缺血性卒中脑血管反应性与颈动脉狭窄的相关研究  

Correlation between cerebrovascular reactivity and carotid stenosis in ischemic stroke

作　　者：单薪宇 李成豪 姜美子[1] 金美善 SHAN Xinyu;LI Chenghao;JIANG Meizi;JIN Meishan(Department of Neurology,the Affiliated Hospital of Yanbian University,Yanji 133000,Jilin,China;Department of General Medicine,the Affiliated Hospital of Yanbian University,Yanji 133000,Jilin,China)

机构地区：[1]延边大学附属医院神经内科,吉林延吉133000 [2]延边大学附属医院全科医学科,吉林延吉133000

出　　处：《中国现代医生》2022年第20期46-50,共5页China Modern Doctor

摘　　要：目的应用经颅彩色多普勒超声(transcranial color Doppler ultrasound,TCD)结合屏气试验分析颈动脉狭窄患者的脑血管反应性(cerebrovascular reactivity,CVR),为干预缺血性卒中的发生进展及预防时机的选择提供依据。方法选取2018年1月至2020年1月于延边大学附属医院神经内科就诊者150例,分为脑梗死组110例,对照组(无颅内外血管狭窄及脑梗死者)40例。脑梗死患者根据是否存在颈动脉狭窄、狭窄程度及有无临床症状进行组别比较。采用经颅彩色多普勒超声检测仪检测双侧大脑中动脉屏气试验前后的血流速度,计算平均血流速度变化值(change value of average blood flow velocity,ΔVm)和呼吸抑制指数(breath-holding index,BHI)。结果脑梗死组ΔVm及BHI值分别低于对照组,差异有统计学意义(P<0.05)。梗死组依据是否合并颈动脉狭窄分为狭窄组和非狭窄组,狭窄组ΔVm及BHI值分别低于对照组,差异有统计学意义(P<0.05)。患侧轻、中度分别与重度狭窄组比较,差异有统计学意义(P<0.05)。狭窄程度与患侧BHI值呈负相关。结论经颅多普勒超声检测CVR具有可行性,BHI可作为评价CVR指标之一。脑血管的反应性与缺血性卒中的发生有相关性,可作为预测缺血性脑卒中发生风险的指标之一。脑血管反应性与颈动脉狭窄程度呈负相关,随着狭窄程度的增加CVR逐步减低。Objective To analyze cerebrovascular reactivity(CVR)in patients with carotid stenosis by transcranial color Doppler ultrasound(TCD)combined with breath holding test,so as to provide basis for intervening the occurrence and progress of ischemic stroke and the choice of prevention time.Methods A total of 150 patients who visited the Department of Neurology in our hospital from January 2018 to January 2020 were selected and divided into 110 cases in the cerebral infarction group and 40 cases in the control group(without extracranial and extracranial vascular stenosis and cerebral infarction dead).Patients with cerebral infarction were compared according to whether there was carotid stenosis,the degree of stenosis and whether there were clinical symptoms.Transcranial color Doppler ultrasound was used to detect the blood flow velocity of bilateral middle cerebral artery before and after breath holding test,and the change value of average blood flow velocity(ΔVM)and respiratory inhibition index(BHI)were calculated.Results The values ofΔVM and BHI in the cerebral infarction group were lower than those in the control group(P<0.05).The infarct group was divided into stenosis group and non stenosis group according to whether it was complicated with carotid stenosis.The values ofΔVM and BHI in the stenosis group were lower than those in the control group(P<0.05).There was significant difference between mild and moderate stenosis group and severe stenosis group(P<0.05).The degree of stenosis was negatively correlated with the value of BHI on the affected side.Conclusion Transcranial Doppler ultrasound is feasible to detect CVR,and BHI can be used as an index to evaluate CVR.Cerebrovascular reactivity is correlated with the occurrence of ischemic stroke,which can be used as one of the indicators to predict the risk of ischemic stroke.Cerebrovascular reactivity was negatively correlated with the degree of carotid stenosis,and CVR gradually decreased with the increase of stenosis.

关 键 词：脑血管反应性 颈动脉狭窄 缺血性卒中 经颅彩色多普勒超声 

分 类 号：R743[医药卫生—神经病学与精神病学]