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目的 :探讨无症状性脑梗死对首发急性脑卒中患者预后的影响。方法 :选择2010年6月~2012年6月在我院接受治疗的135例急性脑卒中患者,按照MRI检查是否伴有无症状脑梗死将患者分为无症状性脑梗死(SCI)组与非无症状性脑梗死(非SCI)组,其中SCI组62例,非SCI组73例,采用蒙特利尔认知评估量表(Mo CA)及简明智力状态检查量表(MMSE)分别对两组患者发生脑卒中2周及3个月进行认知功能评定,并对两组患者肢体活动能力及3年内复发率、死亡率进行统计比较。结果 :SCI组与非SCI组两周及3个月VCIND、VD比较差异具有统计学意义。脑卒中3个月后两组患者认知功能损害均有不同程度的下降,但所占比例仍较高。虽然非SCI组两周及三个月VCIND发生率较SCI组高,但SCI组两周及三个月显示出更高的VD趋势。与卒中后2周比较,非SCI组患者总体认知功能显著改善,视空间执行功能、注意力和抽象思维能力显著改善,比较差异具有统计学意义;而SCI组与两周时比较,卒中后3个月SCI组总体认知功能及视空间执行功能、注意力和抽象思维能力无显著改善,无统计学意义。SCI组不能抬起上肢、不能独立行走及3年内脑梗死复发率、3年内死亡率均显著高于非SCI组,比较差异具有统计学意义。结论 :无症状性脑梗死对首发急性脑卒中患者显示出更高的VD趋势,会进一步加重脑卒中患者认知的损害,并且具有较高的致残率、脑梗死复发率及死亡率。在临床上应重视对SCI的诊断,并使患者对SCI的危害得到充分的认识,积极的采取针对性的措施,以预防脑卒中的发生。
Objective: To investigate the impact of asymptomatic cerebral infarction on the prognosis of patients with acute stroke. Methods: One hundred and thirty-five patients with acute stroke admitted to our hospital from June 2010 to June 2012 were divided into two groups according to MRI examination: asymptomatic cerebral infarction (SCI) and non-SCI Asymptomatic cerebral infarction (non-SCI) group, including 62 cases of SCI group, 73 cases of non-SCI group, using the Montreal Cognitive Assessment Scale (MoCA) and the Simple Mental Status Examination Scale (MMSE) were two groups of patients The cognitive function was assessed at 2 weeks and 3 months after stroke. The limb mobility and the relapse rate and mortality within two years were compared statistically. Results: There was significant difference in VCIND and VD between SCI group and non-SCI group at two weeks and three months. Three months after stroke, cognitive impairment in both groups decreased to some extent, but the proportion was still high. Although the incidence of VCIND was higher at 2 and 3 months in the non-SCI group than in the SCI group, the VD trend was higher at 2 weeks and 3 months in the SCI group. Compared with the two weeks after stroke, the overall cognitive function of non-SCI patients was significantly improved, and the visual function of executive space, attention and abstraction ability were significantly improved, with statistical significance; while in SCI group compared with two weeks, At 3 months, there was no significant improvement in the overall cognitive function and visual function in the SCI group, with no significant improvement in attention and abstraction ability. SCI group can not lift the upper limbs, can not walk independently and within 3 years the recurrence rate of cerebral infarction, 3-year mortality were significantly higher than non-SCI group, the difference was statistically significant. CONCLUSIONS: Asymptomatic cerebral infarction shows a higher VD tendency in patients with first-episode acute stroke, further aggravating the cognitive impairment in stroke patients, and has a higher rate of morbidity, recurrence and mortality of cerebral infarction. Clinically, attention should be paid to the diagnosis of SCI, and make patients fully aware of the dangers of SCI, and actively take targeted measures to prevent the occurrence of stroke.