颈内动脉狭窄相关性脑缺血病变的临床分析  

Clinical analysis of the cerebral ischemic disease related to internal carotid artery stenosis

作　　者：周爱华[1] 谭佩珍[1] 

机构地区：[1]湖南省第二人民医院神经科,长沙410007

出　　处：《临床神经外科杂志》2011年第3期157-159,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨颈内动脉狭窄致脑缺血病变的临床特点及发生机制,为临床指导治疗及判断预后提供依据。方法回顾分析111例经CT血管造影(CTA)证实的颈内动脉狭窄患者的颅内Willis环形态、TCD资料及临床表现。结果颈内动脉轻、中、重度狭窄组脑梗死发生率分别为14.7%、30.6%、46.3%,三组间差异具有显著统计学意义(P<0.05)。颈内动脉轻、中、重度狭窄组侧枝循环出现率分别为14.7%、30.6%、78.0%,三组间差异具有显著统计学意义(P<0.05)。颈内动脉严重狭窄患者中4型Willis环中脑梗死发生率分别为11.1%、36.4%、33.3%、80.0%,Ⅰ型患者脑梗死出现率较其他组比较有显著差异(P<0.01)。颈内动脉严重狭窄患者中,无侧枝循环组、初级代偿组(Willis环代偿)、次级代偿组脑梗死发生率分别为33.3%、36.4%、80.0%。次级侧枝循环出现组的脑梗死患者出现率较另两组比较有显著差异(P<0.01)。结论颈内动脉狭窄程度、Willis环的形态、侧枝循环开放途径与患者的临床预后显著相关。Objective To study the clinical features and mechanisms of the cerebral ischemic disease related to internal carotid artery stenosis. Methods The clinical performance, TCD data and the appearance of Willis＇ circle of 111 patients with internal carotid artery stenosis confirmed by CTA were analyzed retrospectively. Results The occurrence rate of cerebral infarction in slight stenosis groups was 14.7%, moderate stenosis group was 30.6% and severe group was 46.3%. Statistical differences of cerebral infarction were found among the three groups. （ P 〈 0.05 ） . The occurrence rate of collateral circulation in slight stenosis was 14.7%, moderate stenosis group was 30.6%, severe group was 78.0%. Statistical differences of cerebral infarction were found among the three groups. （ P 〈 0.05） . In sereve stenosis patients, the occurrence rate of cerebral infarction in type I Willis＇ circle was 11. 1%, significantly lower than other groups. （ P 〈 0.01 ）. In sereve stenosis patients, the occurrence rate of cerebral infarction in the secondary collateral pathways group was 80.0% , significantly higher than other groups. （ P 〈 0.01 ） Conclusion The degree of internal carotid artery stenosis, the appearance of Willis＇ circle and the pathways of collateral circulation are closely associated with clinical prognosis.

关 键 词：颈内动脉狭窄 侧枝循环 脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]