Mối liên quan giữa lâm sàng và hình ảnh học ở bệnh nhân cao tuổi nhồi máu não hệ động mạch đốt sống thân nền=Results of endoscopic intervention treatment in patients with acute ischemic stroke within the 6-24 hour window using regular imaging and cerebral perfusion imaging

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Thị Thu Hà Bùi, Huy Ngọc Nguyễn, Thị Thu Hằng Nguyễn, Văn Hải Tạ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.163-171

Bộ sưu tập: Metadata

ID: 242210

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Đánh giá mối liên quan giữa lâm sàng và hình ảnh học ở bệnh nhân cao tuổi bị nhồi máu não hệ động mạch đốt sống thân nền. Đối tượng và phương pháp: Gồm 120 bệnh nhân (BN) ≥ 60 tuổi, bị nhồi máu não (NMN) hệ động mạch đốt sống thân nền điều trị tại Trung tâm Đột quỵ Bệnh viện Đa khoa tỉnh Phú Thọ từ 01/2022 - 12/2022. Tiêu chuẩn chọn: các BN thỏa tiêu chuẩn của Tổ chức Y tế Thế giới 1990. Được chụp cộng hưởng từ (MRI) não trong 24 giờ đầu nhập viện và chụp cắt lớp vi tính mạch não (CTA) hoặc TOF 3D trên phim cộng hưởng từ não (MRA). Tiêu chuẩn loại trừ: BN có kèm NMN tuần hoàn trước, chấn thương sọ não, u não, chảy máu não, viêm não, bệnh não chuyển hóa, huyết khối tĩnh mạch não, nhồi máu não cũ có điểm mRS >
1, bệnh nhân và gia đình không đồng ý tham gia nghiên cứu. Phương pháp nghiên cứu tiến cứu cắt ngang, mô tả và phân tích, chọn mẫu thuận tiện, sử lý số liệu bằng phần mềm SPSS 22. Kết quả: Tuổi trung bình: 72,23 tuổi (cao nhất 98 tuổi)
tỷ lệ nam/nữ 1,67/1
Các yếu tố nguy cơ (YTNC) chính: tăng HA (94,2%)
rối loạn chuyển hóa lipid (71,7%)
xơ vữa động mạch theo phân loại TOAST: 66,7% (mạch máu lớn 48,3%, tắc mạch nhỏ 33,3%)
đái tháo đường (30,8%)
chóng mặt (55,85%)
mất thăng bằng (47,5%)
rung giật nhãn cầu (34,2%)
bất thường đồng tử (19,2%)
liệt tứ chi (20%)
bán manh (21,7%)
tổn thương dây thần kinh sọ não ngoại vi (17,5%). Điểm Glasgow (13-15 điểm): 84,2%
NIHSS <
11 điểm: 83,3% điểm pcASPECTS trung bình 8,13 điểm (pc ASPECTS 8-10 điểm: 75,8%
tắc hoàn toàn động mạch thân nền: 20%
tắc động mạch não sau phải, trái lần lượt là 23,3% - 18,3%
tắc động mạch đốt sống phải - trái (25% - 18,2%). Điểm mRS khi ra viện kết cục tốt 74,2% (mRS 0-2 điểm), kết cục xấu 25,8% (mRS 3-6 điểm). Kết luận: pc ASPECTS có tương quan nghịch với NIHSS vào viện (R= - 0,781)
có mối liên quan giữa kích thước tổn thương cầu não với Glasgow và NIHSS vào viện và mRS ra viện với (p<
0,05). Có mối liên quan giữa tắc các mạch (thân nền, đốt sống phải, đốt sống trái, não sau trái) với nhóm NIHSS cao khi vào viện (11-42 điểm), Glasgow vào viện thấp (3-12 điểm) và mRS cao khi ra viện (3-6 điểm). Nhóm tắc từ 2 động mạch trở lên lâm sàng nặng hơn nhóm tắc 1 động mạch.Evaluate the relationship between clinical and imaging in elderly patients with cerebral infarction of the vertebrobasilar artery system. Subjects and methods: Including 120 patients ≥ 60 years old, with cerebral infarction of the vertebrobasilar artery system is treated at the Stroke Center of Phu Tho Provincial General Hospital from January 2022 - December 2022. Selection criteria: patients who meet the criteria of the World Health Organization 1990. Receive magnetic resonance imaging (MRI) of the brain within the first 24 hours of admission and cerebral computed tomography angiography (CTA) or 3D TOF on brain magnetic resonance imaging (MRA). Exclusion criteria: Patients with anterior circulation stroke, traumatic brain injury, brain tumor, brain hemorrhage, encephalitis, metabolic encephalopathy, cerebral venous thrombosis, old cerebral infarction with mRS score >
1, disease Individuals and families do not agree to participate in the study. Cross-sectional prospective research method, description and analysis, convenient sampling, data processing using SPSS 22 software. Results: Average age: 72.23 years old (highest 98 years old)
male/female ratio 1.67/1
Main risk factors: increased BP (94.2%)
lipid metabolism disorders (71.7%)
Atherosclerosis according to TOAST classification: 66.7% (large vessels 48.3%, small vessel occlusions 33.3%)
diabetes (30.8%)
dizziness (55.85%)
loss of balance (47.5%)
nystagmus (34.2%)
pupil abnormalities (19.2%)
quadriplegia (20%)
hemianopia (21.7%)
peripheral cranial nerve damage (17.5%). Glasgow score (13-15 points): 84.2%
NIHSS <
11 points: 83.3% average pcASPECTS score 8.13 points
pcASPECTS 8-10 points: 75.8%
complete basilar artery occlusion: 20%
right posterior cerebral artery occlusion, left is 23.3% - 18.3%
right - left vertebral artery occlusion (25% - 18.2%) respectively. mRS score at hospital discharge had good outcome 74.2% (mRS 0-2 points), bad outcome 25.8% (mRS 3-6 points). Conclusion: pc ASPECTS has a negative correlation with NIHSS admitted to the hospital (R= - 0.781)
There is a relationship between the size of pontine lesions and Glasgow and NIHSS at hospital admission and mRS at hospital discharge (p<
0.05). There is a relationship between occlusion of vessels (basal trunk, right vertebrae, left vertebrae, left posterior brain) with high NIHSS group at hospital admission (11-42 points), low Glasgow hospital admission group (3-12 points) and mRS high when discharged from the hospital (3-6 points). The group with 2 or more arteries occluded was clinically more severe than the group with 1 artery occlusion.

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