【摘要】：目的:研究影響延髓內(nèi)側梗死患者病情進展、嚴重程度和預后的因素。方法:回顧性分析我科2012年4月至2016年6月的急性延髓內(nèi)側梗死的住院病例,總結病例的危險因素、發(fā)病機制、臨床表現(xiàn)、影像學特征及預后,研究影響疾病進展、嚴重程度及預后的因素。結果:34例MMI病例中,(1)高血壓患者85.3%,男性79.4%,糖尿病52.9%,影像存在陳舊性腔隙性腦梗死70.6%,吸煙50%;發(fā)病情況:26.5%為晨起后發(fā)病,14.7%勞累后,14.7%活動中,3.0%飲酒后;病情進展29.4%;(2)臨床表現(xiàn),運動障礙88.2%,82.4%存在構音障礙,55.9%面癱,舌癱52.9%,44.1%出現(xiàn)肢體感覺障礙;(3)梗死灶位于左側47.6%,頭部44.1%,腹側38.2%,32.4%同時累及腹、內(nèi)、中側;椎動脈硬化的61.8%;(4)主要為大動脈粥樣硬化型;出院時61.8%預后良好。進展性卒中組與非進展性卒中組比較,兩組間晨起后發(fā)病、大動脈粥樣硬化發(fā)病機制、小動脈病變發(fā)病機制、病灶累及2個以上層面、病灶累及頭部+中部,差異有統(tǒng)計學意義(P0.05)。小卒中組與中重度卒中組相比較,兩組間既往卒中史、中-重度運動障礙、吞咽困難、飲水嗆咳,差異具有統(tǒng)計學意義(P0.05)。預后比較,兩組間既往卒中史、中-重度運動障礙、言語障礙、吞咽困難、飲水嗆咳、咽反射障礙、病灶位于交界+頭部,差異具有統(tǒng)計學意義(P0.05)。結論:(1)MMI以男性居多,高血壓、糖尿病、吸煙是其前3位危險因素;(2)MMI最常見癥狀是肢體運動和構音障礙;(3)多位于延髓腹側、中上部。
[Abstract]:Objective: to study the factors influencing the progression, severity and prognosis of patients with medial medullary infarction. Methods: the inpatients with acute medial medullary infarction from April 2012 to June 2016 were analyzed retrospectively. The risk factors, pathogenesis, clinical manifestations, imaging features and prognosis were summarized. Severity and prognostic factors. Results among 34 cases of MMI, (1) 85.3% of patients with hypertension, 79.4% of men, 52.9% of diabetes mellitus, there were 70.6% of old lacunar cerebral infarction on images, 50 cases of smoking. The incidence of the disease was 14.7% after onset of illness in the morning, 3.0% in 14. 7% of activities, 29. 4% in progression of disease. (2) Clinical manifestations, 82.4% of the patients had dysarthria, 55.9% of them had facial paralysis, 44.1% of them had palsy of limbs; (3) the infarct was located on the left side 47.6%, the head 44.1%, the ventral 38.2% involved the abdomen, the internal side, the middle side, the vertebral arteriosclerosis 61.8%; (4) the main type of arteriosclerosis was the arteriosclerosis of the great arteries; (3) the infarct was located on the left side 47.6%, the head 44.1%, the ventral 38.2% at the same time, and the internal side, the middle side, the vertebral arteriosclerosis 61.8%; 61.8% had good prognosis at discharge. In the progressive stroke group and the non-progressive stroke group, the pathogenesis of atherosclerosis, arteriolar lesions, the involvement of more than 2 layers, and the middle of the head were found between the two groups. The difference was statistically significant (P0.05). Compared with the moderate and severe stroke group, the two groups had a history of stroke, moderate to severe motor disorder, dysphagia, drinking water choking cough, the difference was statistically significant (P0.05). The prognosis was compared between the two groups: the history of stroke, moderate to severe motor disorder, speech disorder, dysphagia, drinking water choking cough, pharyngeal reflex disorder, lesion located at the head of the junction, the difference was statistically significant (P0.05). Conclusion: (1) MMI is the most common risk factor in male patients with hypertension diabetes and smoking. (2) the most common symptom of MMI is limb movement and dysarthria (3) it is located in the ventral side of medulla oblongata with middle and upper part of medulla oblongata.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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