颈动脉内膜切除术对颅外阻塞性脑血管病脑内循环的影响

Effects of carotid endarterectomy on intracranial circulation in patients suffering from extracranial cerebrovascular occlusion

目的探讨颈动脉内膜切除术对颅外阻塞性脑血管病脑内循环改变的影响。方法将 37例患者分为有症状组 2 9例 ,无症状组 8例。手术前、术中及术后 5d行经颅多普勒 (TCD)检查 ,系统观察脑内循环改变情况。结果术前颅外阻塞性脑血管病患者存在 3种侧支循环类型。有症状组中前交通动脉型占 4 4 8% ,无症状组中前交通动脉型占 87 5 % ,两组比较差异有显著意义 (P <0 0 5 )。有症状组狭窄或闭塞侧大脑中动脉 (MCA)平均血流速度 (Vm)为 (4 8± 7)cm /s,无症状组狭窄或闭塞侧MCAVm为 (6 0± 8)cm /s ,与对侧比较均显著减低 (P <0 0 1) ,且频谱低平呈波浪状 ,波峰变钝。术后 5d行TCD检查 ,两组的侧支循环消失 ,狭窄或闭塞侧的MCAVm与对侧的比较差异无显著意义 (P >0 0 5 ) ,且频谱恢复正常收缩峰特征。结论颈动脉内膜切除术确能改善颅外阻塞性脑血管病患者的脑部血供 ,是预防脑卒中的有效方法。

Objective To evaluate the effects of carotid endarterectomy on intracranial circulation in patients suffering from extracranial cerebrovascular occlusion. Method Thirty-seven patients were divided into two groups, with symptomatic (29 patients) and without (8 patients).Changes of intracranial circulation were observed by TCD system perioperatively. Results Preoperatively, three kinds of collateral circulation existed in patients with cerebrovascular disease caused by extracranial block. A clear difference(P<0.05) was observed between the 2 groups with 87.5% of ACOA in symptomatic group and 44.8% of ACOA in non-symptomatic group. MCA Vm in the stenosis or emphraxic sides was (48.5±7.2) cm/s in the symptoms group while MCA Vm in the narrow sides was (60.2±7.5) cm/s in the non-symptoms group. The MCA Vm in the symptoms group reduced significantly compared with that in the other side (P<0.001).Spectrum was shown low and flat, like waves, with its peaks blunt. Five days after the operation collateral circulation in the 2 groups disappearel after TCD exam. No significant difference was observed between the stenosis or emphraxic side compared with that in the normal sides(P>0.05),and the contracting peaks returned to its normal features. Conclusion Carotid intimectomy improves blood supply to patients with extracranial block, and helps to prevent stroke.