基底节区进展性脑梗死侧支循环形成及其对近期神经功能缺失的影响

Formation of cerebral collateral circulation and its influence on short-term neurological deficits in patients with progressive cerebral infarction in the basal ganglia

目的探讨基底节区进展性脑梗死脑侧支循环形成及其对近期神经功能缺失的影响。方法将该院收治的200例基底节区进展性脑梗死患者作为研究对象,在其入院后均采用头部CT血管造影(CTA)评估患者侧支循环建立情况,根据患者是否建立侧支循环将其分为侧支循环建立组和无侧支循环建立组,并以美国国立卫生研究院卒中量表(NIHSS)评估其入院时、卒中进展时和侧支循环建立后的神经功能缺损情况,探讨不同分级侧支循环、不同侧支循环开放类型的脑梗死患者神经功能缺失情况。结果200例基底节区进展性脑梗死患者中有146例患者成功建立侧支循环,54例患者无侧支循环建立。侧支循环建立组在入院时和卒中进展时的NIHSS评分与无侧支循环建立组比较,差异均不显著(P>0.05);治疗2周时NIHSS评分低于无侧支循环建立组(P<0.05)。3~4级侧支循环患者在入院时和卒中进展时的NIHSS评分与1~2级侧支循环患者比较,差异均不显著(P>0.05);治疗2周时NIHSS评分低于1~2级侧支循环患者(P<0.05)。前循环脑梗死患者侧支循环建立数多于后循环脑梗死患者(P<0.05)。前循环脑梗死患者入院时和卒中进展时的NIHSS评分与后循环脑梗死患者比较,差异均不显著(P>0.05);治疗2周时NIHSS评分低于后循环脑梗死患者(P<0.05)。结论脑侧支循环形成可改善基底节区进展性脑梗死患者近期神经功能缺失情况。

Objective To investigate the formation of cerebral collateral circulation and its influence on short-term neurological deficits in patients with progressive cerebral infarction in the basal ganglia.Methods A total of 200 patients with progressive cerebral infarction in the basal ganglia who were admitted to our hospital were enrolled as subjects.After admission,head computed tomography angiography was performed to evaluate the establishment of collateral circulation,and according to the presence or absence of collateral circulation,the subjects were divided into collateral circulation establishment group and non-collateral circulation establishment group.National Institutes of Health Stroke Scale(NIHSS)was used to evaluate neurological deficits on admission,during the progression of stroke,and after collateral circulation establishment,and neurological deficits were compared between patients with different collateral circulation grades and different types of collateral circulation opening.Results Of all 200 subjects,146 had successful establishment of collateral circulation and 54 had no establishment.There was no significant difference in NIHSS score between the collateral circulation establishment group and the non-collateral circulation establishment group on admission and during the progression of stroke(P>0.05),while after 2 weeks of treatment,the collateral circulation establishment group had a significantly lower NIHSS score than the non-collateral circulation establishment group(P<0.05).There was no significant difference in NIHSS score between the patients with grade 3-4 collateral circulation and those with grade 1-2 collateral circulation on admission and during the progression of stroke(P>0.05),and after 2 weeks of treatment,the patients with grade 3-4 collateral circulation had a significantly lower NIHSS score than those with grade 1-2 collateral circulation(P<0.05).The patients with anterior circulation infarction had a significantly higher number of established collateral circulations than those with posterior circulation infarction(P<0.05).There was no significant difference in NIHSS score between the patients with anterior circulation infarction and those with posterior circulation infarction on admission and during the progression of stroke(P>0.05),and after 2 weeks of treatment,the patients with anterior circulation infarction had a significantly lower NIHSS score than those with posterior circulation infarction(P<0.05).Conclusions Formation of cerebral collateral circulation can improve short-term neurological deficits in patients with progressive cerebral infarction in the basal ganglia.