急性颈内动脉闭塞颅内循环的变化及临床意义

Changes of intracerebral circulation and clinical significance after acute internal carotid artery occlusion

目的分析急性颈内动脉闭塞后颅内血流动力学的变化及临床意义。方法对68例经影像学检查证实急性单侧颈内动脉颅外段闭塞患者,采用经颅多普勒超声(TCD)检测颅内主要动脉的血流动力学变化。结果患侧大脑中动脉峰值流速和搏动指数均显著低于健侧(P<0.001)。在侧支循环开放中,前交通动脉开放占48.53%(33/68),后交通动脉开放为42.65%(29/68),眼动脉参与的侧支循环占32.35%(22/68),无交通支开放14.71%(10/68)。患者颅内侧支循环开放,侧支途径两支以上者、患侧大脑中动脉峰值流速>60cm/s者,临床预后相对较好。结论 TCD检测颅内主要动脉的血流状况,可以快速方便地评价颅内侧支循环状态,对急性颈内动脉闭塞患者治疗方法选择和预后判断具有重要的临床价值。

Objective To analyze intracerebral hemodynamics changes and clinical significance in patients with acute internal carotid artery（ICA）occlusion.Methods Imaging examination were performed in 68 patients with unilateral acute ICA occlusion,and then to evaluate intracerebral artery hemodynamics changes with transcranial cerebral Doppler（TCD）.Results The peak velocity（Vp）and pulsitility index（PI）of middle cerebral artery（MCA）in the stenosis side were significantly lower than those in the healthy side（P〈0.001）.Among 68 patients,the opening of anterior communicating artery（ACoA）was found in 48.53%（33/68）,of posterior communicating artery（PCoA）was 42.65%（29/68）,of ophthalmic artery（OA）was 32.35%（22/68）,while 14.71%（10/68）had no collateral circulation.The patients had relatively good clinical prognosis when two or more collateral channels of intracranial collateral circulation opening,ipsilateral MCA flow velocity 〉60 cm/s.Conclusion TCD can detect intracerebral artery hemodynamics changes and the opening situation of collateral circulation conveniently.These techniques are of great clinical value to choosing treatment and predicting prognosis in patients with acute internal carotid artery occlusion.