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目的探讨脑分水岭梗死的临床治疗。方法回顾分析本院自2004年1月至2009年2月收治的30例CWI患者的临床资料。结果均给予纠正低血压,补充血容量,抑制血小板聚集,积极治疗原发病,按照1996年全国第四届脑血管病会议制定的标准评定疗效,基本痊愈15例,显著进步11例,进步4例。结论CWI分为皮质前型、皮质后型及皮质下型。临床特点与其病变部位有关,皮质前型表现为以上肢为主的偏瘫和偏身感觉障碍,可伴有精神障碍;皮质后型以偏盲最常见;皮质下型主要表现为偏瘫及偏身感觉障碍。由于头颅CT及头颅MRI的特征性改变,使CWI在临床上与其他类型脑梗死更易识别。临床上对此类脑梗死应减少脱水药物的应用,注重病因治疗,积极纠正低血压,扩充血容量,如有老年高血压合并颅内外血管重度狭窄患者,应注意降压的调控,避免过度降压,老年人发生腹泻、脱水时应立即补液,保证有效循环血量,减少CWI的发生。
Objective To investigate the clinical treatment of cerebral watershed infarction. Methods The clinical data of 30 patients with CWI admitted to our hospital from January 2004 to February 2009 were retrospectively analyzed. The results were given to correct hypotension, blood volume, inhibit platelet aggregation, the active treatment of primary disease, according to the 1996 Fourth National Conference on cerebrovascular disease criteria for the development of curative effect, the basic recovery in 15 cases, significant improvement in 11 cases, progress 4 example. Conclusion CWI is divided into pre-cortex, cortex and subcortex type. Clinical features and its related parts of the lesion, cortical prefrontal manifestations of upper limb-based hemiparesis and partial sensory dysfunction, may be associated with mental disorders; cortical posterior to the most common hemianopia; subcortical mainly manifested as hemiplegia and hemifacial dysfunction . Due to the characteristic changes of cranial CT and cranial MRI, CWI is more easily recognized clinically than other types of cerebral infarction. Clinically, we should reduce the application of dehydration drugs on such cerebral infarction, pay attention to the cause of treatment, and actively correct hypotension, blood volume expansion, if elderly patients with hypertension and severe intracranial vascular stenosis, should pay attention to the regulation of antihypertensive to avoid excessive drop Pressure, the elderly diarrhea, dehydration should be immediately rehydration, to ensure effective circulation of blood, reduce the incidence of CWI.