157例儿童动脉缺血性卒中住院病例回顾性分析

A retrospective research of arterial ischemic stroke in 157 children

目的了解儿童动脉缺血性卒中的危险因素、临床症状、神经影像学特点及治疗状况,以期为儿童缺血性卒中提供合理的诊断及治疗方案。方法对1996-01—2006-06首都医科大学附属北京儿童医院收治的157例缺血性卒中患儿病例资料进行回顾性分析。结果157例动脉缺血性卒中儿童中,男92例,女65例,发病年龄4个月至16岁,平均年龄32个月。发现51例患儿(32.5%)未找到任何危险因素,其他明确原因患儿中最常见危险因素为感染(12.1%)、烟雾病(12.1%)、头部外伤(10.8%)。最常见的神经系统损害为偏瘫(81.5%),神经系统影像学检查显示左侧大脑中动脉(36.3%)供血区域显著受累。157例患儿中56例接受了血管内溶栓治疗,除1人并发颅内出血外,其余患儿病情均有改善。结论中国儿童脑卒中常见危险因素与成人及其他遗传背景儿童明显不同。目前,关于儿童脑卒中急性期治疗、初步预防及复发预防,急需大样本的随机对照研究。

Objective To know about the risk factors,clinical symptoms,imaging manifestations and treatment of ischemic stroke in children,in order to provide proper diagnosis and treatment. Methods The clinical data of 157 children with ischemic stroke was retrospectively analyzed ,who were admitted to Beijing Children＇s Hospital between Jan. 1996 to Jun. 2006. Results A total of 157 children with AIS were identified in the 10-year period. The median age at stroke was 32 （4 - 192 ） months. Among those AIS patients with determined etiology, infection （ 12. 1% ） , moyamoya syndrome （ 12. 1% ） and trauma （ 10. 8% ） were found to be most common. There were 51 patients （32.5%） without obvious risk factors. The most frequent neurological deficit was hemiparalysis （ 81.5% ）. The region of left middle cerebral artery （36. 3%） was principally affected. Fifty-six out of the patients （35.7%） were successfully treated by intravascular thrombolysis with one patient presenting hemorrhage complication. Conclusion The most common risk factors of pediatric stroke in China are different from risk factors in other ethnic populations. Randomized controlled trials for primary prevention,acute treatment,and secondary prevention of pediatric ischemic stroke are urgently needed.