外科治疗对合并缺血性眼病的颈动脉狭窄患者眼动脉血流动力学的影响及疗效评价

Effects of Surgical Treatment on Ophthalmic Arterial Blood Flow in Patients with Carotid Artery Stenosis and Ischemic Eye Disease and an Evaluation of Its Efficacy

目的:利用彩色多普勒超声仪(CDFI)对伴有缺血性眼病的颈动脉狭窄患者行颈动脉内膜切除术(CEA)或颈动脉支架成形术(CAS)前、后颈部血管及眼部血管的血流动力学检查,以探讨外科手术治疗对眼动脉血流动力学的影响,并比较CEA和CAS这2种不同的外科手术治疗方法对缺血性眼病的疗效。方法:前瞻性临床研究。收集2017年12月至2018年12月就诊于深圳市第二人民医院神经血管外科,经数字血管减影造影(DSA)诊断为颈动脉狭窄,并需行血运重建手术治疗(CEA或CAS)的患者19例。应用CDFI检测颈动脉狭窄程度、斑块形态以及颈内动脉、眼动脉、视网膜中央动脉的血流动力学参数:收缩期峰值流速(PSV,cm/s)、舒张末期流速(EDV,cm/s)、阻力指数(RI,%),其中RI=(PSV-EDV)/PSV。采用配对t检验行治疗前后数据比较。结果:16例患者行CEA手术,3例患者行CAS手术。术后3个月,眼动脉的PSV和EDV明显增加,差异均有统计学意义(t=5.470、5.098,均P<0.001),RI明显降低(t=3.624,P=0.003)。经CEA或CAS治疗后,患者一过性黑朦症状基本消失。CEA组12例治疗有效,CAS组2例治疗有效。结论:CEA和CAS均可以有效地改善颈动脉狭窄致眼缺血性疾病的眼部血流动力学指标,一定程度上缓解眼缺血性疾病的症状。

Objective:To investigate the effects of carotid endarterectomy(CEA)and carotid artery stenting(CAS)on ophthalmic arterial blood flow mechanics and to compare the therapeutic effects of these two different methods on ocular ischemic disease.CEA and CAS were performed in carotid artery stenosis patients with ocular ischemic disease by color doppler flow imaging(CDFI).Methods:In this prospective clinical study,data were collected from 19 patients between December 2017 and December 2018 in the Second People's Hospital of Shenzhen Nerve Vascular Surgery by color doppler ultrasound examination(CDFI)or digital subtraction angiography(DSA)in the diagnosis of carotid stenosis and surgical treatment of line revascularization(including the CEA and CAS).Testing included dynamic detection of carotid stenosis,plaques and internal jugular vein,ophthalmic artery,central retinal artery,and parameters of central retinal venous blood flow mechanics:Peak systolic velocity(PSV,cm/s),end-diastolic velocity(EDV,cm/s),resistance index(RI),RI=(PSV-EDV)/PSV.Data before and after surgery were analyzed using a paired t test.Results:At last,16 cases underwent CEA surgery,and 3 cases underwent CAS surgery.Three months after carotid endarterectomy and carotid stent plasty,the systolic peak flow rate(PSV)and end-diastolic flow rate(EDV)of the ophthalmic artery were significantly increased(t=5.470,5.098,P<0.001).RI significantly decreased(t=3.624,P=0.003).After CEA or CAS treatment,temporary amaurosis in all patients disappeared.There were 12 cases in CEA group and 2 cases in CAS group got effective treatment.Conclusions:Carotid endarterectomy and carotid stent plasty can effectively improve the ocular hemodynamic indexes of ischemic eye disease caused by carotid artery stenosis and alleviate the symptoms of ischemic eye disease to some extent.