经颅多普勒超声结合二氧化碳试验评价颈动脉狭窄患者的脑血管反应性

The Study of Transcranial Doppler Sonography Detect Cerebral Vascular Reactivity in the Patients of Carotid Artery Stenosis

目的:检测颈动脉狭窄患者的脑血管反应性(CVR),探讨颈动脉狭窄程度与脑血管反应性之间的关系,以期为临床治疗及预防提供依据。方法:对不同程度颈动脉狭窄患者,采用德国DWL MDX 0630型TCD检测仪,通过屏气、过度换气及吸入自体CO2的方法,连续监测双侧MCA脑血流速度变化,计算血管运动反应性(VMR)、脑血管运动储备(CRC)及呼吸抑制指数(BHI)等数值评价脑血管反应性。结果:①颈动脉狭窄组与对照组比较:轻度及中度狭窄组的VMR、BHI、CRC值无明显差异。重度狭窄组的VMR、BHI、CRC值有明显差异(P<0.05)。对照组双侧VMR、BHI、CRC值结果无统计学差异。②呼气末CO2分压(PCO2):对照组与血管狭窄组呼气末CO2浓度变化无统计学差异。结论:①轻中度颈动脉狭窄患者的CVR无明显变化;重度狭窄患者CVR明显减低。②VMR、BHI、CRC值可以作为评价CVR的指标。③经颅多普勒超声检测CVR的可行性,易于推广和普及。

Objective：To assess cerebral vasoreactivity（CVR） among patients suffering from internal carotid artery（ICA） stenosis of different severity and to explore the relationship between the degree of ICA stenosis and CVR.Methods：Combining transcranial doppler sonography（TCD） and the breath-holding technique,hyperventilation technique,CO2 inhalation method,we continuously detected the change of blood flow of MCA,and evaluated CVR through calculating the cerebral vasomotor Reactivity（VMR）,cerebrovascular reserve capacity,and（CRC） breat hholding index（BHI）.Results：No difference was found in value of VMR、BHI、CRC between the control and mild ICA stenosis or moderate ICA stenosis group.VMR、BHI、CRC were both significantly decreased in the subgroup of patients with a severe stenosis.While there is no difference Mean values of PCO2 in the control and ICA stenosis group were not statistically significant.Conclusion：Taken together,these results indicated that the CVR in patients with severe ICA stenosis was compromised and related with the degree of ICA stenosis.