彩色多普勒超声评价脑卒中患者颈动脉血流剪切力临床研究

Clinical study of carotid blood flow shearing-force detected by color Doppler ultrasound in stroke patients

目的应用彩色多普勒超声诊断脑卒中患者颈动脉血流剪切力,探讨脑卒中患者颈动脉血流剪切力的变化。方法选取2009-04-2012-06我院就诊的脑卒中患者为研究对象,应用彩色多普勒超声测量颈动脉内-中膜厚度(IMT)、斑块部位的血管总面积(TVA)及管腔面积(LA),计算重构指数(RI)及斑块总积分、平均流速和血流量及血流动力学改变。据Poiseuille定律的导出公式τp=4μV/ID计算最大血流剪切力(τp)及平均血流剪切力(τm)。结果彩色多普勒超声测量结果比较,脑卒中患者颈动脉各测量指标高于正常对照组,差异有统计学意义(P<0.05)。脑卒中患者两侧颈动脉各指标比较,患侧的各测量指标高于正常侧,差异有统计学意义(P<0.05)。脑卒中患者重构发生率高于正常对照组,差异有统计学意义(P<0.05)。脑卒中患者两侧颈动脉重构发生率差异无统计学意义(P>0.05)。脑卒中患者重构类型高于正常对照组,差异有统计学意义(P<0.05)。脑卒中患者重构类型比较,两侧颈动脉的重构类型差异无统计学意义(P<0.05)。脑卒中IMT与颈动脉血流剪切力呈正相关(r=0.753,P=0.043<0.05)。结论脑卒中患者颈动脉血流剪切力与颈动脉结构重构呈正相关。

Objective To explore the changes of carotid blood flow shearing-force examined by color Doppler ultrasound in stroke patients.Methods We selected stroke cases from April 2009 to June 2012 in our hospital as study objects.The carotid intimal-media thickness（IMT）,the total vascular area of plaque site（TVA）and lumen area（LA）were tested by color Doppler ultrasound to calculate the remodeling index（RI）,total plaque volume,sub-average velocity and the changes of carotid blood flow and hemodynamics.Formula（τp=4μV/ID）applied to calculate the maximum and the average shearing-force（τp,τm）was derived from Poiseuille′s law.Results We found that stroke patients had higher value of the above-mentioned measurable indicators than healthy controls using the comparative analysis of color Doppler ultrasound with a significant difference（P〈0.05）.Comparing parameters on each side of carotid arteries,the measured value on the affected side was significantly higher than that on the healthy side（P〈0.05）.Additionally,the stroke cases showed higher incidence of reconstruction and more types of reconstruction relative to the controls（P〈0.05）.Otherwise,this important difference was not found on the both lateral of carotid（P〈0.05）.There was a positive relation between carotid IMT and shearing-force（r=0.753,P=0.0430.05）.Conclusion Carotid blood flow shearing-force may be positively correlated to carotid reconstruction in stroke patients.