彩色多普勒超声对双侧颈内动脉狭窄血流速度高估的研究  

Study on overestimation of blood flow velocity after bilateral internal carotid artery stenosis with color Doppler ultrasound

作　　者：夏明钰[1] 华扬[1] 贾凌云[1] 周瑛华[1] 

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中国脑血管病杂志》2011年第11期570-575,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：首都特色临床医学技术发展研究项目(Z090507017709023)

摘　　要：目的探讨彩色多普勒超声(CDU)与经颅多普勒超声(TCD)联合评价双侧颈内动脉狭窄后一侧颈内动脉(ICA)狭窄率为70%～99%或闭塞时,对另一侧的ICA(狭窄率为50%～69%)血流动力学的影响。方法连续纳入2005年6月—2011年6月由彩色多普勒血流显像(CDFI)与TCD联合筛查、DSA证实的双侧ICA狭窄(一侧颈内动脉狭窄率为70%～99%或闭塞,另一侧为50%～69%)的患者102例作为研究组(A组),同期选择单侧ICA狭窄率为50%～69%、对侧正常的患者89例为对照组(B组)。比较两组患者中狭窄率为50%～69%狭窄侧的ICA和大脑前动脉(ACA)的收缩期峰值流速(PSV)、舒张期末流速(EDV)、血管阻力指数(RI)和血管搏动指数(PI)的差异。并根据TCD和D)SA检测的结果,将A组分为前交通支开放组(A1组54例)与未开放组(A2组48例),进一步比较两组间中狭窄率为50%～69%狭窄侧ICA、ACA血流动力学参数的差异及血流动力学变化的相关性。结果①A组患者中狭窄率为50%～69%侧ICA、ACA的PSV、EDV高于B组(均P<0.05),RI及PI值较B组降低(P=0.001,P=0.000)。②A1组中狭窄率为50%～69%狭窄侧ICA、ACA的PSV、EDV均高于A2组(均,P<0.01),但A1组ICA的RI值及ACA的PI均低于A2组(P=0.000,P=0.000),差异均有统计学意义。③ICA的PSV、EDV与ACA的呈正相关(r=0.327、r=0.422,P=0.007、P=0.000)。结论当一侧ICA狭窄率为70%～99%,狭窄率为50%～69%狭窄侧ICA的流速测值明显高于实际病变程度的诊断标准。前交通支开放是双侧ICA狭窄的血流动力学变化的基础,双侧ICA狭窄程度的判断应结合颅内外血流动力学变化进行综合评价。Objective To investigate the influence of unilateral internal carotid artery （ICA） steno- sis （70 -99% ） or occlusion evaluated by color Doppler ultrasound （CDU） and transeranial Doppler （TCD） on ICA hemodynamies of contralateral carotid artery（50- 69% stenosis） in patients with bilateral infernal carotid artery stenosis. Methods A total of 102 consecutive patients with bilateral ICA stenosis （unilateral stenosis 50 -69% , contralateral stenosis 70 -99% or occlusion） were enrolled from June 2005 to June 2011 and they were used as study group （group A）. The patients were screened by color Doppler flow imaging （CDFI） and TCD, and they were confirmed as bilateral ICA stenosis by DSA. At the same time, 89 patients with unilateral ICA stenosis 50 -69% and normal contralateral ICA were used as control group （group B）. The differences of ICA stenosis 50 -69% in the two groups and the peak systolic veloci- ty （ PSV）, end-diastolic flow velocity （ EDV）, resistance index （RI） and pulsatility index （PI） of anteriorcerebral artery （ACA） in both groups were compared. Group A was redivided into an anterior communicating antery patent group （A1 group, n =-54 ） and an anterior communicating artery occluded group （A2 group, n = 48） according to the results of TCD and DSA examinations. The differences of the hemodynamic parameters of the 50 - 69% stenotic ICA and ACA stenosis, and the correlations of the hemodynamic changes in both groups were further compared. Results ①The PSV and EDV of unilateral stenotic ICA stenosis and ACA with 50 - 69% stenosis in group A were significantly higher than those in group B （ all P 〈 0. 05） , RI and PI were significantly lower （P = 0. 001, P = 0. 000）. ②PSV and EDV of unilateral ICA and ACA with 50 - 69% stenosis in group A1 were higher than those in group A2 （ all P 〈 0. 01 ） , but RI of ICA and PI of ACA in group A1 were lower than those in group A2 （P =0. 000, P =0. 000） , the differences were statisticall

关 键 词：颈动脉疾病 超声检查 多普勒 血流动力学 高估 

分 类 号：R743[医药卫生—神经病学与精神病学]