本文選題：頸內(nèi)動脈閉塞 + 側(cè)支循環(huán)　； 參考：《遵義醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：評估單側(cè)頸內(nèi)動脈閉塞患者顱內(nèi)側(cè)支循環(huán)建立情況，探討側(cè)支循環(huán)的代償與患者神經(jīng)功能缺損的關(guān)系，為治療方法的選擇、預(yù)后的判斷及有效的預(yù)防提供可靠的依據(jù)。 方法：選擇經(jīng)頸動脈彩超檢測單側(cè)頸內(nèi)動脈閉塞，再通過全腦血管造影檢查證實(shí)患者60例；①根據(jù)發(fā)病原因不同分為：18例臨床表現(xiàn)為腦栓塞的ICA閉塞患者為A組，其余由慢性動脈粥樣硬化引起的42例ICA閉塞患者B組；A、B兩組側(cè)支循環(huán)開放分級的比較。②分析B組患者側(cè)支循環(huán)開放情況并進(jìn)行比較。③根據(jù)B組臨床癥狀分為有癥狀組與無癥狀組并進(jìn)行側(cè)支循環(huán)開放情況比較。④根據(jù)臨床類型表現(xiàn)為腦栓塞、腦血栓形成的患者入院初次檢查依據(jù)美國國立卒中量表分別進(jìn)行評分比較。根據(jù)B組側(cè)支循環(huán)開放情況分為有側(cè)支循環(huán)開放組，無側(cè)支循環(huán)開放者組；每組治療前后，兩組入院時與腦血管科正規(guī)治療6個月后隨訪NIHSS評分比較。 結(jié)果：①腦栓塞組（A組）中1例（5.60%）二級側(cè)支循環(huán)代償，三級側(cè)支循環(huán)開放各1例（5.60%），B組中33例（79%）二級側(cè)支循環(huán)代償，19例（45%）三級側(cè)支循環(huán)開放.B組二、三級側(cè)支循環(huán)代償率明顯高于A組（P0.05）.A組和B組一級側(cè)支循環(huán)代償率無明顯差異（P㧐0.05）。②B組頸內(nèi)動脈閉塞側(cè)支循環(huán)建立患者，各種形式側(cè)支循環(huán)中開放率最高的是前交通動脈開放（62%）。③無癥狀組后交通側(cè)支開放率(67%)、前交通動脈+后交通動脈聯(lián)合開放率(83%)均高于有癥狀組,差異顯著（P0.05）。④根據(jù)NIHSS評分，腦栓塞患者18例中入院臨床癥狀表現(xiàn)為輕度神經(jīng)功能障礙1例（5.6%），中重度神經(jīng)功能障礙12例（61.1%）；腦血栓形成患者32例中入院臨床癥狀表現(xiàn)為輕度神經(jīng)功能障礙16例（50%），中重度神經(jīng)功能障礙8例（25%）；B組中有側(cè)支循環(huán)組入院時和正規(guī)治療出院6月后NIHSS評分比較差異明顯（P 0.01）；而無側(cè)支循環(huán)開放組入院時和正規(guī)治療出院6月后NIHSS評分比較無明顯差異（P0.05）。有無側(cè)支循環(huán)兩組，在發(fā)病后入院未經(jīng)治療前比較，兩組經(jīng)過正規(guī)治療后比較均有顯著差異（P 0.05）; 結(jié)論：①腦栓塞發(fā)病速度快，沒有足夠的時間重塑二、三級側(cè)支循環(huán)。②頸內(nèi)動脈閉塞時，，顱內(nèi)可形成多種類型的側(cè)支循環(huán)，其中ACOA的開放是最主要的代償途徑。部分病例如臨床表現(xiàn)為無癥狀者多以ACOA+PCOA側(cè)支循環(huán)聯(lián)合開放為主。③有側(cè)支循環(huán)開放的腦梗死發(fā)病率低、臨床癥狀較輕、預(yù)后好。腦梗死患者顱內(nèi)側(cè)支循環(huán)與預(yù)后關(guān)系密切對判斷患者預(yù)后具有重要意義。臨床癥狀與側(cè)支循環(huán)建立速度、類型、完善程度密切相關(guān);
[Abstract]:Objective: to evaluate the establishment of intracranial collateral circulation in patients with unilateral internal carotid artery occlusion (ICA), and to explore the relationship between collateral circulation compensation and neurological impairment in patients with unilateral internal carotid artery occlusion (ICA), so as to provide a reliable basis for the selection of treatment methods, the judgment of prognosis and the effective prevention. Methods: 60 patients with unilateral internal carotid artery occlusion detected by color Doppler ultrasonography were divided into two groups: group A (n = 18) with ICA occlusion with cerebral embolism (n = 18). Comparison of open grade of collateral circulation between group B and group B caused by chronic atherosclerosis in 42 patients with ICA occlusion. 2 Analysis of the opening of collateral circulation in group B and comparison of 3. 3 according to the clinical symptoms of group B Comparison of collateral circulation opening between symptomatic group and asymptomatic group .4 according to the clinical manifestations of cerebral embolism, The initial admission examination of patients with cerebral thrombosis was compared with the National Stroke scale. According to the situation of collateral circulation in group B, the patients were divided into two groups: the open collateral circulation group and the non-collateral circulation open group. The NIHSS scores of the two groups were compared after 6 months of regular treatment before and after the treatment. Results in 1 case of cerebral embolism group (A group), one case (5.60%) the collateral circulation compensatory compensation of the second stage, one case of the third grade collateral circulation opening, one case of the third grade collateral circulation opening in each case, 33 cases (79%) in group B (n = 19) the collateral circulation compensation of the second stage was 45%) the third stage collateral circulation was opened in group B (n = 2). The compensatory rate of third grade collateral circulation was significantly higher than that of group A (P 0.05). Group A and group B (group B) had no significant difference in the compensatory rate of collateral circulation of internal carotid artery occlusion, and there was no significant difference between group A and group B in establishing collateral circulation of internal carotid artery occlusion. Among all kinds of collateral circulation, the opening rate of the anterior communicating artery (ACA) 62.3 was higher than that of the symptomless group (67%), and the combined opening rate of the anterior communicating artery and the posterior communicating artery (83th) was higher than that of the symptomatic group (P0.05.4, according to the NIHSS score). Among the 18 patients with cerebral embolism, the clinical symptoms of admission were mild neurological dysfunction in 1 case, moderate and severe neurological dysfunction in 12 cases, and mild neurological dysfunction in 16 cases among 32 patients with cerebral thrombosis. There were significant differences in NIHSS scores between the patients with collateral circulation in group B and those in group B (P < 0.01), but there was no significant difference in NIHSS score between patients with no collateral circulation and those with normal treatment (P 0.05). There were significant differences between the two groups with or without collateral circulation before and after admission without treatment, and there was significant difference between the two groups after regular treatment (P 0.05). Conclusion the cerebral embolism of 1 / 1 has a rapid onset rate and there is not enough time to reconstruct the second or third grade internal carotid artery occlusion. Multiple types of collateral circulation can be formed in the brain, in which the opening of ACOA is the main compensatory pathway. In some cases with asymptomatic symptoms, the incidence of cerebral infarction with ACOA PCOA collateral circulation combined with open collateral circulation was low, the clinical symptoms were mild, and the prognosis was good. The relationship between intracranial collateral circulation and prognosis in patients with cerebral infarction is of great significance in judging the prognosis of patients. The clinical symptoms were closely related to the establishment speed, type and perfection of collateral circulation.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 黃立安;王建民;宋雪文;徐安定;林志超;王永安;周環(huán);;MRA顯示顱內(nèi)大動脈狹窄的急性腦血栓形成患者腦血流動力學(xué)研究[J];廣東醫(yī)學(xué);2008年03期

