急性脑梗死部位、体积与临床预后的关系  

Correlation of the site and volume of acute cerebral infarction with the clinical outcome

作　　者：梁菲菲 孙子慧 包曼 LIANG Feifei;SUN Zihui;BAO Man(Department of Geriatrics,Zhangjiakou First Hospital,Hebei,Zhangjiakou 075000,China)

机构地区：[1]河北省张家口市第一医院老年病科,075000

出　　处：《河北医药》2024年第3期384-387,共4页Hebei Medical Journal

基　　金：张家口市重点研发计划项目(编号:2121136D)。

摘　　要：目的探讨老年(年龄60~70岁)急性岛叶梗死患者的梗死部位、梗死体积与临床预后的关系。方法选取2021年2~12月张家口市第一医院老年病科及全科医学科收治的100例老年急性岛叶梗死患者作为研究对象,受试者的脑梗死部位均运用核磁共振成像(magnetic resonance imaging,MRI)筛查并明确,按Pullicino公式计算其脑梗死体积。根据脑梗死体积大小分组,脑梗死体积<3 cm^(3)组(A组)61例,脑梗死体积≥3 cm^(3)组(B组)39例,利用美国国立卫生院卒中量表(national institutesof health stroke scale,NIHSS)、蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)、脑卒中改良Rankin量表(modifed rankin scale,mRS)、日常生活能力评估量表(activity of daily living scale,ADL)和简易精神状况量表(mini-mental state examination,MMSE)分别评估所有受试者入院时、出院时、出院后的神经功能缺损程度、认知、功能恢复、日常生活能力及精神状态进行综合评估。用秩和检验、Spearman等级相关性检验NIHSS、MoCA、mRS、ADL、MMSE评分与梗死部位、梗死体积的相关性。结果组内比较,A、B组入院时NIHSS、mRS评分依次高于出院时,出院后3、6个月时,MoCA、ADL、MMSE评分及TST剩余值依次低于出院时(P<0.05)。组间比较,A组入院时、出院期(出院时,出院后3、6个月)NIHSS、mRS评分显著低于B组,MoCA、ADL、MMSE评分及TST剩余值显著高于B组(P<0.05)。A组梗死部位(基底核、皮质、脑干、小脑、丘脑、混合病变)的TST剩余值均高于B组(P<0.05)。急性岛叶梗死患者的TST剩余值、NIHSS评分、mRA评分与脑梗死体积呈负相关(rs=-0.358、-0.425、-5.06,P=0.003、0.06、0.09),MoCA、ADL、MMSE评分与脑梗死体积呈正相关(rs=0.547、0.614、0.548,P均<0.001)。结论老年急性岛叶梗死患者的脑梗死部位与神经功能缺损程度、功能恢复呈负相关,与认知、日常生活能力及精神状态呈正相关,其中脑梗死体积与�Objective To investigate the correlation of the site and volume of acute insular infarction with the clinical outcome in elderly patients with the age of 60-70 years.Methods A total of 100 elderly patients with acute insular infarction admitted to Zhangjiakou First Hospital from February 2021 to the end of December 2021 were selected as the research subjects.The cerebral infarction sites of all subjects were screened and identified by magnetic resonance imaging(MRI),and the volume of cerebral infarction was calculated according to the Pullicino formula.Stratified by the volume size of cerebral infarction,patients were divided into group A(brain infarction volume<3cm^(3),n=61)and group B(brain infarction volume≥3cm^(3),n=39).The National Institutes of Health Stroke Scale(NIHSS),the Montreal Cognitive Assessment(MoCA)scale,the modified Rankin Scale(mRS),the Activity of Daily Living Scale(ADL)and the Mini-Mental State Examination(MMSE)scale were used to evaluate the degree of neurological deficit,cognition,functional recovery,daily living ability and mental status at admission,at discharge and after discharge.The correlation of NIHSS,MoCA,mRS,ADL and MMSE scores with the infarct site and infarct volume was tested by rank sum test and Spearman rank correlation.Results Intragroup comparison showed that the NIHSS and mRS scores in both groups were significantly higher at admission than those at discharge,while the MoCA,ADL,MMSE scores and TST residual values at 3 and 6 months after discharge were significantly lower than at discharge(P<0.05).The inter-group comparison showed that the NIHSS and mRS scores of Group A at admission and after discharge(discharge,3 and 6 months after discharge)were significantly lower than those of group B,while the MoCA,ADL,MMSE scores and TST residual values were significantly higher(P<0.05).The residual values of TST in infarct sites(basal nucleus,cortex,brainstem,cerebellum,thalamus,mixed lesions)were significantly higher than those of group B(P<0.05).The TST residual value,NIHSS score

关 键 词：老年 急性岛叶梗死 梗死部位 临床预后 梗死体积 

分 类 号：R743.33[医药卫生—神经病学与精神病学]