TCD对颈内动脉严重狭窄或闭塞的急性脑梗死患者侧支循环的评估价值及意义

The value and significance of TCD in the evaluation of collateral circulation in acute cerebral infarction patients with severe carotid artery stenosis or occlusion

目的探讨经颅多普勒(TCD)超声对单侧颈内动脉(ICA)严重狭窄或闭塞所致的急性脑梗死患者脑侧支循环情况的评估价值及其与临床预后的关系。方法收集40例单侧ICA重度狭窄或闭塞所致的急性脑梗死患者,其中重度狭窄组22例,闭塞组18例。用德力凯EMS-9PB型TCD检测其颅内脑血流情况,分析重度狭窄组和闭塞组侧支循环开放率。根据侧支循环开放的血管条数将患者分为3组,无侧支循环组(A组)、1条或2条侧支循环组(B组)、3条侧支循环均开放组(C组),并在初次入院时和2周后行卒中量表(NIHSS)评分,6个月后行改良RANKIN量表(mRS)评分,分析患者侧支循环开放情况与临床预后的关系。结果 ICA闭塞组侧支循环开放率为88.89%,明显高于重度狭窄组59.09%(P=0.036)。入院时A组、B组、C组患者之间NIHSS评分差异无统计学意义。入院2周后3组间NIHSS评分差异有显著性(P=0.002),6个月后3组mRS评分有统计学差异(P=0.023)。结论颈内动脉狭窄程度越严重,其侧支循环建立越好。侧支循环形成的数目与脑梗死患者临床预后有一定相关性,侧支循环建立越完善者,其临床预后越良好。

Objective To evaluate the value of transcranial Doppler ultrasound in the assessment of cerebral collateral circulation in patients with acute cerebral infarction caused by severe unilateral internal carotid artery stenosis or occlusion and its relationship with clinical prognosis. Methods Forty cases of acute cerebral infarction caused by severe unilateral ICA stenosis or occlusion were collected,including 22 cases of severe stenosis and 18 cases of ICA occlusion group. Using the Delica EMS-9 PB type TCD to detect intracranial cerebral blood flow,the patients were divided into three groups according to the number of open cranial collateral circulation. No collateral circulation group（ group A）,1 or 2 collateral circulation groups（ group B）,and 3 collateral circulations are all open groups（ group C）. All patients underwent NIHSS at the time of initial admission and at 2 weeks,followed by 6 months of follow-up and mRS scores. The relationship between the patient＇s collateral circulation and clinical outcome was analyzed. Results The open rate of collateral circulation in the ICA group was 88. 89%,which was significantly higher than that of the severe group（ 59. 09%）（ P= 0. 036）. There was no significant difference in NIHSS scores among patients A,B,C at admission. NIHSS scores were statistically different between the three groups after admission for 2 weeks（ P = 0. 002）. After 6 months,the mRS scores of the three groups were statistically different（ P = 0. 023）. Conclusion The more serious the degree of carotid artery stenosis,the better the establishment of collateral circulation. The number of collateral circulation affects the clinical outcome of patients with cerebral infarction,the more perfect the establishment of collateral circulation,the better its clinical prognosis.