| Objective:Cerebral infarction has the characteristics of high incidence,high disability rate,high recurrence rate and high mortality rate in China,and the number of patients is increasing year by year,which brings great pain to individuals and causes heavy burden to families and society.Large artery atherosclerotic cerebral infarction is the most common type in TOAST classification,which is closely related to carotid atherosclerotic plaque.Hypertension is an important risk factor for atherosclerosis.Hypertension has strong mechanical pressure on vascular wall.lt can damage vascular endothelial cells,causing the increase of lipoprotein infiltration into intima,adhesion of platelets and monocytes,migration of medial smooth muscle cells into intima,and so on,which could promote the development of atherosclerosis including carotid artery.Luo Hao and others found that the higher the level of hypertention,the more severe carotid atherosclerosis.He Yanlin and others found that the morbidity of carotid atherosclerosis in hypertension group was significantly higher than that in non-hypertension group(P<0.01),77.4%of hypertension patients complicated with carotid atherosclerosis.Carotid atherosclerotic plaque was found to be the main cause of cerebral infarction due to hypertension.Severe carotid atherosclerosis can cause vascular stenosis.Study shows that microembolism are easy to be produced in badly narrow vessels,which may be related to changes in hemodynamics.The more obvious the vessel stenosis,the faster the blood flow in the stenotic region,the greater the biological shear stress on the wall and plaque of the stenosis,the plaque could break down and fall off.,At the same time,when the blood enters the wider vascular cavity,it is easy to gather in the eddy current to form clots,resulting in microembolism.Domestic studies have shown that carotid atherosclerotic plaque and the formation of microembolism are closely related to cerebral infarction,both of which provide a basis for the pathogenesis of cerebral infarction.The presence of microembolism suggests the instability of plaques,plaques could break down and fall off many times,causing recurrent attacks of cerebral infarction.Therefore,monitoring the change of carotid atherosclerotic plaques and the occurrence of microembolism and giving active antithrombotic therapy can effectively prevent the occurrence of cerebral infarction and reduce the mortality.Transcranial Doppler has been widely used because of its advantages of noninvasive,real-time,convenient and so on.Microembolism monitoring is one of the main application fields,which has been carried out all over the world and has been recognized by experts and scholars at home and abroad.It has been widely used in ischemic cerebrovascular diseases,including pathogenesis,secondary prevention,drug efficacy and prognosis evaluation.Transcranial Doppler microembolism monitoring can be used to observe the occurrence of microembolism in atherosclerotic vessels real-timely,accurately and dynamically.It could help to evaluate and screen the high risk population of ischemic stroke and the treatment options,and provide evidence for the study of the pathogenesis of cerebral infarction.The aim of this study is to observe the blood pressure level on admission and the detection rate of microembolism in patients with large artery atherosclerotic cerebral infarction complicated with hypertension.To explore the correlation between the detection rate of microembolism and the blood pressure at admission.And explore the correlation between the detection rate of microembolism and the age and years of hypertension.To provide clinical basis and reference for blood pressure regulation and treatment in patients with large artery atherosclerotic cerebral infarction complicated with hypertension.Methods:According to diagnosis,inclusion and exclusion criteria,122 inpatients with acute large artery atherosclerotic cerebral infarction complicated with hypertension,aged 64.67±9.009 years,are selected as subjects from department of neurology,Fifth affiliated Hospital of Kunming Medical University,from June 2016 to January 2018.0f these,69 males(56.56%),aged 64.07±9.062 years,and 53 females(43.44%),aged 65.45±8.965 years.According to the blood pressure level measured immediately before microembolism monitoring after admission,the subjects were divided into four groups according to the<Chinese guidelines for the Prevention and Treatment of Hypertension 2010>:normal blood pressure group,hypertension grade 1 group,hypertension grade 2 group,hypertension grade 3 group.There are 30 patients in the normal blood pressure group,including 16 males and 14 females,aged 65.80±9.301 years;there are 29 patients in the hypertension grade 1 group,including 17 males and 12 females,aged 65.31±9.138 years;there are 31 patients in the hypertension grade 2 group,including 18 males and 13 females,aged 63.42±9.021 years;there are 32 patients in the hypertension grade 3 group,including 18 males and 14 females,aged 64.25±8.850 years.All the patients are monitored microembolism within 24 hours of admission before antithrombotic therapy.The monitoring time is 30 minutes.According to the monitoring results of microembolism,the detection rate of microembolism in 4 groups is calculated respectively and compared with each other.According to the different years of hypertension,the median of 122 patients with hypertension was 10 years,and the patients were divided into<10 years group and>10 years group.There are 60 cases in the<10 years group,including 37 males and 23 females,aged 63.08±8.302 years old.There were 62 cases in the>10 years group,including 32 males and 30 females,aged 66.21±9.458 years.To study the correlation between the detection rate of microembolism and the years of hypertension.According to the age of the patients,the median age of 122 patients was 65 years old.The patients were divided into<65 years old group and>65 years old group.There were 60 cases in the<65 years old group,including 35 males and 25 females,aged 56.77 ±4.405 years old.There are 62 cases in the>65 years old group,including 34 males and 28 females,aged 72.32 ±4.612 years old.The detection rate of microembolism in the two groups was compared and analyzed,to study the correlation between the detection rate of microembolism and age.Results:1.lmicroembolism case is detected in normal blood pressure group(3.33%),2 cases are detected in the hypertension grade 1 group(6.90%),7 cases are detected in the hypertension grade 2 group(22.58%),10 cases are detected in the hypertension grade 3 group(31.25%).The detection of microembolism in the above four groups was compared by pairwise comparison and we have found:the detection rate of microembolism in the hypertension grade 3 group is higher than that in the hypertension grade 2 group,the hypertension grade 1 group and the normal blood pressure group.The detection rate of hypertension grade 2 group is higher than that in the hypertension grade 1 group and normal blood pressure group,and the detection rate of hypertension grade 1 group is higher than that in the normal blood pressure group.The detection rate of the four groups is detected by pairwise x2 test.It is found that the difference between normal blood pressure group and hypertension grade 3 group is statistically significant,x2 value 8.269,P<0.05.The difference between hypertension grade 1 group and hypertension grade 3 group is statistically significant,x2 value 5.710,P<0.05.There is no statistical significance of the difference between the remaining groups.2.There are 4 microembolism cases are detected in<10 years group(6.67%),and 16 microembolism cases are detected in>10 years(25.81%).x2 value 8.150,<0.05.The difference is statistically significant.3.There are 5 microembolistn cases are detected in the age group of<65 years old(8.33%),and 15 microembolism cases are detected in the age group of>65 years old(24.19%).x2 value 5.596,P<0.05.The difference is statistically significant.Conclusions:1.This study showed that the detection rate of microembolism in 122 patients with large artery atherosclerotic cerebral infarction complicated with hypertension is correlated with the blood pressure level at admission.The higher the blood pressure level,the higher the detection rate of microembolism.2.This study showed that the detection rate of microembolism in 122 patients with large artery atherosclerotic cerebral infarction complicated with hypertension is positively correlated with the years of hypertension.The longer the years of hypertension,the higher the detection rate of microembolism.3.This study showed that the detection rate of microembolism in 122 patients with large artery atherosclerotic cerebral infarction complicated with hypertension is positively correlated with age.The higher the age,the higher the detection rate of microembolism. |
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