性脑血管病患者发病时起到重要的作用。
[Abstract]:Cerebrovascular disease is a kind of disease with high incidence, high disability rate and high mortality rate in China. It is common in the middle and old people, causing heavy economic burden and nursing burden to the state and family. This disease includes two major categories: hemorrhagic and ischemic cerebrovascular diseases. In recent years, the cost of economic expenditure caused by this disease in China is nearly 20 billion yuan. The RMB, at the same time, has brought heavy medical care, nursing and economic burden to the family. It has become an important public health problem. At present, the clinical treatment methods of cerebrovascular disease are not much, including drug treatment, rehabilitation, surgical treatment and interventional therapy. With the progress of imaging and pharmacy, progress of materials, ischemia The interventional therapy of cerebrovascular disease has developed rapidly, the technology is constantly updated and developed, and its application is more extensive. Intravascular interventional therapy is an effective method for the treatment of ischemic encephalopathy. The progress of intravascular interventional therapy in the treatment of ischemic encephalopathy and diagnosis of vascular variation is further discussed. Intracranial and extracranial artery stenosis is the most important cause of its disease. Traditional treatment mainly includes drug treatment, surgical treatment, rehabilitation therapy, but it still can not effectively avoid the high mortality and disability rate caused by ischemic encephalopathy. With the development and popularization of interventional technique, vascular intervention, especially stenting is widely used in intracranial external movement. Intravascular interventional therapy, as a minimally invasive operation, has small damage to brain tissue, relatively simple operation, high success rate and improved blood supply of ischemic brain tissue, which has been widely concerned by scholars both at home and abroad. In recent years, the relationship between vascular change and ischemic cerebrovascular disease has been gradually paid attention to.Wi LLIS rings often have structural or hemodynamic variations, and their incompleteness and complex anastomotic branches play a vital role in the development of ischemic encephalopathy. To observe the recent, long-term effects and complications of vascular interventional therapy for ischemic encephalopathy, and to explore the vascular variation of the Willis artery ring in ischemic cerebral blood. The role of the tube in the development of the individualized ischemic encephalopathy provides a certain clinical basis. Methods: an observation study of the prospective clinical therapeutic effect in the first hospital of Shijiazhuang (Central Hospital) selected the patients with ischemic cerebrovascular disease in hospital from February 2012 to February 2015, 175 For this study, 88 males and 87 females, aged 43-85 years, average age (69.2 + 3.2) years, 97 cases of cerebral infarction (54 cases of cerebral hemisphere infarction, 23 cerebellar infarcts, 20 cases of cerebral infarction), 78 cases of transient ischemic hair, all patients and their families were informed consent of this study. The study was made by stone family. The first hospital of Zhuang City and the ethics committee of the Central Hospital of Shijiazhuang are approved and supervised. The hospitalized patients are prepared by routine intravascular interventional diagnosis and treatment, then intravascular interventional therapy, stent implantation, parallel ascending aorta angiography, bilateral cerebral vascular imaging and bilateral carotid selective angiography. The results of angiography, complications, follow-up and blood vessel variation, and statistical analysis. Results: all 181 vessels were successfully implanted into the stent. The success rate of the interventional procedure was immediately after 100%. intervention, and the overall stenosis was significantly improved than that before the operation. The difference was statistically significant (P0.05). There were 10 patients who had heart rate decline and blood pressure drop after operation, 4 patients had puncture site bleeding and hematoma, 3 patients had transient ischemic attack after operation, and the total number of complications was 17 cases. The total incidence rate was 9.7%. for all patients for 12 months, 3 months, 6 months and 12 months after operation respectively. The stenosis rate of the total vascular restenosis was 4.9%. During the follow-up period, there were 1 cases of death, 5 cases of cerebral infarction and 4 cases of transient ischemic hair. There were 60 cases of A1 dominance, 11 cases of carotid artery supply, 14 cases of mixed donor blood type, and the total Willis ring incomplete vascular variation rate was 48.6%. conclusion: 1 for craniofacial and inside and outside the skull Patients with ischemic encephalopathy with vascular stenosis have high success rate, good curative effect, high safety, and obviously improved.2 in patients with ischemic cerebrovascular disease after interventional therapy. The proportion of patients with incomplete Willis ring is higher, and the hemodynamic compensatory abnormalities caused by vascular variation are abnormal in patients with ischemic cerebrovascular disease. To an important role.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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