颈动脉内膜切除术患者脑血流动态调节与术后高灌注的相关性研究  

Correlation between hemodynamic characteristics or dynamic cerebral autoregulation and postoperative hyperperfusion in patients undergoing carotid endarterectomy

作　　者：李娜[1] 周福波 陆夏[2] 李秋萍[1] 陈虹秀 赵越[1] 邢英琦[1] Li Na;Zhou Fubo;Lu Xia;Li Qiuping;Chen Hongxiu;Zhao Yue;Xing Yingqi(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华超声影像学杂志》2023年第2期105-110,共6页Chinese Journal of Ultrasonography

基　　金：首都医科大学宣武医院国自然青年培育项目(QNPY2020021)。

摘　　要：目的分析颈动脉内膜切除术(CEA)患者术侧血流动力学、脑血流动态调节(dCA)与术后高灌注发生的相关性及预测价值。方法前瞻性连续纳入2021年1-8月在首都医科大学宣武医院因颈动脉狭窄接受颈动脉内膜切除术治疗的患者63例。根据有无术后高灌注将患者分为高灌注组(13例)与无高灌注组(50例), 比较两组间一般资料及血流动力学参数的差异。采用传递函数法得出通过平均脑血流速度(CBFV)随血压变化的波动幅度(gain)、随血压变化产生波动的相位差(phase)及平均CBFV与血压变化间的一致性(coherence), 分析评估两组间dCA的差异。通过ROC曲线及曲线下面积(AUC)分析dCA参数用于预测CEA术后发生高灌注的诊断价值。结果①高灌注组高血压病比例高于无高灌注组(P<0.05)。②高灌注组颈动脉狭窄段收缩期峰值流速、舒张末流速、狭窄段与狭窄远段收缩期峰值流速比值高于无高灌注组, 高灌注组患侧大脑中动脉收缩期峰值流速低于无高灌注组, 组间差异有统计学意义(均P<0.05)。③在超低频域、低频域内, 高灌注组相位差低于无高灌注组, 组间差异有统计学意义(均P<0.05), 而在高频域内, 两组相位差差异无统计学意义(P>0.05)。在超低频、低频和高频三个域中, 两组增益、一致性差异无统计学意义(均P<0.05)。④ROC曲线分析显示, 超低频域相位差=33.28是预测CEA术后发生高灌注的最佳截断值(AUC=0.766, 95%CI=0.629~0.904, P=0.03), 其特异性为0.700, 敏感性为0.846。结论 CEA术后高灌注组与无高灌注组血流动力学、dCA存在差异, 术前患侧dCA功能受损是术后高灌注的独立预测因子。Objective To investigate the hemodynamic characteristics and dynamic cerebral autoregulation(dCA)of patients with severe carotid stenosis before carotid endarterectomy(CEA),and to analyze their correlations with hyperperfusion after CEA.Methods A total of 63 patients with unilateral severe carotid artery atherosclerotic stenosis who underwent CEA were consecutively recruited prospectively in Xuanwu Hospital,Capital Medical University from January 2021 to August 2021.According to postoperative hyperperfusion,patients were divided into hyperperfusion group(13 cases)and non-hyperperfusion group(50 cases).The general clinical data and hemodynamic parameters were compared between the two groups.The dCA was evaluated by the transfer function analysis that measured the fluctuation amplitude of mean cerebral blood flow velocity(CBFV)with blood pressure change,the time difference of phase with blood pressure change,and the correlation between mean CBFV and blood pressure change.The value of dCA for predicting postoperative hyperperfusion was analyzed through the ROC curve and the area under the curve(AUC).Results①The proportion of hypertension in hyperperfusion group was higher than that in non-hyperperfusion group(P<0.05).②The peak systolic velocity(PSV)at the stenosis lesion of the internal carotid artery,the end-diastolic velocity(EDV)at the stenosis lesion of the internal carotid artery and the ratio of PSV at the stenosis lesion of the internal carotid artery to the distal internal carotid artery in the hyperperfusion group were higher than the non-hyperperfusion group.And the PSV of the ipsilateral middle cerebral artery in the hyperperfusion group was lower than the non-hyperperfusion group(all P<0.05).③In the very low-frequency and low-frequency region,the phase in the hyperperfusion group was lower than that in the non-hyperperfusion group(all P<0.05),while there was no significant difference in the high-frequency regions(P>0.05).In the three regions of very low-frequency,low-frequency and high-frequency,th

关 键 词：超声检查 多普勒 颈动脉内膜切除术 脑血流动态调节 高灌注 血流动力学 

分 类 号：R654.3[医药卫生—外科学]