幕上脑分水岭梗死与中医体质临床分析

发布时间：2018-04-20 08:08

本文选题：中医体质 + 脑分水岭梗死　；参考：《山东中医药大学》2016年硕士论文

【摘要】：目的:探讨幕上脑分水岭梗死患者中医体质分布特点,脑分水岭梗死的病灶分型、中医体质及颈内动脉系统大血管狭窄之间的关系。方法:收集经头颅CT或MRI及临床证实的127例幕上脑分水岭梗死(cerebral watershed infarction,CWI)患者的一般信息及临床资料;采用体质评分量表评估每位入组患者的中医体质类型;根据影像学资料分析幕上脑分水岭梗死患者的病灶分型;同时采集颈内动脉系统中的病变血管及其狭窄程度;运用统计软件SPSS19.0对数据进行统计学分析。结果:(1)气虚质、痰湿质、阳虚质在入组患者中各占21.26%、16.54%、14.96%。(2)男女脑分水岭梗死发病年龄的差异有统计学意义,男性发病年龄低于女性;60岁及60岁以上患者有90例,占70.87%。(3)各体质类型间颈内动脉系统大血管狭窄率及狭窄部位的差异均无统计学意义。(4)皮质上型(32.94%)、皮质下上型(31.76%)、皮质后型(19.61%)三种类型构成比较高。按皮质型、皮质下型、混合型进行分析得出:皮质型37例(29.13%)、皮质下型25例(19.69%)、混合型65例(51.18%),提示混合型构成比最大。(5)颈内动脉、大脑中动脉、大脑前动脉占所有病变血管的百分比分别为41.50%(61/147)、48.98%(72/147)、9.52%(14/147)。(6)大脑中动脉与颈内动脉比较重度狭窄或闭塞发生率的差别有统计学意义。(7)各病灶分型间颈内动脉系统大血管狭窄部位的差异有统计学意义。(8)气虚质、痰湿质、阳虚质在狭窄组中各占20.18%、16.51%、15.60%。不同体质类型间血管狭窄程度的差异无统计学意义,进一步将体质分为实性体质、虚性体质、平和体质,分析得出仍无统计学意义。(9)各病灶分型间血管狭窄程度的差异有统计学意义。结论:(1)气虚质、痰湿质、阳虚质为幕上脑分水岭梗死患者高危体质。(2)脑分水岭梗死患者老年人多见。男性发病年龄低于女性。(3)不能认为各体质间颈内动脉系统大血管狭窄率及狭窄部位不同。(4)皮质上型、皮质下上型、皮质后型出现频率较多。在皮质型、皮质下型、混合型三者中,以混合型所占比例最大。(5)幕上脑分水岭梗死以大脑中动脉和颈内动脉狭窄或闭塞为主,且大脑中动脉病变率更高,大脑中动脉较颈内动脉发生重度或闭塞的频率更高。(6)混合型较皮质型发生颈内动脉和大脑中动脉病变频率高,皮质型较混合型大脑前动脉病变率高。(7)不能认为各体质类型间血管狭窄程度不同。(8)混合型较皮质下型在血管重度狭窄或闭塞上发生率更高。
[Abstract]:Objective: to investigate the distribution characteristics of TCM constitution in patients with supratentorial cerebral watershed infarction, the types of lesions in cerebral watershed infarction, the relationship between TCM constitution and the stenosis of internal carotid artery system. Methods: the general information and clinical data of 127 patients with cerebral watershed infarction with supratentorial cerebral watershed infarction confirmed by CT or MRI were collected, and the physique types of each patient were evaluated by physique score scale. According to the imaging data, the focus classification of the patients with supratentorial cerebral watershed infarction was analyzed. At the same time, the pathological vessels and the degree of stenosis in the internal carotid artery system were collected. The statistical software SPSS19.0 was used to analyze the data statistically. Results (1) Qi deficiency, phlegm and dampness, yang deficiency accounted for 21.26% of the patients respectively. There were significant differences in the age of onset of cerebral watershed infarction between men and women. The onset age of male patients was lower than that of female patients aged 60 years or over. There was no significant difference in the stenosis rate and the stenotic site of the internal carotid artery system among the three types of constitution. There was no significant difference among the three types. There was no significant difference among the three types: the superior cortical type (32.94), the subcortical type (31.7661) and the posterior type (19.61)). According to the analysis of cortical type, subcortical type and mixed type, it was found that 37 cases of cortical type were involved in 29.13 cases, 25 cases of subcortical type were involved in 19.69C, and 65 cases of mixed type were 51.18T, which suggested that the mixed type had the largest ratio of internal carotid artery and middle cerebral artery. The percentage of anterior cerebral artery in all diseased vessels was 41. 50% 1477% and 48. 98% respectively. There was a significant difference in the incidence of severe stenosis or occlusion between middle cerebral artery and internal carotid artery compared with internal carotid artery. The difference of QI is statistically significant. Phlegm dampness and yang deficiency accounted for 20.18% and 16.51% respectively in the stenosis group. There was no significant difference in vascular stenosis between different physique types. The constitution was further divided into solid constitution, vacuity constitution, peaceful constitution, The results showed that there was no significant difference in the degree of vascular stenosis among different types of lesions. Conclusion (1) Qi deficiency, phlegm dampness and yang deficiency are high risk constitution in patients with supratentorial cerebral watershed infarction. The incidence age of male was lower than that of female. (3) the rate of large vessel stenosis of internal carotid artery system and different stenosed sites were not considered among different physique. The upper cortical type, subcortical type and postcortical type appeared more frequently. Among the cortical type, subcortical type and mixed type, the mixed type accounted for the largest proportion. 5) the main type of supratentorial cerebral watershed infarction was stenosis or occlusion of the middle cerebral artery and the internal carotid artery, and the lesion rate of the middle cerebral artery was higher. The middle cerebral artery (MCA) was more frequently involved in the internal carotid artery (ICA) and middle cerebral artery (MCA) than in the cortical type (P < 0.05). The cortical type is higher than the mixed type of anterior cerebral artery lesion rate. 7) it can not be considered that the degree of vascular stenosis is different among different physical types.) the mixed type has a higher incidence of severe stenosis or occlusion than the subcortical type.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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