一侧颈动脉狭窄或闭塞的TCD诊断标准与分型推荐一种评价侧支循环开放的盗血指数  

The Criteria for TCD Diagnosis in Unilateral Occlusion or Stenosis of Internal Carotid Artery—Recommendation of the Steal Index

作　　者：吴钢[1] 许国英[1] 郑依勇[1] 曹代荣[1] 方哲明[1] 柯晓刚[1] 郭平凡[1] 慕容慎行[1] 

机构地区：[1]福建医科大学附属第一医院

出　　处：《中国超声医学杂志》1998年第11期41-46,共6页Chinese Journal of Ultrasound in Medicine

摘　　要：本文报告１５例经ＴＣＤ诊断为一侧颈动脉狭窄或闭塞的病例，均经ＭＲＩ、颈动脉双功Ｂ超或ＤＳＡ证实，结合文献探讨一侧颈动脉病变的ＴＣＤ诊断标准、分型以及推荐一种评价侧枝循环开放的盗血指数ＳＩ（ＳｔｅａｌＩｎｄｅｘ）。诊断标准为：①颈内动脉病变侧ＭＣＡ平均血流速度减低，尤其是收缩期峰流速减低、波形减弱；②病变侧ＭＣＡ的ＰＩ值及ＰＴＩ值减低，尤其是ＰＴＩ减低为著；③侧枝循环开放：分为ＰＣＯＡ、ＡＣＯＡ、ＲＯＡＦ及ＣＯＭＰ等四型；④开放的侧枝循环血流与相邻血流的ＳＩ明显升高；⑤压颈总动脉试验，用以判断闭塞或不完全闭塞以及侧支血流来源。以上①、②是诊断的必要条件（敏感性指标）；③是诊断的重要条件（特异性指标）；①、②加上③中的其中之一型，即可诊断为一侧颈动脉狭窄或闭塞。④、⑤为诊断的辅助条件，用来评价开放的侧枝循环血流所致的盗血程度和闭塞程度。This article reports the use of Transcranial Doppler(TCD)ultrasound in diagnosis of fifteen cases with occlusion or stenosis of unilateral internal carotid artery(ICA).All cases were confirmed by MRA,High Frequency Duplex Doppler ultrasound or DSA.On the basis of our study,the Steal Index(SI),an evaluation for development of collateral circulation,was recommended and the criteria for TCD diagnosis of unilateral ICA occlusion were put forward.The criteria were:(1)decrease of the systolic peak flow velocity(Vs);(2)decrease of PI and PTI in ipsilateral middle cerebral artery(MCA),especially if PTI was marked;(3)the development of collateral circulation.According to the apparent patterns of collateral circulation during the TCD diagnosis,we further divided the 15 cases into four types:(i)anterior communicating artery(ACOA),(ii)posterior communicating artery(PCOA),(iii)Retrograde OA Flow(ROAF),and(iv)Complication(COMP),(4)rise of SI in the blood flow of the collateral circulation and neighbor vessels,(5)press common carotid artery(CCA)test,used to determine stenosis or occlusion.The above(1)and(2)are the necessary for diagnosis(sensitive indicators);(3)is the important conditions(specific indicator);diagnosis can be made if the conditions(1)and(2)plus one type of (3).(4)and (5)are the adjuvant conditions,and they are for evaluation of the extent of blood stealing resulting from the development of the collateral circulation,and the extent of the stenosis of ICA as well.

关 键 词：颈动脉狭窄 闭塞 超声波诊断 诊断标准 盗血指数 

分 类 号：R543.404[医药卫生—心血管疾病] R445.1[医药卫生—内科学]