脑分水岭梗死84例临床分析

CLINICAL ANALYSIS OF 84 PATIENTS WITH CEREBRAL WATERSHED INFARCTION

目的分析脑分水岭梗死(cerebral watershed infarction,CWI)临床特征及相关因素,为临床预防和治疗提供依据。方法回顾性分析CWI患者84例的病史、体格检查、辅助检查及预后转归等临床资料。结果安静时起病47例(55.95%),睡眠时起病26例(30.95%),活动时起病11例(13.10%)。合并高血压、血脂异常、冠状动脉粥样硬化性心脏病、高同型半胱氨酸血症、糖尿病分别为52例(61.90%)、18例(38.09%)、18例(21.43%)、14例(16.67%)、30例(35.71%);既往有吸烟、饮酒史占59例(70.24%)、46例(54.76%)。7例(84.52%)发现血管狭窄或闭塞,轻度、中度、重度狭窄分别占13处(14.94%)、35处(40.23%)、39处(44.83%)。大脑中动脉狭窄或闭塞、颈内动脉狭窄或闭塞分别占38处(43.68%)、37处(42.53%)。皮质下型血管病变率最高,大脑中动脉病变率最高(P<0.01);皮质前型颈内动脉病变率最高(P<0.01)。基本治愈35例(41.67%),显著进步43例(51.19%),进步6例(7.14%)。结论 CWI与体液循环、大脑中动脉和颈内动脉狭窄密切相关,应积极预防,避免不可逆损害发生。

Objective To analyze the clinical feature and relevant factors of cerebral watershed infarction（CWI） in order to provide the reference for treatment and prevention. Methods The medical history, physical examination, auxiliary examination and prognosis of 84 patients with CWI were reviewed. Results The onset of 47 cases （ 55.95 % ） was during rest, 26 cases （ 30.95% ） during sleep, 11 cases （13.10%） during activity. Of all the patients, 61.90%, 38.09%, 21.43%, 16.67% and 35.71% respectively were combined with hypertension, dyslipidemia, coronary heart disease, hyperhomocysteinemia and diabetes mellitus. Seventy point two four percent and 54.76% of all had smoking and drinking history. 84.52% of all were detected with vascular narrowing or block, and mild, moderate and severe level accounted for 14.94% ,40.23% and 44.83%. Middle cerebral artery stenosis or occlusion, internal carotid stenosis or occlusion accounted for 43.68% and 42.53%. S - CWI angiopathy rate was the highest, thereinto, middle cerebral artery angiopathy was the most （P 〈 0. 01 ）. The internal carotid angiopathy rate of C - CWI was the highest（ P 〈 0.01 ）. The cure rate was 41.67%, obvious effective rate was 51.19%, effective rate was 7.14%. Conclusion CWI was related to systemic circulation, middle cerebral artery and internal carotid stenosis or occlusion. If treated earlier, the serious injure can be prevented.