远隔缺血预适应治疗患者侧枝循环与脑缺血关系的探讨

A exploration into the relation between collateral circulation and ischemic brain lesions in patients treated with remote ischemic preconditioning

目的:探讨远隔缺血预适应治疗患者侧枝循环与脑缺血关系。方法:选择我院门诊患者30例,所有患者均行远隔缺血预适应治疗。根据有无侧枝代偿将患者分为两组,有侧枝代偿组12例,无侧枝代偿组18例。经颅多普勒超声(transcranial Doppler,TCD)检查证实患单侧颅内动脉中、重度狭窄或闭塞。磁共振成像(magnetic resonance imaging,MRI)检查除外脑占位病变及脑出血性病变。分别对两组患者的脑血流灌注显像结果进行对比分析。结果:无侧枝代偿组患者额、颞、顶、枕叶的血流灌注治疗前后无显著性差异(P>0.05),基底节、丘脑的血流灌注治疗前后有显著差异(t=-2.223,P=0.04;t=-3.164,P=0.006)。有侧枝代偿组患者治疗前后仅基底节区血流灌注有显著差异(t=-2.92,P=0.014),余额、颞、顶、枕叶及丘脑治疗前后血流灌注无显著差异(P>0.05)。结论:行远隔缺血预适应治疗的患者,治疗前后基底节血流灌注明显改善,与侧枝循环的存在与否无关;丘脑血流灌注变化与侧枝代偿有关,无侧枝代偿患者治疗后丘脑对缺血产生显著耐受性,有侧枝代偿者则变化不明显。

Objective:To approach the relation between collateral flow and ischemic brain lesions in patients treated with ischemic preconditioning.Methods:30 patients in our hospital were selected.All patients were treated with remote ischemic preconditioning and were divided into two groups according to collateral circulation,i.e.,18 cases without collateral circulation group and 12 cases with collateral circulation group.The transcranial Doppler examination confirmed the presence of severe stenosis or occlusion in unilateral intracranial artery.Brain lesions and cerebral hemorrhagic lesions were excluded by magnetic resonance imaging.The results of patients with ischemic stroke in two groups,who underwent single photon emission computed tomography perfusion scan of cerebral blood flow before and after treatment were analyzed respectirely.Results:The ratio of the impaired area to the opposite area in frontal,temporal,parietal,occipital lobe in patients without collateral circulation group had no statistical significant difference before and after treatment(P>0.05).But in basal ganglia and thalamus,that had statistical significant difference(t=-2.223,P=0.04;t=-3.164,P=0.006).The ratio of the impaired area to the opposite area in basal ganglia in patients with collateral circulation had statistical significant difference(t=-2.92,P=0.014) and had no statistical significant difference in the above-mentioned parts before or after treatment(P>0.05).Conclusion:Blood flow perfusion in basal ganglia of patients with or without collateral circulation are significantly improved after remote hypoxic preconditioning.Thalamus in patients without collateral circulation has significant ischemic tolerance and has no significant change in patients with collateral circulation.