颈内动脉闭塞患者侧支循环建立与临床预后关系的研究

发布时间：2018-05-31 06:47

本文选题：颈内动脉闭塞 + 侧支循环　；参考：《遵义医学院》2014年硕士论文

【摘要】：目的：评估单侧颈内动脉闭塞患者颅内侧支循环建立情况，探讨侧支循环的代偿与患者神经功能缺损的关系，为治疗方法的选择、预后的判断及有效的预防提供可靠的依据。方法：选择经颈动脉彩超检测单侧颈内动脉闭塞，再通过全脑血管造影检查证实患者60例；①根据发病原因不同分为：18例临床表现为脑栓塞的ICA闭塞患者为A组，其余由慢性动脉粥样硬化引起的42例ICA闭塞患者B组；A、B两组侧支循环开放分级的比较。②分析B组患者侧支循环开放情况并进行比较。③根据B组临床症状分为有症状组与无症状组并进行侧支循环开放情况比较。④根据临床类型表现为脑栓塞、脑血栓形成的患者入院初次检查依据美国国立卒中量表分别进行评分比较。根据B组侧支循环开放情况分为有侧支循环开放组，无侧支循环开放者组；每组治疗前后，两组入院时与脑血管科正规治疗6个月后随访NIHSS评分比较。结果：①脑栓塞组（A组）中1例（5.60%）二级侧支循环代偿，三级侧支循环开放各1例（5.60%），B组中33例（79%）二级侧支循环代偿，19例（45%）三级侧支循环开放.B组二、三级侧支循环代偿率明显高于A组（P0.05）.A组和B组一级侧支循环代偿率无明显差异（P㧐0.05）。②B组颈内动脉闭塞侧支循环建立患者，各种形式侧支循环中开放率最高的是前交通动脉开放（62%）。③无症状组后交通侧支开放率(67%)、前交通动脉+后交通动脉联合开放率(83%)均高于有症状组,差异显著（P0.05）。④根据NIHSS评分，脑栓塞患者18例中入院临床症状表现为轻度神经功能障碍1例（5.6%），中重度神经功能障碍12例（61.1%）；脑血栓形成患者32例中入院临床症状表现为轻度神经功能障碍16例（50%），中重度神经功能障碍8例（25%）；B组中有侧支循环组入院时和正规治疗出院6月后NIHSS评分比较差异明显（P 0.01）；而无侧支循环开放组入院时和正规治疗出院6月后NIHSS评分比较无明显差异（P0.05）。有无侧支循环两组，在发病后入院未经治疗前比较，两组经过正规治疗后比较均有显著差异（P 0.05）; 结论：①脑栓塞发病速度快，没有足够的时间重塑二、三级侧支循环。②颈内动脉闭塞时，，颅内可形成多种类型的侧支循环，其中ACOA的开放是最主要的代偿途径。部分病例如临床表现为无症状者多以ACOA+PCOA侧支循环联合开放为主。③有侧支循环开放的脑梗死发病率低、临床症状较轻、预后好。脑梗死患者颅内侧支循环与预后关系密切对判断患者预后具有重要意义。临床症状与侧支循环建立速度、类型、完善程度密切相关;
[Abstract]:Objective: to evaluate the establishment of intracranial collateral circulation in patients with unilateral internal carotid artery occlusion (ICA), and to explore the relationship between collateral circulation compensation and neurological impairment in patients with unilateral internal carotid artery occlusion (ICA), so as to provide a reliable basis for the selection of treatment methods, the judgment of prognosis and the effective prevention. Methods: 60 patients with unilateral internal carotid artery occlusion detected by color Doppler ultrasonography were divided into two groups: group A (n = 18) with ICA occlusion with cerebral embolism (n = 18). Comparison of open grade of collateral circulation between group B and group B caused by chronic atherosclerosis in 42 patients with ICA occlusion. 2 Analysis of the opening of collateral circulation in group B and comparison of 3. 3 according to the clinical symptoms of group B Comparison of collateral circulation opening between symptomatic group and asymptomatic group .4 according to the clinical manifestations of cerebral embolism, The initial admission examination of patients with cerebral thrombosis was compared with the National Stroke scale. According to the situation of collateral circulation in group B, the patients were divided into two groups: the open collateral circulation group and the non-collateral circulation open group. The NIHSS scores of the two groups were compared after 6 months of regular treatment before and after the treatment. Results in 1 case of cerebral embolism group (A group), one case (5.60%) the collateral circulation compensatory compensation of the second stage, one case of the third grade collateral circulation opening, one case of the third grade collateral circulation opening in each case, 33 cases (79%) in group B (n = 19) the collateral circulation compensation of the second stage was 45%) the third stage collateral circulation was opened in group B (n = 2). The compensatory rate of third grade collateral circulation was significantly higher than that of group A (P 0.05). Group A and group B (group B) had no significant difference in the compensatory rate of collateral circulation of internal carotid artery occlusion, and there was no significant difference between group A and group B in establishing collateral circulation of internal carotid artery occlusion. Among all kinds of collateral circulation, the opening rate of the anterior communicating artery (ACA) 62.3 was higher than that of the symptomless group (67%), and the combined opening rate of the anterior communicating artery and the posterior communicating artery (83th) was higher than that of the symptomatic group (P0.05.4, according to the NIHSS score). Among the 18 patients with cerebral embolism, the clinical symptoms of admission were mild neurological dysfunction in 1 case, moderate and severe neurological dysfunction in 12 cases, and mild neurological dysfunction in 16 cases among 32 patients with cerebral thrombosis. There were significant differences in NIHSS scores between the patients with collateral circulation in group B and those in group B (P < 0.01), but there was no significant difference in NIHSS score between patients with no collateral circulation and those with normal treatment (P 0.05). There were significant differences between the two groups with or without collateral circulation before and after admission without treatment, and there was significant difference between the two groups after regular treatment (P 0.05). Conclusion the cerebral embolism of 1 / 1 has a rapid onset rate and there is not enough time to reconstruct the second or third grade internal carotid artery occlusion. Multiple types of collateral circulation can be formed in the brain, in which the opening of ACOA is the main compensatory pathway. In some cases with asymptomatic symptoms, the incidence of cerebral infarction with ACOA PCOA collateral circulation combined with open collateral circulation was low, the clinical symptoms were mild, and the prognosis was good. The relationship between intracranial collateral circulation and prognosis in patients with cerebral infarction is of great significance in judging the prognosis of patients. The clinical symptoms were closely related to the establishment speed, type and perfection of collateral circulation.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

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