颈动脉重度狭窄声学特征与血流动力学变化及伯努利效应的相关性研究  

Correlation of acoustic characteristics with hemodynamic changes and Bernoulli effect in severe carotid artery stenosis

作　　者：赵越[1] 华扬[1] 刘玉梅[1] 周瑛华[1] 刘然[1] Zhao Yue;Hua Yang;Liu Yumei;Zhou Yinghua;Liu Ran(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 10053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科

出　　处：《中国脑血管病杂志》2019年第11期581-586,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：首都卫生发展科研专项(首发2018-2-2011)

摘　　要：目的探讨颈动脉重度狭窄(SCAS)病变处责任斑块声学特征与血流动力学变化及伯努利效应的关系。方法回顾性连续纳入2016年1月至2018年1月因单纯SCAS在首都医科大学宣武医院神经外科、血管外科接受颈动脉内膜切除术治疗的患者138例。根据术前责任病变斑块的超声声学特征,将138例患者分为低回声组(80例)及非低回声组(58例),比较两组间临床症状、斑块形态、血流动力学参数及伯努利效应产生的压力梯度的差异性,进一步分析低回声斑块与压力梯度的相关性。结果低回声组与非低回声组的年龄、性别及脑血管病相关危险因素(高血压病、糖尿病、高脂血症、吸烟)差异无统计学意义(均P>0.05)。低回声组症状性SCAS[63.8%(51/80)比29.3%(17/58),χ^2=15.955]及主要责任病变是溃疡型斑块[21.2%(17/80)比5.2%(3/58),χ^2=7.013]发生率显著高于非低回声组(均P<0.05)。低回声组狭窄处收缩期峰值流速(PSV 1,510±16 cm/s比457±16 cm/s,t=2.286)、狭窄处舒张末期流速(EDV 1,226±10 cm/s比184±9 cm/s,t=3.054)、狭窄处平均流速(MV 1,317±12 cm/s比275±11 cm/s,t=2.524)及PSV 1与狭窄远段收缩期峰值流速(PSV 2)比值(PSV 1/PSV 2,12.4±1.0比8.5±0.5,t=3.121)均高于非低回声组(均P<0.05),且压力梯度显著升高(110±7 mmHg比89±7 mmHg,t=2.123,P<0.05),但两组间PSV 2(55±4 cm/s比60±2 cm/s,t=-1.068)、狭窄远段舒张末期流速(EDV 2,26±1 cm/s比27±1 cm/s,t=-0.843)及狭窄远段平均流速(MV 2,36±2 cm/s比38±1 cm/s,t=-1.024)差异无统计学意义(均P>0.05)。低回声组,低回声面积(0.25±0.01 mm^2,r=0.32,P<0.05)及其所占斑块总面积比(47.5%±1.9%,r=0.28,P<0.05)与伯努利压力梯度可能存在相关性。结论SCAS责任斑块不同声学特征的血流动力学存在差异;伯努利效应在颈动脉狭窄进展及易损斑块的发展过程中可能发挥着作用。Objective To investigate the correlation of acoustic characteristics with hemodynamic changes and Bernoulli effect of offending lesions in severe carotid artery stenosis(SCAS).Methods From January 2016 to January 2018,a total of 138 consecutive SCAS patients receiving carotid endarterectomy(CEA)in the Department of Neurosurgery and Vascular Surgery of Xuanwu Hospital,Capital Medical University for simple SCAS were enrolled retrospectively.According to the acoustic characteristics of plaques,138 cases were divided into the hypoechoic group(80 cases)and the non-hypoechoic group(58 cases).Differences of clinical symptoms,plaque morphology,hemodynamic parameters and pressure gradient generated by Bernoulli effect between the two groups were compared.Also,the correlation between hypoechoic plaque and pressure gradient was further analyzed.Results There was no significant difference in age,gender and risk factors related to cerebrovascular diseases(hypertension,diabetes,hyperlipidemia,smoking)between the hypoechoic group and the non-hypoechoic group(all P>0.05).The incidence of symptomatic stroke(63.8%[51/80]vs.29.3%[17/58],χ^2=15.955)and ulcerative plaque(21.2%[17/80]vs.5.2%[3/58],χ^2=7.013)was significantly higher in the hypoechoic plaque group(all P<0.05).The peak systolic velocity at stenosis(PSV 1,510±16 cm/s vs.457±16 cm/s,t=2.286),end diastolic velocity at stenosis(EDV 1,226±10 cm/s vs.184±9 cm/s,t=3.054),mean velocity(MV 1)at stenosis(317±12 cm/s vs.275±11 cm/s,t=2.524)of the stenosis segment,and the ratio of PSV 1 to the peak systolic velocity distal to the stenosis(PSV 2,PSV 1/PSV 2,12.4±1.0 vs.8.5±0.5,t=3.121)were all higher in the hypoechoic plaque group than non-hypoechoic plaque group(all P<0.05).The gradient pressure also increased significantly(110±7 mmHg vs.89±7 mmHg,t=2.123,P<0.05).However,there were no differences of PSV 2(55±4 cm/s vs.60±2 cm/s,t=-1.068),EDV 2(26±1 cm/s vs.27±1 cm/s,t=-0.843)and MV 2(36±2 cm/s vs.38±1 cm/s,t=-1.024)distal to the stenosis between the two groups(all

关 键 词：伯努利效应 斑块 血流动力学 颈动脉内膜切除术 

分 类 号：R54[医药卫生—心血管疾病]