短暂性脑缺血发作患者脑动脉平均血流速度与脑血管血液动力学参数的相关性

Correlation between the mean blood flow velocity in cerebral arteries and cerebrovascular hemodynamic indexes in patients with transient ischemic attack

目的:探讨短暂性脑缺血发作患者通过经颅多普勒超声测得的脑动脉平均血流速度与脑血管动力学参数间的关系。方法:选择1997-06／2000-06广西医科大学第一附属医院收治的颈动脉系统短暂性脑缺血发作患者32例,以同期35名健康体检者为对照组。两组分别进行经颅多普勒超声和脑血管动力学检测仪检测,并将结果进行对比,分析不同脑动脉平均血流速度时脑血管动力学参数差异。结果:67例被试者全部进入结果分析。①经颅多普勒超声结果:脑动脉平均血流速度增高16例(轻度增高2例,中度增高9例,高度增高5 例),低流速者7例,正常流速者9例。②脑血管动力学检测结果:32例患者病侧异常28例(82％),对侧异常18例(56％)。③两组相关性:与平均血流速度正常组相比,平均血流速度增高和减低组最小血流速度和最小大脑半球供血量低(P<0．05或0．01);平均血流速度高度增高组和减低组颈动脉平均血流速度、平均大脑半球供血量和动态阻力等参数也低(P<0．01)。与平均血流速度中度增高组相比:平均血流速度高度增高组和减低组颈动脉平均和最小血流速度,平均和最小大脑半球供血量均低,动态阻力高(P<0．05或0．01)。特性阻抗、脉搏波波速两指标平均血流速度减低组高于其他各组(P<0．05或0．01)。其他各项参数 (脑血管阻力、顺应性、零压顺应性、临界压力)各组间无差异(P>0．05)。结论:脑血管动力学参数中反映两半球供血状况的参数(平均和最小血流速度,平均和最小大脑半球供血量)及脑血管自动调节能力的参数(特性阻抗、脉搏波波速)与经颅多普勒超声测得的脑动脉平均血流速度有较好的一致性,其余参数无相关性。提示两种检测方法各有侧重点,两者联合应用可较全面反映颈动脉系统短暂性脑缺血发作患者的脑血管血流动力学状况。

AIM： To explore the correlations between the mean velocity （Vmean） of cerebral arteries and cerebrovascular hemodynamic indexes （CVDI） of measured by transcranial Doppler ultrasound （TCD） in patients with transient ischemic attack. METHODS： Thirty-two patients with transient ischemic attack of carotid artery, who were treated at the First Affiliated Hospital, Guangxi Medical University between June 1997 and June 2000, were selected. Thirty-five healthy people who were made body examination in the same period were selected as control group. People in the two group were detected with TCD and cerebrovascular hemodynamics analyzer（CVA）, respectively. The results were compared to analyze the difference of CVDI at different Vmean. RESULTS： Sixty-seven testees were all involved in the result analysis.① Result of TCD： The Vmean of cerebral arteries increased in 16 cases （mild increase in 2 cases, moderate increase in 9 cases and severe increase in 5 cases）. There were 7 cases with low flow-rate and 9 cases with normal flow-rate. ② Result of kinetic detect of cerebral vessels： Among 32 patients, there were 28 cases with abnormal injured side （82%） and 18 cases with eontralateral abnormality （56%）. ③ Association of the two groups： Compared with the Vmean in the normal group, Vmin and Qmin were low in the increase and decrease Vmean group （P〈 0.05 or 0.01 ）. Vmean of carotid artery, Qmean and dynamic resistance were low in the increase and decrease Vmean group （P〈 0.01 ）. Compared with the moderate increase of Vmean group, Vmean, Vmin, Qmean and Qmin of carotid artery was low in the increase and decrease Vmean group, but dynamic resistance was high （P 〈 0.05 or 0.01 ）. Zcv and pulse wave velocity （Wv） in the decrease of Vmean group were higher than those in the other groups （P〈0.05 or 0.01 ）. There was no difference of other parameters [cerebral vascular resistance （CVR）, compliance, Co and CP] in every group （P〉 0.05）. CONCLUSION： The parameters （Vmean, Vmin, Qmean and Qmin） that reflects blood supply of two hemispheres and parameters （Zcv and Wv） with self-adjustment ability of cerebral vessels in CVDI have fine concordance with Vmean of cerebral arteries detected by TCD, which has no correlation with other parameters. It is indicated that this two detecing method both have emphasis, and the associated application of the two can reflect fully hemodynamic status of cerebral vessels in patients with transient ischernic attack of carotid artery.