大脑中动脉区脑梗死患者侧支循环状况对病情和预后的影响

Influence of collateral circulation on disease condition and prognosis in patients with cerebral infarction of middle cerebral artery territory

目的探讨大脑中动脉(MCA)区脑梗死患者侧支循环状况对病情和预后的影响。方法对65例MCA供血区域脑梗死患者,在发病7 d内进行经颅多普勒超声(TCD)和时间飞跃法磁共振血管成像(Tof法MRA)检查;分别在发病3 d内、3个月时采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损程度评分。结果 MCA区脑梗死患者TCD检查显示:40例患者有大脑前动脉(ACA)代偿,9例患者有大脑后动脉(PCA)代偿,13例患者既有ACA又有PCA代偿;Tof法MRA检查显示:24例患者有同侧PCA优势(DIPCA)现象。既有ACA又有PCA代偿的患者发病3 d内、3个月时NIHSS评分均显著低于ACA代偿患者与PCA代偿患者,而ACA代偿患者又显著低于PCA代偿患者(均P<0.01)。有DIPCA现象的患者发病3 d内、3个月时NIHSS评分均显著低于无DIPCA现象的患者(均P<0.05)。结论 MCA区脑梗死患者中,侧支循环状况好的患者病情相对轻,预后较好。前循环代偿较后循环代偿、有后循环代偿较无后循环代偿患者的病情轻、预后好。

Objective To explore the influence of collateral circulation on disease condition and prognosis in patients with cerebral infarction of middle cerebral artery（MCA） territory.Methods 65 patients with cerebral infarction of MCA territory were examined by transcranial doppler ultrasonography（TCD） and time-of-flight magnetic resonance angiography（Tof MRA） in 7 d after onset.The National Institutes of Health Stroke Scale（NIHSS） was uesd to investigate the degree of nervous functional defects of all the patients in 3 d and at 3 month after onset.Results TCD showed that 40 cases were compensated by ACA,9 cases were compensated by PCA,and 13 cases were compensated by both ACA and PCA.Tof MRA showed that 24 patients were found dominant ipsilateral PCA（DIPCA） phenomenon.The NIHSS scores of patients with both ACA and PCA compensation were significantly lower than that of patients with ACA or PCA compensation in 3 d and at 3 month after onset;and the NIHSS scores of ACA compensated patients were significantly lower than that of PCA compensated patients（all P〈0.01）.The NIHSS scores of patients with DIPCA phenomenon were significantly lower than that of patients without DIPCA phenomenon in 3 d and at 3 month after onset（all P〈0.05）.Conclusions Among the patients with cerebral infarction of MCA territory,the disease condition and prognosis in patients with enough collateral circulation are comparatively better.The disease condition and prognosis get better in anterior circulation compensated patients than in posterior circulation compensated patients,and it get better in patients with compensation of posterior circulation than without.