不同类型缺血性卒中患者血管反应性比较  

Comparing the Cerebral Vasomotor Reactivity in Different Types of Ischemic Stroke

作　　者：刘俊艳[1] 李燕[1] 

机构地区：[1]河北医科大学第三医院神经内科,河北省石家庄市050051

出　　处：《中国卒中杂志》2008年第3期174-177,共4页Chinese Journal of Stroke

摘　　要：目的探讨不同类型缺血性卒中患者的脑血管反应性,为卒中二级预防中血压水平的调控提供理论依据。方法选取症状性大脑中动脉粥样硬化性狭窄(MCAS)患者70例(32例为双侧MCAS患者),腔隙性脑梗死患者30例,年龄、性别相匹配的健康人36例为对照组。采用经颅多普勒(TCD)超声检测屏气前、屏气末双侧大脑中动脉(MCA)血流速度,计算屏气指数(BHI)。结果症状性MCAS患者病灶侧、非病灶侧病变MCA的BHI均明显低于健康对照组(0.91±0.43vs1.53±0.80;1.24±0.42vs1.53±0.80,P均<0.01),病灶侧MCA的BHI明显低于非病灶侧(0.91±0.43vs1.24±0.42);腔隙性脑梗死患者BHI明显低于健康对照组(1.28±0.86vs1.53±0.80,P<0.05)。症状性MCAS患者中,重度狭窄组BHI明显低于轻、中度狭窄组(0.65±0.36vs1.41±0.59;0.65±0.36vs1.11±0.42,P均<0.05)。结论症状性MCAS及腔隙性脑梗死患者的脑血管反应性均存在不同程度的受损,检测其脑血管反应性有助于卒中二级预防中血压水平的调控。Objective To evaluate cerebral vasomotor reactivity(CVR) in patients with different types of ischemic stroke and to provide evidence for adjusting optimal blood pressure level in secondary prevention of stroke. Methods We evaluated the breath-holding index(BHI) using the breath-holding index technique during bilateral Transcranial Doppler monitoring of flow velocity in the middle cerebral arteries(MCA) of 70 patients with symptomatic middle cerebral artery atherostenosis(MCAS) and30 patients with lacunar infarction and 36 sex-and age-matched healthy volunteers. Results BHI was significantly lower in patients with symptomatic MCAS in bilateral MCAs than that in the control subjects (0.91±0.43 vs 1.53±0.80; 1.24±0.42 vs 1.53±0.80,P<0.01) and BHI in MCA with infarction focus was significantly lower than with no focus(0.91±0.43 vs 1.24±0.42). Compared with controls,BHI in patients with lacunar infarction was significantly lower(1.28±0.86 vs 1.53±0.80,P<0.05). Moreover,BHI decreased progressively with changing of the severity of cerebrovascular stenosis(0.65±0.36 vs 1.41±0.59,0.65±0.36 vs 1.11±0.42,P<0.05). Conclusion The cerebral vasomotor reactivity is impaired in patients with symptomatic MCAS and lacunar infarction. CVR assessment is helpful to adjust optimal blood pressure level in secondary prevention of stroke.

关 键 词：脑血管反应性 脑梗死 动脉粥样硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]