| Objective1Select the stroke patients that with the blood stasis r esistance as the main syndrome types and there are multiple a rtery atherosclerotic stenosis in his intracranial arteries, divided the patients into two groups according to the drugs t hat the patients discharged with, and all patients were follo wed up after2years.To observe the clinical efficacy of Gink ga biloba on patient with the blood stasis resistance as the main syndrome types and multiple intracranial artery stenosis and cerebral infarction by clinical research though follow-u P.2Observe the cerebral haemodynamics of Stroke patients b y320-slice CT perfusion imaing (320CTPI), aiming to explore the the threshold that chronic cerebral circulation insuffici ency development to acute cerebral infarction. It can provide a reference for the prevention and treatment of cerebral isc hemic stroke. Methods 1Select the stroke patients that with the blood stasis r esistance as the main syndrome types and with multiple artery atherosclerotic stenosis in intracranial arteries.All patien s were Selected from the Department of Neurology of Wuhan Gen eral Hospital during January2010to December2010.Assess the NIHSS score for all patients when discharged and divided the m into two groups according to the drugs with them. Finally, select the159patients that adhere to the medication and fol low-up successfully as the object of study. The treatment gro up have79patients, the control group have80patients.The t reatment group were gave Bayaspirin100mg once a day and Tana kan40mg three times a day,then the control group were only g ave Bayaspirin100mg once a day. All patients were gave conve ntional treatments such as anti-platelet aggregation, stabling plaque,Control of blood pressure and blood glucose when they left hospital.And assess the NIHSS score for all patients.Th e treatment course was2years. Then telephone follow-up all p atients.The follow-up content included stroke symptom improve ment, whether the symptoms complete remission, recurrence or worsening, their medication compliance and the outpatient ref erral situation. Divided the efficacy results into cure, effe ctive, ineffective and recurrence, count up the efficacy resu Its of the two groups, and to analysis of Ginkgo biloba effic acy of such patients.2Select22CCCI and22ACI patients in the Department of Neurology of Wuhan General Hospital of Guangzhou Military R egion from May2012to February2013that just one side of th e internal carotid artery system have stenosis or occlusion c onfirmed by320CTA. All objects underwent head MRI, head CT scan,head and neck CT angiography and the whole brain CT perf usion by320-slice CT to understand the situation of ischemia and infarction within2days after in hospital. several lcm2r egions of interest (ROIs) were manually seted on each perfusio n map in the center of ischemia of CCCI and infarct of ACI TTP,MTT, CBF, CBV of each ROI was measured. The ROIs’on the o ther side of cerebral hemisphere were also measured through t he mirror imaging software. Symmetry of the two sets perfusio n parameters were matched and then get out rTTP, rMTT, rCBF and rCBV. ROIs which CBF and CBV decline in the CCCI group and R OIs in infarcts center in the ACI group were selected to rese arch. Than, two sets of the rTTP, rMTT,rCBF, rCBV were statstica lly analyzed and explore the threshold that chronic cerebral circulation insufficiency development to acute cerebral infar ction.Results1The clinical observation on the Ginkgo biloba Efficacy of s troke patients1.1The baseline characteristics including age, gender, p ast history and the NIHSS score when discharged and NIHSS sco re were comparable before treatment, no significant differenc e was found (P>0.05).1.2The efficent of treatment group was significantly hig her than Control group (82.55%vs56.25%, P<0.05). The cure rate of treatment group was significantly higher than Control gro up (26.85%vs2.5%,P<0.05). The relapse rate of treatment group was significantly lower than Control group (10.13%vs28.75%, P <0.05).1.3The standard treatment for hypertension, diabetes pla y a positive role in prevention of stroke recurrence! P<0.05).2The diagnostic applications of320CTA and CTP in stroke patie nts2.1MRI A total of29acute infarcts were found by MRI. The CCCI group showed0acute infarcts, while7case showed in Leuk oencephalopathy.2case showed in the centrum semiovale,7case showed in the periventricular.The ACI group showed29acute inf arcts.4case showed in frontal,19case showed in