进展性脑卒中的临床与影像学研究

Clinical and imaging study on stroke in progression

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。

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 trealed 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 d0.01）. The infarct size in 22 patients of SIP group and 1 patient of contrd 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 farction, 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 concurrent effects of various factors and mechanisms.