TCD检测颈内动脉颅外段重度狭窄或闭塞后颅内血流动力学改变的临床价值

摘要

目的 分析采用经颅多普勒超声(TCD)检测颈内动脉颅外段(ICAex)重度狭窄或闭塞后颅内动脉血流动力学参数的变化及其临床意义.方法 选取2015年1月-2015年12月在我院确诊为ICAex重度狭窄或闭塞的52例病人为观察组,另选取52例ICAex血管正常的病人为对照组.对比分析两组病人双侧大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)的收缩期峰值流速(PSV)及血管搏动指数(PI),并判断侧支循环开放类型.结果 ICAex重度狭窄或闭塞病人颅内血流动力学参数有明显改变,与健侧相比,患侧MCA、ACA血流速度明显下降,频谱形态呈弥散圆钝状,PSV和PI值明显下降(P<0.01);患侧PCA血流速度明显上升,PSV和PI变化差异有统计学意义(P<0.05);患侧OA血流方向逆转,血流速度相对升高,PI减低;TCD检测的侧支循环开放类型及程度与数字减影血管造影(DSA)的检出结果基本一致,二者差异无统计学意义(P>0.05).结论 TCD可以检测到ICAex重度狭窄或闭塞后颅内动脉血流动力学的改变,能为临床及时选择适宜治疗方法提供重要参考.%Objective To analyze the haemodynamic changes and its clinical value in the patients with severe stenosis or occlusion of internal carotid artery-extracranial segment (ICA-ECS) by using TCD (transcranial Doppler ultrasound).Methods Fifty-two patients with severe stenosis or occlusion of ICA-ECS were evaluated by TCD as observation group,while 52 age-matched nomnal subjects were as control group.The peak systolic velocity (PSV) and pulsatile index (PI) of the bilateral middle cerebral artery (MCA),anterior cerebral artery (ACA),posterior cerebral artery (PCA) were detected and compared,and the type of collateral circulation opened were judged.Results The change of cranial internal carotid artery severe stenosis or with occlusive of patients with intracranial hemodynamic parameters was significant;compared with the health side,the other side MCA,ACA blood flow were decreased significantly and morphological spectrum showed diffuse blunt shape,PSV and PI decreased significantly (P<0.01);PCA blood flow was increased significantly,PSV and PI index changed had significant difference (P<0.05).The bilateral artery OA blood flow showed was moved towards the positive,spectrum morphology of peripheral vascular high impedance wave.TCD and DSA (digital subtraction angiography) detected basically consistent about the type and degree of collateral circulation,there was no significant statistical significance(P>0.05).Conclusion TCD can accurately detect the haemodynamic changes in the patients with severe stenosis or occlusion of ICA-ECS and can provide the important information for guiding the clinical treatment and identifying the prognosis.