联合应用经颅多普勒超声(TCD)及定量脑电图(qEEG)评估单侧大脑中动脉重度狭窄或闭塞者脑功能改变的临床价值

The clinical value of transcranial doppler combined with quantitative EEG in patients with unilateral middle cerebral artery severe stenosis or occlusion

目的探讨联合应用经颅多普勒超声(transcranial doppler,TCD)及定量脑电图(quantitative electroencephalogram,qEEG)对单侧大脑中动脉(middle cerebral artery,MCA)重度狭窄或闭塞者脑功能改变的早期诊断价值。方法对2012年5月-2014年9月在吉林大学第一医院神经内科经TCD诊断单侧MCA重度狭窄或闭塞者74例,包括症状组45例及无症状组29例,及年龄性别匹配的健康对照组25例,应用联合了EEG及TCD的神经监护仪、核磁共振灌注成像(perfusion weight imaging,PWI)、美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分,分别比较MCA重度狭窄或闭塞侧与健侧脑区的qEEG相对波段功率(relative band power,RBP)、软脑膜侧支的血流动力学参数、脑灌注及神经功能缺损程度。结果与无症状组比较,症状组qEEG的δ波、θ波RBP值高,而α波RBP值低(P<0.05)。症状组MCA分布区δ波RBP值狭窄侧较健侧高,α波、β波RBP值低(P<0.01)。TCD显示MCA重度狭窄或闭塞侧大脑前动脉、大脑后动脉血流动力学的参数无症状组高于症状组(P<0.05)。PWI显示CBF下降组δ波RBP值较CBF正常组高(P<0.05)。症状组全脑区δ波RBP值与NIHSS分值呈正相关(r=0.83,P=0.000)。结论 qEEG的RBP参数是评估MCA重度狭窄或闭塞者脑缺血神经功能缺损的预测指标。TCD联合qEEG的神经血流监护仪是评估MCA狭窄神经元功能、侧支循环及脑组织灌注的新工具。

Objective The transcranial doppler（ TCD） and quantitative Electroencephalogram（ qEEG） can be used in combination to detection blood flow and neuronal activity simultaneously. This study hypothesized that the combination of TCD and qEEG can predict ischemia risk in patients with middle cerebral artery（ MCA） severe stenosis/occlusion.Methods 74 patients with unilateral MCA severe stenosis or occlusion by TCD from May 2012 to September 2014 as the patient group in the department of Neurology,and 25 normal volunteers as the control group were recruited in the First Hospital of Jilin University,in which included 45 symptomatic group and 29 asymptomatic group. The relative band power（ RBP） was monitored by the continuous EEG; and the cerebral hemodynamics were evaluated using TCD. The results of continuous EEG and TCD will be compared with head perfusion weight imaging（ PWI） and national institute of health stroke scale（ NIHSS）. Results There were significant differences in the brain function between symptomatic and asymptomatic MCA stenosis/occlusion group. The RBPs of δ,θ waves of symptomatic group is significantly higher than that of asymptomatic group,and the RBPs of α wave decreases significantly. There are some correlations between RBP indexes and NIHSS scores in symptomatic group. The velocity of the collateral were higher in the symptomatic group. The parameters of PWI correlated with the RBPs of parameters in the evaluation of cerebral ischemia after MCA stenosis. Conclusion The qEEG parameters and TCD hemodynamical finding can be usud in combination simultaneously as a valuable index to the neuronal function in MCA stenosis/occlusion patients.