不同程度急性缺血性脑卒中患者颈动脉血流动力学观察及其对预后的影响  

The observation of carotid hemodynamics and its effect on prognosis in patients with acute ischemic stroke

作　　者：李慧[1] 曾理[1] Li Hui;Zeng Li(First People’s Hospital of Tianmen,Tianmen 431700,China)

机构地区：[1]天门市第一人民医院,天门431700

出　　处：《湖南师范大学学报（医学版）》2021年第3期174-178,共5页Journal of Hunan Normal University(Medical Sciences)

摘　　要：目的:探讨不同严重程度急性缺血性脑卒中(AIS)患者的颈动脉(颈总动脉和颈内动脉)狭窄处收缩期最大血流速度(PSV)、舒张末期最低血流速度(EDV)和血流量等血流动力学指标的差异,并观察这些指标对患者病情预后和复发的影响。方法:选择150例不同严重程度的AIS(腔隙性脑梗死、中等面积脑梗死和大面积脑梗死)患者,在入院后对患者的颈总动脉和颈内动脉的内膜-中膜厚度(IMT)进行检测,同时对颈动脉狭窄处PSV、EDV和血流量等指标进行检测,采用NIHSS评分对患者进行神经功能评估,在治疗后90天采用改良的Rankin量表(mRS)对各组患者进行功能恢复评定,通过随访调查患者在两年内的AIS的复发情况。结果:随着患者脑损伤程度的增加,颈动脉狭窄的比例呈现增加的趋势,且颈动脉狭窄多出现于病灶同侧。各组患者颈动脉狭窄处PSV、EDV显著高于对照组,而颈动脉血流量显著低于对照组。随着患者病情的加重和NIHSS评分的增加,PSV、EDV呈现逐渐升高的趋势,而血流量呈现下降趋势。功能恢复评定结果显示恢复不良组患者的PSV、EDV显著高于恢复良好组,而颈动脉血流量低于恢复良好组。随访结果显示,各研究组出现复发患者的PSV、EDV显著高于未复发患者,而复发患者的血流量显著低于未复发患者。结论:AIS患者的PSV、EDV和血流量等颈动脉血流动力学指标能对患者病情和神经损伤程度以及患者神经功能恢复和病情复发有一定的预测作用。Objective To explore the different severity of acute ischemic stroke(acute ischemic stroke,AIS)in patients with carotid artery,common carotid artery and internal carotid artery stenosis in the largest systolic blood flow velocity(peak systohc velocity,PSV),end-diastolic blood flow to the minimum speed(end-diastole velocity,EDV)and the difference of hemodynamic parameters,such as blood flow and to observe the impact of these indicators to patients prognosis and recurrence.Methods Choose 150 cases of different severity of AIS(lacunar cerebral infarction,moderate area of cerebral infarction and large area cerebral infarction patients,for patients after admission in the common carotid artery and internal carotid artery Intima-film thickness(Intima media thickness,IMT),at the same time for carotid stenosis in PSV,EDV and blood flow index,USES the NIHSS score for patients with neurologic evaluation,90 days after treatment using modified Rankin scale(mRS)for functional recovery in patients with groups of evaluation,Patients were followed up for AIS recurrence within 2 years.Results With the increase of the degree of brain injury,the proportion of carotid artery stenosis increased,and the carotid artery stenosis was mostly on the same side of the lesion.In each group,the PSV and EDV of carotid stenosis were significantly higher than that of the control group,while the carotid blood flow was significantly lower than that of the control group.With the aggravation of patients’condition and the increase of NIHSS score,PSV and EDV showed a trend of increasing gradually,while blood flow showed a trend of decreasing.The results of functional recovery evaluation showed that the PSV and EDV of patients with poor recovery were significantly higher than those with good recovery,while the carotid blood flow was lower than those with good recovery.Follow-up results showed that the PSV and EDV of patients with recurrence were significantly higher than that of patients without recurrence,and the blood flow of patients with recurrence

关 键 词：急性缺血性脑卒中 颈动脉收缩期最大血流速度 颈动脉舒张末期最低血流速度 颈动脉血流量 

分 类 号：R445.1[医药卫生—影像医学与核医学]