经颅多普勒超声（TCD）联合双频超声检测椎动脉起始段血管成形术的血流动力学改变

发布时间：2018-05-29 18:00

本文选题：经颅多普勒超声 + 双频超声　；参考：《广西医科大学》2014年硕士论文

【摘要】：[目的]椎动脉是后循环系统重要的供血血管,随着社会步入老龄化,动脉硬化斑块所致的椎动脉狭窄也日渐增多,而椎动脉狭窄以起始段较为常见,近20年来,随着介入治疗的迅速发展,脑血管成形术已逐步成为椎动脉起始段重度狭窄的主要治疗方法,因而迫切需要一种准确、方便的检查方法进行评估支架植入术后的效果及远期随访。经颅多普勒超声(TCD)及颈部血管超声超声技术是无创、方便、可重复、经济等优点的检测手段,目前在临床广泛应用,本文为探讨TCD联合双频超声技术在椎动脉起始段支架植入术前后的血流动力学改变,研究其在椎动脉起始段支架植入术前后的应用价值。 [方法]2013年1月至2014年2月我院行椎动脉起始段支架植入术的30例患者为研究组,均在术前1天及术后3天行颈部血管超声及TCD检查,另选取门诊健康体检者60例为对照组,行TCD及颈部血管超声检查,评估：1.术前研究组狭窄侧与对照组的椎动脉起始段的内径、椎动脉起始段、椎间段、颅内段的血流速度、阻力指数、搏动指数及频谱形态；2.术前研究组狭窄侧与健侧、健侧与对照组的椎动脉的内径及血流动力学的对比；3.术前TCD、双频超声及TCD联合双频超声评估椎动脉起始段狭窄结果与DSA的比较；4.对比研究组狭窄侧及健侧在支架植入术后椎动脉起始段的内径及椎动脉起始段、椎间段、颅内段的血流动力学改变。 [结果]1、支架植入术前,研究组与对照组年龄差异无统计学意义(P0.05)。双频超声示研究组狭窄侧椎动脉起始段内径(1.71±0.40mam)较对照组内径(3.77±0.60mam)窄,差异有统计学意义(P0.05)；健侧椎动脉起始段内径(4.10±0.45mam)较对照组差异无统计学意义(P0.05)；狭窄侧椎动脉起始段收缩期峰值血流速度(236.43±60.03cm/s)较对照组(68.92±9.36cm/s)增快,阻力指数(0.82±0.12)较对照组(0.64±0.19)升高,椎间段血流速度(44.34±12.15cm/s)较对照组(55.18+12.83cm/s)减慢,阻力指数(0.41±0.10)较对照组(0.62±0.15)降低,差异均有统计学意义(P0.01)；而健侧椎动脉起始段流速(73.98+12.08cm/s)、椎间段血流速度(68.73±18.27cm/s)、阻力指数(0.59±0.09)分别与对照组相比较,差异均无统计学意义(P0.05)；2、经颅多普勒超声(TCD)示研究组狭窄侧椎动脉颅内段血流速度(31.56±11.65cm/s)较对照组(77.47±11.35cm/s)减慢,搏动指数(0.62±0.23)较对照组降低(0.91±0.18),差异均有统计学意义(P0.05)；而研究组健侧与对照组相比较,椎动脉颅内段血流速度及搏动指数均较健侧无明显差异(P0.05)。研究组基底动脉PSV、PI与对照组相比较,差异无统计学意义(P0.05)。3、以DSA为检测椎动脉起始段狭窄的标准,单用双频超声检测,灵敏度为81.7%,特异性为92.8%,单用TCD检测,灵敏度为83.3%,特异性为89.7%；联合使用TCD及双频超声检查,灵敏度为91.7%,特异性为96.2；4、研究组中,患者行支架植入术前后对比,术后狭窄侧椎动脉起始段内径增宽至(3.75±0.56mm),较术前平均增宽133.0%,差异有统计学意义(P0.01)；椎动脉起始段血流速度降至(73.98±12.08cm/s),较术前平均减慢了71.8%,阻力指数降低至(0.69±0.18),较术前平均降低了17.1%,椎动脉椎间段血流速度增快至(56.37±9.84cm/s),较术前增快了31.3%,阻力指数升高至(0.61±0.19),较术前升高了46.1%,差异均有统计学意义(P0.05)；椎动脉颅内段血流速度增快至(76.12±15.30cm/s),较术前平均增快了162.0%,血管搏动指数增高至(0.90±0.23),较术前平均增高了54.9%,差异也均有统计学意义(P0.01)；而健侧椎动脉椎动脉起始段内径、血流速度及阻力指数,椎间段、颅内段血流速度及搏动指数均较术前无显著差异(P0.05),基底动脉血流速度及搏动指数也均较术前无显著差异(P0.05)。 [结论]利用TCD联合超声检测椎动脉起始段支架植入术血流动力学改变,其中椎动脉起始段血流速度改善了71.9%,阻力指数降低了17.1%,且TCD联合超声检测灵敏度为91.7%,特异性为96.2%,提示TCD联合颈部血管超声是一种准确评价椎动脉起始段狭窄支架植入术前血流动力学改变及术后效果评价的重要检测手段。
[Abstract]:[Objective] the vertebral artery is an important blood supply vessel for the posterior circulation system. With the aging of the society, the stenosis of the vertebral artery caused by atherosclerotic plaque is increasing, and the stenosis of the vertebral artery is more common. In the last 20 years, with the rapid development of interventional therapy, cerebral angioplasty has gradually become a severe stenosis of the initial segment of the vertebral artery. As a result, an accurate and convenient method is urgently needed to evaluate the effect and long-term follow-up of stent implantation. Transcranial Doppler ultrasound (TCD) and cervical vascular ultrasound technique are non invasive, convenient, repeatable, economical and so on, and are widely used in clinical practice. This paper is to explore the combination of TCD and two. The hemodynamic changes before and after implantation of vertebral artery initial segment were studied by frequency ultrasound.
