经颅多普勒超声评估大脑中动脉供血区急性脑梗死早期神经功能恶化的效果  

Evaluation of transcranial Doppler for early neurologic deterioration in patients with acute middle cerebral artery infarction

作　　者：王琴 张中宝 曾雅清 戚妹 何建丽 宋志彬 郭艺华 WANG Qin;ZHANG Zhongbao;ZENG Yaqing;QI Mei;HE Jianli;SONG Zhibin;GUO Yihua(Neuroelectrophysiology,Department of Neurology,Xiaolan Hospital Affiliated to Southern Medical University,Zhongshan 528415,China)

机构地区：[1]南方医科大学附属小榄医院神经内科神经电生理室,广东中山528415

出　　处：《中国实用神经疾病杂志》2019年第21期2345-2352,共8页Chinese Journal of Practical Nervous Diseases

基　　金：中山市医学科研项目(编号:2018J194)。

摘　　要：目的 探讨经颅多普勒超声在大脑中动脉供血区急性脑梗死早期神经功能恶化中的评估.方法 回顾性连续纳入2016-12-2019-01于南方医科大学附属小榄医院神经内科住院的大脑中动脉供血区急性脑梗死并完成全脑DSA及经颅多普勒超声检查的患者64例.早期神经功能恶化(END)定义为人院48 h内美国国立卫生研究院卒中量表(NIHSS)评分较入院时评分总分增加2分以上或肢体运动项增加1分以上.所有患者入院后是否发生END分为END组23例和非END组41例,采用单因素分析2组间临床资料,比较2组患者侧支循环 、脑局部血流量丧失指数(regional cerebral blood flow loss index,rCBFLI)、过度换气指数(hyperventilation index,HVI).结果 END组与非END在TCD参数HVI、rCBFLI比较差异有统计学意义(F1=18.867,P1=0.000;F2=5.323,P2=0.024);END组与非END侧支循环比较差异有统计学意义(Z=-3.374,P=0.001);多因素Logistic回归分析提示,TCD参数HVI(OR=0.561,P=0.026)、rCBFLI(OR=0.478,P=0.014)及侧支循环(OR=0.976,P=0.012)与早期进展性脑梗死发生具有相关性.结论 rCBFLI、HVI在一定程度上能早期预测大脑中动脉供血区急性脑梗死患者是否发生END,为早期预测END发生提供相对的客观指标.Objective To evaluate the role of transcranial Doppler(TCD)in the early neurological deterioration of acute cerebral infarction in the middle cerebral artery(MCA).Methods From December 2016 to January 2019,64 patients with acute cerebral infarction complete DSA and transcranial Doppler ultrasonography in the Department of Neurology,Xiaolan Hospital Affiliated to Southern Medical University were enrolled.END was defined as that the National Institutes of Health Stroke Scale(NIHSS)score increased≥2 or the motor score increased≥1 with in 48 h after admission compared with the baseline score on admission.All the patients were divided into either an END group(23 cases)or a non END group(41 cases)according to whether the occurrence of END.The differences of clinical data between the two groups were analyzed by univariate analysis.Results There were significant differences between END group and non END group in TCD parameter hyperventilation index(HVI),regional cerebral blood flow loss index(rCBFLI)(F 1=18.867,P 1=0.000;F 2=5.323,P 2=0.024).There was significant difference in collateral circulation between END group and non END group(Z=-3.374,P<0.001).The results of multivariate Logistic regression analysis suggested that TCD parameter HVI(OR=0.561,P=0.026),rCBFLI(OR=0.478,P=0.014)and collateral circulation(OR=0.976,P=0.012)was correlated with the occurrence of early progressive cerebral infarction.Conclusion The rCBFLI and HVI can early predict the occurrence of END to some extent and provide a relative objective index for predicting the occurrence of END in the early stage in patients with acute middle cerebral artery infarction.

关 键 词：急性脑梗死 早期神经功能恶化 经颅多普勒超声 侧支循环 过度换气指数 局部脑血流量丧失指数 

分 类 号：R743.33[医药卫生—神经病学与精神病学]