颈内动脉狭窄程度和血流速度与颈内动脉支架置入术后高灌注损伤的相关性研究

The study on the correlation between degree of internal carotid artery stenosis and blood flow velocity and hyperperfusion injury after internal carotid artery stenting

目的探讨颈内动脉狭窄程度和血流速度与颈内动脉支架置入术后高灌注损伤的相关性。方法选取2014年1月-2019年2月本院收治的298例颈内动脉狭窄患者为研究对象,全部患者采取颈内动脉支架置入术治疗,根据术后是否发生高灌注脑出血将其分为高灌注脑出血组(观察组,n=8)与未发生高灌注脑出血组(对照组,n=290);采用改良RANKIN量表(mRS评分)评估2组受试者手术前、手术30 d后残疾程度,分别于手术前、手术后3 d采用彩色多普勒超声测定2组受试者患侧颈内动脉狭窄程度及血流速度,应用经颅多普勒TCD测定2组受试者患侧大脑中动脉血流速度;采用NIHSS评分评估2组受试者手术前、手术30 d后神经功能缺损程度,采用LOGSTIC多元回归分析颈内动脉支架置入术后高灌注脑出血的影响因素。结果观察组手术30 d后mRS评分高于对照组(P<0.05);观察组手术前患侧颈内动脉狭窄程度高于对照组(P<0.05);观察组手术前患侧大脑中动脉动脉血流速度(Vm)低于对照组(P<0.05);观察组手术30 d后NIHSS评分高于对照组(P<0.05);Logistic多因素回归分析显示,颈内动脉支架置入术后高灌注脑出血与术前颈内动脉狭窄程度、血流速度、术后3 d患侧大脑中动脉血流速度(Vm)呈正相关(P<0.05),与术前患侧大脑中动脉血流速度(Vm)呈负相关(P<0.05)。结论颈内动脉狭窄程度和血流速度是颈内动脉支架置入术后发生高灌注脑出血的独立影响因素。

Objective To investigate the correlation between the degree of internal carotid artery stenosis and blood flow velocity and hyperperfusion injury after internal carotid artery stenting. Methods 298 patients with internal carotid artery stenosis admitted to our hospital from January 2014 to February 2019 were selected as the research objects. All patients were treated with internal carotid artery stenting. According to whether hyperperfusion cerebral hemorrhage occurred after operation, they were divided into hyperperfusion cerebral hemorrhage group(observation group,n=8) and no hyperperfusion cerebral hemorrhage group(control group,n=290). Modified RanKIN scale(mRS score) was used to evaluate the degree of disability of the two groups before and 3 months after operation. The degree of internal carotid artery stenosis and blood flow velocity were measured by color Doppler ultrasound before and after operation. The blood flow velocity of middle cerebral artery in the affected side of the two groups was measured by transcranial Doppler TCD. The NIHSS score was used to evaluate the spirit of the two groups before and after operation. The influence factors of hyperperfusion cerebral hemorrhage after internal carotid artery stenting were analyzed by LOGSTIC multiple regression analysis. Results The mRS score of observation group was higher than that of control group 3 months after operation(P<0.05). The degree of internal carotid artery stenosis in the observation group was higher than that in the control group(P<0.05). The blood flow velocity of the affected middle cerebral artery in the observation group was lower than that in the control group(P<0.05). The NIHSS score of the observation group was higher than that of the control group(P<0.05). Logistic multivariate regression analysis showed that hyperperfusion cerebral hemorrhage after internal carotid artery stenting was positively correlated with preoperative stenosis of internal carotid artery, blood flow velocity of middle cerebral artery(MCA) and negatively correlated with preoperative MCA blood flow velocity(P<0.05). Conclusion The degree of stenosis of internal carotid artery and the velocity of blood flow are independent factors affecting the occurrence of hyperperfusion cerebral hemorrhage after internal carotid artery stenting.