temporal lobe,4case showed in parietal,2case showed in occipital lobe. In w hich,6case showed in basal ganglia,7case showed in corona ra diata. All acute infarcts were distributed in responsibility Va scular blood flow area.2.2320CTA2.2.1All of the44patients in ACI and CCCI groups, we f ound72Vascular lesions.57of them was intracranial Vascula r lesions,15of them was extracranial Vascular lesions.53o f them was the anterior circulation vessels,19of them was po sterior circulation vessels.23of them was occlusion of blood vessels,49of them was narrow blood vessels. In CCCI group,16cases (72.73%) had a single stenosis,6cases (27.27%) had wid e range of stenosis. In ACI group,7cases (31.82%) had a single stenosis,15case(68.18%) had wide range of stenosis. There w as a significant difference between the two groups.(x2=7.38, P<0.05).2.2.2In CCCI group,8cases (36.36%) had vascular occlusio n,14cases (63.64%) had vascular stenosis. In ACI group,15case s (68.18%) had vascular occlusion,7cases (31.82%) had vascular stenosis. There was a significant difference between the two groups.(x2=4.46,P<0.05).2.3320CTP2.3.1A total of69abnormal perfusion areas were found f rom all the44Patients. In CCCI group,there were30abnormal perfusion areas.22of them were in middle cerebral artery blo od supply zone.3of them were in anterior cerebral artery blo od supply zone.5of them were in posterior cerebral artery bl ood supply zone.In ACI group,there were39abnormal perfusion areas.22of them were in middle cerebral artery blood supply zone.10of them were in anterior cerebral artery blood suppl y zone.7of them were in posterior cerebral artery blood supp ly zone.2.3.2A total of556ROIs are selected in the two groups.266of them were in CCCI group,300of them were in ACI group. The n A total of283sets of perfusion parameters were got. The rTT P, rMTT, rCBF, rCBV was (1.22±0.12),(1.05±0.19),(0.78±0.15),(0.86+0.76) in the CCCI group, while (1.31±0.16),(0.76+0.21),(0.63±0.20),(0.47±0.16) in the ACI group, ther e was a significant differences between the two groups.(P<0.05).2.3.3By discriminant analysis, the best thresholds of rTT P, rMTT, rCBF and rCBV to determine anterior circulation CCCI an d ACI threshold was1.27,0.89,0.64,0.68, when each of them a s a single predictor. The distinguish coincidence rate was62.2%,75.6%,67.5%,88.0%respectively. By the ROC curve analysis, rCBV showed the largest area under the curve,up to95.5%, tip ping as a single definition of indicator, rCBV was superior th-an rTTP, rMTT and rCBF. when rCBV threshold is equal to0.68, the sensitivity was82.7%and the specificity was94.0%.Conclusions1Ginkgo biloba and Bayaspirin had better clinically effect ive in treating in stroke based on the blood stasis orifices ty pewith multiple with intracranial atherosclerotic arteries narr ow than Bayaspirin. Ginkgo biloba and Bayaspirin can relieve the symptoms of the stroke patients and reduce the rate of cerebra1infarction recurrence. To cerebral infarction patients especia lly with multiple with intracranial atherosclerotic arteries na rrow, it was more suitable for using Ginkgo biloba and Bayaspir in combination treatment in the secondary prevention of stroke.2According to the two-years follow-up results, we found th at the specification of the stroke therapy such as anti platele t aggregation, control of blood pressure, fall blood sugar and stable plaques treatment for stroke play a positive role in pre vent ion of recurrence.3All of the44patients in ACI and CCCI groups, we found72Vascular lesions.57of them was intracranial Vascular le sions,15of them was extracranial Vascular lesions.53of th em was the anterior circulation vessels,19of them was poster ior circulation vessels.23of them was occlusion of blood ves sels,49of them was narrow blood vessels. The results show th at320CTA had important diagnostic value of intracranial vasc ular stenosis in patients with ischemic stroke. 4320CTP can evaluate ischemic stroke in patients with cer ebral blood flow dynamics. The rTTP, rMTT, rCBF, rCBV can evaluate the hemodynamic between the anterior circulation CCCI and ACI as index. The rCBV was the best prdictor, the best threhold of rCBV was0.68. In addition, this study found that MTT of infarct s central was shorten than the contralateral,the reason may be related to different calculation method, contrast agent through the capillary path change and so on.5This study shows that320cta CTP has important applicati on value in clinical diagnosis of ischemic stroke. |
PDF Full Text Request