支架植入术联合高压氧干预对颈内动脉狭窄患者脑血流动力学的影响

Impact of carotid artery stenting combined with hyperbaric oxygen on cerebral hemodynamics in patients with internal carotid artery stenosis

目的探讨颈动脉支架植入术（CAS）联合高压氧干预对颈内动脉严重狭窄患者脑血流动力学的影响。方法78例单侧颈内动脉重度狭窄（≥70%）患者签署知情同意书，并经医院伦理委员会批准后，分为对照组（n＝36）和观察组（n＝42），均接受CAS治疗，术后对照组接受抗血小板等常规治疗，观察组除常规治疗外于术后24 h内行高压氧干预，采用经颅多普勒超声（TCD）和CT灌注成像（CTP）检测手术前后、术后2周时脑血流动力学变化，观察1年内卒中复发率。结果2组患者术后患侧大脑中动脉平均血流速度（Vm）、收缩期峰值流速（PSV）、搏动指数（PI）和脑血管储备能力（CVR）较术前明显增加，且观察组术后2周内变化值高于对照组（P〈0.05）；脑组织局部血容量（rCBV）和局部血流量（rCBF）高于术前，平均通过时间（rMTT）和达峰时间（rTTP）低于术前，观察组在术后2周时其rCBF、rMTT和rTTP变化值大于对照组（P〈0.05）。随访1年观察组卒中复发率低于对照组（11.9% vs. 16.7%, P〈0.05）。结论支架植入联合高压氧能够有效改善颈内动脉狭窄患者的脑血流动力学，并降低卒中复发率。

ObjectiveTo investigate the impact of carotid artery stenting （CAS） combined with hyperbaric oxygen （HBO） on cerebral hemodynamics in patients with internal carotid artery stenosis.MethodsSeventy-eight patients with severe unilateral carotid artery stenosis were randomly divided into the control group （n=36） and the experimental group （n=42）, which all received carotid artery stenting. After surgery, the control group was treated with anti-platelet and other routine treatment, while the experimental group received HBO therapy within 24 hours after surgery, in addition to routine treatment. Trancranial Doppler （TCD） and Computed tomography perfusion （CTP） were used to detect changes in cerebral hemodynamics both before and after surgery, as well as 2 weeks after surgery, and the rate of stroke recurrence was also observed within one year of surgery.ResultsMean velocity （Vm） of blood flow, peak systolic velocity （PSV）, pulse index （PI） and cerebrovascular reserve （CVR） of the affected middle cerebral artery were significantly increased after surgery. Moreover, 2 weeks after surgery, regional cerebral blood volume and flow （rCBV and rCBF） of the experimental group were also significantly higher, as compared with those before surgery （P〈0.05）. Mean transit time （rMTT） and peak time （rTTP） were all lower than those before surgery. Changes in rCBF, rMTT and rTTP 2 weeks after surgery were all greater than those of the control group（P〈0.05）. One-year follow-up indicated that stroke recurrence rate of the experimental group was lower than that of the control group （11.9% vs. 16.7%, P〈0.05）.ConclusionsCarotid artery stenting combined with HBO intervention could improve cerebral hemodynamics in patients with severe internal carotid artery stenosis, and at the same time could reduce stroke recurrence rate.