进展性卒中的相关因素研究

摘要

Objective： In order to prophylactic treat stroke in progression (SIP), we analysed risk factors and imagery characters of SIP patients. Methods: retrospectively study 58 cases SIP patients, and analysis relevent factors of SIP, which includ blood pressure(systolic pressure and diastolic pressure), blood glucose and blood lipid level, the changes of magnetic resonance angiography and transcranial Dopple. All data were analysed by chi-test. Results: 1. Results showed that 46 patients of 58 SIP were accompanied with hypertension. among them, 18 patients` systolic prssure were less than 150 mmHg and 13 cases with a decrement of pulse pressure (P<0.001). and patients with a long course history and informal treatment hypertension, especially those patients accompanied by low systolic pressure, were easy suffer from SIP. 2. In SIP group, 31 pateints were accompanied wiht DM, the morbidity was obviously higher than that of control (P<0.000). 3. Among 21 SIP patients examined by MRA or/and TCD, 14 patients showed intracranial of/and extracraial vascular stenosis of occlusion. there were only 4 cases in control group. In thosse patients, low perfusion pressure that resulting from artery trunk stenosis or occlusion and decrement of pulse pressure was main cause of SIP. 4. On image, most common infarction site of SIP were in body of lateral ventricles and water-shed territoy, which is usually suggesting large vessel disease. Conclusion: HT, especially the hypertension whth lower systolic pressure, DM, intra-or extracranial vascular stenosis/occlusion and severely function defciency in neurologic system are associated whth SIP. The latter ply a main role in progressive of late phase in first week. About treatment therapy of SIP patients, we emphasize not to reduce blood pressure, excessively meanwhile giving anticoagulation, we should apply for a MRA or TCD exam and early find vascular change, further prevent relapse with cerebral vascular diseases.%目的：寻找引起进展性卒中的危险因素。方法：回顾性分析了58例进展性卒中患者，对其血压、血糖、血脂水平、病情严重程度以及有无血管狭窄等情况进行了相关分析研究。结果：①58例进展性卒中患者伴高血压(Hypertension, HT)者 46例，其中18例收缩压低于150mmHg， 13例脉压差小于30mmHg，明显高于对照组(P<0.001)。②31例合并有糖尿病(Diabetes Millium, DM)，对照组仅仅18例，两组比较差异显著(P<0.0001)。③21例SIP患者行TCD或/和MRA检查者14例显示有不同程度的颅内外血管狭窄，这部分患者脉压差下降以及由此导致的低灌流与进展性卒中有关。其中12例MD患者行MRA或TCD检查，均发现有小血管显影不良或狭窄， 6例有大血管病变。④影像学检查显示分水岭梗塞或顶深部侧脑室体旁梗塞多提示大血管病变，尤其是MCA起始部或主干支狭窄，常预示进展性卒中的可能。结论：进展性卒中的危险因素多与高血压，糖尿病以及是否并发颅内外大血管狭窄或闭塞有关。而患者的收缩压下降、脉压差小也易引起SIP。 SIP患者影像学上的特殊表现常提示此类患者侧枝循环建立不完善，故在抗凝治疗的同时，一定要保证充足的脑灌注压，切记不要过分降低血压，尤其疑为大血管病变者。