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目的分析症状性大脑中动脉重度狭窄患者缺血性脑卒中复发率及影响因素。方法回顾性分析症状性大脑中动脉重度狭窄患者67例,均经数字减影血管造影(DSA)或CTA证实,其中脑梗死55例、短暂性脑缺血发作(TIA)12例;随访12个月,确定患者的结局,评价缺血性脑卒中复发率,对患者脑卒中各种相关危险因素和是否规律服用降压药物、抗血小板药物、他汀类药物等进行分析。结果失访2例,死亡3例;存活的62例患者中,复发缺血性脑卒中13例(21.0%),发生于重度狭窄大脑中动脉区域的复发患者9例(14.5%)。复发患者与未复发患者规律服用抗血小板药物发生率和低密度脂蛋白胆固醇(LDL-C)水平比较,差异有统计学意义(P<0.05)。结论症状性大脑中动脉狭窄患者的复发率高,未规律服用抗血小板药和血清LDL-C不达标是复发的主要影响因素,应强化抗动脉粥样硬化和规律服用抗血小板药物以预防复发。
Objective To analyze the recurrence rate and influencing factors of ischemic stroke in patients with symptomatic severe middle cerebral artery stenosis. Methods A retrospective analysis of 67 patients with symptomatic severe middle cerebral artery stenosis were confirmed by digital subtraction angiography (DSA) or CTA, including 55 cases of cerebral infarction and 12 cases of transient ischemic attack (TIA); 12 cases were followed up Month, determine the patient’s outcome, evaluate the relapse rate of ischemic stroke, the various risk factors associated with stroke and whether taking regular antihypertensive drugs, antiplatelet drugs, statins and other analysis. Results Two cases were lost to follow-up and 3 died. Among the 62 surviving patients, 13 (21.0%) had recurrent ischemic stroke and 9 (14.5%) had recurrence in the severely stenosed middle cerebral artery. The incidence of antiplatelet drugs and the level of LDL-C in regularly relapsed and non-relapsed patients were significantly different (P <0.05). Conclusions The recurrence rate of patients with symptomatic middle cerebral artery stenosis is high. Unreasonable use of antiplatelet agents and non-compliance of serum LDL-C are the main factors of recurrence. Anti-atherosclerosis and anti-platelet drugs should be taken regularly to prevent relapse.