前循環(huán)單支動(dòng)脈病變所致急性腦梗塞的臨床研究.pdf

1、摘要目的：通過(guò)對(duì)前循環(huán)腦梗塞患者磁共振彌散加權(quán)成像及磁共振血管成像的觀察，對(duì)腦梗塞進(jìn)行病變類型的影像學(xué)分類，觀察DWI序列梗死灶在相應(yīng)供血?jiǎng)用}區(qū)的不同分布，從而探討其可能的發(fā)病機(jī)制，并對(duì)入選患者進(jìn)行預(yù)后評(píng)估，從而在臨床上可以通過(guò)影像學(xué)改變來(lái)對(duì)腦梗塞的可能發(fā)病機(jī)制，預(yù)后進(jìn)行評(píng)估，進(jìn)而達(dá)到臨床對(duì)腦梗塞全面認(rèn)識(shí)并提高臨床治療質(zhì)量及改善患者預(yù)后的目的。方法：對(duì)患者進(jìn)行頭顱核磁檢查，包括彌散加權(quán)成像，磁共振血管成像檢查，選擇腦梗塞患者病變部位位于

2、前循環(huán)供血區(qū)，包括頸內(nèi)動(dòng)脈供血區(qū)、大腦前動(dòng)脈供血區(qū)，大腦中動(dòng)脈供血區(qū)，同時(shí)相應(yīng)的供血?jiǎng)用}存在中重度狹窄或閉塞。將DWI類型分成9種病變類型。首先分為單發(fā)性梗塞和多發(fā)性梗塞。前者包括穿支動(dòng)脈供血區(qū)梗塞、皮質(zhì)分支動(dòng)脈供血區(qū)梗塞、大區(qū)域性梗塞和分水嶺區(qū)梗塞；后者包括穿支動(dòng)脈供血區(qū)梗塞皮層梗塞、穿支動(dòng)脈供血區(qū)梗塞分水嶺梗塞、皮層梗塞分水嶺梗塞、穿支動(dòng)脈供血區(qū)梗塞皮層梗塞分水嶺梗塞以及皮層梗塞皮層梗塞。觀察頸內(nèi)動(dòng)脈，大腦前動(dòng)脈，大腦中動(dòng)脈中度、重

3、度狹窄以及閉塞時(shí)相應(yīng)供血區(qū)域梗塞灶的類型，探討其可能的發(fā)病機(jī)制。并對(duì)梗塞的體積進(jìn)行計(jì)算，1個(gè)月后對(duì)入選患者通過(guò)門診或電話隨訪，評(píng)估DWI類型與梗塞體積以及預(yù)后的關(guān)系。所有數(shù)據(jù)使用SPSSl70統(tǒng)計(jì)軟件分析處理，P005認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果：(1)前循環(huán)狹窄或閉塞引起的梗塞的危險(xiǎn)因素分析：三組血管粥AbstractObject：AccordingtoobservingtheDWIandMRAofthepatientswhosufferi

4、ngfromcerebralinfarctionlocatedinanteriorcirculation，toinvestgatedifferentdistributionincorrespondingfeedingarteryarea，identifyimagingclassification，explorethepossibleinfarctionpathogenesis，andevaluatethepatient’prognosi

5、s，SOthatthosecansupplyinformationsaboutthepossibleinfarctionpathogenesisandprognosisthroughimagingchangesinclinic，andhelptoachievethefullunderstandingofcerebralinfarctionandimproveclinicalqualityandpatientprognosisMethod

6、s：ThroughMRIincludingDWIandMRA，thepatientsincerebralinfarctionlocatedinanteriorcirculationwerechoosed，includinginternalcarotidartery，anteriorcerebralartery，middlecerebralarteryfeedingarea，incorrespondingfeedingarteryinmo

7、deratetosevereICA，MCAorACAstenosisorocclusionTheinfarctionpattenweredividedintoninelesiongroupsaccordingtoDWITheywereclassifiedassingleandmultiplefirstlyTheformerincludeperforatingarteryinfarct(PAl)，pialinfarct(PI)，large

8、territorialinfarctionandborderzoneinfarction(BZ)ThelatterincludePAIPI，PAIBZ，PIBZ，PAIPIBZ，andPIPIAccordingtothecategoryofinfarctionlesioncorrespondingblood—supplyareainmidrange，seriousstenosisandocclusionofinternalcarotid