进展性脑卒中的临床与影像学研究

目的探讨进展性脑卒中(SIP)发病的相关因素。方法回顾性分析入住我院的SIP患者65例(SIP组),脑梗死患者65例(对照组),对两组患者一般临床资料和头颅CT、MRI进行对比分析。结果 SIP组患者入院前和入院后出现发热者32例(49.2%),对照组11例(16.9%);SIP组患者脉压差<30 mm Hg(1 mm Hg=0.1 33 kPa)者22例(33.8%),对照组5例(7.7%);SIP组患者高血糖43例(66.2%),对照组9例(13.9%),两组比较差异有统计学意义(P<0.01)。SIP组患者头颅CT或MRI检查早期显示病灶者42例(64.6%),大脑中动脉供血区梗死面积>33%者22例,分水岭梗死10例,脑干梗死5例;早期未显示病灶而大脑中动脉呈高密度影8例(12.3%)。对照组早期显示病灶者26例(40.0%),大脑中动脉供血区梗死面积>33%者1例,分水岭梗死2例,脑干梗死1例。SIP组患者大脑中动脉供血区梗死面积>33%、分水岭和脑干梗死以及大脑中动脉高密度影与对照组比较,差异有统计学意义(P<0.01)。结论发热、高血糖、低脉压差、大脑中动脉高密度影、大脑中动脉供血区梗死面积>33%、脑干及分水岭梗死是SIP发病的主要相关因素。SIP是多种因素、多种机制共同作用的结果。

Clinical and imaging study on stroke in progression

Objective To explore the risk factors for stroke in progression(SIP).Methods Clinical manifestations and CT/MRI changes were retrospectively investigated in 65 patients with SIP (SIP group).All data were analysed by comparison with 65 non-SIP patients who were treated in the same period(control group).Results Thirty two patients(49.2%) had fever on admission in the SIP group,and 11(16.9 %) in the control group (P<0.01).Twenty-two patients (33.8%) had perfusion pressure less than 30 mm Hg(1 mm Hg=0.133 kPa) on admission in the SIP group,and 5(7.7%) in the control group (P<0.01).Forty-three patients(66.2%) had hypergly- cemia on admission in the SIP group,and 9(13.9 %) in the control group (P<0.01).Forty-two patients(64.6%) in SIP group were found to have focuses of infarct on early CT,and 26 (40.0%) in the control group (P<0.01).The infarct size in 22 patients of SIP group and 1 patient of con- trd group was larger than 33% of MCA blood supply area (P<0.01),Ten patients in SIP group and 2 patients in the control group had cerebral watershed infarction (P<0.01).Five patients in SIP group and 1 patient in control group had brain stem infarction (P<0.01).Eight patients in SIP group and no one in control group had hyperdense middle cerebral artery(HMCA) image (P<0.01).Conclusions Fever,low perfusion pressure,hyperglycemia,cerebral watershed in- arction,brain stem infarction,HMCA image,and infarct size larger than 33 % of MCA blood sup- ply area are the major risk factors for SIP,and the occurrence of SIP may be the result of concur- rent effects of various factors and mechanisms.