颅内动脉侧枝循环对颈动脉内膜剥脱术安全性的预测  

The prediction of the security of carotid endarterectomy by the assessment of cerebral collateral circulation

作　　者：李娜[1] 华扬[1] 刘蓓蓓[1] 周瑛华[1] 张楠[1] 杨洁[1] 杜利勇[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：《中华医学超声杂志（电子版）》2017年第7期506-511,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨经颅彩色多普勒超声(TCCD)联合经颅多普勒超声(TCD)对拟接受颈动脉内膜剥脱术(CEA)治疗的患者术前颅内侧枝循环的整体化评估对CEA安全性的预测价值。方法选取2013年1月至2015年11月因颈动脉狭窄接受CEA治疗患者共437例。根据TCCD联合TCD对颅内侧支循环的评估结果,分为单纯前交通动脉开放组(A组)、单纯后交通动脉开放组(B组)、前、后交通动脉均开放组(C组)及单纯颈内-外动脉侧枝开放或无交通动脉开放组(D组)。比较4组患者CEA术中颈动脉夹闭后及CEA血运重建后术侧大脑中动脉平均流速(MV_(MCA))及血管搏动指数(PI_(MCA))的变化率。结果 CEA术中夹闭颈动脉后,4组患者术侧MV_(MCA)、PI_(MCA)下降率比较,差异均有统计学意义(F=43.737、9.298,P均<0.001),其中D组下降率明显高于其余3组,差异均有统计学意义(与A组比较:t=9.330607、0.488951;与B组比较:t=5.534661、2.797039;与C组比较t=10.0751、0.488951;P均<0.05)。颈动脉开放后,与麻醉后4组患者术侧MV_(MCA)、PI_(MCA)升高率比较,差异均有统计学意义(F=6.260、2.840,P均<0.05);与颈动脉夹闭时相比,4组患者术侧MV_(MCA)升高率,差异有统计学意义(H=62.210,P<0.001),而4组间PI_(MCA)升高率比较,差异无统计学意义(P>0.05),D组MV_(MCA)升高率均明显高于其余3组(与A组比较:t=4.104773,与B组比较:t=2.190371,与C组比较:t=3.06337;P均<0.05)。4组患者脑过度灌注综合征(CHS)发生率比较,差异有统计学意义(X^2=13.255,P=0.004),D组CHS发生率明显高于A、C组(X^2=8.734、6.764,P均<0.01),无颅内侧枝循环是CHS发生的独立危险因素(OR=5.917,95%CI:1.325~26.415,P=0.02)。结论 TCCD联合TCD对CEA术前患者颅内动脉侧枝循环的评估,对于预知术后CHS高危患者、提高CEA的成功率与安全性具有指导意义。Objective The aim of this study is to investigate whether functional intracranial collateral circulation can predict the security of carotid endarterectomy （CEA） by transcranial doppler （TCD） combined with transcranial color code duplex （TCCD） preoperatively. Methods A total of 437 patients with carotid stenosis undergone CEA surgeries from January 2013 to November 2015 were included in this study. According to the functional intracranial collateral artery via TCD and TCCD, patients were divided into four groups： （A） anterior communicative artery （ACoA） （B） posterior communicative artery （PCoA） （C） both ACoA and PCoA and （D） external-internal carotid artery （E-ICA） or no communicative artery. Velocities and the pulsatility index （PI） of the ipsilateral middle cerebral artery （MVMcA） were compared among the four groups during clamping and de-clamping period. Results After clamping, there were significant difference of decreasing scale of MVMcA and PIMcA among the four groups （F=43.737, P〈 0.001; F=9.298,P 〈 0.001）, especially for the group D （t=9.330607, 0.488951, t=5.534661, 2.797039, t=10.0751, 0.488951; all P 〈 0.005）. After de-clamping, compared with the baseline, there were also significant difference of increasing scale of MVMcA and PIMcA among the four groups （F=6.260, 2.840, all P 〈 0.05）; compared with clamping, there were also significant difference of increasing scale of MVMcA among the four groups （H=62.210, P 〈 0.001）, the increasing scale of MVMcA for group D was significant higher than the other three groups （t=4.104773, 2.190371, 3.06337, all P 〈 0.005）. However, there was no differences of increasing scale of PIMCA among the four groups （P 〉 0.05）. The occurrence of cerebral hyperperfusion syndrome （CHS） were in significant differences （χ^2=13.255, P=0.004） among the four groups. Higher occurrence rate of CHS was found in group D compared with groups A and C （H=8.734, 6.764, all P 〈 0.01）. Insuff

关 键 词：颈动脉内膜剥脱术 侧支循环 超声检查 多普勒 彩色 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]