羟乙基淀粉治疗分水岭脑梗死临床疗效研究
发布时间：2018-12-09 18:30
【摘要】：目的研究扩容药物羟乙基淀粉(HES)对分水岭脑梗死(CWI)在临床中的治疗效果,分析HES对不同类型CWI患者的临床疗效差异及不同类型CWI与颅内外血管狭窄的关系,为临床工作中的个体化治疗寻找依据。方法选择2010年10月-2016年05月住院的CWI患者93例,所有研究对象符合第四届脑血管病学术会议的脑血管病诊断标准。入组者为发病24小时内经颅脑磁共振(MRI)常规检查联合扩散加权成像(DWI)检查技术确诊为CWI患者,存在与梗死灶明确相关的临床症状和体征,初次发病者以及既往有脑梗死病史但未存留显著神经系统受损表现者,排除全身低灌注、心源性栓塞、自身免疫相关性疾病、脑出血、肿瘤及对羟乙基淀粉过敏患者,所有患者完善颈内动脉颅外段(internal carotid artery,ICA)彩超和颅内血管磁共振3D TOF血管造影(MRA)成像检查。将分水岭脑梗死的患者93例随机分为两组,试验组为50例和对照组43例。试验组患者给予抗血小板、脑细胞保护等一般治疗+6%中分子羟乙基淀粉注射液130/0.4 500ml ivdrip qdx14天扩容治疗,对照组给予上述一般治疗。采用NIHSS评分评估患者入院时、入院第七天、入院第十四天的神经功能缺损程度。结果1.两组患者年龄、性别、CWI类型、高血压、冠心病、糖尿病、高脂血症、吸烟史、饮酒史比较并无统计学意义(P0.05)。2.两组患者入院时比较NIHSS评分无统计学差异(P0.05),治疗第7天、治疗第14天NIHSS评分两组患者均较入院时有显著好转,分别与入院时比较有统计学意义(P0.05),同时,试验组与同期对照组比较有统计学意义(P0.05)。两组治疗第7天、第14天疗效比较差异有统计学意义(P0.05)。试验组中两种类型CWI患者神经功能恢复有统计学差异(P0.05),HES扩容治疗对皮质下分水岭脑梗死(IWSI)效果优于皮质分水岭脑梗死(CWSI)。3.不同类型CWI病灶侧血管的狭窄检出率不同,CWSI多伴有同侧相应颈内动脉(ICA)狭窄(OR值为0.019;95%CI为0.003~0.227;P=0.016);IWSI多伴有同侧大脑中动脉(MCA)狭窄(OR值为39.271;95%CI为3.179~399.818;P=0.021)。结论1.HES扩容治疗CWI疗效显著,患者的神经功能受损症状得到改善。HES扩容治疗对IWSI神经功能恢复效果优于CWSI。2.颅内外大血管病变与CWI的发生有重要关系,病灶侧血管ICA、MCA病变的发生比例依CWI类型不同亦有差别。CWSI多伴有病灶侧ICA狭窄;IWSI多伴有病灶侧MCA狭窄。
[Abstract]:Objective to study the therapeutic effect of dilatation drug hydroxyethyl starch (HES) on watershed cerebral infarction (CWI) in patients with cerebral infarction, and to analyze the difference of clinical efficacy of HES in patients with different types of CWI and the relationship between different types of CWI and intracranial and extracranial vascular stenosis. To find the basis for individualized treatment in clinical work. Methods 93 patients with CWI were selected from October 2010 to May 2016. All the subjects met the diagnostic criteria of cerebrovascular disease of the 4th Symposium on Cerebrovascular Disease. The patients in the group were diagnosed as CWI within 24 hours after the onset of the disease by conventional craniocerebral magnetic resonance (MRI) combined with diffusion weighted imaging (DWI), and there were clinical symptoms and signs related to the infarct foci. Patients with primary onset and previous history of cerebral infarction without significant neurological damage were excluded from systemic hypoperfusion, cardiogenic embolism, autoimmune related diseases, cerebral hemorrhage, tumors and hypersensitivity to hydroxyethyl starch. All the patients were examined by color Doppler ultrasonography and 3 D TOF angiography (MRA) of internal carotid artery extracranial segment. 93 patients with watershed cerebral infarction were randomly divided into two groups: the experimental group (n = 50) and the control group (n = 43). The patients in the experimental group were treated with anti-platelet and cerebral cell protection, and the patients in the control group were given the general treatment of 6% of hydroxyethyl starch injection (130 / 0.4 500ml ivdrip qdx14 / d). NIHSS score was used to assess the degree of neurological impairment at admission, on day 7 and day 14. Result 1. Age, sex, CWI type, hypertension, coronary heart disease, diabetes, hyperlipidemia, smoking history, drinking history were not statistically significant (P0.05). There was no significant difference in NIHSS scores between the two groups on admission (P0.05). On the 7th day and 14th day of treatment, the NIHSS scores of the two groups were significantly improved compared with the admission time (P0.05), at the same time, there was no significant difference between the two groups (P0.05). There was significant difference between the experimental group and the control group in the same period (P0.05). There was significant difference between the two groups on the 7th day and the 14th day (P0.05). There was significant difference in the recovery of nerve function between the two types of CWI patients in the trial group (P0.05). The effect of), HES expansion on subcortical watershed cerebral infarction (IWSI) was better than that of cortical watershed cerebral infarction (CWSI). 3. The positive rate of stenosis in different types of CWI lesions was different. CWSI was associated with ipsilateral (ICA) stenosis of the internal carotid artery (OR = 0.019 卤95 CI = 0.003 卤0.227). IWSI was associated with ipsilateral (MCA) stenosis of the middle cerebral artery (OR = 39.271, 95 CI = 3.179, 399.818, P = 0.021). Conclusion 1.HES dilatation is effective in the treatment of CWI, and the symptoms of nerve function impairment are improved. HES dilatation is superior to CWSI.2. in the recovery of IWSI nerve function. There was an important relationship between extracranial and extracranial macrovascular lesions and CWI, and the incidence of ICA,MCA in the lesion side was different according to the type of CWI. CWSI was associated with ICA stenosis on the lesion side and IWSI with MCA stenosis on the lesion side.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2369841
