进展性脑梗死相关因素分析  

Study on related factors of deteriorating cerebral infarction

作　　者：樊双义[1] 王天昊[1] 何宝明[2] 魏东宁[3] 刘景峰[1] 马朋林[1] 

机构地区：[1]解放军总医院第二附属医院急救部,北京100091 [2]解放军总医院第二附属医院放射科,北京100091 [3]解放军总医院第二附属医院神经内科,北京100091

出　　处：《中国急救医学》2008年第12期1118-1121,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨进展性脑梗死的相关因素,为临床早期诊断和治疗提供依据。方法将起病在24h内852例首次发病的脑梗死患者分成两组。比较有进展与无进展的脑梗死患者的特征、危险因素、重要体征、头部CT、彩超下颈动脉粥样硬化特征以及预后情况。进展性脑梗死的诊断根据起病到7d内肌力下降情况或神经功能缺损评分来判断。结果852例患者中有206例发展为进展性脑卒中(24.18%),有进展的患者头颅CT早期异常(78.24%)及严重颈动脉狭窄的患者较无进展的患者多;血流动力学指标异常率高;有进展的患者入院时血糖较无进展的高;医源性处理不当亦为进展性脑梗死形成的重要危险因素。有进展的脑梗死患者急性期病死率高,神经功能恢复差。结论进展性脑梗死的发生与很多因素有关(如头颅CT早期异常、颈动脉粥样硬化的严重程度、狭窄程度、入院时高血糖及血流动力学指标变化),医源性处理不当,均可能是进展性脑梗死发生的重要因素。Objective To investigate the possible cause of the deteriorating stroke in various types patients with cerebral infarction in order to provide important objective basis for clinical diagnosis and treatment. Methods 852 patients with the first cerebral infarction hospitalized within 24hr after the onset of disease were divided into the 2 groups. The deteriorating stroke was diagnosed according to a decrease of muscular strength and neurological function deficits scale during 7days after the onset. In each group, the patients＇ background characteristics, risk factors, important physical signs, cranial CT, carotid artery stenosis under colorful transonic examination and the prognosis were compared in deteriorating （ D ） and non - deteriorating （ ND ） patients. Results Among 852patients, 206 cases were deteriorating stroke （24.18%）. Early abnormalities of the cranial CT and severe carotid artery stenosis were more in D patients than in ND patients. For cerebral infarction patients, the blood glucose, hemodynamic abnormalities were higher in D patients than in ND patients. Incorrect iatrogenic treatment was also the important factor for cerebral infarction patients. The acute - phase mortality was higher in D patients than in ND patients. The recovery of neurological function and the prognosis were worse in D patients. Conclusions The incidence of deteriorating cerebral infarction was significantly different in various types groups, and the prognosis was worse in D patients than in ND patients. Early abnormalities of cranial CT, carotid artery stenosis under colorful transonic examination, hyperglycemia, hemodynamic abnormality, incorrect iatrogenic treatment were important factors for deteriorating ischemic stroke.

关 键 词：脑梗死 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]