经颅多普勒超声屏气试验评价重度颈动脉狭窄脑血管储备功能

Evaluation of Cerebrovascular Reserve Capacity in Patients with High-grade Carotid Stenosis by Transcranial Doppler Sonography with Breath-holding Test

目的:应用经颅多普勒超声(TCD)屏气试验评价重度颈动脉狭窄患者脑血管储备(CVR)功能。方法:选取30例健康对照者(正常对照组)、26例单侧重度颈动脉狭窄患者(颈动脉狭窄组),其中无症状性颈动脉狭窄14例(无症状亚组)、症状性颈动脉狭窄12例(症状亚组)。症状亚组中9例行颈动脉支架置入(CAS)术。比较各组患者的屏气指数(BHI),评估CVR功能。结果:与正常对照组比较,颈动脉狭窄组狭窄侧的BHI明显降低(P=0.000);与无症状亚组狭窄侧相比,症状亚组狭窄侧BHI明显降低(P=0.000);颈动脉狭窄组症状亚组患者CAS术后狭窄侧BHI与术前比较升高(P=0.021),术后狭窄侧的BHI低于健侧(P=0.019)。结论:重度颈动脉狭窄患者狭窄侧CVR功能降低,症状性颈动脉狭窄患者较无症状性颈动脉狭窄患者降低更明显,CAS可以改善症状性颈动脉狭窄患者CVR功能。

Objective：To evaluate the cerebrovascular reserve （CVR） capacity in patients with high-grade carotid stenosis by transcranial Doppler sonography （TCD） with breath-holding test. Methods：Thirty healthy controls and 26 patients with high-grade carotid stenosis （stenosis group） were enrolled. There were 14 asymptomatic patients with carotid stenosis （asymptomatic subgroup） and 12 symptomatic patients （symptomatic subgroup） in the stenosis group. Nine symptomatic patients were given carotid angioplasty stenting （CAS） operation. The breath-holding index （BHI） of each group and the BHI change before and after the CAS operation were assessed. The CVR capability was evaluated with BHI. Results：Compared with the BHI in the normal control group, the BHI of the stenotic arteries in the stenosis group was significantly lower （ =0.000）. The BHI of the stenotic arteris in the symptomatic subgroup was lower than that in the asymptomatic group （ =0.000）. In the symptomatic subgroup, the BHI of the stenotic arteries after the CAS operation was higher than that before the operation （ =0.021）, and was lower than the BHI of the normal arteries （ =0.019）. Conclusion：The CVR capacity in patients with high-grade carotid stenosis were impaired, especially in the symptomatic patients with carotid stenosis. The impaired CVR capacity of the stenotic arteries in patients with symptomatic unilateral high-grade carotid stenosis can be improved after CAS.