经颅多普勒超声结合屏气试验评价肝硬化患者大脑中动脉血流动力学改变

Evaluation the hemodynamics of middle cerebral artery in patients with liver cirrhosis by transcranial Doppler ultrasound combined with breath-holding test

目的 应用经颅多普勒超声(TCD)结合屏气试验检测不同程度肝硬化患者大脑中动脉的血流动力学变化。方法 对照组为20例健康志愿者;48例肝硬化患者按Child-Pugh分级分为A、B、C 3组。用TCD检测各组屏气前后大脑中动脉的平均血流速度(Vm)、阻力指数(RI)、搏动指数(PI)、血流量(BF),并计算流量储备(CVR)。结果 B、C组的PI、RI较对照组增加,B组分别为0.87±0.19、0.62±0.07;C组分别为0.96±0.17、0.67±0.05;对照组分别为0.74±0.18、0.58±0.06。Vm、BF较对照组减低( P <0.05),B组分别为(61.18±6.93)cm/s、201.73±60.32;C组分别为(50.54± 5.77 )cm/s、159.53±60.83;对照组分别为(72.58±6.793)cm/s、238.69±55.39。屏气后各组大脑中动脉Vm、BF较屏气前增加,PI、RI较前减低, A组屏气前Vm、PI、RI、BF分别为(73.02±7.82)cm/s、 0.76±0.20、 0.56±0.05、240.37± 52.26 ,屏气后分别为(92.23±8.59)cm/s、0.64±0.10、0.46±0.06、331.89±49.82;B组屏气前Vm、PI、RI、BF分别为(61.18±6.93)cm/s、0.87±0.19、0.62±0.07、201.73±60.32,屏气后分别为(79.37±6.98)cm/s、0.79±0.13、0.54± 0.07、 272.53±56.38;C组屏气前Vm、PI、RI、BF分别为(50.54±5.77)cm/s、0.96±0.17、 0.67±0.05、159.53±60.83,屏气后分别为(65.21±7.57)cm/s、0.88±0.12、0.62±0.06、201.06±48.91。A、B、C 3组的CVR均较对照组减低( P <0.05),分别为39.65±12.76、31.49±15. 24.52±14.58,且CVR在三组间有明显差异。结论 肝硬化患者大脑中动脉有不同程度的血流动力学改变,CVR可发现早期肝硬化患者大脑中动脉功能状态改变。

Objective To detect the hemodynamic changes of middle cerebral artery (MCA) in patients with different degrees of cirrhosis by transcranial Doppler ultrasound (TCD) combined with breath-holding test. Methods In the study, 20 healthy volunteers were enrolled as control group, 48 patients with cirrhosis were divided into 3 groups according to Child-Pugh grade. The mean blood flow velocity (Vm), resistance index (RI), pulsatility index (PI) and blood flow volume (BFV) of MCA were measured by TCD before and after breath-holding test, and the cerebrovascular reserve (CVR) was calculated. Results Compared with the control and group A, the PI and RI of group B and C were significantly increased ( P <0.05), the Vm and BFV in group B and C were significantly decreased ( P <0.05). After holding the breath, the Vm and BFV of the MCA increased, the PI and RI decreased in all groups. The CVR of group A, B and C were 39.65±12.76, 31.49±15 and 24.52±14.58, respectively, which were significantly lower than those of the control group ( P <0.05), and CVR differences were significant between the 3 groups ( P <0.05). Conclusion The MCA in patients with cirrhosis has different degrees of hemodynamic changes. CVR can effectively reflect the variation of MCA vascular function in patients with early cirrhosis.