112例脑动脉系统微栓子监测的临床研究

Clinical analysis and study of 112 cases of cerebral arterial microembolism monitoring

目的 研究脑动脉系统微栓子 (MES)的产生机制及其相关因素。方法 将 112例 MES监测的临床资料进行总结分析。结果 本组微栓子检出率为 33.93% ,且全部见于有明显脑卒中症状者 ;脑梗死 MES检出率为35 .87%且以原发性大面积梗死为主 ;MES阳性与病程有明显相关 ,病程 <72 h易检出微栓子 ,阳性率为 4 7.72 % ;颅内血管狭窄是微栓子产生的主要原因 ;颈动脉异常与正常组微栓子出现率无明显差异 ,但发现本组病例中微栓子出现以左侧为主 ,与颈动脉病变部位一致率为 5 5 .5 5 % ;确定微栓子来源于有病变的颅外颈动脉 2例 ,来源于有病变的颅内颈动脉系 5例 ,来源于同时伴有颅内外血管病变 12例 ,表明颅内外动脉同时伴有病变时微栓子检出率增高 ;MES的阳性率与血液成分无相关性 ,但在血液成分异常组中血粘度增高以及血小板聚集降低 MES阳性率明显增高。结论 脑动脉系统中监测到微栓子说明患者有活动的栓子来源 ,易发生或复发脑梗死 ,TCD能正确的监测、判断脑循环中微栓子 ,确定其发生率、性质。

Objective To investigate the mechanism and related factors of the cerebral arterial microemboli signal (MES). Methods The clinical data of 112 cases of cerebral arterial microembolism monitoring was conclusively analyzed. Results MES were detected in 33.93% of patients and all of them were found with distinct stroking symptom. The detectable rate of MES in patients with cerebral infarction was 35.87%,and which mainly had great proportion of primary cerebral infarction. MES was more prevalent with disease course. It was easy to detect MES,when the disease course was less than 72 hours,and the positive rate was 47.72%. The intracranical artery stenosis was the first course of generating MES. The occurrence of MES had no evident difference between the carotid abnormality group and the normal group,however,the occurrence was mainly in the left side and the consistency with the lesion site of carotid was 55.55%. In our study,there were 2 cases of MES originated from the extracranial carotid artery which had pathological changes,5 cases originated from the diseased intracranical carotid artery,and 12 cases originated from the both lesions. It was indicated that the detectable rate was risen when the intracranial and extracranial artery both have lesions. The positive rate of MES had no correlation with the blood composition,however,the positive rate of MES was obviously risen under the condition of blood rislosity rising and platelet aggression decreasing in the group of blood composition abnormality. Conclusion MES is detected in the cerebral arterial,which illustrates that there is active microembolism origin and the patients is easy to occur or recur cerebral infarction. Trancranial Doppler can monitor and judy of MES in the brain circulation correctly and also can make certain the occurrence property origin and the relation with diseases. It is no doubt that this is the significant contribution for screening high danger population of cerebral infarction,and it is in favour of preventing and treating cerebrovascular diseases,decreasing the occurrence and death rate of the cerebrovascular diseases.