颈内动脉重度狭窄或闭塞病人颅内外动脉血流动力学参数的变化

THE CHANGES IN HEMODYNAMIC PARAMETERS OF INTRA-AND EXTRA-CRANIAL ARTERIES IN PATIENTS WITH SEVERE STENOSIS OR OCCLUSION OF INTERNAL CAROTID ARTERY

目的分析颈内动脉(ICA)重度狭窄或闭塞后颈总动脉(CCA)与大脑中动脉(MCA)血流动力学参数的变化,以提高经颅多普勒超声(TCD)对ICA重度狭窄或闭塞检测的准确性。方法选择经全脑数字减影血管造影(DSA)检查证实一侧ICA重度狭窄或闭塞且双侧CCA和MCA正常或狭窄<50%的病人30例。全部行TCD检查,测量双侧CCA和MCA的收缩期血流速度(Vs)、平均血流速度(Vm)和搏动指数(PI)。结果 ICA狭窄或闭塞侧CCA的Vm和Vs均较无病变侧明显降低(t=14.35、11.26,P<0.05)。病变侧CCA的PI较无病变侧明显增高(t=9.56,P<0.05)。ICA狭窄或闭塞侧MCA的Vm、Vs和PI均较无病变侧明显降低(t=10.19～15.61,P<0.05)。结论 TCD检查CCA和MCA的血流动力学参数的变化对ICA重度狭窄或闭塞的准确诊断具有重要指导价值。

Objective To analyze the changes of hemodynamic parameters of common carotid artery（CCA） and middle cerebral artery（MCA） in patients with severe internal carotid artery（ICA） stenosis or occlusion,so as to raise the accuracy of diagnosis of severe ICA stenosis or occlusion by transcranial Doppler（TCD）. Methods Thirty patients with unilateral severe ICA stenosis or occlusion,and bilateral CCA and MCA normal or narrow 50%,confirmed by digital subtraction angiography（DSA）,were enrolled in this study.The systolic velocity（Vs）,mean velocity（Vm） and pulsitility index（PI） of bilateral CCA and MCA in all cases were detected by TCD. Results The Vm and Vs of CCA in the lesion sides of ICA with severe stenosis or occlusion were significantly lower（t=14.35,11.26;P0.05）,while PI was significantly higher than that in the normal sides（t=9.56,P0.05）.The Vm,Vs and PI of MCA in the side of ICA with severe stenosis or occlusion were significantly lower than that in the normal sides（t=10.19-15.61,P0.05）. Conclusion TCD detection for hemodynamic parameters of CCA and MCA is of important directory value in accurate diagnosis of severe ICA stenosis or occlusion.