延髓内侧梗死病情进展、严重程度及预后的相关因素分析

发布时间：2018-08-27 11:54

【摘要】：目的:研究影响延髓内侧梗死患者病情进展、严重程度和预后的因素。方法:回顾性分析我科2012年4月至2016年6月的急性延髓内侧梗死的住院病例,总结病例的危险因素、发病机制、临床表现、影像学特征及预后,研究影响疾病进展、严重程度及预后的因素。结果:34例MMI病例中,(1)高血压患者85.3%,男性79.4%,糖尿病52.9%,影像存在陈旧性腔隙性脑梗死70.6%,吸烟50%;发病情况:26.5%为晨起后发病,14.7%劳累后,14.7%活动中,3.0%饮酒后;病情进展29.4%;(2)临床表现,运动障碍88.2%,82.4%存在构音障碍,55.9%面瘫,舌瘫52.9%,44.1%出现肢体感觉障碍;(3)梗死灶位于左侧47.6%,头部44.1%,腹侧38.2%,32.4%同时累及腹、内、中侧;椎动脉硬化的61.8%;(4)主要为大动脉粥样硬化型;出院时61.8%预后良好。进展性卒中组与非进展性卒中组比较,两组间晨起后发病、大动脉粥样硬化发病机制、小动脉病变发病机制、病灶累及2个以上层面、病灶累及头部+中部,差异有统计学意义(P0.05)。小卒中组与中重度卒中组相比较,两组间既往卒中史、中-重度运动障碍、吞咽困难、饮水呛咳,差异具有统计学意义(P0.05)。预后比较,两组间既往卒中史、中-重度运动障碍、言语障碍、吞咽困难、饮水呛咳、咽反射障碍、病灶位于交界+头部,差异具有统计学意义(P0.05)。结论:(1)MMI以男性居多,高血压、糖尿病、吸烟是其前3位危险因素;(2)MMI最常见症状是肢体运动和构音障碍;(3)多位于延髓腹侧、中上部。
[Abstract]:Objective: to study the factors influencing the progression, severity and prognosis of patients with medial medullary infarction. Methods: the inpatients with acute medial medullary infarction from April 2012 to June 2016 were analyzed retrospectively. The risk factors, pathogenesis, clinical manifestations, imaging features and prognosis were summarized. Severity and prognostic factors. Results among 34 cases of MMI, (1) 85.3% of patients with hypertension, 79.4% of men, 52.9% of diabetes mellitus, there were 70.6% of old lacunar cerebral infarction on images, 50 cases of smoking. The incidence of the disease was 14.7% after onset of illness in the morning, 3.0% in 14. 7% of activities, 29. 4% in progression of disease. (2) Clinical manifestations, 82.4% of the patients had dysarthria, 55.9% of them had facial paralysis, 44.1% of them had palsy of limbs; (3) the infarct was located on the left side 47.6%, the head 44.1%, the ventral 38.2% involved the abdomen, the internal side, the middle side, the vertebral arteriosclerosis 61.8%; (4) the main type of arteriosclerosis was the arteriosclerosis of the great arteries; (3) the infarct was located on the left side 47.6%, the head 44.1%, the ventral 38.2% at the same time, and the internal side, the middle side, the vertebral arteriosclerosis 61.8%; 61.8% had good prognosis at discharge. In the progressive stroke group and the non-progressive stroke group, the pathogenesis of atherosclerosis, arteriolar lesions, the involvement of more than 2 layers, and the middle of the head were found between the two groups. The difference was statistically significant (P0.05). Compared with the moderate and severe stroke group, the two groups had a history of stroke, moderate to severe motor disorder, dysphagia, drinking water choking cough, the difference was statistically significant (P0.05). The prognosis was compared between the two groups: the history of stroke, moderate to severe motor disorder, speech disorder, dysphagia, drinking water choking cough, pharyngeal reflex disorder, lesion located at the head of the junction, the difference was statistically significant (P0.05). Conclusion: (1) MMI is the most common risk factor in male patients with hypertension diabetes and smoking. (2) the most common symptom of MMI is limb movement and dysarthria (3) it is located in the ventral side of medulla oblongata with middle and upper part of medulla oblongata.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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