彩色多普勒血流成像测量脑梗死患者脑血流灌注量的临床应用价值

Clinical value of measurement of cerebral blood flow volume by color Doppler flow imaging in patients with cerebral infarction

目的探讨彩色多普勒血流成像测量脑梗死(CI)患者脑血流灌注量的临床应用价值。方法选择驻马店市中心医院2015年2月至2017年2月收治的136例CI患者作为研究对象(CI组),并选择同期住院治疗的非CI患者40例作为对照组,患者均予以彩色多普勒血流成像测量椎动脉和颈内动脉的舒张末期流速、收缩期峰值流速、阻力指数及平均流速,并计算前、后循环及全脑血流灌注量。同时,通过CI组患者的彩色多普勒检查结果,根据供血区范围将其分为前循环供血区梗死(前循环组,101例)和后循环供血区梗死(后循环组,35例),并根据供血动脉将前循环组患者分为皮质支型组(32例)、穿支型组(55例)及分水岭区型组(14例),后循环组患者分为远端梗死组(15例)、中端梗死组(12例)及近端梗死组(8例),并对各组患者的脑血流灌注量进行比较。结果 CI组患者的椎动脉舒张末期流速显著低于对照组,阻力指数显著高于对照组(P<0.05)。CI组患者颈内动脉血管内径及舒张末期流速显著低于对照组,阻力指数显著高于对照组(P<0.05)。CI组患者椎动脉血管内径及颈内动脉和椎动脉收缩期峰值流速与对照组比较差异无统计学意义(P>0.05)。CI组患者右侧椎动脉血流量及左右侧颈内动脉血流量、前循环、全脑血流灌注量显著低于对照组,而后循环脑血流灌注量显著高于对照组(P<0.05)。前循环组患者的前循环脑血流灌注量低于后循环组(P<0.05),后循环脑血流灌注量高于后循环组(P<0.05)。前循环组和后循环组患者的全脑血流灌注量比较差异无统计学意义(P>0.05)。皮质支型组、穿支型组及分水岭区型组患者前循环脑血流灌注量、后循环脑血流灌注量及全脑血流灌注量比较差异无统计学意义(P>0.05);远端梗死组、中端梗死组及近端梗死组患者前循环脑血流灌注量、后循环脑血流灌注量及全脑血流灌注量比较差异均无统计学意义(P>0.05)。结论采用彩色多普勒血流成像测量脑血流灌注量能够对CI患者椎动脉和颈动脉的血流动力学及脑血流灌注量进行较好的分析和评估,在CI诊断中有一定的临床应用价值。

Objective To explore the clinical value of measurement of cerebral blood flow volume by color Doppler flow imaging in patients with cerebral infarction. Methods One hundred and thirty six patients with cerebral infarction in Central Hospital of Zhumadian City from February 2015 to February 2017 were selected as CI group,and 40 non-CI patients in the corresponding time period were chosen as control group. The end diastolic flow velocity,systolic peak systolic velocity,resistance index,and mean flow velocity of the vertebral artery and internal carotid arteries of all the patients were detected by color Doppler flow imaging,and anterior and posterior circulation and total cerebral blood flow were calculated. At the same time,through the color Doppler flow imaging results of the CI group,the patients were divided into anterior circulation blood-supply infarction( anterior circulation group,101 cases) and posterior circulation blood-supply infarction( posterior circulation group,35 cases) according to the blood-supply scope. The patients in the anterior circulation group were divided into cortical branches group( 32 cases),perforating branche group( 55 cases) and watershed group( 14 cases) according to the feeding artery,while the patients in the posterior circulation group were divided into distal infarction group( 15 cases),mid-range infarction group( 12 cases) and proximal infarction group( 8 cases). The cerebral blood flow volume were compared among the groups. Results The end diastolic flow velocity of vertebral artery in the CI group was significantly lower than that in the control group,and the resistance index was significantly higher than that in the control group( P < 0. 05). The carotid intravascular diameter and the end diastolic flow velocity in the CI group was significantly lower than those in the control group,and the resistance index was significantly higher than that in the control group( P < 0. 05). There was no significant difference in the vertebral artery diameter,the peak velocity of internal carotid artery and vertebral artery between the CI group and the control group( P >0. 05). The right vertebral artery blood flow,the left and right internal carotid artery blood flow,cerebral blood flow of the anterior circulation and the total cerebral blood flow in the CI group were significantly lower than those in the control group,and cerebral blood flow of the posterior circulation was significantly higher than that in the control group( P < 0. 05). The cerebral blood flow of the anterior circulation in the anterior circulation group was lower than that in the posterior circulation group( P <0. 05),while the cerebral blood flow of the posterior circulation was significantly higher than that in the posterior circulation group( P < 0. 05). There was no significant difference in the total cerebral blood flow between the anterior circulation group and the posterior circulation group( P > 0. 05). There was no significant difference in the cerebral blood flow of anterior circulation and posterior circulation,the total cerebral blood flow among the cortical branches group,the perforating branche group and the watershed group( P > 0. 05). Also there was no significant difference in the cerebral blood flow of anterior circulation and posterior circulation,the total cerebral blood flow among the distal infarction group,the mid-range infarction group and the proximal infarction group( P > 0. 05). Conclusion The hemodynamics indexes and cerebral blood flow of vertebral artery and internal carotid are well analyzed and evaluated by color Doppler flow imaging,and the color Doppler has a certain clinical values on the diagnosis for CI.