65岁以上脑血管病患者DSA分析及病因研究

发布时间：2018-06-24 06:45

本文选题：老年 + 脑血管病　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：应用数字减影脑血管造影(Digital Subtraction Angiography，DSA)技术，研究65岁以上脑卒中人群脑血管病变的特点及分布情况，并分析脑血管病危险因素对脑血管的影响。资料与方法：回顾研究对象2008年9月至2014年1月在中日联谊医院神经内二科住院的65岁以上已行DSA检查脑卒中患者33例。并设同期年龄在25-45岁之间的青年脑卒中患者40例，作为对照组。采用Seldinger技术及改良技术，通过股动脉穿刺、插管行全脑血管造影检查，记录颅内、外动脉狭窄的部位、程度、侧枝循环及Willis环开放情况等，对血管病变类型、特点及分布情况进行分析，并对脑血管病的危险因素（包括高血压、糖尿病、卒中病史、吸烟、饮酒、高脂血症）进行记录分析。研究65以上老年人群病因及血管病变特点及病因。使用SPSS17.0软件，进行数据录入与统计，计数资料使用了卡方检验，计量资料使用方差分析。其中P0.05表示差异有统计学意义。血管狭窄程度按NASCET标准分为4级①完全闭塞;②重度狭窄：狭窄程度在70%~99%;③中度狭窄：狭窄程度在50%~69%;④轻度狭窄或正常：指狭窄程度50%或无异常。以血管狭窄超过50%即认为动脉病变。结果： 1、33例65岁以上老年患者，最高81岁，最低65岁，平均年龄70.47±4.17岁，男：女为21:12=1.75:1。高血压病17例，糖尿病4例，高血脂11例，吸烟6例，酗酒2例，卒中病史12例，其中2项以上18例。 2、老年组DSA检查见28例出现血管病变，血管病变49处，2处以上病变14例，其中血管闭塞17处，重度狭窄15处，中度狭窄9处，轻度7处，动脉瘤1处。其中发现了19处侧枝循环血管开放，一级侧枝循环（Willis环）开放共13处：前交通动脉共6处，后交通动脉共7处，二级侧枝循环开放共6处：发现前软脑膜吻合动脉开放2例，后软脑膜吻合动脉开放2例，眼动脉开放1例，穿支动脉开放1例。 3、40例对照组青年患者，最高45岁，最低28岁，平均年龄39.67±4.26岁，男：女为29:11=2.64:1。高血压病21例，糖尿病4例，高血脂14例，吸烟19例，酗酒11例，卒中病史5例，其中2项以上20例。 4、青年组DSA检查见28例出现血管病变，血管病变36处，2处以上病变7例，其中血管闭塞16处，重度狭窄4处，中度狭窄7处，轻度9处，动脉瘤1处，烟雾病2处。其中可见16处侧枝循环开放，一级侧枝循环（Willis环）开放11处：前交通动脉6处，后交通动脉5处，二级侧枝循环开放5处：前软脑膜吻合支开2例，后软脑膜吻合支开放2例，眼动脉开放1例。结论： 1、65岁以上老年组中，危险因素排序依次为高血压病17（51.5%）、卒中病史12（36.4%）、高脂血症11（33.3%）、吸烟6（18.2%）、糖尿病4（12.1%）、酗酒2（6.1%）。青年对照组中，危险因素排序依次为高血压病21（52.5%）、吸烟19（47.5%）、高血脂14（35%）、酗酒11（27.5%）、卒中病史5（12.5%）、糖尿病4（10%）。占前3位的发病危险因素分别为：老年组的高血压、脑卒中史及高血脂，青年组的高血压、吸烟及高血脂。高血压和高血脂为两组共同主要危险因素。老年的卒中病史及青年的吸烟、酗酒为各自重要危险因素。 2、老年组血管病变率28/33=84.8%，青年组血管病变率28/40=70%。单一血管病变发生率，老年组为14/28=50%，青年组为21/28=75%。其中2处以上血管的病变比例也有区别，，老年组为14/28=50%，青年组为7/28=25%。颅内外血管的病变比例，老年组为10/39=0.26：1，青年组为30/6=5：1。老年组血管病变率高于青年组，老年组2处以上病变多见，青年组单一血管病变多见，老年组颅外血管病变发生率较高，青年组颅内血管病变发生率较高(P0.05)。重度狭窄及血管闭塞比例，老年组：青年组=65.3%：55.6%。 3、侧枝循环开放情况，老年组11例（33.3%）一级侧枝循环开放，共13处，5例（15.2%）二级侧枝循环6处，青年组8例（20%）一级侧枝循环开放，共11处，3例（7.5%）二级侧枝循环5处。两组侧枝循环开放情况相当。
[Abstract]:Objective:
Digital Subtraction Angiography (DSA) technique was used to study the characteristics and distribution of cerebrovascular disease in patients with cerebral apoplexy over 65 years of age, and to analyze the effect of risk factors of cerebrovascular disease on cerebral vessels.
Information and methods:
From September 2008 to January 2014, 33 cases of cerebral apoplexy were examined by DSA in two families in the neurology hospital of Sino Japanese Friendship Hospital from September 2008 to January 2014, and 40 cases of stroke patients aged 25-45 years old were set up as the control group.
Using the Seldinger technique and the improved technique, through the femoral artery puncture and the intubation of the whole brain angiography, the location of the intracranial and external artery stenosis, the degree, the collateral circulation and the opening of the Willis ring were recorded, and the types, characteristics and distribution of the vascular diseases were analyzed, and the risk factors of cerebrovascular disease (including hypertension, diabetes, pawns) were also analyzed. History, smoking, drinking and hyperlipidemia were recorded and analyzed. The etiology and angiopathy of more than 65 Elderly people were studied. SPSS17.0 software was used to carry out data entry and statistics. Counting data were used in Chi square test and measurement data were analyzed with variance. P0.05 indicated that the difference was statistically significant.
The degree of vascular stenosis was divided into 4 levels, complete occlusion according to NASCET standard, and severe stenosis: the degree of stenosis was 70%~99%; (3) moderate stenosis: the degree of stenosis was 50%~69%; (4) mild stenosis or normal: the degree of stenosis was 50% or no abnormal. Artery stenosis was considered to be more than 50%.
Result:
