[1968-1998年和2010-2015年儿童缺血性脑卒中特点]。

Przeglad lekarski Pub Date : 2016-01-01
Izabela Witek, Sławomir Kroczka, Marek Kaciński
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引用次数: 0

摘要

背景:儿童缺血性中风是罕见的。儿童和青少年缺血性卒中的病因和危险因素不同于典型的成人。临床症状与中枢神经系统损伤的部位、程度和年龄有关。该研究的目的是比较两个时期儿童缺血性中风的临床表现。材料与方法:本研究纳入了1968-1998年发生中风的儿童:32名儿童(I组),2010-2015年27名儿童(II组)。每个病例都进行了病史、体格和神经学检查、实验室检查和神经影像学检查。为了确定儿童缺血的位置,采用牛津社区卒中项目分类。采用Ashworth量表评定偏瘫评分。结果:参与研究的大多数儿童的妊娠、分娩、新生儿期和神经病史没有界限。第一组20例患儿出现脑卒中病因。13例患儿通过血管造影诊断缺血性脑卒中,其余19例通过头部CT诊断缺血性脑卒中。TACI患儿11例,PACI患儿21例。在Ashworth量表中观察14例儿童麻痹I分;5个孩子中有2个得分。3分小儿麻痹11例,4分小儿麻痹2例。第二组有6例患儿出现脑卒中病因。所有儿童的缺血性中风都是基于CT扫描诊断的。24例行MRI, 4例行CT血管造影,5例行MRA。3例患儿诊断为TACI, 21例患儿诊断为PACI, 3例患儿诊断为POCI。Ashworth量表1分麻痹8例,16分麻痹2分。2例患儿轻瘫评分3分,1例患儿麻痹评分4分。第一组和第二组没有儿童发生出血性中风。在脑卒中急性期的药物治疗中主要采用类固醇治疗和利尿剂,在儿童感染时采用抗生素治疗。2例患儿接受抗血栓治疗。采用神经保护治疗(吡拉西坦)和康复治疗。ⅰ组缺血性脑卒中患儿平均住院80天。第二组平均住院时间为23天。结论:1。尽管实验室诊断的动态发展,检测缺血性脑卒中的病因在儿童没有提高。2. 计算机断层扫描仍然是诊断儿童中风的主要诊断工具。3.观察两组1968-1998年和2010-2015年住院儿童缺血后的临床后果。4. 大多数儿童缺血性中风后都有小程度的瘫痪。5. 门诊多学科康复治疗的可及性提高,使2010-2015年儿童住院时间明显缩短。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Characteristics of ischemic stroke in children in the years 1968-1998 and 2010-2015].

Background: Ischemic strokes in children are rare. The etiology and risk factors for ischemic stroke in children and adolescence differ from those typical in adults. Clinical symptoms depend on the location, extent of damage of the central nervous system and age. The aim of the study was to compare the clinical picture of ischemic stroke in children at two periods.

Material and methods: The study included children who had a stroke: 32 children (group I) in the years 1968-1998 and 27 children (group II) in 2010-2015. In each case medical history, physical and neurological examination, laboratory tests and neuroimaging were taken. To determine the location of ischemia in children The Oxford Community Stroke Project classification was used. To determine the score of hemiparesis the Ashworth scale was used.

Results: Pregnancy, delivery, neonatal period and neurological history in the majority of children enrolled to the study, was unbounded. Etiology of stroke in first group was found in 20 children. Diagnosis of ischemic stroke was made on the basis of angiography in 13 children, while the remaining 19 based on head CT. TACI were found in 11 children, while PACI had 21 children. In the Ashworth scale I score of paralysis was observed in 14 children; 2 score in 5 children. 3 score had 11 children and 2 children 4 score of paralysis. In the second group, the etiology of stroke was found in 6 children. Ischemic stroke in all children was diagnosed based on CT scans. Additionaly, 24 children had MRI, 4 children had CT angiography and in 5 children MRA. TACI was diagnosed in 3 children, in the next 21 children PACI and POCI in other 3 children. The Ashworth Scale score 1 paralysis were observed in 8 children and score 2 at 16. 2 children had paresis score 3, in 1 paralysis had score 4. No child in group I and II, had hemorrhagic stroke. In the pharmacological treatment of the acute phase of stroke steroidotherapy and diuretics were used, in children with infection antibiotic therapy was introduced. Antithrombotic therapy was administered in 2 children. Neuroprotective treatment (piracetam) and rehabilitation therapy was used. Children with ischemic stroke in group I were hospitalized an average of 80 days. Hospitalization time in group II was an average of 23 days.

Conclusions: 1. In spite of dynamic development of laboratory diagnosis detection of the etiology of ischemic stroke in children has not improved. 2. Computed tomography is still a primary diagnostic tool in the diagnosis of stroke in children. 3. In both groups of children hospitalization in the years 1968-1998 and 2010-2015 clinical consequences after ischemic were observed. 4. Majority of children after ischemic stroke has a small degree of paralysis. 5. Better availability of outpatient multidisciplinary rehabilitation treatment enabled significantly shortened hospitalization of children in 2010-2015.

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