颈动脉内膜剥脱术前、术中、术后颅内外血流动力学变化的研究

Extracranial and intracranial hemodynamic change before, during and after carotid endarterectomy

目的 研究颈动脉内膜剥脱术 (CEA)前、术中、术后颈动脉及颅内动脉的血流动力学变化。方法 用彩色多普勒血流成像 (CDFI)和经颅多普勒超声 (TCD)对 2 7例CEA患者术前术后病变局部管径、流速及同侧大脑中动脉 (MCA)术前、术中、术后流速、搏动指数 (PI)和交通支开放情况进行分析。结果 CEA术后 ,颈动脉管径、血流速度恢复正常。患侧的MCA流速及PI升高 (P <0 .0 0 1)。侧支循环关闭。术中患侧MCA流速下降幅度 <40 %与前交通开放相关 (P =0 .0 15 )。结论 CEA后颅外和颅内动脉的血流动力学恢复正常。CDFI与TCD结合 ,可评价CEA患者术前、术中、术后颅内外动脉的血流动力学变化 ,为CEA手术提供可靠的客观依据 ,并可作为评价手术效果的有效方式。

Objective To study the extracranial and intracranial arterial hemodynamic changes before, during and after carotid endarterectomy (CEA). Methods Color Doppler flow imaging (CDFI) and transcranial Doppler (TCD) were used to examine the diameter and velocity of the stenotic area of extracranial internal carotid artery (ICA), and the velocity and pulsatility of ipsilateral middle cerebral artery (MCA) and collateral circulations respectively before, during and after CEA. Results After CEA, the diameter and velocity of extracranial ICA returned to normal. The velocity and pulsatility of ipsilateral MCA increased significantly ( P <0.001), and the established collateral circulation were closed. During the operation, the decrease of MCA velocity less than 40% was in correlation with the opening of anterior communicating artery (AcoA) ( P = 0.015 ). Conclusion After CEA, the extracranial and intracranial arterial hemodynamic parameters return to normal. Combined with TCD, CDFI is effective in evaluating the extracranial and intracranial arterial hemodynamic changes.