217例脑干梗死患者血管病变分析  

Analysis of vascular lesions in 217 cases with brainstem infarction

作　　者：熊静[1] 张婕[1] 韩剑虹[1] 贾文姬[1] 李春艳[1] 李佳敏[1] 朱榆红[1] 

机构地区：[1]昆明医科大学第二附属医院神经内科,云南昆明650101

出　　处：《中国医药导报》2015年第11期80-83,92,共5页China Medical Herald

基　　金：云南省科技惠民计划项目(编号2013CA008)

摘　　要：目的探讨脑干梗死患者的血管病变特点。方法回顾性分析2011年8月-2014年3月于昆明医科大学第二附属医院住院的217例脑干梗死患者的临床资料,所有患者均给予了256层螺旋CT进行头颈部动脉三维成像检查,比较分析中脑、脑桥及延髓梗死患者的血管病变特点。结果 217例患者中,181例（83.41%）存在椎-基底动脉狭窄,其中91.71%的患者合并动脉粥样斑块,8.84%的患者合并椎动脉发育不良,45.30%的患者合并前循环血管狭窄。中脑和脑桥梗死患者,椎-基底动脉狭窄主要为轻度狭窄（P〈0.01）,其中大脑后动脉狭窄发生率最高（P〈0.01）。脑桥梗死患者,合并前循环动脉狭窄率明显高于中脑和延髓梗死者（P〈0.01）。延髓梗死患者中,椎-基底动脉重度狭窄率明显高于中脑和脑桥梗死者（P〈0.01）,其中椎动脉狭窄发生率最高（P〈0.01）,椎动脉发育不良发生率也明显高于中脑和脑桥梗死患者（P〈0.05）。结论脑干不同部位梗死的患者,椎-基底动脉病变存在差异,要区别对待,这对于脑干梗死患者的药物或血管内治疗和预后评估有重要意义。Objective To investigate the cerebrovascular features in patients with acute brainstem infarction. Methods Clinical data of 217 patients with brainstem infarction from August 2011 to March 2014 in the Second Affiliated Hospital of Kunming Medical University were retrospectively analyzed and all the patients were given the detection of 256 layers spiral CT three-dimensional imaging of head and neck artery. Characteristics of vascular lesions of patients with vascular lesions in midbrain, pons, medulla oblongata were compared and analyzed. Results Of the 217 patients, 181cases（83.41%） were found vertebral-basilar arteries stenosis. Of the 181 patients, 91.71% cases were combined with atherosclerotic plaques, 8.84% cases were combined with vertebral artery hypoplasia and 45.30% cases were combined with vascular stenosis involved the anterior circulation. Mild stenosis in vertebral-basilar arteries were significantly higher in patients with midbrain and pons infarction（P〈0.01）, while the incidence of posterior cerebral artery stenosis was the highest（P〈0.01）. The involvement of the anterior circulation stenosis was significantly higher in patients with pons infarction than that of patients with midbrain and medulla（P〈0.01）. Severe stenosis in vertebral-basilar arteries were significantly higher in patients with medulla oblongata infarction than those patients with midbrain and pons infarction（P〈0.01）. The stenosis of the vertebral artery was most prominent in medulla infarction（P〈0.01）. The incidence of vertebral artery hypoplasia was significantly higher in medulla oblongata infarction than those patients with midbrain and pons infarction（P〈0.05）. Conclusion Vertebral-basilar artery lesions are different in patients with different distribution of brainstem infarction, so these patients should be treated separately. The results indicate important significance in drug or endovascular treatments and prognosis assessments for the patients with brainstem infarction.

关 键 词：缺血性卒中 脑干病变 CT血管造影 

分 类 号：R743[医药卫生—神经病学与精神病学]