经颅多普勒超声结合二氧化碳试验评价颈内动脉狭窄患者的脑血管反应  

Study of cerebral vascular reserve function of intracranial artery tenosis patients by TCD combined with ETCO2

作　　者：袁端华[1] 林小慧[1] 蒋丽丽[1] 黄紫薇[1] 苏庆华[1] 

机构地区：[1]桂林医学院附属医院神经内科,广西桂林541001

出　　处：《癫痫与神经电生理学杂志》2016年第6期326-329,共4页Journal of Epileptology and Electroneurophysiology(China)

基　　金：广西壮族自治区卫生厅计划课题（Z2016382）

摘　　要：目的：检测颈内动脉（intracranial artery，ICA）狭窄患者的脑血管反应性（CVR），探讨其狭窄程度与脑血管反应性之间的关系，以期为临床治疗及预防提供依据。方法：对不同程度ICA狭窄患者，采用德国DWL型经颅多普勒超声（TCD）检测仪，结合二氧化碳试验分别测得过度换气、吸入CO2气体、屏气后的大脑中动脉（MCA）的脑血流速度以计算CVR。结果：①病例组中ICA—MCA狭窄患者通过过度换气、吸入CO2气体、屏气后MCA的最大速度变化率、平均速度变化率均显著低于对照组（P〈0．05）；②病例组轻、中、高度ICA狭窄或者闭塞ICA—MCA狭窄患者吸入CO2气体后各组MCA血流速度增加率依次减低，并且两两比较，P〈0．05，差异有显著意义。ICA—MCA狭窄患者由于血管狭窄、闭塞、血流受阻使CVR功能降低，狭窄程度越重，CVR功能越差，发生低灌注的危险性越大。结论：经颅多普勒超声检测CVR可行，可作为评估CVR的简便手段之一。Objective：To assess cerebral vasoreactivity （CVR） in patients with internal carotid artery （ICA）stenosis of different severity and to explore the relationship between the degree of ICA stenosis and CVR. Methods.. Through transcranial doppler sonography （TCD） combined with COz test hyperventilation technique and CO2 inhalation method, the change of blood flow of middle cerebral artery （MCA） ,and CVR through calculation of CVR was evaluated. Results.. The capacity of MCA stenosis sig- nificantly decrease than in the normal control group. The CVR of patients with asymptomatic MCA stenosis and symptomatic MCA stenosis significantly decreases than in the normal control group. The capacity of cerebrovascular reserve was reduced in patients with ICA-MCA artery stenonsis than in the normal control group. Conclusion：The CVR in patients with severe ICA stenosis was compromised and related with the degree of ICA stenosis. TCD combined with breath test could be used as an easy way for the evaluation of cerebrovascular reactivity.

关 键 词：颈内动脉(ICA) 大脑中动脉(MCA) 狭窄 脑血管反应性(CVR) 经颅多普勒超声 (TCD) 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R743.9[医药卫生—临床医学]