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目的探讨老年人颅脑外伤后缺血性脑卒中发作特点及个性化治疗方案。方法针对7例颅脑外伤后急性期出现缺血性脑血管病症状的老年患者,通过脑血管造影检查分析其发病原因并根据不同的脑血管特点决定治疗方案。结果大多数患者(6/7)受伤前已存在不同程度的颅内外血管狭窄、血管壁溃疡以及附壁血栓形成等改变,提示脑缺血发作主要与这些病变为基础的脑血流下降、血栓脱落等因素密切相关。而外伤后脑灌注降低、脑血管痉挛是脑缺血发作的诱发因素。结论老年人外伤后的缺血性脑卒中发作主要与原有的脑血管基础疾病有关,预防和治疗老年人外伤后缺血性脑卒中发作,应基于这些病变特征并选择个体化治疗方案。
Objective To investigate the characteristics and individualized treatment of ischemic stroke after craniocerebral trauma in the elderly. Methods Aiming at the elderly patients with ischemic cerebrovascular disease in acute stage after traumatic brain injury in 7 cases, the cause of cerebral infarction was analyzed by cerebral angiography and the treatment plan was decided according to the different cerebrovascular characteristics. Results The majority of patients (6/7) had varying degrees of intracranial and extracranial vascular stenosis, vascular wall ulceration and mural thrombosis before injury, suggesting that cerebral ischemia was mainly associated with these pathological changes of cerebral blood flow, thrombosis Off and other factors are closely related. Traumatic cerebral perfusion decreases, cerebral vasospasm is a predisposing factor for cerebral ischemic attack. Conclusions The main causes of ischemic stroke after trauma in the elderly are related to the existing cerebrovascular basic diseases. To prevent and treat the ischemic stroke after trauma in the elderly, the individualized treatment plan should be based on the characteristics of these lesions.