伴有颅内动脉狭窄的缺血性脑卒中患者脑血管储备能力研究

The study on vascular reserve of large cerebral arteries in acute cerebral ischemia patients with intracranial stenosis

目的对伴有颅内动脉狭窄的缺血性脑卒中患者采用口服乙酰唑胺实验研究颅内大动脉血流储备能力。方法对17例经磁共振血管显影(magnetic resonance angiography,MRA)/或经颅多谱勒超声(transcranial doppler ultrasonography,TCD)证实颅内动脉狭窄大于50%的缺血性脑卒中患者,按TOAST分型为动脉粥样硬化性脑梗死,通过TCD共测定187条颅内大血管血流速度,2 d后再口服乙酰唑胺2 g,2 h后再行TCD检查,比较乙酰唑胺前后颅内大血管血流速度改变情况。结果乙酰唑胺实验可使颅内血管血流速度明显增加。右颈内动脉(right internal carotid artery,RICA)、右大脑中动脉(right middle cerebral artery,RMCA)和右大脑后动脉(right posterior cerebral artery,RPCA)在乙酰唑胺后血流速度增加但无统计学差异(P值分别为0.086,0.258,0.084),而其他颅内血管在乙酰唑胺后血流速度显著增加(P值都小于0.05)。非狭窄血管较狭窄血管乙酰唑胺后血流速度增加,但无统计学差异(P=0.08)。中度狭窄血管与重度狭窄血管乙酰唑胺后血流速度改变无差异(P=0.65)。结论乙酰唑胺前后TCD可以准确测定颅内大动脉的血管血流储备能力,颅内狭窄血管较非狭窄血管血流储备能力有下降的趋势,而中度和重度狭窄血管血流储备能力无明显差异,但仍有待进一步的研究。

Objective To study the vascular reserve of large cerebral arteries in patients with acute cerebral thrombosis with more than 50% stenosis of the intracranial arteries.Methods Seventeen patients with acute cerebral thrombosis with magnetic resonance artery（MRA）/ transcranial doppler ultrasonography（TCD） confirmed stenosis of the intracranial arteries,were recruited in the study.Patients were examined by TCD before admission and 2 hour after oral Diamox treatment two days later.The changes of the blood flow before and after Diamox were compared in 187 large arteries.Results The cerebral blood flow was increased obviously following diamox.The blood flows in the right internal carotid artery（RICA）,right middle cerebral artery（RMCA）,right posterior cerebral artery（RPCA） were increased after diamox but the difference did not reach statistically significance（P=0.086,0.258,0.084）but,other arteries increased cerebral blood flow significantly（P0.05）.There was more increase in blood flow in non-stenosis arteries than in stenosis arteries but the difference did not reach statistically significance（P=0.08）.There were no significant differences in the blood flow changes between moderate stenosis arteries and severe stenosis arteries（P=0.65）.Conclusions Diamox test in TCD can precisely measure the large cerebral artery vascular reserve.Stenosis arteries have a decline tendency in vascular reserve compared with non-stenosis arteries.However,there is not significant difference in vascular reserve between moderate stenosis arteries and severe stenosis.