大面积脑梗死患者脑血流动力学动态变化分析

Evaluation of intracranial arteries and hemodynamic changes in massive cerebral infarction using transcranial Doppler sonography

目的观察大面积脑梗死患者脑血流动力学指标在发病两周内的变化特点。方法选取40例大面积脑梗死患者及40名健康体检人群为研究对象,分别纳入观察组及对照组,利用经颅多普勒超声(TCD)比较两组人群颅内血流动力学指标的差异。并动态监测观察组入院后1d、2d、3d、7d、14d血流动力学指标的变化,以及相应时间神经功能NIHSS评分的变化。结果观察组MCA、ICA均显著低于对照组(P<0.05),以MCA降低更为明显(P<0.01)。观察组2周内MCA的平均血流量(Vm)稍有增加,但无统计学意义(F=1.067,P>0.05)。PI前3d呈上升趋势,在第3天达最高,然后缓慢降低,具有统计学意义(F=3.252,P<0.05);NIHSS评分入院后前3d逐渐增加,随血流再通、侧枝循环建立后逐渐降低(F=2.926,P<0.05)。结论根据大面积脑梗死患者血流动力学指标及神经功能缺损评分的动态变化,可评估颅内压的动态变化,并及时发现血管再通、侧支循环代偿情况,从而正确评价治疗反应,为制定合适的治疗方案提供参考。

Objective To observe the patients with massive cerebral infarction cerebral hemodynamic indexes in onset within two weeks of changing characteristics. Methods 40 cases of large area cerebral infarction patients and 40 cases of healthy people as the research object,respectively,into the observation group and the control group,using transcranial Doppler ultrasound（TCD）were compared between the two groups of intracranial hemodynamics index difference. And dynamic monitoring of the observation group after admission to 1D,2D,3D,7D,14D hemodynamic changes,as well as the corresponding time neural function NIHSS score changes. Results In the observation group,MCA,ICA were significantly lower than in control group（P〈0.05）,MCA decreased more obviously（P0.01）. The observation group 2 weeks MCA average blood flow （Vm）increased slightly,but not statistically significant（F=1.067,P〈0.05）. PI 3D shows ascendant trend,in the 3D reaches a maximum,and then decreases,with statistical significance（F=3.252,P〈0.05）;NIHSS score on admission after anterior 3D gradually increased,with reperfusion,collateral circulation after the establishment of decreased gradually（F=2.926,P〉0.05）. Conclusion According to the large area of cerebral infarction patients hemodynamic indexes and neural function defect score changes,can be assessed by intracranial pressure changes,and timely detection of recanalization,compensation of collateral circulation,thus the correct evaluation of response to therapy,in order to develop an appropriate treatment plan to provide reference