TCD对小动脉病变为主的腔隙性脑梗死脑血流动力学评价

Evaluation of cerebral hemodynamics in patients with lacunar infarction by transcranial Doppler

目的探讨以小动脉病变为主要发病机制的腔隙性脑梗死患者的血流动力学改变。方法利用颈部血管彩超和MRA等排除伴有显著大血管病变的患者后,利用TCD观察115例腔隙性脑梗死患者脑内主要动脉的血流动力学改变,并与年龄和动脉血压等进行相关分析。同时以同年龄阶段、头颅影像学检查正常的30例健康体检者作为对照。结果腔隙性脑梗死组大脑中、前、后动脉的平均血流速度均低于对照组、脉动指数均高于对照组[分别为(1．05±0．26)、(1．01±0．24)、(1．05±0．23)和(0．87±0．12)、(0．88±0．20)、(0．88±0．16),均P＜0．05]。其中大脑中、前、后动脉的脉动指数均与年龄呈正相关(r=0．394、0．299、0．352,均P＜0．05),大脑前动脉脉动指数与收缩压和脉压差呈正相关(r=0．338、0．353,P＜0．05),大脑中动脉脉动指数与脉压差呈正相关(r=0．220,P＜0．05)。结论以小动脉为主要发病机制的腔隙性脑梗死患者脑血流动力学表现为血流速度轻度减慢,脉动指数显著升高,其中脉动指数与年龄和动脉血压有一定的关系。

Objective To observe the cerebral hemodynamics in patients with lacunar infarction which comes primarily from arteriolar occlusion. Methods After excluding the lacunar infarction cases manifesting a pathogenesis relative to carotid stenosis by ultrasonic examination or MRA, the cerebral hemodynamic indexes of 115 cases with lacunar infarction were measured by transcranial Doppler. Meanwhile, the controls included 30 healthy cases, their cranial CT or MRI normal. Results The mean velocity of middle, anterior and posterior cerebral artery in lacunar infarction cases was slower than that of the controls, but pulse indexes were higher than those in control group （respectively 1.05±0.26,1.01 ±0.24, 1.05±0.23 and 0.87±0.12, 0.88±0.20, 0.88±0.16, P〈0.05）, which were positively correlative to ages in lacunar infarction cases （r=0.394, 0.299, 0.352, P〈0.05）. The pulse index in anterior cerebral artery was correlated with systolic pressure and pulse pressure （r=0.338, 0.353, P〈0.05）, and that in middle cerebral artery only with pulse pressure （r=0.220, P〈0.05）. Conclusion The cerebral hemodynamics in patients with lacunar infarction coming primarily from arteriolar occlusion shows slower cerebral blood velocity and higher pulse index, which is relative to age and blood pressure.