颈动脉超声、动态血压及微栓子监测对急性脑梗死患者血管评估的价值

Value of carotid ultrasound,monitoring ambulatory blood pressure and microemboli signals derived from TCD in assessment of vascular lesions for acute cerebral infarction patients

目的探讨颈动脉超声、动态血压及微栓子信号（microemboli signals,MES）监测在急性脑梗死患者血管评估中的价值。方法收集2010年5月至2013年12月经CT或MRI证实的急性脑梗死住院患者157例,均在发病6~48 h内行24 h动态血压监测,并获得动态动脉硬化指数（AASI）;行颈动脉血管超声检查,并获得有颈动脉斑块的患者例数;应用经颅多普勒超声监测仪进行脑动脉MES监测,并观察脑动脉系统存在MES的患者例数。分析MES与AASI、颈动脉斑块的关系。结果 157例急性脑梗死患者中,MES阳性77例,MES阴性80例;颈动脉有斑块者91例,颈动脉无斑块者66例;AASI〉0.51者90例,AASI≤0.51者67例。有颈动脉斑块和AASI〉0.51者的MES阳性构成比分别高于无斑块、AASI≤0.51者[70.1%vs 29.9%,χ2=9.18,P〈0.01;68.8%vs 31.2%,χ2=8.18,P〈0.01]。结论颈动脉超声、动态血压及MES监测对急性脑梗死患者血管评估及预测其风险有一定临床意义。

Objective To explore the values of relative information provided by carotid ultrasound,ambulatory blood pressure monitoring（ ABPM） and transcranial Doppler sonography（ TCD） including carotid plaque,ambulatory arterial stiffness index（ AASI） and microemboli signals（ MES） for assessing vasculopathy in patients with acute cerebral infarction. Methods A total of 157 patients with acute cerebral infarction confirmed by CT or MRI admitted between May 2010 and December2013 were collected in this study. AASI was acquired by ABPM in 6-48 hours of onset; carotid plaque was detected by carotid color Doppler ultrasound; MES monitoring of cerebral arteries was conducted using TCD. The relationship between the MES and AASI was analyzed. Results Out of 157 cases,there were 77 cases with MES positive versus 80 cases with MES negative,91 cases with carotid plaque versus 66 cases without carotid plaque,90 cases with AASI more than 0. 51 versus 67 cases with AASI less than or equal to 0. 51. MES-positive ratios in patients with carotid plaques and AASI 0. 51 was significantly higher than that in patients without plaque and AASI ≤0. 51 [70. 1% vs 29. 9%,χ2= 9. 18,P 〈0. 01; 68. 8% vs31. 2%,χ2= 8. 18,P 〈0. 01],respectively. Conclusion The carotid ultrasound,ABPM and MES monitoring have good values for assessing vasculopathy and forecasting the risk in patients with acute cerebral infarction.