大脑中动脉急性脑梗死的经颅多普勒的血流动力学分型与预后

Transcranial Doppler hemodynamic typing of middle cerebral artery acute ischemic stroke and its outcome

目的 探讨大脑中动脉急性脑梗死未溶栓患者经颅多普勒超声（TCD）的血流动力学分型与预后及其对近期神经功能恢复的影响。方法 纳入大脑中动脉急性脑梗死患者52例,于入院24h内行TCD检查。将患者分为完全闭塞组6例（TIBI 0~1级）,部分闭塞组16例（TIBI 2~3级）及非闭塞组30例（TIBI 4~5级）。于入院30min内、发病后第7、14天分别行美国国立卫生研究院卒中量表评分,于发病后3个月行改良Rankin量表评分评定神经功能恢复。结果 完全闭塞组与非闭塞组第7、14天神经功能缺损评分比较,差异有统计学意义[（5.83±2.23）分vs（3.03±2.53）分,（4.83±2.32）分vs（1.90±2.28）分,P〈0.05]。闭塞组与非闭塞组近期神经功能恢复比较,差异有统计学意义（40.9%vs 83.3%,P=0.001）。结论 脑梗死非溶栓急性期患者采用TCD对病灶血流动力学的分型,可预测完全闭塞较非闭塞患者神经缺损程度明显,指导临床治疗及预后评估。

Objective To study the transcranial Doppler hemodynamic typing of middle cerebral artery AIS and its Outcome. Methods Fifty-two middle cerebral artery AIS patients who underwent transcranial Doppler uhrasonography within 24 h after admission were divided into complete oc- clusion group （n=6）, partial occlusion group （n= 16）, and non occlusion group （n = 30）. Their neurological function recovery was scored according to the NIHSS within 30 rain after admission and on days 7 and 14 after onset of the disease, and according to the modified Rankin Scale 3 months after onset of the disease. Results The NIHSS score was significantly higher in complete occlusion group than in non-occlusion group （5. 83±2.23 vs 3.03±2.53,4.83±2.32 vs 1.90± 2.28,P〈0.05）. The neurological function recovery differed greatly between complete occlusion group and non-occlusion group （40.9% vs 83.3% ,P=0. 001）. Conclusion Transcranial Doppler hemodynamic typing of middle cerebral artery AIS can predict the neurological defifits more accu rately in complete occlusion patients than in non-occlusion patients,and can thus be used to guide the clinical treatment of middle cerebral artery AIS and its outcome assessment.