伴有颅内外动脉狭窄或闭塞的急性脑梗死后侧支循环建立与预后的关系  

Correlation of collateral circulation and prognosis in patients with acute cerebral infarction

作　　者：刘新通[1] 王伟[2] 王丽娟[1] 何池忠[1] 卢海克[1] 李昌茂[1] 张雄[1] 代成波[1] 王硕[1] 马桂贤[1] 杨哲贤[1] 马腾云[1] 

机构地区：[1]510080,广州,广东省人民医院神经科,广东省神经科学研究所,广东省医学科学院 [2]华中科技大学同济医学院同济医院神经科

出　　处：《中华医学杂志》2011年第11期766-768,共3页National Medical Journal of China

摘　　要：目的 通过数字减影全脑血管造影评估急性脑梗死患者侧支循环的建立情况,并探讨其与患者临床病情和预后的关系.方法 以2007年1月至2009年12月广东省人民医院神经科260例首次发病的急性脑梗死（病程1周内）的住院患者为研究对象,在发病一周内完成全脑血管造影检查,采用NIHSS评分评估入院时病情,采用改良Rankin评分评估患者3个月时的预后.结果 260例中有86例患者的罪犯血管是颅内、外大血管严重狭窄或闭塞,其中48例为前循环病变,出现侧支代偿36例（75.00%）.38例为后循环病变,出现侧支代偿11例（28.64%）,前者明显高于后者（P＜0.001）;有侧支代偿组入院时的NIHSS评分显著低于无侧支代偿组（P＜0.001）,有侧支代偿组随访3个月时改良的Rankin评分≤2分的患者的比例显著多于无代偿组（P＜0.0001）.结论 对于颅内或颈部动脉严重狭窄或闭塞所致的急性脑梗死患者,通过DSA能准确评估患者的侧支循环的建立与否,从而判断预后,有侧支循环患者的预后明显优于无侧支循环患者.Objective To evaluate the correlation of collateral circulation with prognosis in patients with acute cerebral infarction.Methods A total of 260 patients with acute ischemie stroke within 1 week of symptom onset underwent digital subtraction angiogram （DSA）.The National Institutes of Health Stroke Scale （NIHSS） scores were obtained at admission.And the Modified Rankin scores （mRS） were assessed at a 3-month follow-up.The follow-up data were acquired through clinic visits or telephone interviews.Results Among them,86 were found to have intra- or extra-cranial culprit artery severe stenosis or occlusion.And 36（75.00%） in 48 patients had collateral arterial circulation while 11 （28.64%）in 38 patients posterior circulation.There were statistical differences in the NIHSS scores at admission and favorite clinical outcome （mRS≤2） at 3-month follow-up for patients with and without collateral circulation.Conclusion DSA is the golden standard for the assessment of collateral circulation in patients with severe cerebral artery stenosis or occlusion.The prognosis is better in stroke patients with collateral circulation.

关 键 词：血管造影数字减影术 脑梗死 侧支循环 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]