彩色多普勒血流显像评价不同类型颈内动脉闭塞患者血管结构与血流动力学变化  

Analysis of vascular structure and hemodynamics of different types of internal carotid artery occlusion

作　　者：赵新宇[1] 华扬[1] 贾凌云[1] 

机构地区：[1]首都医科大学宣武医院血管超声科,北京100053

出　　处：《中华医学超声杂志（电子版）》2011年第12期2493-2501,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金(81070924)

摘　　要：目的 通过彩色多普勒血流显像(CDFI)评价不同类型颈内动脉闭塞(ICAO)患者血管结构与血流动力学变化。方法 选择由CDFI和经颅多普勒(TCD)联合检测并经数字减影血管造影(DSA)证实的单侧ICAO患者132例。根据DSA影像结果将132例ICAO患者分为颅外段起始全程闭塞组51例和颅内段闭塞组81例。并根据ICAO病变部位与眼动脉(OA)分支的解剖关系,将81例颅内段闭塞组患者进一步分为OA分支前闭塞组38例与OA分支后闭塞组43例。比较各组ICAO患者双侧颈总动脉(CCA)和颈内动脉(ICA)管径、收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)及血管阻力指数(RI),分析颅内段闭塞组患者ICA多普勒频谱特征的差异。结果 (1)颅外段起始全程闭塞组与颅内段闭塞组患者患侧CCA管径分别为(6.8±1.1)、(6.9±0.9)mm,与健侧的(6.9±1.0)、(6.8±0.9)mm比较差异均无统计学意义(t=-0.48、0.71,P均>0.05)。颅外段起始全程闭塞组与颅内段闭塞组患者患侧ICA管径分别为(3.4±0.8)、(3.0±0.7)mm,较健侧的(4.8±0.6)、(4.9±0.7)mm减小,差异均有统计学意义(t=-9.99、-17.30,P均=0.000);颅外段起始全程闭塞组患者患侧ICA管径较颅内段闭塞组患者增宽,差异有统计学意义(t=3.02,P<0.05)。(2)ICAO患者患侧CCA的PSV、EDV分别为(55.4±16.7)、(10.2±5.3)cm/s,较健侧的(89.4±23.2)、(26.5±9.0)cm/s降低,但RI较健侧升高(0.85±0.13vs0.71±0.07),差异均有统计学意义(t=-11.37、-13.98、12.75,P均=0.000)。颅内段闭塞组患者中,OA分支前闭塞组患者ICA的PSV为(32.2±4.9)cm/s,低于OA分支后闭塞组患者的(66.2±10.7)cm/s,差异有统计学意义(t=-17.90,P=0.000);OA分支前闭塞组患者的RI值为1.09±0.09,高于OA分支后闭塞组患者的0.77±0.06,差异有统计学意义(t=19.02,P=0.000)。(3)OA分支前闭塞组ICA为单向收缩期低速或伴舒张早期低速反相血流频谱改变(单峰型、振荡型);OA分支后闭塞组ICA为低流速伴随RI值升高的多Objective To investigate the vascular structures and the hemodynamic changes of different types of internal carotid artery occlusion(ICAO)by color Doppler flow imaging(CDFI).Methods A total of 132 patients one side with ICAO(illness side)and normal on the opposite(health side)detected by CDFI and confirmed by digital subtraction angiography(DSA)were included in the study.According to the imaging results of DSA,the patients were divided into extracranial segment occlusion group(n=51)and intracranial segment occlusion group(n=81).And according to the relationship between the location of occlusion and ophthalmic artery(OA)branch,the patients with intracranial segment occlusion were divided into anterior OA occlusion group(n=38)and posterior OA occlusion group(n=43) further.The differences among the different groups of ICAO were compared and analyzed in the diameter,the peak systolic velocity(PSV),end-diastolic velocity(EDV)and resistance index(RI)of bilateral common carotid artery(CCA)and internal carotid artery(ICA).The characteristics of spectrum morphology of intracranial segment occlusion group were recorded and analyzed.Results (1)There were no significant differences in the diameter of CCA between the occlusion side and the healthy side in extracranial ICAO[(6.8±1.1)mm vs (6.9±1.0) mm,t=-0.48,P>0.05]and intracranial ICAO[(6.9±0.9)mm vs (6.8±0.9)mm,t=0.71,P>0.05].But the diameter of ICA on the side of occlusion was decreased more significantly than those on the healthy side in extracranial ICAO[(3.4±0.8) mm vs (4.8±0.6)mm,t=-9.99,P=0.000]and intracranial ICAO[(3.0±0.7) mm vs (4.9±0.7) mm,t=-17.30,P=0.000].And the diameter of ICA in extracranial ICAO was larger than that of intracnial ICAO(t=3.02,P<0.05).(2)The PSV and EDV of CCA on the affected side were decreased more significantly than those on the unaffected side in ICAO patients[(55.4±16.7) cm/s vs (89.4±23.2)cm/s,(10.2±5.3)cm/s vs (26.5±9.0) cm/s,t=-11.37,-13.98,P=0.000].But the value of RI was higher on the illness side than healthy one(0.85±

关 键 词：彩色多普勒超声检查 颈内动脉 动脉闭塞性疾病 血流动力学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]