多模态监测对急性脑梗死患者脑颈血流动力学及神经功能预后的评估  

Prognostic evaluation of cerebral neck hemodynamics and neurological function in patients with acute cerebral infarction by multimodal monitoring

作　　者：王婧[1] 陈蕾[1] 王俊力[1] 陈国华[1] 梅俊华[1] Wang Jing;Chen Lei;Wang Junli;Chen Guohua;Mei Junhua(Department of Neurology,Wuhan First Hospital,Hubei Province,Wuhan 430033,China)

机构地区：[1]武汉市第一医院神经内科,430033

出　　处：《疑难病杂志》2022年第11期1129-1134,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：武汉市卫计委医学科研项目(WX18D52)。

摘　　要：目的探讨多模态监测对急性脑梗死患者脑颈血流动力学及神经功能预后的评估价值。方法选择2019年8月—2021年3月武汉市第一医院神经内科收治急性脑梗死患者78例作为研究对象,进行多模态MR监测,根据改良Rankin量表(mRS)、灌注异常情况和颈动脉狭窄程度分组。比较各组急性脑梗死患者脑颈血流动力学指标变化,Spearman法分析急性脑梗死患者颈动脉狭窄程度、神经功能预后情况与脑颈血流动力学指标的相关性。结果预后良好组(n=40)与预后不良组(n=38)患者相对局部脑血流量(rCBF)差异无统计学意义(P>0.05),预后不良组患者相对平均通过时间(rMTT)、对比剂达峰时间(rTTP)均明显高于预后良好组,相对局部脑血容量(rCBV)明显低于预后良好组(t/P=10.258/<0.001、12.646/<0.001、6.635/<0.001);预后不良患者rCBV值随灌注异常分期升高而降低,差异有统计学意义(F/P=8.125/0.002),而不同分期患者之间rCBF、rMTT、rTTP比较差异无统计学意义(P>0.05);随着颈动脉狭窄程度加重rMTT、rTTP值逐渐升高,差异有统计学意义(F/P=3.015/0.001、2.926/0.009),而rCBV、rCBF比较差异无统计学意义(P>0.05);经Spearman相关性分析显示,急性脑梗死患者rMTT、rTTP值与神经功能预后及颈动脉狭窄程度均呈显著正相关(rMTT:r/P=0.851/<0.001、0.789/<0.001;rTTP:r/P=0.986/<0.001、0.450/0.004)。结论多模态MR监测可有效地对急性脑梗死患者脑颈血流动力学和颈动脉狭窄程度进行评价,对其预后不良的诊断和预防也具有重要的临床意义。Objective To explore the prognostic value of multimodal monitoring on cerebral neck hemodynamics and neurological function in patients with acute cerebral infarction.Methods Seventy-eight patients with acute cerebral infarction admitted to the Department of Neurology of Wuhan First Hospital from August 2019 to March 2021 were selected as the subjects for multimodal MR monitoring.They were grouped according to the modified Rankin Scale(mRS),perfusion abnormalities and carotid stenosis.To compare the changes of cerebral and neck hemodynamics in patients with acute cerebral infarction in each group,Spearman method was used to analyze the correlation between the degree of carotid stenosis and the prognosis of neurological function and cerebral and neck hemodynamics in patients with acute cerebral infarction.Results There was no significant difference in relative regional cerebral blood flow(rCBF)between the patients with good prognosis(n=40)and those with poor prognosis(n=38)(P>0.05).The relative mean transit time(rMTT)and contrast medium peak time(rTTP)of patients with poor prognosis were significantly higher than those with good prognosis(t/P=10.58/<0.001,12.646/<0.001,6.635/<0.001);The rCBV value decreased with the increase of the stage,and the difference was statistically significant(F/P=8.125/0.002).There was no significant difference in rCBF,rMTT,rTTP between patients with different stages of cerebral neck blood flow(P>0.05);The rMTT and rTTP values increased gradually with the severity of carotid stenosis(F/P=3.015/0.001,2.926/0.009),but there was no significant difference between rCBV and rCBF(P>0.05);Spearman correlation analysis showed that the rMTT and rTTP values in patients with acute cerebral infarction were positively correlated with the prognosis of neurological function and the degree of carotid stenosis(rMTT:r/P=0.851/<0.001,0.789/<0.001;rTTP:r/P=0.986/<0.001,0.450/0.004).Conclusion Multimodal MR monitoring can effectively evaluate the cerebral carotid hemodynamics and the degree of carotid stenosis

关 键 词：脑梗死 急性 多模态监测 血流动力学 神经功能预后 相关性 

分 类 号：R743.33[医药卫生—神经病学与精神病学]