大脑中动脉狭窄脑梗死颅内血流动力学及侧支循环研究  

Hemodynamics changes and collateral flow in patients with middle cerebral artery serious stenosis

作　　者：姬卫东[1] 徐丽君[2] 周玉珍[3] 

机构地区：[1]商丘市第一人民医院神经内科,河南商丘476000 [2]南昌大学第二附属医院神经内科,江西南昌330006 [3]南昌大学第二附属医院经颅多普勒室,江西南昌330006

出　　处：《中风与神经疾病杂志》2008年第1期46-48,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨大脑中动脉(MCA)狭窄或闭塞的脑梗死患者颅内血流动力学改变和侧支循环的代偿及神经功能缺损的关系。方法通过经颅多普勒(TCD)检查,计算双侧大脑前动脉(ACA)、大脑后动脉(PCA)峰流速及其比值(RVACA、RVPCA),并与正常对照组比较。结果共观察38例单侧MCA狭窄或闭塞的脑梗死患者。(1)病例组ACA、PCA血流速度代偿性增快,以ACA代偿为主(76.3%);(2)病例组RVACA明显较对照组高(P<0.01);(3)MCA主干及皮层支梗死患者的RVACA明显较对照组及深穿支梗死组高(P<0.01,P<0.05);MCA重度狭窄或闭塞脑梗死患者的RVACA较对照组及中度狭窄组高(P<0.05);(4)病例组RVACA及RVPCA与NIHSS呈负相关(P<0.01)。结论皮质软脑膜侧支吻合血管开放成为MCA狭窄或闭塞脑梗死侧支循环的主要途径,其代偿程度与预后相关。Objective To investigate the hemodynamic changes and compensation of collateral flow in patients with serious middle cerebral artery（MCA） stenosis or occlusion, and to approach the relationship of collateral flow with the patients＇ neurologic impairment. Methods Through the examination of transcranial doppler（TCD） , the ratio of bilateral anterior cerebral artery （RVACA） flow velocity and the ratio of the bilateral posterior cerebral artery （RVPCA） flow velocity were Calculated in patients with the middle cerebral artery serious stenosis or oclhision, and compared with the healthy controis. Results 38 patients with single middle cerebral artery stenosis or occlusion were studied. The patient group had compensative acceleration of the ACA and PCA velocity. RVACA in the patient group was significantly higher than ratios of controls （ P 〈 0.01 ） ;RVACA in the patient, with stem and cortex infarction was higher than those of controls. There was an negative correlation between the RVACA and the NIHSS in patient group, and the same for RVPCA. Condusion The opening of leptomeningeal anastomoses vessel is the important way of collateral circulation in cases of serious stenosis or occlusion of MCA,and the collateral flow between MCA and ACA is dominant. There is a inverse correlation between the RVACA/RVPCA and the NIHSS.

关 键 词：TCD 大脑中动脉 狭窄或闭塞 血流动力学 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]