颈动脉斑块的性质与其社区高危人群常见危险因素的关系及对颈动脉支架植入术的影响

发布时间：2018-07-31 06:52

【摘要】：第一部分颈动脉斑块的性质与其社区高危人群常见危险因素的关系目的：探讨颈动脉斑块的性质与其社区高危人群常见危险因素之间的关系。方法：收集2008年1月至2012年8月查颈彩超的本地社区动脉粥样硬化高危人群的资料(共277例)，以单因素及多因素方法分析颈动脉斑块的性质(扁平斑、软斑、硬斑和溃疡斑)与其常见危险因素的关系。结果：单因素分析发现：颈动脉的扁平斑和溃疡斑的检出率随年龄增长呈增多趋势；扁平斑80岁以上者明显多于65岁以下者(P 0.01)，溃疡斑80岁以上者明显多于80岁以下者(P 0.05)。女性(P 0.01)及高血压(P 0.05)患者的软斑检出率明显减少。多因素分析发现：年龄不仅是影响颈动脉斑块形成(OR=1.098, P=0.000)，而且是影响扁平斑(OR溃疡斑=1.048, P=0.011）和溃疡斑(OR扁平斑=1.034,P=0.012)增多的主要危险因素。结论：颈动脉斑块的性质与高危人群的年龄、性别及高血压相关；女性及高血压患者颈动脉软斑相对较少，高龄患者扁平斑及溃疡斑明显增多。第二部分斑块的性质对颈动脉支架植入术的影响目的：探讨斑块的性质对颈动脉支架植入术的影响资料方法：收集从2012年1月到2014年1月在我院神经内科住院治疗并且经影像学及DSA检查后证实符合颈动脉支架植入治疗共48例资料.所有患者资料按斑块的性质分为软斑块组23例，硬斑块组16例，溃疡斑块组9例。观察颈动脉支架植入术（CAS）中血压及心率的变化情况及术前、术后影像学的改变。结果：软斑块组球囊扩张前的收缩压（147.03±8.78vs133.53±10.92, t=9.98, P=0.000）及心率（81.09±7.08vs73.55±6.81, t=7.15, P=0.000）与球囊扩张后相比均有明显降低，达统计学差异，血氧饱和度在球囊扩张前后无明显差异；支架植入前后血压、心率及均无明显改变。硬斑块组收缩压（152.67±9.67vs126.88±13.41, t=14.16, P=0.000）及舒张压（80.01±8.61vs69.78±8.85, t=3.03, P=0.008）在球囊扩张后均有明显下降；心率在球囊扩张前后亦有统计学差异（84.59±6.69vs70.82±7.21, t=9.72, P=0.000）；球囊扩张前后血氧饱和度无明显改变（t=1.89, P=0.07）。支架植入前后收缩压（P=0.28）、舒张压（P=0.13）改变无统计学意义，而支架植入前后心率有统计学意义（84.52±6.69vs79.23±7.21, t=3.95, P=0.001）。溃疡斑块组心率在球囊扩张前后有统计学意义（77.75±7.01vs74.51±8.73, t=5.8, P=0.001），而收缩压（149.25±13.43vs146.01±9.51, t=1.38, P=0.38）、舒张压（72.33±3.41vs70.22±6.31, t=1.99, P=0.28）及血氧饱和度（t=0.59, P=0.15）在球囊扩张前后均无统计学意义。收缩压（P=0.35）、舒张压（P=0.81）及心率（P=0.35）及在支架植入前后均无统计学意义。组间比较：三组中硬斑块组在球囊扩张时所需要的压力（χ2=27.25, P=0.000）及扩张次数（χ2=18.504, P=0.003）明显多于软斑组及溃疡斑块组，有统计学意义；硬斑块组球囊扩张前后收缩压（F=35.86，P=0.000）、舒张压(F=22.835,P=0.000)及心率（F=14.45，P=0.001）明显高于软班组和溃疡斑块组。软斑组深穿支梗死占11.1%（2/18），皮质梗死占89.8%（16/18）,硬斑块出现深穿支梗死占66.7%（6/9），，皮质梗死占33.3%（3/9），两组相比具有统计学意义（χ2=6.417，P=0.011）。结论：软斑块组术中球囊扩张时所需压力比硬斑块组小，次数比硬斑块组少；球囊扩张后收缩压及心率有明显下降，但支架植入前后两者无明显改变。硬斑块组术中球囊扩张时需要压力比软斑块组及溃疡斑块组大，次数比软斑块组及溃疡斑块组多；球囊扩张前后血压及心率有明显改变；支架植入前后血压无明显变化，但心率有明显改变。溃疡斑块组术中球囊扩张时需要压力最低，次数比硬斑块组少；球囊扩张前后血压，无明显改变；而心率有明显变化。支架植入前后血压及心率均无明显改变。颈动脉支架植入术后软斑块易导致皮质梗死，而硬斑块易导致深穿支梗死。
[Abstract]:Part one
The relationship between the nature of carotid plaques and the common risk factors of high-risk population in the community
Objective:
Objective to explore the relationship between the nature of carotid plaques and the common risk factors of high-risk population in the community.
Method:
Data (277 cases) were collected from the local community atherosclerosis high risk population from January 2008 to August 2012. The relationship between the characteristics of carotid plaque (flattened spots, soft spots, hard spots, and ulcer spots) with common risk factors was analyzed by single factor and multi factor method.
Result:
Single factor analysis showed that the detection rate of flattened plaques and ulceration spots increased with age; those with flat spots over 80 years of age were obviously more than those under the age of 65 (P 0.01), and those over 80 years old were significantly more than those under the age of 80 (P 0.05). The detection rate of soft spots in women (P 0.01) and high blood pressure (P 0.05) decreased significantly. It was found that age not only affects the formation of carotid plaque (OR=1.098, P=0.000), but also the main risk factor affecting the increase of the flat plaque (OR =1.048, P=0.011) and the ulcer plaque (OR flat plaque =1.034, P=0.012).
Conclusion:
The characteristics of carotid artery plaque are associated with age, sex and hypertension in high risk groups. There are relatively few carotid plaques in women and hypertensive patients, and there is a significant increase in flattened spots and ulcerative spots in older patients.
The second part
Effects of plaque characteristics on carotid artery stenting
Objective: To investigate the effects of plaque characteristics on carotid artery stenting.
Data method:
A total of 48 patients were collected from January 2012 to January 2014 in the neurology department of our hospital and confirmed by imaging and DSA examination. The data were divided into 23 cases in soft plaque group, 16 cases of hard plaque group and 9 cases of ulcer plaque group according to the nature of plaque. The blood pressure and blood pressure in carotid artery stent implantation (CAS) were observed. The change of heart rate and preoperative and postoperative imaging changes.