1,33 aged over 65 years old, the highest 81 years old, the lowest 65 years old, the average age of 70.47 + 4.17 years, male: female 21:12=1.75:1. hypertension, 17 cases, diabetes 4 cases, hyperlipidemia 11 cases, smoking 6 cases, 2 cases of alcoholism, 12 cases of stroke, among them 2 more 18 cases.
2, the DSA examination in the elderly group showed that 28 cases had vascular lesions, 49 vascular lesions and 14 cases above 2 lesions, including 17 vascular occlusion, 15 severe stenosis, 9 moderate stenosis, mild 7, and 1 aneurysms. Among them, 19 collateral circulation vessels were open and primary collateral circulation (Willis ring) was open to 13 places: anterior communicating artery 6, posterior traffic movement The total vein was 7, and the two grade collateral circulation opened in 6 places: 2 cases were open before the discovery of the pia anastomosis artery, 2 cases of posterior PIA anastomosis artery opening, 1 cases of open ophthalmic artery, and 1 perforator artery open cases.
3,40 cases of young patients in the control group, the highest 45 years old, the lowest 28 years old, the average age was 39.67 + 4.26 years old, male: women were 29:11=2.64:1. hypertension 21 cases, diabetes 4 cases, hyperlipidemia 14 cases, smoking 19 cases, alcoholism 11 cases, 5 cases of stroke disease history, of which 2 more 20 cases.
4, the DSA examination in the youth group showed 28 cases of vascular lesions, 36 vascular lesions and 7 cases above 2 lesions, including 16 vascular occlusion, 4 severe stenosis, 7 moderate stenosis, 9 mild, 1 aneurysms and 2 moyamoya disease. Among them, the circulation of collateral branches in the 16 places was open and the first grade collateral circulation (Willis ring) opened in 11: anterior communicating artery 6, posterior communicating artery There were 5 lateral collateral circulation at two levels: 2 cases of anterior PIA anastomosis, 2 cases of posterior PIA anastomosis and 1 cases of open ophthalmic artery.
Conclusion:
The order of risk factors was 17 (51.5%), 12 (36.4%) of stroke disease, 11 (33.3%) of hyperlipidemia, 6 (18.2%), 4 (12.1%) and 2 (6.1%). In the young control group, the order of risk factors was high blood pressure disease 21 (52.5%), high blood lipid, alcoholism, alcoholism and stroke history. .5%), diabetes 4 (10%). The risk factors for the first 3 were: hypertension in the elderly group, the history of stroke and hyperlipidemia, hypertension in the youth group, smoking and hyperlipidemia, hypertension and hyperlipidemia as the common risk factors in two groups. The history of stroke in the elderly and the smoking and drinking of young people were the major risk factors.
2, the rate of vascular lesions in the elderly group was 28/33=84.8%, the rate of 28/40=70%. single vascular lesion in the young group was 14/28=50%, the elderly group was 14/28=50%, and the proportion of the lesions in the young group was 2 and more. The elderly group was 14/28=50%, the young group was the 7/28=25%. lesion ratio of the external intracranial vessels, and the elderly group was 10/39=0.26:1, green. The rate of vascular lesions in the elderly group was higher than that of the young group, and more than 2 lesions in the elderly group were more common, the single vascular lesions in the young group were more common, the incidence of extracranial vascular lesions in the elderly group was higher, the incidence of intracranial vascular lesions in the young group was higher (P0.05). The proportion of severe stenosis and vascular closure was in the elderly group: the young group was =65.3%:55.6%.
3, the circulation of lateral branches was open, 11 cases (33.3%) in the elderly group were open, 13, 5 (15.2%), 6 of the grade two collateral circulation, 8 (20%) in the youth group (20%), 11, 3 (7.5%) collateral circulation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

【参考文献】