伴有意识障碍的急性脑梗死患者临床特征分析

Clinical characteristics analysis of acute cerebral infarction patients with consciousness disturbance

目的探讨伴有意识障碍的脑梗死患者的相关影响因素及预后情况。方法选取2022年1—12月天津市第一中心医院收治的伴有意识障碍的急性脑梗死患者54例为研究对象,总结分析其病因、临床特点、治疗及预后情况。结果经住院治疗后,40例患者出院,14例患者死亡,出院时脑卒中改良Rankin量表(mRS)评分好转有11例,美国国立卫生研究院卒中量表(NIHSS)评分好转有30例,意识好转有32例,意识无变化8例。54例患者中,大动脉粥样硬化性脑梗死37例、占比68.52%,心源性脑梗死共计15例、占比27.78%,其他原因导致的脑梗死2例、占比3.70%。临床表现中言语不利44例、肢体活动不利54例、凝视32例、面瘫28例,其中肢体活动不利、言语不利患者较多,同时大动脉粥样硬化、心源性血栓等是导致伴有意识障碍的脑梗死发作的关键因素。结论伴有意识障碍的脑梗死较为严重,临床表现复杂多样,尤其是昏迷患者,往往提示预后不良,针对此类患者通过控制脑水肿、抗血小板聚集、他汀调脂、稳定斑块、清除自由基、改善脑循环等措施进行规范治疗,可取得良好效果,改善患者预后。

Objective To investigate the related influencing factors and prognosis condition of cerebral infarction patients with consciousness disturbance.Methods From January to December 2022,54 patients with acute cerebral infarction with consciousness disturbance admitted to Tianjin First Central Hospital were selected as the research subjects.The etiology,clinical features,treatment and prognosis condition were summarized and analyzed.Results After hospitalization treatment,40 patients were discharged and 14patients died,at discharge,11 patients were improved in the modified Rankin scale(m RS)score,30patients were improved in the national institutes of health stroke scale(NIHSS)score,32 patients were improved in consciousness,8 patients were unchanged in consciousness.Among the 54 patients,there were37 cases of large atherosclerotic cerebral infarction,accounting for 68.52%,15 cases of cardiogenic cerebral infarction,accounting for 27.78%,and 2 cases of cerebral infarction caused by other reasons,accounting for 3.70%.The clinical manifestations included 44 cases of speech impairment,54 cases of limb mobility impairment,32 cases of gaze impairment,and 28 cases of facial paralysis.Among them,there were more patients with limb mobility impairment and speech impairment.At the same time,large atherosclerosis,cardiogenic thrombosis and others were the key factors that led to the onset of cerebral infarction with consciousness impairment.Conclusion Cerebral infarction with consciousness disturbance was more serious,with complex and diverse clinical manifestations,especially in comatose patients,which often indicated bad prognosis.Standardized treatment for such patients could achieve good results and improve patients prognosis by controlling brain edema,anti platelet aggregation,statin lipid-lowering,stabilizing plaques,clearing free radicals and improving cerebral circulation.