评估颈动脉阻断后脑侧支循环代偿能力——经颅多普勒脑血流检测法(英文)  

Transcranial Doppler Evaluation of Cerebral Collateral Circulation as An Approach for——Cerebral Blood Flow Monitoring after Carotid Obstruction

作　　者：傅向军[1] 黄健男[1] 张学辉[1] 朱文敏[2] 彭树文[1] 

机构地区：[1]广东省第二人民医院耳鼻咽喉-头颈外科,广东广州510317 [2]广东省第二人民医院特检科,广东广州510317

出　　处：《广州医学院学报》2006年第1期41-44,共4页Academic Journal of Guangzhou Medical College

基　　金：中国人民解放军广州军区医学科研基金项目(99-k-18)

摘　　要：目的：探讨在经颅彩色多普勒（TCD）辅助下，行肿瘤合并颈动脉切除术前，颈动脉压迫训练时脑血流动力学改变的临床价值。方法：采用TCD为14例手术患者经颞窗检测，观察在阻断患侧颈动脉后双侧ACA（大脑前动脉），MCA（大脑中动脉）的血流速度变化和Willis环开放情况。结果：通过颈动脉压迫训练，DSA（数字减影脑血管造影）和TCD检测发现9例病人（64．3％，9／14）Willis环代偿能力不良，在接受颈动脉压迫训练2～6周后，TCD检测其开放状态和脑侧枝循环建立良好，患侧ACA、MCA血流速度基本达到阻断前水平，颈动脉压迫训练前、后患侧颈动脉阻断时TCD检测对照ACA t=19．278，P〈0．05；MCA t=22、278。P〈0.05，ACA和MCA训练前后颈动脉阻断时比较差异有显著性，符合颈动脉切除术标准。14例随访1年以上未见肿瘤复发，无1例手术死亡或脑血管并发症。结论：TCD是一种无创伤，重复性好，安全可靠，易被接受的脑血流监测评估手段。对肿瘤合并颈动脉切除术尤为重要。Objective： To investigate the clinical value of transcranial doppler test （TCD） in cerebral hemodynamic monitoring for selective patients who were having carotid pressure training before tumor-carotid segment block resection. Methods： The blood velocity variations of left and right anterior cerebral arteries （ACA） and the middle cerebral artery （MCA） in the 14 patients, after their carotids were obstructed, were checked with TCD through temporal windows. Results： Nine of the 14 patients （64. 3% ）, who were found to have insufficient Willis ring compensation by TCD and digital subtraction angiography （DSA）, experienced re-opened rings well-constructed cerebral collateral circulations after receiving carotid pressure training for 2 to 6 weeks, monitored by TCD. All blood flow velocities of affected ACA and MCA had resumed unobstructed level with significant differences before and after training （ ACA t = 19. 278, P 〈0.05 ; MCA t =22. 278, P 〈0.05）, which fulfilled the standards of carotid resection. Follow-up of these 14 patients over 1 year revealed that neither death from operation nor cerebral vascular complications occurred in patients with effective carotid training confirmed by TCD and DSA tests. Conclusions： As a non-invasive and reproducible approach to monitor cerebral blood velocity, TCD is safe and reliable, easily accepted by patients, and especially important for tumor-carotid segment block resection.

关 键 词：经颅多普勒 颈动脉切除术 术前 评估 

分 类 号：R653[医药卫生—外科学]