单纯枕叶梗死的临床研究

发布时间：2018-09-06 15:48

【摘要】：目的：1)研究单纯枕叶梗死危险因素与其他部位脑梗死的差异性；2)研究单纯枕叶梗死的病因；3)研究单纯枕叶梗死的临床表现；4)研究枕叶梗死的预后。 方法：收集2003年1月至2013年12月于我院（大连医科大学附属第二医院）神经内科住院的152例患者。其中41例为单纯枕叶梗死，，71例为枕叶合并其他部位梗死和40例非枕叶后循环梗死患者。住院时离发病时间最早为2小时，最晚1个月，诊断标准按照第五届全国脑血管病会议制定的标准。入院后均行颅脑核磁共振检查及血管评估检查，记录入选对象高血压病史、吸烟、糖尿病病史、饮酒、冠心病、房颤、既往脑梗死病史等脑梗死的相关危险因素以及临床表现。所有病例依据梗死部位分为3组，即A组为单纯枕叶梗死组、B组为枕叶合并其他部位梗死组、C组为后循环非枕叶梗死组。A组中，男31例,女10例，男女比例3.10:1，年龄44-91岁，平均年龄67.3211.856岁；B组中，男42例，女29例，男女比例1.45:1，年龄40-92岁，平均年龄68.1711.426岁；C组中,男23例,女17例，男女比例1.35:1，年龄50-83岁，平均年龄68.159.736岁。采用单因素方差分析和χ2检验比较三组的危险因素；采用χ2检验比较三组病因构成比之间差异；预后相关分析采用Logistic回归。设定检验标准为0.05， P＜0.05时，差异有统计学意义。 结果：危险因素:三组所有的危险因素比较，均为P〉0.05，差异无统计学意义，A组、B组及C组的危险因素无差异性。高血压病在危险因素中所占的比例最高，其次是吸烟，三组中男性比女性脑梗死的发病率更高。病因分析中，发现A组和B组,B组和C组之间病因构成比存在差异性,A组和C组之间病因构成比无差异性；A组和C组病因最多见的是大动脉粥样硬化,其次是穿支动脉疾病；单纯枕叶梗死中，大动脉狭窄≥50%的最常见的是椎动脉，其次是颈内动脉，第三是大脑后动脉。临床表现：视觉障碍、头痛、肢体瘫痪、感觉障碍在单纯枕叶梗死中有较高的发生率,单纯枕叶梗死还可表现出眩晕和（或）呕吐、言语不清、失语、TIA、小便失禁、无症状、共济失调，但无特异性；视觉障碍中以视物模糊及视力减退最常见,视觉障碍和预后有相关性，相关系数为-1.167，呈负相关，存在视觉障碍的枕叶梗死预后不良。预后：按组别为分类标准，对三组的预后进行检验，发现2=6.044，P=0.1960.05，三组的预后无明显差异性；但以是否发生视觉障碍为分类标准，发现2=6.043，P=0.0490.05，差异有统计学意义，存在视觉障碍的枕叶梗死预后不良。 结论：1.单纯枕叶梗死的病因最常见的是大动脉粥样硬化，单纯枕叶梗死中狭窄≥50%的大动脉最多见的是椎动脉，其次是颈内动脉，第三是大脑后动脉； 2．视觉障碍及头痛在单纯枕叶梗死中具有较高的发生率,单纯枕叶梗死还可以有眩晕和（或）呕吐、言语不清、失语、TIA、小便失禁、无症状、共济失调等表现。
[Abstract]:Objective: to study the difference between the risk factors of occipital infarction and other cerebral infarction (2) to study the etiology of occipital lobe infarction (3) to study the clinical manifestations of occipital lobe infarction 4) to study the prognosis of occipital infarction. Methods: from January 2003 to December 2013, 152 patients were hospitalized in Department of Neurology, Dalian Medical University (second affiliated Hospital of Dalian Medical University). Among them, 41 cases were simple occipital lobe infarction, 71 cases were occipital lobe with other infarction and 40 cases were non-occipital posterior circulation infarction. The first two hours from the onset of the disease, the latest one month, the diagnostic criteria according to the Fifth National Conference on Cerebrovascular Disease standards. After admission, MRI and vascular assessment were performed to record the risk factors and clinical manifestations of cerebral infarction, such as history of hypertension, smoking, diabetes mellitus, alcohol consumption, coronary heart disease, atrial fibrillation and previous history of cerebral infarction. All the patients were divided into three groups according to the infarct location. Group A was simple occipital infarction group B group was occipital lobe infarction group C group was posterior circulation non-occipital lobe infarction group, male 31 cases, female 10 cases, male to female ratio 3.10: 1, age 44 to 91 years old. The average age of group B was 67.3211.856 years old. There were 42 males and 29 females, the ratio of male to female was 1.45: 1, the age was 40-92 years old, the average age was 68.1711.426 years old, there were 23 males and 17 females, the ratio of male to female was 1.35: 1, the age was 50-83 years old, the average age was 68.159.736 years old. Univariate ANOVA and 蠂 2 test were used to compare the risk factors of the three groups, 蠂 2 test was used to compare the difference of the etiological composition ratio among the three groups, and Logistic regression was used to analyze the prognostic correlation. The test standard was 0.05, P < 0.05, the difference was statistically significant. Results: all the risk factors in the three groups were compared with each other (P > 0.05). There was no significant difference in the risk factors between group A and group C. Hypertension accounted for the highest proportion of risk factors, followed by smoking. The incidence of cerebral infarction in males was higher than that in females. In etiological analysis, it was found that there was a difference in etiological composition ratio between group A and group B and group C. The most common etiology of group A and group C was atherosclerosis, followed by perforating artery disease. In simple occipital infarction, the main artery stenosis 鈮

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