2 蘇蘭花;沈岳飛;秦超;陳婭;陳淵;;經(jīng)顱多普勒檢查對單側(cè)頸動脈狹窄或閉塞側(cè)支循環(huán)的評價[J];臨床薈萃;2008年17期

3 張雄偉,牛俊英,牟培源,尹世敏,張紅麗,武澗松;經(jīng)顱多普勒超聲評估老年頸內(nèi)動脈閉塞患者的側(cè)支循環(huán)代償能力[J];中華老年心腦血管病雜志;2005年01期

4 江紅,史庭慧,張?zhí)K明;腦栓塞研究進(jìn)展[J];內(nèi)科急危重癥雜志;2000年02期

5 陳惠靈;何艷;崔穗晶;;腦梗死患者顱內(nèi)側(cè)支循環(huán)與預(yù)后的關(guān)系探討[J];中國醫(yī)藥導(dǎo)報(bào);2012年14期

6 趙云輝,馬著彬,許乙凱;頸內(nèi)動脈狹窄或閉塞側(cè)支循環(huán)途徑的DSA和MR血管成像研究[J];中華放射學(xué)雜志;2004年10期

7 ;各類腦血管疾病診斷要點(diǎn)[J];中華神經(jīng)科雜志;1996年06期

8 張鴻;宋利春;劉艷艷;馬英;呂永利;;Pinacidil抑制線粒體和死亡受體通路減少大鼠腦缺血再灌注后神經(jīng)元凋亡(英文)[J];Neuroscience Bulletin;2007年03期

9 鄭宇,華揚(yáng),凌晨,段春,張蕾,王力力,劉玉梅,周瑛華;頸動脈嚴(yán)重狹窄或閉塞對顱內(nèi)循環(huán)的影響[J];中國醫(yī)學(xué)影像技術(shù);2004年06期

10 陳惠靈;何艷;曾璇;;單側(cè)頸內(nèi)動脈閉塞患者的顱內(nèi)側(cè)支循環(huán)代償與腦缺血發(fā)生的相關(guān)性[J];中國現(xiàn)代醫(yī)生;2012年30期

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