MCA区不同部位脑梗死脑血流动力学改变的研究

A study on cerebral hemodynamics in patients with different sites cerebral infarction of the middle cerebral artery area

目的探讨大脑中动脉(MCA)区不同部位脑梗死脑血流动力学改变。方法利用经颅多普勒超声(TCD)对入院前后行头颅CT和/或MRI检查证实为大脑中动脉(MCA)区脑梗死的66例患者,于发病后第3天、第10天进行2次TCD检查。结果①MCA主干梗死后患侧MCA的平均血流速度(Vm)明显低于对照组和健侧(P<0.01),患侧大脑前动脉(ACA)的Vm高于对照组(P<0.01),患侧MCAVm>ACAVm的生理关系消失。②深穿支梗死组和皮层支梗死组患侧MCAVm与健侧及对照组比较变化不大(P>0.05)。③TCD动态观察揭示MCAVm随有效治疗而增加,42%(11/26)的患者闭塞血管可再通。结论MCA区不同部位脑梗死其脑血流动力学的改变不同,脑血流动力学的改变有助于判断脑梗死的部位、临床治疗选择和疗效判断。

Objective To investigate the changes of cerebral hemodynamics in patients with cerebral infarction of the middle cerebral artery area. Methods sixty-six stroke patients proven by CT and/or MRI scan in the MCA area, got TCD serial examination at 6, and 15 days after stroke. Results （1）The MCAVm of the stem occlusion was significantly lower than that of the contralateral and the control group （P 〈0.01 ） ; and the Vm in affected side anterior cerebral artery（ACA） in isehemic stroke was significantly higher than that of the control （P 〈 0.01 ）. The physiological phenomenon of MCAVm 〉 ACAVm disappeared. （2） The MCAVm of cortex infarction and lacuna infarction were not significantly lower than that of the contralateral and the control groups （ P 〉 0. 05 ）. （3） The MCA Vm was increasing with the effective therapy; and that the spontaneous reperfusion was found in some patients （42%）. Conclusion The cerebral hemodynamies varied with different sites of cerebral infarction of the middle cerebral artery. The changes of cerebral hemodynamics were helpful to find the area of ischemic stroke, to select the clinical therapeutic method, and to evaluate the therapeutic effects.