大面积脑梗死的脑血流动力学动态变化与卒中预后的观察  

Observation of cerebral blood flow dynamic change and prognosis of stroke after large-area cerebral infarction

作　　者：温世斌[1] 夏金花[1] 彭德强[1] 尤玉娟[1] 葛晓玲[1] 郭百海[1] 丁志强[1] 闫贵国[1] 

机构地区：[1]酒泉市人民医院神经内科,甘肃酒泉735000

出　　处：《临床荟萃》2013年第2期164-167,171,共5页Clinical Focus

摘　　要：目的探讨大面积脑梗死后颅内血管血流动力学动态变化特点及其与临床预后的关系。方法 64例大面积脑梗死患者根据影像学供血模型分为完全大脑中动脉(MCA)型和MCA皮质型,急性期大面积脑梗死患者,利用床旁经颅彩色多普勒(TCD)于入院当天和1周内隔日1次及第14天动态检测颅内血流情况,通过测定脑底动脉血流速度、搏动指数及血流速度比值(RVACA和RVPCA),观察颅内血管血流动力学变化。应用美国国立卫生研究院卒中量表(NIHSS)及3个月后存活者日常生活活动能力量表(Barthel指数)评分评价脑血流动力学和神经功能变化与临床预后的关系。选取我院健康体检者64例作为对照组。对照组为同期健康体检人群。性别与年龄选取与病例组具有可比性。结果大面积脑梗死病灶侧MCA平均血流速度(Vm)、颈内动脉(ICA)平均血流速度均明显低于对照组(P<0.05),完全MCA型组较MCA皮质型组MCA血流速度明显减慢(P<0.01);完全MCA型与MCA皮质型梗死后动态观察除部分再通外,MCA血流动态变化不明显(P>0.05),NIHSS评分及脉动指数(PI)在第3,5,7天较第1天明显增高(P<0.05),在第3,5,7天比较差异无统计学意义(P>0.05)。结论大面积脑梗死患者可通过床旁TCD动态检测,可评价大面积脑梗死患者的闭塞血管部位,及时发现侧支循环代偿及血管再通情况,评价颅内压动态变化,观察脱水降颅压治疗效果;在完全MCA型患者中,治疗过程中如果存在RVACA和RVPCA增高,且NIHSS评分稳定,往往对脱水剂治疗敏感,预后较好,可以考虑内科保守治疗。Objective To investigate the relationship between the characteristics of intracranial vascular hemodynamic change after large-area cerebral infarction and the clinical outcomes. Methods Sixty-four patients with large area-cerebral infarction were divided into completely middle cerebral artery（MCA） type and MCA cortical type on the basis of imaging of blood model. In the acute stage of patients with large-area cerebral infarction, bedside transcranial color Doppler（TCD） was used to test the intracranial blood flow dynamic change on the first day and once a week on alternate days and 14 days in the hospital, through the flow velocity of brain artery blood, throb index and blood flow velocity ratio（RVACA and RVPCA） testing, to understand hemodynamic change of intracranial vascular dynamics, to observe hemodynamic changes,and retrospectively analyze with application of the United States National Institutes of Health Stroke Scale （NIHSS） scores and after 3 months survived patients＇ activities of daily living scale （Barthel index） score, evaluate the relationship between the cerebral blood flow dynamic characteristics and nerve function with the clinic prognosis. Healthy subjects from body check served as controls with gender and age in matches. Results The mean blood flow velocity（Vm） of the brain disease side MCA, mean blood flow velocity with internal carotid artery（ICA） in large-area cerebral infarction were significantly lower than those of control group（ P 0.05）. Compared with MCA cortical type group, MCA blood flow velocity in completely MCA type group slowed down obviously （ P d0.05）. Dynamic observation in addition to part revaseularization in two types, MCA blood flow dynamic change was not obvious;after infarction of completely MCA, pulsatility index（PI） was significantly higher at 3,5 and 7 days compared with 1st day（ P d0.05）; among at 3,5 and 7 days comparison the changes were not statistically significant（ P ~ 0.05）. Conclusion The patients of large-area

关 键 词：脑梗塞 超声检查 多普勒 经颅 预后 

分 类 号：R743.1[医药卫生—神经病学与精神病学]