颈动脉闭塞性血管病的颅内脑血流改变与症状体征的关系  

Clinical findings and hemodynamic changes of internal carotid artery stenosis and occlusion

作　　者：许惠萍 

机构地区：[1]牡丹人民医院,山东菏泽274015

出　　处：《菏泽医学专科学校学报》2006年第2期24-26,共3页Journal of Heze Medical College

摘　　要：目的分析颈内动脉严重狭窄或ICASO患者颅内脑血流改变与临床表现的关系。方法经全脑DSA检查证实的ICASO患者66例(单侧病变50例,双侧16例)。临床分为脑梗死组、TIA组和无体征组。应用TCD检测双侧大脑中血流速度并判断颅内侧枝循环的开放。结果与DSA比较TCD对ACOA判断的敏感性97%,特异性93%;PCOA敏感性92%,特异性83%;OA开放的敏感性98%,特异性90%。无体征组和TIA组ACOA和PCOA同时存在的出现率高,而脑梗死组则仅有OA存在的出现率最高。狭窄同侧血流速度(39.55±13.28)cms明显低于对侧(78.90±24.15)cm/s(P<0.01),频谱低平呈波浪状。脑梗死组低于TIA组和无症状组(P<0.05)。结论TCD可以无创性地检测颈内动脉严重狭窄或闭塞后脑血流动力学的改变,并与临床表现相关。前后交通动脉代偿良好时不易出现脑梗死;仅有眼动脉反向存在及大脑中动脉血流速度的明显降低,往往提示代偿不足,易发生缺血性病变。Objective To investigate the clinical features of patients with different degree of intemal carotid artery stenosis and occlusion . Methods 66 cases of angiograph-confirmed internal carotid artery stenosis or occlusion （ICASO） were categorized into three groups：stroke 32 cases , transient ischemic attacks （TEA）24 eases , asymptomatic patients 10 cases , Transcanial Doppler ultrasonography was used to evaluate mean blood velocity of middle cerebral artery （Vmca） and collateral supply. Results 1. Compared with DSA, ACOA detection in TCD had sensitivity of 97% and a specificity of 93% ; PCOA detection in TCD had a sensitivity of 92%and a specificity of 83%. directional changes in OA had a sencitivity of 98% ,and a specificity of 90% . The frequency of ACOA and PCOA flow abnormalities were higher in TEA and asymptematic patients than in stroke patients . Vmca was（39.55±13.28） cm/s ipsilateral to an occlusion , （78.90±24.15） cm/s contralateral to an occlusion （ P 〈 0.01 ）. Vmc was the lowest in stroke patients among three groups （ P 〈 0.05）. Conclusion TCD permits noninvasivc quantification of the cerebral blood flow and assessment of collateral supply of ICASO . In the presence of poor collateral blood supply from ACOA and PCOA , cerebral infarcts are more likely to occur .

关 键 词：颈动脉狭窄修断 经颅多谱勒 超声 闭塞性脑血管病/诊断 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]