Result:
The systolic pressure (147.03 + 8.78vs133.53 + 10.92, t=9.98, P=0.000) and heart rate (81.09 + 7.08vs73.55 + 6.81, t=7.15, P=0.000) before balloon dilatation in soft plaque group were significantly lower than that of balloon dilatation. There was no significant difference between balloon dilatation and balloon dilatation. There was no significant difference in blood oxygen saturation before and after balloon dilatation; blood pressure and heart rate were not obvious before and after stent implantation. Change.
The systolic pressure (152.67 + 9.67vs126.88 + 13.41, t=14.16, P=0.000) and diastolic pressure (80.01 + 8.61vs69.78 + 8.85, t=3.03, P=0.008) in the hard plaque group decreased significantly after the balloon dilation, and the heart rate was also statistically different (84.59 + 6.69vs70.82 + 7.21, t=9.72, P=0.000) before and after the balloon dilation, and the oxygen saturation was not obvious before and after the balloon dilation. The changes (t=1.89, P=0.07). The systolic pressure (P=0.28) and diastolic pressure (P=0.13) before and after the stent implantation had no statistical significance, but the heart rate before and after the stent implantation was statistically significant (84.52 + 6.69vs79.23 + 7.21, t=3.95, P=0.001).
The heart rate of the ulcer plaque group was statistically significant before and after balloon dilatation (77.75 + 7.01vs74.51 + 8.73, t=5.8, P=0.001), while systolic pressure (149.25 + 13.43vs146.01 + 9.51, t=1.38, P=0.38), diastolic pressure (72.33 + 3.41vs70.22 + 6.31, t=1.99, P=0.28) and oxygen saturation (t=0.59, P=0.15) were not statistically significant before and after balloon dilatation. P=0.35), diastolic blood pressure (P=0.81) and heart rate (P=0.35) were not statistically significant before and after stent implantation.
Group comparison: the pressure (chi 2=27.25, P=0.000) and expansion times (x 2=18.504, P=0.003) in the three groups of hard plaque group were significantly more than that in the soft plaque group and the ulcer plaque group, with statistical significance. The systolic pressure (F=35.86, P=0.000), diastolic pressure (F=22.835, P=0.000) and heart rate (F=14.45, P=0.001) before and after balloon dilatation in the hard plaque group were statistically significant. It was significantly higher than the soft group and the ulcer plaque group. The deep perforating infarction in the soft spot group was 11.1% (2/18), the cortical infarct accounted for 89.8% (16/18), the deep perforating infarction of the hard plaque was 66.7% (6/9), the cortical infarct accounted for 33.3% (3/9), and the two groups were statistically significant (x 2=6.417, P= 0.011).
Conclusion:
The pressure of balloon dilatation in the soft plaque group was smaller than the hard plaque group, and the number of times was less than that in the hard plaque group. The systolic pressure and heart rate decreased significantly after the balloon dilation, but there was no significant change in the two groups before and after the stent implantation.
In the hard plaque group, the pressure of the balloon was larger than the soft plaque group and the ulcer plaque group. The number of times was more than the soft plaque group and the ulcer plaque group. The blood pressure and heart rate before and after the balloon dilation were obviously changed. The blood pressure before and after the stent implantation did not change obviously, but the heart rate was obviously changed.
In the ulcer plaque group, the balloon dilatation needs the lowest pressure, less times than the hard plaque group, and the blood pressure before and after the balloon dilatation does not change obviously, but the heart rate has obvious changes.
Soft plaque after carotid artery stent implantation can cause cortical infarction, while hard plaque can lead to deep perforating infarction.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.33

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