延髓梗死临床及影像学特点与预后相关性的分析  

Analysis of clinical and imaging correlations with prognosis in bulbar infarction

作　　者：陈越 徐建华 CHEN Yue;XU Jian-hua(Department of Neurology,Shanghai Jiading District Central Hospital,Shanghai 201800,China;不详)

机构地区：[1]上海市嘉定区中心医院神经内科,上海201800

出　　处：《慢性病学杂志》2024年第12期1761-1765,共5页Chronic Pathematology Journal

基　　金：基层卒中中心网络流程信息化建设对缺血性卒中救治时间窗及短期预后的影响(JDKW-2018-W13)

摘　　要：目的 探讨延髓梗死的临床及影像学特点,分析影响延髓梗死预后的相关因素。方法 选取2022年1月—2024年5月在上海市嘉定区中心医院接受治疗的40例急性延髓梗死患者,根据90 d改良Rankin量表(modified Rankin scale,mRS)评分分为两组,mRS<3分纳入预后良好组(n=26),mRS≥3分纳入预后不良组(n=14)。回顾性分析研究对象的人口学资料(性别、年龄)、临床资料(头晕或眩晕、吞咽困难、饮水呛咳、构音障碍、肢体无力、感觉障碍、共济失调、面瘫、意识障碍、眼震、呼吸衰竭)、影像学资料(头颅磁共振、头颈部CT血管造影)以及并发症(肺部感染、应激性溃疡)、美国国立卫生院卒中量表(National Institute of Health Stroke scale,NIHSS)评分、急性缺血性脑卒中试验(trial of ORG 10 172 in acute stoke treatment,TOAST)病因分型等,分析影响预后的相关因素。结果 共纳入40例符合入选标准的患者,其中预后良好组26例,预后不良组14例。延髓梗死男女比例为3.4∶1,但性别不是预后不良的影响因素(P>0.05)。两组的年龄、高血压、糖尿病、高脂血症、高同型半胱氨酸血症、心房颤动、吸烟、饮酒等方面比较,差异无统计学意义(均P>0.05)。单因素分析显示,入院时的NIHSS评分(t=-3.050)、早期神经功能恶化(χ^(2)=14.652)、构音障碍(χ^(2)=7.033)、呼吸衰竭(P=0.011)、肺部感染(χ^(2)=7.072)、TOAST病因分型(χ^(2)=13.812)是预后不良的危险因素(均P<0.05)。横断面内,延髓左侧梗死较右侧更常见,发病比例约为1.8∶1,两组左侧、右侧或横轴位分布(腹外侧、腹内侧、背侧、外侧或多部位)比较,差异无统计学意义(均P>0.05);而在纵轴位,预后不良组较预后良好组更容易出现多层面受累,差异有统计学意义(P=0.014);两组在是否合并延髓外梗死病灶、椎动脉发育不良方面比较,差异无统计学意义(均P>0.05);两组在椎动脉重度狭窄或闭塞方面比较,差�Objective To explore the clinical and imaging characteristics associated with bulbar infarction and to identify factors that influence patient prognosis.Methods We conducted a retrospective analysis of 40 patients with acute bulbar infarction admitted to Shanghai Jiading District Central Hospital from January 2022 to May 2024.Patients were categorized into 2 groups based on their 90 d modified Rankin scale(mRS)score:the good prognosis group with mRS score of less than 3(n=26)and the poor prognosis group with mRS score of 3 or higher(n=14).Demographic details,clinical manifestations(including dizziness,dysphagia,dysarthria,limb weakness,sensory disturbances,and other symptoms),imaging findings(brain MRI,head and neck CT angiography),complications(such as pulmonary infection and stress ulcers),the National Institutes of Health Stroke scale(NIHSS)scores,and the trial of ORG 10172 in acute stoke treatment(TOAST)etiological classificationwere analyzed to determine factors affecting prognosis.Results A total of 40 patients were included in the study,with 26 in the good prognosis group and 14 in the poor prognosis group.The maleto-female ratio in bulbar infarction was 3.4∶1,yet gender did not significantly influence prognosis(P>0.05).There were no significant differences in age,hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia,atrial fibrillation,smoking,and alcohol consumption between the two groups(both P>0.05).Univariate analysis identified NIHSS score(t=-3.050),early neurological deterioration(χ^(2)=14.652),dysarthria(χ^(2)=7.033),respiratory failure(P=0.011),pulmonary infection(χ^(2)=7.072),and TOAST etiological classification(χ^(2)=13.812)as significant risk factors for poor prognosis(both P<0.05).Infarctions were more frequently observed on the left side of the medulla,with a ratio of approximately 1.8∶1,and no significant difference in the distribution along the left,right,or transverse axis was found between groups(P>0.05).However,the poor prognosis group showed a higher likelihood of involvemen

关 键 词：延髓梗死 呼吸衰竭 椎动脉狭窄 预后 

分 类 号：R741[医药卫生—神经病学与精神病学]