基底动脉尖综合征50例临床分析

发布时间：2018-11-18 18:55

【摘要】：目的:基底动脉尖综合征(Top of the Basilar Syndrome TOBS)是由Caplan在1980年提出的,是指基底动脉尖端部位急性缺血或闭塞所导致的相应供血区的血液循环障碍,临床上以丘脑、中脑、小脑、枕叶、颞叶内侧面梗死为表现的一组综合征。TOBS发病率较低,但病情凶险,预后差,死亡率高。本研究通过对TOBS患者危险因素、临床表现、影像学特点、并发症、预后等方面的分析,以提高临床医生对TOBS的认识,做到早期诊断,早期治疗,改善预后。方法:收集2015年6月到2016年10月在河北医科大学第二医院神经内科住院的50例TOBS患者。所有入选患者均符合1995年全国第四届脑血管病学术会议制定的脑梗死的诊断标准,并经头颅CT或MRI检查诊断为TOBS。统计TOBS患者发病的危险因素、病因、临床症状和体征、影像学特点、并发症和预后等相关临床资料,进行统计学分析。结果:1 TOBS的危险因素从高到低依次为高血压、吸烟或饮酒、高脂血症、高同型半胱氨酸血症、糖尿病、心脏病、脑梗死及TIA病史。TOBS病因最多见为脑栓塞。2临床表现最多见的为意识障碍,其次依次为眼球运动障碍,瞳孔异常,运动障碍,行为和认知障碍,言语障碍,偏盲或皮质盲,眩晕,感觉障碍。3各解剖部位按发病频率由高到低依次为:丘脑、小脑、中脑、枕叶、颞叶、桥脑。4 TOBS患者主要的并发症为感染,原因主要为肺部感染和泌尿系感染,其次依次为低蛋白血症、电解质、酸碱平衡紊乱,应激性溃疡,下肢静脉血栓。5 50例患者中21例预后较好,29例预后差,其中8例死亡。结论:1 TOBS最常见的危险因素是高血压,脑栓塞为本病的最主要的病因。2 TOBS的临床表现复杂多样,不同的部位受累,会出现不同的临床表现,其中最常见者为意识障碍和眼球运动障碍,但以上并非诊断本病的必要条件。3临床医生应注重全面查体,并尽早行MRI、DWI、MRA或CT、CTA检查,做到早期诊断,以免漏诊。4基底动脉尖综合征预后差,死亡率和致残率均较高,并发症的出现会加重病情,影响预后。
[Abstract]:Objective: basilar artery apex syndrome (Top of the Basilar Syndrome TOBS) was proposed by Caplan in 1980. It refers to the disturbance of blood circulation in the corresponding blood supply area caused by acute ischemia or occlusion at the tip of the basilar artery. It is clinically characterized by thalamus, midbrain and cerebellum. Occipital and temporal medial infarction is a group of syndrome. The incidence of TOBS is low, but the disease is dangerous, the prognosis is poor, and the mortality is high. In this study, the risk factors, clinical manifestations, imaging features, complications and prognosis of TOBS patients were analyzed in order to improve clinicians' understanding of TOBS, early diagnosis, early treatment and improvement of prognosis. Methods: 50 patients with TOBS were collected from June 2015 to October 2016 in Department of Neurology, second Hospital of Hebei Medical University. All the selected patients were in accordance with the criteria for the diagnosis of cerebral infarction established by the fourth National Symposium on Cerebrovascular Disease in 1995, and were diagnosed as TOBS. by CT or MRI. The risk factors, etiology, clinical symptoms and signs, imaging features, complications and prognosis of TOBS patients were analyzed statistically. Results: 1 the risk factors of TOBS from high to low were hypertension, smoking or drinking, hyperlipidemia, hyperhomocysteinemia, diabetes, heart disease. Cerebral infarction and history of TIA. Cerebral embolism was the most common cause of TOBS. 2 the most common clinical manifestation was consciousness disorder, followed by eye movement disorder, pupil abnormality, motor disorder, behavioral and cognitive disorder, speech disorder, hemianopsia or cortical blindness. The main complications of the patients with vertigo, sensory disturbance and pontine were: thalamus, cerebellum, midbrain, occipital lobe, temporal lobe and pons. 4 the main complications were infection, mainly caused by pulmonary infection and urinary tract infection. Hypoproteinemia, electrolyte, acid-base balance disorder, stress ulcer, venous thrombosis of lower extremity were followed by hypoproteinemia. 21 of 550 patients had good prognosis, 29 had poor prognosis, 8 of them died. Conclusion: 1 the most common risk factor for TOBS is hypertension, and cerebral embolism is the main etiology of the disease. 2 the clinical manifestations of TOBS are complex and diverse, and different sites will be involved, and different clinical manifestations will occur. The most common of them are consciousness disorder and ocular movement disorder, but these are not necessary conditions for diagnosis of this disease. 3 clinicians should pay attention to comprehensive physical examination, and do MRI,DWI,MRA or CT,CTA examination as soon as possible, so as to make early diagnosis. 4 the prognosis of basilar artery apex syndrome was poor, the mortality and disability rate were higher, and the occurrence of complications would aggravate the condition and affect the prognosis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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