颈总动脉狭窄闭塞性病变时脑血流动力学改变及侧支循环途径  

Cerebral hemodynamic changes and collateral circulation pathways in patients with steno-occlusive disease of common carotid artery

作　　者：张雄伟[1] 王磊[1] 王开平[1] 张以善[1] 李曼[1] 王翠玉[1] 张红丽[1] 白云[1] 

机构地区：[1]解放军第二炮兵总医院神经内科,北京100088

出　　处：《中国现代医学杂志》2008年第18期2680-2683,共4页China Journal of Modern Medicine

摘　　要：目的探讨颈总动脉(CCA)严重狭窄或闭塞患者的脑血流动力学改变及侧支循环途径。方法对67例CCA严重狭窄或闭塞患者(患者组)和60例无颅内及颈动脉狭窄性病变患者(对照组)行经颅多普勒超声(TCD)和颈动脉连续波多普勒超声(CWD)检测。结果35例狭窄患者中,15例(43%)检出CCA局限性严重狭窄血流。32例闭塞患者未探及到病变侧CCA血流信号。患者组病变远端的颈内动脉和大脑中动脉血流波形异常,表现为收缩峰圆钝、峰时延长,其血流速度和搏动指数明显低于对照组(P<0.01)。TCD和CWD检测显示,患者组中79%的患者椎动脉-颈外动脉侧支循环开放,91%的患者Willis环侧支循环开放,均未见眼动脉侧支开放的血流表现。结论TCD和CWD有助于了解CCA严重狭窄或闭塞的血流动力学改变和侧支循环途径,为临床确定诊断和更深入研究缺血性脑血管病的发病机制提供重要的客观依据。[Objective] To explore the cerebral hemodynamic changes and collateral circulation pathways in patients with serious stenosis or occlusion of common carotid artery （CCA）. [Methods] Sixty seven patients with CCA serious stenosis or occlusion were selected to serve as patient group and sixty patients without stenosis disease of intracranial and carotid artery were selected to serve as controls. All patients were measured by transcranial doppler （TCD） and cervical continuous-wave doppler（CWD）. [Results] In 35 stenosis patients, the focus serious stenosis flow of CCA was found in 15 patients（43%）. The flow signal of disease side CCA was not found in 32 occlusion patients. With distal internal carotid artery and middle cerebral artery, both TCD and CWD showed abnormal flow waveforms that manifested blunt systolic peak and delayed systolic velocity acceleration. Their blood flow velocity and pulsitility index were signifieantly lower than eontrols （P 〈0.01）. TCD and CWD showed collateral pateney of vertebral artery-external carotid artery in 79% and collateral pateney of circle of Willis in 91% of patient group.The ophthalmie artery collateral was not found in all patients. [Conclusions] Both TCD and CWD might further help to know the hemodynamic change and collateral circulation pathway of CCA serious stenosis or ocelusion. It was suggested that they might be important and objective index in determining the diagnosis and in exploring deeply the patghogenesis of ischemie eerebrovascular disease.

关 键 词：动脉狭窄 闭塞 超声检查 多普勒 经颅 连续波 脑血流动力学 侧支循环 

分 类 号：R543.4[医药卫生—心血管疾病]