单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估  

Evaluation of cerebral hemodynamics in patients with unilateral internal carotid artery occlusion undergoing superficial temporal artery-middle cerebral artery bypass

作　　者：魏淑婕 惠品晶[1] 丁亚芳[1] 张白[1] 颜燕红[1] 周鹏[2] 黄亚波[2] Wei Shujie;Hui Pinjing;Ding Yafang;Zhang Bai;Yan Yanhong;Zhou Peng;Huang Yabo(Department of Neurosurgery Carotid and Cerebrovascular Ultrasound,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科-颈脑血管超声科,215006 [2]苏州大学附属第一医院神经外科,215006

出　　处：《中华医学超声杂志（电子版）》2023年第10期1046-1055,共10页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：苏州市民生科技项目(SS202061);苏州大学技术开发合作项目(H211064)。

摘　　要：目的应用经颅多普勒超声(TCD)及CT灌注成像(CTP)评估单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥(STA-MCA bypass)术前后的脑血流动力学变化。方法回顾性连续纳入2016年1月至2021年5月于苏州大学附属第一医院神经外科因慢性单侧颈内动脉闭塞行STA-MCA bypass术的患者85例。根据美国介入和治疗神经放射学学会/介入放射学学会(ASITN/SIR)标准将患者分为A组65例(ASITN/SIR 0~2级)和B组20例(ASITN/SIR 3级)。运用经颅多普勒(TCD)评估患者STA-MCA bypass术前后的双侧大脑中动脉(MCA)远段(检测深度30~40 cm)平均血流速度(Vm)、收缩期峰值血流速度(Vs)、舒张期末血流速度(Vd)、血管搏动指数(PI)。评估患者双侧基底节及颞叶CTP参数,计算脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及达峰时间(TTP),并计算患侧/健侧CTP(rCTP)。采用美国国立卫生研究院卒中量表(NIHSS)评估患者神经系统评分。采用Spearman秩相关分析患侧MCA远段Vm与NHISS评分的相关性。结果TCD参数:术前及术后A、B两组的患侧MCA远段的Vm、Vs、Vd以及PI均低于健侧(P均<0.05)。术前A组患侧Vm、Vs、Vd以及PI均低于B组,2组患者术后的Vm、Vs、Vd以及PI均高于术前,差异均有统计学意义(P均<0.05);术后2组间的Vm、Vs、Vd以及PI比较差异无统计学意义(P均>0.05)。rCTP参数:术前A组rCBF和rCBV均低于B组(P均<0.05),rMTT及rTTP均大于B组(P均<0.05);2组术后的rCBF均高于术前,rMTT、rTTP均低于术前(P均<0.05),B组术后的rCBV低于术前(P均<0.05),A组术后颞叶rCBV较术前升高(P<0.05),基底节rCBV与术前相比差异无统计学意义(P>0.05)。NHISS评分:A组患者术前及术后NHISS评分均高于B组,差异均有统计学意义(P均<0.05);2组患者术后NHISS评分均低于术前,差异均有统计学意义(P均<0.05)。A、B两组患者术前MCA Vm与NHISS评分呈负相关(r=-0.659、-0.626,P均<0.01),而术后MCA Vm与NHISS评分不存在线性相关�Objective To evaluate cerebral hemodynamics before and after unilateral internal carotid artery occlusion in patients undergoing superficial temporal artery-middle cerebral artery bypass(STA-MCA bypass)by transcranial Doppler ultrasound(TCD)and CT perfusion imaging(CTP).Methods Eighty-five patients who underwent STA-MCA bypass grafting for unilateral internal carotid artery occlusion at the Neurosurgery Department of the First Affiliated Hospital of Soochow University from January 2016 to May 2021 were retrospectively enrolled.According to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)criteria,the patients were divided into group A(65 cases;ASITN/SIR Grade 0-2)and group B(20 cases;ASITN/SIR Grade 3).The average blood flow velocity(Vm),peak systolic blood flow velocity(Vs),end-diastolic blood flow velocity(Vd),and vascular pulse index(PI)of the bilateral middle cerebral arteries(MCA)in the distal section(detection depth 30~40 cm)were evaluated by TCD before and after STA-MCA bypass.CTP parameters of the bilateral basal ganglia and temporal lobes were evaluated to calculate cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and peak time(TTP),as well as CTP of the affected side/healthy side(rCTP).The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological score.Spearman rank correlation was used to analyze the correlation between the Vm of the MCA distal segment and NHISS score.Results The Vm,Vs,Vd,and PI of the MCA distal segment on the affected side were lower than those on the healthy side in both groups A and B before and after surgery(P<0.05 for all).Preoperative Vm,Vs,Vd,and PI of the affected side in group A were lower than those in group B,and postoperative Vm,Vs,Vd,and PI of the two groups were significantly higher than those before surgery(P<0.05 for all).There were no significant differences in Vm,Vs,Vd,or PI between the two groups after surgery(P>0.05 for all).Before operation,rCB

关 键 词：超声检查 多普勒 经颅 CT灌注成像 颈内动脉闭塞 颞浅动脉-大脑中动脉搭桥术 血流动力学 侧支循环 

分 类 号：R65[医药卫生—外科学]