急性脑梗死患者病程中不同时间脑血流动力学变化与日常生活能力恢复的关系

Relationship between the changes of cerebrovascular hemodynamics at various time and the rehabilitation of daily life capability in patients with acute cerebral infarction

目的:探讨急性脑梗死患者脑血流动力学变化的规律,评价脑血流动力学检查(cerebrovascularhemodynamicsanalysis,CVA)在急性脑梗死病情评判、预后分析以及临床治疗指导中的作用。方法:选择北京大学人民医院神经内科收治符合急性颈内动脉系统脑梗死确诊标准、又缺乏限定并发症的住院患者25例,依据临床神经功能缺损程度分组,动态观察各组患者入院24h内,病程第7,14,28,90天时的脑血流动力学情况,并与患者的头颅CT和MRI等影像学资料、临床症状和体征、治疗终点时日常生活能力等进行对比研究。结果:急性脑梗死患者主要脑血流动力学指数(cerebrovascularhemody-namicsindex,CVDI)异常与临床神经功能缺损程度及影像学梗死灶大小成正相关;入院24h内CVDI阳性率明显高于头颅CT和MRI(头颅CT和MRI阳性率为56%,CVDI阳性率为84%);CVDI改变与临床征象具有一定同步性;溶栓成功的患者CVDI短期内迅速改善;病程第90天时日常生活能力(Barthel指数)严重减低的患者首次最低血流速度多<4.5cm/s。结论:急性脑梗死患者脑血流动力学变化具有一定的规律性;CVA有助于急性脑梗死的发病及病况预测,并对病程与预后分析有指导价值。

AIM:To explore the rule of the cerebrovascular hemodynamic changes in patients with acute cerebral infarction,and evaluate the functions of cerebrovascular hemodynamics analysis(CVA) in diagnosis,analysis and clinical treatment during this disease and after prognosis. METHODS:A total of 25 inpatients coincided with diagnosis criterion of acute cerebral infarctions of internal carotid artery system and without definite complications were selected as samples from Department of Neurology, People's Hospital of Peking University.According to the degree of the neural functional deficit,all patients were divided into several groups to continuously observe their cerebrovascular hemodynamic situation in different periods, including the first 24 hours,7th,14th,28th and 90th days after hospitalization.The data were analyzed compared with CT and MRI data,clinical symptoms, signs and daily life capability at the end of treatment. RESULTS:The main abnormality of cerebrovascular hemodynamics index (CVDI) and deficient degree of a clinical neural function,the size of image focus of infarct in patients with acute cerebral infarctions were positively correlated. The positive rates of CVDI(84%) were obviously higher than those of CT and MRI(56%) during the first 24 hours.The changes of CVDI and clinical symptoms were relative synchronism.CVDI in those patients who had completed thrombolytic therapy successfully was improved obviously in a short time.At day 90,the blood speed of the patients whose daily life capability(Barthel index) was obviously decreased was slower than 4.5 cm/s firstly. CONCLUSION:The changes of cerebrovascular hemodynamics in patients with acute cerebral infarction have a certain rule.CVA is helpful for predicting the episode and the condition of acute cerebral infarction and is significant to the analysis of disease course and prognosis.