大面积脑梗死104例临床特点及病因分析

The clinical character and cause analysis of 104 massive cerebral infarction patients

目的分析104例大面积脑梗死临床表现、影像学特点及发病因素,为预防梗死发生提供依据。方法 104例大面积脑梗死患者行心电图、超声心动图、CT\CTA或MRI\MRA、经颅多普勒及颈部血管超声检查,分析大面积脑梗死的部位、闭塞血管及其病因。结果心源性脑栓塞69例(占66.3%),其中冠心病39例,陈旧性心肌梗死16例,风心病7例,扩张性心肌病3例,甲亢性心脏病2例,肥厚性心肌病1例,心肌致密化不全1例。104例中并发心房纤颤63例(60.6%),并发高血压病75例(72.1%)。结论心房纤颤、心源性脑栓塞是大面积脑梗死的重要病因。在大动脉粥样硬化狭窄基础上,动脉-动脉栓塞是大面积脑梗死的另一发病原因。

Objective To investigate the clinical manifestations, clinical imaging features and related risk factors of 104 massive cerebral infarction patients, and to provide the basis for the prevention of large area cerebral in- farction. Methods By reviewing the records of 104 massive cerebral infarction patients who had been performed ECG, echocardiogram, compntetized tomography, magnetic resonance imaging or angiography, transcranial Doppler, and Carotid color Doppler ttltrasound evaluation, both the site of infarctions and the causes of vascular occlusion were investigated. Results Among the 104 massive cerebral infarction patients, 69 patients （66. 3% ） had cardiogenic cerebral embolism, including 39 cases of coronary heart disease, 16 cases of old myocardial infarction, 7 cases of rheumatic heart disease, 3 cases of dilated cardiomyopathy, 2 cases of hyperthyroid heart disease, and 1 case of myo- cardial noncompaction. 63 （60. 6% ） patients had atrial fibrillation, and 75 patients （72. 1% ） had hypertension. Con- clusion Both atrial fibrillation and cardiogenic cerebral infarction are the most important cause of massive cerebral infarction, and artery-artery embolization is its another important cause on the basis of the artery stenosis.