TCD对颈内动脉重度狭窄引起大脑中动脉血流动力学变化及侧支循环的评估价值  

Value of Transcranial Doppler Ultrasound in the Assessment of Haemodynamic Changes in the Middle Cerebral Artery and Collateral Circulation Due to Severe Stenosis of the Internal Carotid Artery

作　　者：李丽 宋彬彬[1] 段智慧[2] 宁金丽 辛果果 王亚星 LI Li;SONG Binbin;DUAN Zhihui;NING Jinli;XIN Guoguo;WANG Yaxing(Department of Neurological Function,Luoyang Central Hospital,Luoyang 471000,China;Department of Neurology,Luoyang Central Hospital,Luoyang 471000,China)

机构地区：[1]洛阳市中心医院神经功能科,河南洛阳471000 [2]洛阳市中心医院神经内科,河南洛阳471000

出　　处：《河南医学研究》2024年第16期2980-2983,共4页Henan Medical Research

摘　　要：目的探讨经颅多普勒超声(TCD)对颈内动脉重度狭窄引起大脑中动脉血流动力学变化及侧支循环的评估价值。方法选取2020年10月至2022年10月在洛阳市中心医院就诊的96例颈内动脉狭窄患者作为研究对象,根据数字减影血管造影(DSA)结果分为轻度狭窄、中度狭窄、重度狭窄,采用TCD测量大脑中动脉血流动力学参数[收缩期峰值血流速度(Vs)、搏动指数(PI)、脑血流储备能力(CVR)],分析大脑中动脉血流动力学参数与颈内动脉狭窄程度相关性及评估价值,并比较有无侧支循环开放患者大脑中动脉血流动力学参数及DSA、TCD对侧支循环开放检出率。结果不同颈内动脉狭窄程度患者Vs、PI、CVR比较:重度狭窄<中度狭窄<轻度狭窄(P<0.05);经相关性分析显示,大脑中动脉血流动力学参数Vs、PI、CVR与颈内动脉狭窄程度均呈负相关(P<0.05);Vs、PI、CVR对轻度与中度颈内动脉狭窄诊断曲线下面积(AUC)分别为0.798、0.763、0.854,联合诊断AUC为0.893,对轻度、中度与重度颈内动脉狭窄诊断AUC分别为0.832、0.795、0.856,联合诊断AUC为0.927;与无侧支循环患者比较,有侧支循环患者Vs、PI、CVR较高(P<0.05);TCD、DSA对于侧支循环开放检出率比较,差异无统计学意义(P>0.05)。结论TCD可评估颈内动脉重度狭窄引起的大脑中动脉血流动力学变化,为临床早期诊断颈内动脉狭窄程度、侧支循环建立提供参考,以针对性制定治疗方案,改善预后。Objective To investigate the value of transcranial Doppler ultrasound(TCD)in assessing the hemodynamic changes of the middle cerebral artery and collateral circulation caused by severe stenosis of the internal carotid artery.Methods A total of 96 patients with internal carotid artery stenosis in Luoyang Central Hospital from October 2020 to October 2022 were selected as the study objects.According to the results of digital subtraction angiography(DSA),they were divided into mild stenosis,moderate stenosis and severe stenosis.TCD was used to measure the cerebral arterial hemodynamics parameters[velocity systolic(Vs),pulse index(PI),cerebrovascular reserve(CVR)],and analyzed the correlation and evaluation value between the cerebral arterial hemodynamics parameters and the degree of internal carotid artery stenosis.The hemodynamic parameters of cerebral arteries and the detection rates of DSA and TCD in patients with and without open collateral circulation were compared.Results The comparison of Vs,PI and CVR in patients with different internal carotid artery stenosis was as follows:severe stenosis<moderate stenosis<mild stenosis(P<0.05).The correlation analysis showed that the blood flow parameters Vs,PI and CVR were negatively correlated with the degree of internal carotid artery stenosis(P<0.05).The area under curve(AUC)of Vs,PI and CVR for mild and moderate internal carotid artery stenosis was 0.798,0.763 and 0.854,respectively.The AUC of combined diagnosis was 0.893,the AUC of mild,moderate and severe internal carotid artery stenosis was 0.832,0.795 and 0.856,respectively.The AUC of combined diagnosis was 0.927.Compared with patients without collateral circulation,patients with collateral circulation had higher Vs,PI and CVR(P<0.05).There was no significant difference between TCD and DSA in the detection rate of collateral circulation opening(P>0.05).Conclusion TCD can evaluate the hemodynamic changes of cerebral middle arteries caused by severe internal carotid artery stenosis,and provide reference for early d

关 键 词：经颅多普勒超声 颈内动脉重度狭窄 大脑中动脉血流动力学 侧支循环 

分 类 号：R743[医药卫生—神经病学与精神病学]