颈动脉闭塞性血管病的颅内脑血流改变与临床表现的关系  

Clinical findings and hemodynamic changes of internal carotid artery stenosis and occlusion.

作　　者：高山[1] 黄一宁[1] 汪波[1] 李敬府[2] 金征宇[3] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经内科,100730 [2]中国医学科学院中国协和医科大学北京协和医院超声科 [3]中国医学科学院中国协和医科大学北京协和医院放射科

出　　处：《中国神经精神疾病杂志》2000年第6期334-336,共3页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的　分析颈内动脉严重狭窄 (狭窄≥ 75 % )或闭塞患者 (ICASO)颅内脑血流改变与临床表现的关系。方法　经全脑数字减影血管造影 (DSA)检查证实的ICASO患者 66例 (单侧病变 5 0例 ,双侧 16例 )。临床分为脑梗死组、TIA组和无体征组。应用经颅多谱勒超声 (TCD)检测双侧大脑中动脉 (MCA)血流速度 (Vmca)并判断颅内侧枝循环的开放。结果　①与DSA比较TCD对前交通动脉 (ACOA)判断的敏感性 97% ,特异性 93 % ;后交通动脉 (PCOA)敏感性 92 % ,特异性83 % ;眼动脉 (OA)开放的敏感性 98% ,特异性 90 %。无体征组和TIA组ACOA和PCOA同时存在的出现率高 ,而脑梗死组则仅有OA存在的出现率最高。②狭窄同侧Vmca(3 9 5 5± 13 2 8)cm/s明显低于对侧 (78 90± 2 4 15 )cm/s(P <0 0 1) ,频谱低平呈波浪状。脑梗死组低于TIA组和无症状组 (P <0 0 5 )。结论　TCD可以无创性地检测颈内动脉严重狭窄或闭塞后脑血流动力学的改变 ,并与临床表现相关。前后交通动脉代偿良好时不易出现脑梗死 ;仅有眼动脉反向存在及大脑中动脉血流速度的明显降低往往提示代偿不足 ,易发生缺血性病变。Objective To investigate the clinical features of patients with different degree of internal carotid artery stenosis and occlusion.Methods 66 cases of angiograph confirmed internal carotid artery stenosis or occlusion (ICASO) were categorized into three groups:stroke 32 cases, transient ischemic attacks (TIA) 24 cases, asymptomatic patients 10 cases. Transcanial Doppler ultrasonography was used to evaluate mean blood velocity of middle cerebral artery (Vmca) and collateral supply. Results 1. Compared with DSA, ACOA detection in TCD had sensitivity of 97% and a specificity of 93%; PCOA detection in TCD had a sensitivity of 92% and a specificity of 83%; directional changes in OA had a sencitivity of 98%, and a specificity of 90%. The frequency of ACOA and PCOA flow abnormalities were higher in TIA and asymptematic patients than in stroke patients. Vmca was (39 55±13 28) cm/s ipsilateral to an occlusion, (78 90±24 15) cm/s contralateral to an occlusion ( P <0 01). Vmca was the lowest in stroke patients among three groups ( P <0 05). Conclusions TCD permits noninvasive quantification of the cerebral blood flow and assessment of collateral supply of ICASO. In the presence of poor collateral blood supply from ACOA and PCOA, cerebral infarcts are more likely to occur.

关 键 词：颈动脉狭窄 经颅多谱勒超声 闭塞性脑血管病 

分 类 号：R743[医药卫生—神经病学与精神病学]