TCD对烟雾病患者脑硬脑膜动脉血管融通术前后颞浅动脉血流变化的评估价值

Assessment of hemodynamic changes in superficial temporal arteries before and after encephalo-duro-arterial synangiosis in patients with Moyamoya disease by transcranial Doppler sonography

目的探讨经颅多普勒超声(TCD)对烟雾病患者行脑硬脑膜动脉血管融通术(EDAS)前后颞浅动脉血流变化的评估价值。方法对2010年2月至2010年6月收治的45例烟雾病患者行EDAS前后进行TCD检查,检测手术前后患者颞浅动脉的频谱形态及各项血流参数的变化,并与其DSA结果进行比较。结果 TCD检测示术前患者的颞浅动脉呈典型颅外动脉频谱,频窗清晰;术后频谱明显颅内动脉化,血流速度明显增加,血供增加。手术前后患者颞浅动脉的平均流速分别为(24.96±8.96)cm/s和(40.33±16.57)cm/s,手术前后搏动指数分别为(2.06±0.69)和(1.44±0.69),手术前后均差异显著(P<0.05)。术后复查DSA显示,血管重建良好25例,中等16例,差4例;TCD复查示良好21例,中等18例,差6例,与DSA比较总符合率为82.22%(37/45)。结论 TCD能够准确检测烟雾病患者行EDAS前后颞浅动脉血流动力学的变化,可为其手术疗效的评估提供一定的客观依据;因其具有简便、快速、无创、经济、可重复、可动态检测的特点,对定期随访观察病程发展更具有优越性。

Objective To explore the applied value of transcranial Doppler sonography （TCD） to the assessment of the hemodynamic changes in the superficial temporal arteries （STA） before and after the encephalo-duro-arterial synangiosias （EDAS） in the patients with Moyamoya disease.Methods EDAS was performed from February,2010 to June,2010 in 45 patients with Moyamoya disease,who received TCD examination before and after the EDAS in order to assess the hemodynamic change in STA.The hemodynamic parameters of STA before and after the surgery were statistically analyzed.Results The spectrums of STA were the typical spectrums of the excranial arteries,the pulsatility index （PI） was 2.06±0.69,and the mean velocity （Vm） was （24.96±8.96） cm/s before the surgery.The spectrums of STA TCD were similar to the intracranial arteries spectrums,the PI was 1.44±0.69 and Vm was （40.33±16.57） cm/s after the surgery.Vm and PI of STA TCD after the surgery were significantly different from those before the surgery （P0.05）.The outcomes of the vascular reconstruction shown by TCD were consistent with ones shown by DSA in 37 patients （82.22%） after EDAS.Conclusions The hemodynamic changes in STA before and after EDAS can be noninvasively detected easily by TCD,which can provide objective basis for the assessment of the curative effect of the EDAS on the patents with Moyamoya disease.