临床神经病学杂志
臨床神經病學雜誌
림상신경병학잡지
JOURNAL OF CLINICAL NEUROLOGY
2015年
3期
218-220
,共3页
内分水岭梗死%脑血管储备%进展%转归%大脑中动脉
內分水嶺梗死%腦血管儲備%進展%轉歸%大腦中動脈
내분수령경사%뇌혈관저비%진전%전귀%대뇌중동맥
internal border zone infarction%cerebrovascular reserve%progress%outcome%middle cerebral artery
目的：评估重度大脑中动脉狭窄所致内分水岭区梗死（ IBZI）的脑血管储备（ CVR）功能，并探讨对疾病的进展及临床转归的影响。方法收集我院单纯一侧大脑中动脉重度狭窄的急性IBZI患者84例。通过屏气诱发高碳酸血症，行TCD检测大脑中动脉血流速度变化，评估CVR。根据CVR将患者分为储备下降组（ CVR＜10％）和储备正常组（ CVR≥10％）。入院后14 d内行NIHSS评分评价神经功能缺损情况，出院时对两组患者行mRS评分观察急性期转归。随访6个月，分析两组患者复发、合并症和死亡率情况。人数比例为34．78％、结果储备下降组进展性脑梗死的发生率（67．39％）高于储备正常组（42．11％）（P＜0．05）。储备下降组发生转归不良的比率（63．04％）高于储备正常组（36．84％）（P＜0．05）。在6个月随访过程中，储备下降组病例复发及发生合并症的人数比率分别为34．78％45．65％，均明显高于储备正常组（15．79％，23．68％）（均P＜0．05）。而两组的死亡率差异无统计学意义（P＞0．05）。结论对于重度大脑中动脉狭窄所致的IBZI患者，CVR的下降可能预示着其易于进展和临床转归不良。
目的：評估重度大腦中動脈狹窄所緻內分水嶺區梗死（ IBZI）的腦血管儲備（ CVR）功能，併探討對疾病的進展及臨床轉歸的影響。方法收集我院單純一側大腦中動脈重度狹窄的急性IBZI患者84例。通過屏氣誘髮高碳痠血癥，行TCD檢測大腦中動脈血流速度變化，評估CVR。根據CVR將患者分為儲備下降組（ CVR＜10％）和儲備正常組（ CVR≥10％）。入院後14 d內行NIHSS評分評價神經功能缺損情況，齣院時對兩組患者行mRS評分觀察急性期轉歸。隨訪6箇月，分析兩組患者複髮、閤併癥和死亡率情況。人數比例為34．78％、結果儲備下降組進展性腦梗死的髮生率（67．39％）高于儲備正常組（42．11％）（P＜0．05）。儲備下降組髮生轉歸不良的比率（63．04％）高于儲備正常組（36．84％）（P＜0．05）。在6箇月隨訪過程中，儲備下降組病例複髮及髮生閤併癥的人數比率分彆為34．78％45．65％，均明顯高于儲備正常組（15．79％，23．68％）（均P＜0．05）。而兩組的死亡率差異無統計學意義（P＞0．05）。結論對于重度大腦中動脈狹窄所緻的IBZI患者，CVR的下降可能預示著其易于進展和臨床轉歸不良。
목적：평고중도대뇌중동맥협착소치내분수령구경사（ IBZI）적뇌혈관저비（ CVR）공능，병탐토대질병적진전급림상전귀적영향。방법수집아원단순일측대뇌중동맥중도협착적급성IBZI환자84례。통과병기유발고탄산혈증，행TCD검측대뇌중동맥혈류속도변화，평고CVR。근거CVR장환자분위저비하강조（ CVR＜10％）화저비정상조（ CVR≥10％）。입원후14 d내행NIHSS평분평개신경공능결손정황，출원시대량조환자행mRS평분관찰급성기전귀。수방6개월，분석량조환자복발、합병증화사망솔정황。인수비례위34．78％、결과저비하강조진전성뇌경사적발생솔（67．39％）고우저비정상조（42．11％）（P＜0．05）。저비하강조발생전귀불량적비솔（63．04％）고우저비정상조（36．84％）（P＜0．05）。재6개월수방과정중，저비하강조병례복발급발생합병증적인수비솔분별위34．78％45．65％，균명현고우저비정상조（15．79％，23．68％）（균P＜0．05）。이량조적사망솔차이무통계학의의（P＞0．05）。결론대우중도대뇌중동맥협착소치적IBZI환자，CVR적하강가능예시착기역우진전화림상전귀불량。
Objective To assess cerebrovascular reserve ( CVR) function in patients with internal border zone infarction(IBZI) induced by severe middle cerebral artery (MCA) stenosis, and investigate the impact on progression and outcome of the disease .Methods A total of 84 patients with unilateral severe MCA stenosis were selected . Hypercapnia was induced by holding breath .The change of blood flow velocity in MCA was measured by transcranial Doppler ( TCD ) to calculate CVR .According to CVR , patients were divided into impaired regional CVR group ( CVR <10%) and normal CVR group ( CVR ≥10%) .The NIHSS was used to evaluate neurological function in both groups within 14 d, and mRS was used to evaluate acute stage outcome of the patients at discharge .All the patients were followed-up for 6 months, the incidences of recurrence , complications and mortality in the two groups were analyzed .Results The incidence of progressive cerebral infarction in the impaired regional CVR group (67.39%) was significantly higher than that in the normal CVR group (42.11%) ( P<0.05).The impaired regional CVR group showed higher proportion of patients with poor clinical outcome at discharge ( mRS≥3 ) (63.04%)compared to the normal CVR group (36.84%) (P<0.05).In the followed-up 6 months, the incidences of recurrence and complications were 34.78% and 45.65% respectively in the impaired regional CVR group , they were significantly higher than that in normal CVR group (15.79%,23.68%)(P<0.05).The overall mortality rates did not differ significantly between the two groups ( P>0.05 ) .Conclusion Impaired regional CVR may be predictive of subsequent progressive cerebral infarction and poor clinical outcomes in patients with IBZI induced by severe MCA stenosis .
