颈动脉多普勒超声在颈动脉剥脱术前评估中的应用价值  

Application value of carotid artery Doppler ultrasound before carotid endarterectomy

作　　者：郭为衡 朴雪梅 刘国华 董鑫昌 Guo Weiheng;Piao Xuemei;Liu Guohua;Dong Xinchang(Department of Ultrasonography,Pinggu Hospital,Beijing Friendship Hospital,Capital Medical University,Beijing 101200,China;Department of Vascular Surgery,Pinggu Hospital,Beijing Friendship Hospital,Capital Medical University,Beijing 101200,China)

机构地区：[1]首都医科大学附属北京友谊医院平谷医院超声科,北京101200 [2]首都医科大学附属北京友谊医院平谷医院血管外科,北京101200

出　　处：《血管与腔内血管外科杂志》2023年第4期425-429,共5页Journal of Vascular and Endovascular Surgery

基　　金：平谷区医院科研项目(Pgyy2018-28)。

摘　　要：目的 探讨颈动脉多普勒超声在颈动脉剥脱术(CEA)术前评估中的应用价值。方法 收集2017年1月至2022年5月首都医科大学附属北京友谊医院平谷医院收治的113例疑似颈动脉狭窄患者的临床资料,以CEA术中测量结果为金标准,分析术前彩色多普勒超声的诊断效能及其与金标准的一致性,比较手术前后CEA患者病变指标的变化情况。结果 符合CEA治疗患者的共82例,104处狭窄病灶。术前颈动脉彩色多普勒超声对符合CEA治疗患者的诊断结果与金标准具有高度一致性(Kappa=0.911),诊断价值较高(AUC=0.873)。术前颈动脉彩色多普勒超声对狭窄程度的评估结果与金标准具有较高一致性(Kappa=0.850)。术前颈动脉彩色多普勒超声对斑块性质的诊断结果与金标准具有较高一致性(Kappa=0.882),诊断价值较高(AUC=0.850)。术后狭窄处颈动脉内径明显高于术前,收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、颈内动脉(ICA)PSV与颈总动脉(CCA)PSV的比值(PSVICA/PSVCCA)均明显低于术前,差异均有统计学意义(P﹤0.01)。结论 颈动脉多普勒超声在CEA术前评估中具有较高的诊断价值,可术前详细评估患者的狭窄程度、斑块性质,为患者治疗方案的选择提供较为准确的参考。Objective To analyze the application value of carotid artery Doppler ultrasonography before carotid endarterectomy(CEA).Method Clinical data of 113 patients with suspected carotid artery stenosis admitted in Pinggu Hospital,Beijing Friendship Hospital,Capital Medical University from January 2017 to May 2022 were collected.With the results of intraoperative CEA measurements as the gold standard,the diagnostic efficacy of color Doppler ultrasound in all patients before and after surgery and its consistency with the gold standard were analyzed,and the changes of lesion indexes in patients with CEA before and after surgery were compared.Result A total of 82 patients with 104 stenosis lesions were diagnosed,preoperative carotid color Doppler ultrasound showed high consistency with the gold standard(Kappa=0.911)and high diagnostic value(AUC=0.873)for CEA patients.Preoperative carotid artery color Doppler ultrasound was highly consistent with the gold standard for stenosis(Kappa=0.850).The results of preoperative carotid color Doppler ultrasound diagnosis of plaque properties were highly consistent with the gold standard(Kappa=0.882),with high diagnostic value(AUC=0.850).The carotid artery diameter in postoperative stenosis was significantly higher than before surgery,peak systolic velocity(PSV),end diastolic peak flow velocity(EDV),the ratio of the internal carotid artery(ICA)PSV to the common carotid artery(CCA)PSV(PSVICA/PSVCCA)were significantly lower than before surgery,the differences were statistically significant(P<0.01).Conclusion Carotid Doppler ultrasound has a high diagnostic value in preoperative assessment of CEA,which can be used to evaluate the stenosis degree and plaque nature of patients in detail before surgery,and provide a more accurate reference for the selection of treatment programs for patients.

关 键 词：颈动脉狭窄 斑块性质 狭窄程度 颈动脉内膜剥脱术 应用价值 

分 类 号：R543[医药卫生—心血管疾病]