气虚血瘀型缺血性卒中患者脑动静脉脉搏波传导时间的研究

发布时间：2018-02-03 13:12

本文关键词： 缺血性卒中气虚血瘀脉搏波传导时间　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：从气虚血瘀型缺血性卒中的血流动力学特点入手,研究气虚血瘀型缺血性卒中患者脑动静脉间脉搏波传导时间(cerebral arerio-venous pulse wave time, CAV-PWT),分析该类型卒中患者的CAV-PWT与血流动力学相关指标及颈动脉情况的相关性,从而为气虚血瘀型缺血性卒中患者的预防、诊断与治疗提供新的依据。方法：选择在2014年10月至2015年5月期间收入深圳市第二人民医院神经内科住院的气虚血瘀型腔隙性脑梗死患者22例,平均年龄(67.36±12.82)岁,男性11例,女性11例；气虚血瘀型大动脉粥样硬化型脑梗死患者20例,平均年龄(63.4±11.98)岁,男性13例,女性7例,同时选择同期住院的20例未发生缺血性卒中的患者作为对照组,平均年龄(58.17±13.02)岁,其中男性12例,女性8例,采用经颅多普勒(transcranialdoppleultransonograp,TCD)同时监测颈内动脉终末段(terminal internal carotid artery,TICA)与基底静脉(Rosenthal's veins;venae basalis, BVR)的脉搏波,用相移方法计算CAV-PWT。采用SPSS 19统计软件对所得数据资料进行统计分析,检验水准α=0.05。结果：1.气虚血瘀型腔隙性脑梗死组(气虚血瘀型LI组)、气虚血瘀型大动脉粥样硬化组(气虚血瘀型LAA组)与对照组CAV-PWT相比,有统计学差异(P0.05),气虚血瘀型LI组与LAA组组间比较差异无统计学意义(P0.05)。2. CAV-PWT与年龄、HCY存在负相关性(r=-0.425,-0.29,P0.05)；与身高、体重、体重指数、头围、FBG、2h-PBG、TG、CHO、LDL-C、HDL-C等未有相关性(P0.05)。3. CAV-PWT与心率、收缩压、舒张压、脉压、平均动脉压存在负相关性(r=-0.048, r=-0.039, r=-0.29, r=-0.33, r=-0.25, P＜0.05)4. CAV-PWT与LVEF存在显著正相关性(r=0.42,P0.01),与LVS、LVD无相关性(P0.05)。5. L-CAV-PWT与LTICA-PI、LTICA-RI、LBVR-PI、LBVR-RI存在相关性(r=-0.28, r=-0.26, r=0.27, r=0.27, P＜0.05),此种情况同样出现在右侧,与Vs、Vd无相关性(P0.05)。6. CAV-PWT与颈动脉斑块长度存在显著负相关性(L-r=-0.55, R-r=-0.59, P＜0.05),而与斑块厚度无相关性(P＞0.05);CAV-PWT是颈动脉硬化较为敏感的危险因素(L-Exp(B)=0.00,R-Exp(B)=0.00,P＜0.01)。结论：1.气虚血瘀型缺血性卒中患者都有不同程度的脑动脉硬化；2.气虚血瘀型缺血性卒中患者的CAV-PWT与心率、LVEF密切相关,提示心气虚对缺血性卒中患者的血流动力学变化起着重要作用。3.气虚血瘀型缺血性卒中患者CAV-PWT与PI、RI有相关性,而与颅内血管血流速度无相关性,提示CAV-PWT主要是反映血管壁弹性、血管阻力的指标,而颅内血管血流速度对CAV-PWT的影响可能较小。4.气虚血瘀型缺血性卒中患者CAV-PWT与颈动脉斑块长度关系密切,而与斑块厚度无关,这提示,如果斑块的存在未明显影响血管直径,对CAV-PWT的影响可能比较小,但是斑块的长度,由于直接影响到动脉僵硬节段的距离,对CAV-PWT的影响则较大。
[Abstract]:Objective: to study the hemodynamic characteristics of ischemic stroke with deficiency of qi and blood stasis. To study cerebral arerio-venous pulse wave time in cerebral arteriovenous pulse wave conduction in patients with ischemic stroke with deficiency of qi and blood stasis. CAV-PWTG, to analyze the correlation between CAV-PWT and hemodynamics and carotid artery in patients with this type of stroke, so as to prevent ischemic stroke with deficiency of qi and blood stasis. New basis for diagnosis and treatment. Methods:. From October 2014 to May 2015, 22 patients with lacunar cerebral infarction of Qi deficiency and blood stasis were enrolled in the Department of Neurology, second people's Hospital of Shenzhen. The average age was 67.36 卤12.82 years old, 11 males and 11 females; There were 20 patients with Atherosclerosis cerebral infarction with deficiency of qi and blood stasis, with an average age of 63.4 卤11.98 years, 13 males and 7 females. At the same time, 20 inpatients with no ischemic stroke were selected as the control group. The average age was 58.17 卤13.02 years old, including 12 males and 8 females. Transcranial doppler transonograp was used. The terminal terminal internal carotid artery of the internal carotid artery was monitored by TCD. TICA) and Rosenthalus veins; The pulse wave of venae basalis (BVR) was calculated by phase shift method. The data were analyzed by SPSS 19 software. Results: 1. Lacunar cerebral infarction group (Li group) with Qi deficiency and blood stasis (Qi deficiency and blood stasis type). Qi deficiency and blood stasis type of atherosclerosis group (Qi deficiency and blood stasis type LAA group) compared with the control group CAV-PWT, there was statistical difference (P0.05). There was no significant difference between Li group and LAA group in Qi deficiency and blood stasis. There was a negative correlation between CAV-PWT and age. -0.29 (P0.05); And height, body weight, body mass index, head circumference FBGG 2h-PBGN TGG, CHOU LDL-C. There was no correlation between CAV-PWT and heart rate, systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure. There was a negative correlation between CAV-PWT and heart rate, systolic blood pressure, pulse pressure and mean arterial pressure. R-0.039, r-0.29, r-0.33, r-0.25. There was a significant positive correlation between CAV-PWT and LVEF (P < 0.05). There was a significant positive correlation between CAV-PWT and LVS. There was no correlation between LVD and LBVR-PI. L-CAV-PWT and LTICA-Pi. There were significant correlations between LBVR-RI and LBVR-RI, such as r-0.28, r-0.26, r-0.27, r-0.27, P < 0.05, which also occurred on the right side. There was no significant correlation between CAV-PWT and plaque length of carotid artery. There was a significant negative correlation between CAV-PWT and carotid plaque length. P < 0.05, but no correlation with plaque thickness (P > 0.05). CAV-PWT is a sensitive risk factor for carotid atherosclerosis. Conclusion 1. All patients with ischemic stroke with deficiency of qi and blood stasis have different degrees of cerebral arteriosclerosis. 2. The CAV-PWT of patients with ischemic stroke with deficiency of qi and blood stasis was closely related to heart rate. It is suggested that deficiency of heart qi plays an important role in hemodynamic changes of ischemic stroke patients. 3. There is a correlation between CAV-PWT and Pi RI in patients with ischemic stroke with deficiency of qi and blood stasis. However, there was no correlation between CAV-PWT and blood flow velocity of intracranial vessels, suggesting that CAV-PWT is an index of vascular wall elasticity and vascular resistance. The effect of intracranial blood flow velocity on CAV-PWT may be small. 4. The relationship between CAV-PWT and carotid plaque length is close, but not with plaque thickness in patients with ischemic stroke with deficiency of qi and blood stasis. This suggests that if the plaque does not significantly affect the diameter of the vessel, the effect on CAV-PWT may be relatively small, but the length of the plaque is directly related to the distance between the rigid segments of the artery. The effect on CAV-PWT is greater.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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