I级侧支循环对闭塞颈内动脉远端血流动力学的代偿作用  

Compensatory effects of grade I compensatory circulation on hemodynamics in the distal occlusion of internal carotid artery

作　　者：张萍淑[1] 吴小英[1] 孔祥慧[1] 元小冬[1] 陶莉[1] 王京[1] 张健 Zhang Pingshu;Wu Xiaoying;Kong Xianghui;Yuan Xiaodong;Tao Li;Wang Jing;Zhang Jian(Department of Neurology, Kailuan General Hospital, Tangshan 063000, Chin)

机构地区：[1]河北省唐山市开滦总医院神经内科,063000 [2]河北省神经生物机能重点实验室

出　　处：《中国综合临床》2018年第3期232-236,共5页Clinical Medicine of China

基　　金：2015河北省医学科学研究重点课题（20150839）

摘　　要：目的分析颈内动脉颅外段闭塞（EICAO）后脑动脉Ⅰ级侧支循环开放和远端血流灌注的血流动力学变化。方法选择EICAO患者96例为病例组，其中左侧EICAO 46例（A组）、右侧EICAO 50例（B组）和正常志愿者30名为对照组（C组）。应用彩色经颅多普勒超声（TCD）检测大脑中动脉（MCA）收缩期峰值血流速度（Vs）、舒张末期血流速度（Vd）、平均血流速度（Vm）、搏动指数（PI），动脉的血流动力学指标和Ⅰ级侧支循环前交通动脉（ACOA）、后交通动脉（PCOA）开放率。结果A、B、C组左、右侧Vs、Vm、Vd、PI比较差异均有统计学意义（F值分别为56.046、31.027、39.283、18.614、49.658、24.992、15.035、22.069，P均〈0.001），且A、B组左、右侧MCA的Vs、Vd、Vm、PI与C组左、右侧比较差异均有统计学意义（P均〈0.01），其中A组左侧MCA的Vs、Vd、Vm、PI较C组左侧均明显降低（P均〈0.05），而B组右侧Vs、Vd、Vm、PI均较C组右侧均明显降低（P均〈0.01）。A、B组Ⅰ级侧支循环单纯ACOA开放率分别为26.09%、30.00%，单纯PCOA开放率分别为23.91%、36.00%，ACOA和PCOA同时开放率分别为36.96%、30.00%，A、B组中此三种血管类型的Ⅰ级侧支循环开放率比较差异均无统计学意义（χ2值分别为0.223、2.881、0.808，P值分别为0.637、0.090、0.369）。A组的MCA供血区脑梗死发病率，左侧60.87%、右侧8.70%，左侧显著高于右侧（χ2＝57.165，P〈0.001）；B组的MCA供血区脑梗死发病率，左侧14.00%、右侧60.00%，右侧显著高于左侧（χ2＝43.436，P〈0.001）。结论EICAO患者虽然有较高的Ⅰ级侧支循环开放率，但其患侧颈内动脉远端的MCA供血区仍处于明显的低血流灌注状态，并且脑梗死发病率也较高，因此Ⅰ级侧支循环开放并不能完全降低这类患者发生脑梗死的危险，此类患者仍是发生脑梗死的高危人群。Objective To analyze the hemodynamic changes of cerebral arterial collateral circulation and distal perfusion of cerebral arteries after external carotid artery occlusion （EICAO）.MethodsNinety-six patients with EICAO were selected as the case group, of which 46 cases of left EICAO （group A）, 50 cases of right EICAO （group B） and 30 normal volunteers were selected as the control group.Color Doppler ultrasonography （TCD） was used to detect peak systolic velocity （Vs） in the middle cerebral artery （MCA）, end diastolic velocity （Vd）, mean blood flow velocity （Vm）, pulsatility index （PI）, hemodynamic parameters of arteries, and opening rate of grade I anterior communicating artery （ACOA） and posterior communicating artery （PCOA）.ResultsThere were significant differences in Vs, Vm, Vd, and PI among group A, B and C （F=56.046, 31.027, 39.283, 18.614, 49.658, 24.992, 15.035, 22.069, P〈0.001）. The Vs, Vd, Vm, and PI of the left MCA in the group A were significantly lower than those of the left side in the control group （P〈0.01）; the Vs, Vd, Vm, and PI of the right MCA in the group B were significantly lower than those of the right side in the control group （P〈0.01）. In group A and B, the open rate of simple ACOA in the stage I collateral circulation was 26.09% and 30.00%.The open rate of PCOA alone was 23.91% and 36.00%, respectively, and the concurrent opening rate of ACOA and PCOA was 36.96% and 30.00%, respectively, There was no significant difference in the open rate of grade I collateral circulation among the three types of blood vessels （χ2=0.223, 2.881, 0.808, P=0.637, 0.090, 0.369）. The incidence of cerebral infarction at the MCA donor site in the group A was 60.87% on the left side and 8.70% on the right side.The data of the left side was significantly higher than that of the right side （χ2=57.165, P〈0.001）. The incidence of cerebral infarction at the MCA in the group B was 14.00% on the left side and 60.00% on the right side, and the data

关 键 词：颈内动脉 闭塞 血流动力学 侧支循环 代偿反应 

分 类 号：R743[医药卫生—神经病学与精神病学]