进展性缺血性卒中的临床分析

目的探讨不同类型的脑梗死患者进展性卒中的发生率、可能的预测指标以及预后。方法将起病在24小时内486例首次发病的脑梗死患者分成四组:即完全前循环梗死组(TACI),部分前循环梗死组(PACI),腔隙性脑梗死组(LACI)和后循环梗死组(POCI)。进展性卒中的诊断根据起病到7天内肌力下降情况或神经功能缺损评分来判断。比较各组有进展与无进展的脑梗死患者的特征、危险因素、重要体征、头部CT、彩超下颈动脉粥样硬化特征以及预后情况。结果486例患者中有116例发展为进展性卒中(23.87%),其中完全前循环梗死组发生率最高为36.59%,其次为腔隙性脑梗死组26.70%及后循环梗死组20.34%,而部分前循环梗死组发生率最低为12.10%。完全前循环梗死组患者中,有进展的患者头颅CT早期异常及严重颈动脉狭窄的患者较无进展的患者多。腔隙性脑梗死组中,有进展的患者入院时血糖较无进展的高,而头颅CT早期异常率较无进展的患者低。有进展的脑梗死患者急性期病死率高,神经功能恢复差,影响到患者预后。结论不同脑梗死组患者进展性卒中的发生率不同,有进展的患者预后差。完全前循环梗死组头颅CT早期异常、颈动脉粥样硬化的严重程度及狭窄程度、腔隙性脑梗死组入院时高血糖及低头颅CT异常,均可能是进展性卒中发生的预测指标。

The Clinical Study of Deteriorating Ischemic Stroke

Objective To investigate the incidence,possible predictive factors and prognosis of deteriorating ischemic stroke in various types patients with cerebral infarction.Methods 486 patients with the first cerebral infarction hospitalized within 24h at the onset were divided into the following 4 groups: total anterior circulation infarct(TACT),partial anterior circulation infarct(PACI),lacunar infarct(LACI) and posterior circulation infarct(POCI).The deteriorating stroke was defined as a decrease of muscle force and neurological function deficits scale during 7 days after the onset.In each group,patients' background characteristic,risk factors,important physical signs,cranial CT,carotid atherosclerosis under color ultrasonography and the prognosis were compared in deteriorating(D) and non-deteriorating(ND) patients.Results Among 486 patients,116 cases were deteriorated(23.87%).The D incidence was 36.59%,26.70%,20.34% and 12.10% for TACI,LACI,POCI and PACI,respectively.For TACI patients,early abnormalities of the cranial CT and severe carotid stenoses were more often in D patients than in ND patients.For LACI patients,the blood glucose was higher in D patients than in ND patients,but the early abnormalities of the cranial CT was less in D patients than in ND patients.The acute-phase mortality was higher in D patients than in ND patients.The neurological function recovered and the prognosis were worse in D patients.Conclusions The incidence of deterioration in acute cerebral infarct was significantly different in various types' groups,and the prognosis was worse in D patients than in ND.Early abnormalities of cranial CT,the severity of carotid atherosclerosis and stenosis in TACI group,the level of blood glucose at entry in LACI group were some predict factors for deteriorating ischemic stroke.