[Abstract]:Objective to study the therapeutic effect of dilatation drug hydroxyethyl starch (HES) on watershed cerebral infarction (CWI) in patients with cerebral infarction, and to analyze the difference of clinical efficacy of HES in patients with different types of CWI and the relationship between different types of CWI and intracranial and extracranial vascular stenosis. To find the basis for individualized treatment in clinical work. Methods 93 patients with CWI were selected from October 2010 to May 2016. All the subjects met the diagnostic criteria of cerebrovascular disease of the 4th Symposium on Cerebrovascular Disease. The patients in the group were diagnosed as CWI within 24 hours after the onset of the disease by conventional craniocerebral magnetic resonance (MRI) combined with diffusion weighted imaging (DWI), and there were clinical symptoms and signs related to the infarct foci. Patients with primary onset and previous history of cerebral infarction without significant neurological damage were excluded from systemic hypoperfusion, cardiogenic embolism, autoimmune related diseases, cerebral hemorrhage, tumors and hypersensitivity to hydroxyethyl starch. All the patients were examined by color Doppler ultrasonography and 3 D TOF angiography (MRA) of internal carotid artery extracranial segment. 93 patients with watershed cerebral infarction were randomly divided into two groups: the experimental group (n = 50) and the control group (n = 43). The patients in the experimental group were treated with anti-platelet and cerebral cell protection, and the patients in the control group were given the general treatment of 6% of hydroxyethyl starch injection (130 / 0.4 500ml ivdrip qdx14 / d). NIHSS score was used to assess the degree of neurological impairment at admission, on day 7 and day 14. Result 1. Age, sex, CWI type, hypertension, coronary heart disease, diabetes, hyperlipidemia, smoking history, drinking history were not statistically significant (P0.05). There was no significant difference in NIHSS scores between the two groups on admission (P0.05). On the 7th day and 14th day of treatment, the NIHSS scores of the two groups were significantly improved compared with the admission time (P0.05), at the same time, there was no significant difference between the two groups (P0.05). There was significant difference between the experimental group and the control group in the same period (P0.05). There was significant difference between the two groups on the 7th day and the 14th day (P0.05). There was significant difference in the recovery of nerve function between the two types of CWI patients in the trial group (P0.05). The effect of), HES expansion on subcortical watershed cerebral infarction (IWSI) was better than that of cortical watershed cerebral infarction (CWSI). 3. The positive rate of stenosis in different types of CWI lesions was different. CWSI was associated with ipsilateral (ICA) stenosis of the internal carotid artery (OR = 0.019 卤95 CI = 0.003 卤0.227). IWSI was associated with ipsilateral (MCA) stenosis of the middle cerebral artery (OR = 39.271, 95 CI = 3.179, 399.818, P = 0.021). Conclusion 1.HES dilatation is effective in the treatment of CWI, and the symptoms of nerve function impairment are improved. HES dilatation is superior to CWSI.2. in the recovery of IWSI nerve function. There was an important relationship between extracranial and extracranial macrovascular lesions and CWI, and the incidence of ICA,MCA in the lesion side was different according to the type of CWI. CWSI was associated with ICA stenosis on the lesion side and IWSI with MCA stenosis on the lesion side.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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