颈部旋转手法对颈动脉粥样硬化患者脑血流动力学的影响

Effect of Cervical Rotatory Manipulation on Cerebral Hemodynamics of Patients with Carotid Atherosclerosis

目的:检测颈椎旋转手法时颈动脉粥样硬化患者的脑血流变化,为颈椎旋转手法的安全性提供依据。方法:选择40例经彩色多普勒检测证实为颈动脉粥样硬化的老年患者,通过彩色多普勒超声分别检测在颈椎中立位以及旋转45°、60°时对颈总动脉、颈内动脉及动脉的内径和脑血流动力学指标[收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、平均血流速度(MTV)、血管阻力指数(RI)、血管搏动指数(PI)]的影响。结果:在旋转至45°时颈内动脉、颈总动脉及椎动脉的血管内径减小,颈内动脉、颈总动脉收缩期峰值血流速度(PSV)显著增大,椎动脉收缩期峰值血流速度(PSV)减慢,颈内动脉、颈总动脉及椎动脉舒张末期血流速度(EDV)均减慢,颈内动脉、颈总动脉平均血流速度(MTV)增大,而椎动脉减慢。阻力指数(RI)和搏动指数(PI)无显著变化。在旋转至60°时,颈内动脉、颈总动脉的内径和中立位相比并无显著性变化,而椎动脉的内径减小,颈内动脉、颈总动脉及PSV增大,椎动脉的PSV减慢,颈内动脉、颈总动脉及椎动脉的EDV、MTV均减慢,阻力指数(RI)和搏动指数(PI)增大。结论:颈部旋转手法会对动脉粥样硬化患者脑血流动力学产生显著地的影响,而对不同的血管存在着不同程度的影响。

Objective： To test the effect of cervical rotatory manipulation on cerebral hemodynamics of the patients with carotid atherosclerosis and evaluate the safety of its clinical use. Methods： Forty carotid atherosclerosis patients were selected and the color Doppler ultrasound was used to measure the diameter and hemodynamics indexes,such as common carotid artery（ CCA）,internal carotid artery（ ICA） and vertebral artery（ VA）,with the cervical spine in neutral and then rotated to 45° and 60° respectively.This indexes contained peak systolic velocity（ PSV）,end diastolic velocity（ EDV）,mean velocity（ MTV）,resistive index（ RI）and pulsatility index（ PI）. Results： When rotated to 45°,the diameter values of CCA,ICA and VA were diminished. The PSV and MTV values of CCA and ICA were increased while those of VA decreased. The EDV values of this three arteries were reduced. PI and RI of these three arteries had no significant changes. To 60°,the diameter values of CCA and ICA had no obvious change,but that of the VA was diminished. The PSV values of CCA and ICA wee increased while that of VA decreased. The EDV and MTV values of these three arteries were reduced. The PI and RI of this arteries were increased. Conclusion： Cervical rotatory manipulation has significant influence on cerebral hemodynamics in the patients with carotid atherosclerosis and different arteries have different effects.