老年人颈内动脉严重狭窄或闭塞的颅内血流变化

Cerebral blood stream changes of internal carotid stenosis or occlusion in senile patients

目的分析老年人颈内动脉严重狭窄与闭塞后的颅内血流变化。方法采用双功能彩色多普勒超声和经颅多普勒超声,检测34例颈内动脉严重狭窄或闭塞患者颈内动脉病变程度、颅内血流变化、侧支循环类型以及患侧大脑中动脉的血流速度、搏动指数的变化,并与20例正常人进行对照。结果彩色多普勒超声检测单侧颈内动脉严重狭窄16例,单侧闭塞18例。颈内动脉狭窄残余管径0．4-1．7 mm。经颅多普勒超声检测有3种类型侧支循环,前交通开放占85％,后交通开放为55％,颈内-颈外侧支开放占33％。患侧和健侧大脑中动脉的血流速度、搏动指数比较值存在显著性差异(P<0．001)。结论颈内动脉严重狭窄或闭塞后,颅内血流明显减低并出现侧支循环,侧支循环的评价对选择治疗方法、判断预后有重要意义。

Objective To analyze cerebral blood stream changes of internal carotid stenosis or occlusion in senile patients. Methods The extent of severe stenosis or occlusion of internal carotid artery, intracranial blood stream, patterns of collateral circulation, systole velocity（Vs） and pulsation index（PI） in stenosis side of MCA were detected in 34 cases by color duplex flow imaging（CDFI） and transcranial Doppler（TCD）, and compared with 20 normal cases. Results 16 cases of severe stenosis and 18 cases of occlusion in single internal carotid were detected by CDFI. Surveying diameters in internal carotid were 0.4-1.7 mm. Patterns of collateral circulation were detected by TCD. Anterior communicating artery was 85%. Posterior communicating artery was 55%. Ophthasmoic-artery was 33%. The Vs and PI in the stenosis side and healthy side of MCA were significantly different（P 〈 0.001）. Conclusion Intracranial blood flow was decreased and collateral circulation was changed after internal carotid artery stenosis or occlusion. It is suggested that collateral circulation is significant to treatment and prognosis.