[Methods] 30 patients with vertebral artery initial stent implantation in our hospital from January to February 2014]2013 were selected as the study group. The cervical vascular ultrasound and TCD examination were performed 1 days before and 3 days after the operation, and 60 patients in the outpatient health examination were selected as the control group. The TCD and cervical vascular ultrasound examinations were performed, and the stenosis side and the control group before the 1. operation group were evaluated. The internal diameter of the initial segment of the vertebral artery, the initial segment of the vertebral artery, the intervertebral segment, the velocity of the blood flow, the resistance index, the pulsation index and the spectrum shape; 2. the comparison of the internal diameter and hemodynamics of the vertebral artery in the stenosis side and the healthy side in the study group before the operation; and 3. before operation TCD, double frequency ultrasound and TCD combined double frequency ultrasound to evaluate the origin of vertebral artery. The results of segmental stenosis were compared with that of DSA; 4. the hemodynamic changes in the initial segment of the vertebral artery, the initial segment of the vertebral artery, the intervertebral segment and the intracranial segment were compared in the stenosis side and the healthy side of the study group after the stent implantation.
[results]1, the age difference between the study group and the control group was not statistically significant before the stent implantation (P0.05). The internal diameter of the stenosis side vertebral artery in the study group (1.71 + 0.40mam) was narrower than that of the control group (3.77 + 0.60mam), and the difference was statistically significant (P0.05), and there was no difference between the initial segment of the vertebral artery (4.10 + 0.45mam) in the healthy side compared with the control group. Statistical significance (P0.05); the peak systolic velocity (236.43 + 60.03cm/s) of the initial segment of the narrow lateral vertebral artery was faster than that of the control group (68.92 9.36cm/s), the resistance index (0.82 + 0.12) was higher than that of the control group (0.64 + 0.19), and the velocity of the intervertebral segment (44.34 + 12.15cm/s) was slower than that of the control group (55.18+12.83cm/s), and the resistance index (0.41 + 0.10) was compared with the control group. In the group (0.62 + 0.15), the difference was statistically significant (P0.01), while the velocity of the initial segment of the vertebral artery (73.98+12.08cm/s), the velocity of the intervertebral body flow (68.73 + 18.27cm/s), and the resistance index (0.59 + 0.09) were compared with the control group, and the difference was not statistically significant (P0.05). 2, the transcranial Doppler ultrasound (TCD) showed the stenosis of the vertebral artery in the study group. The velocity of blood flow in the intracranial segment (31.56 + 11.65cm/s) was slower than that of the control group (77.47 + 11.35cm/s), and the pulsatile index (0.62 + 0.23) was lower than the control group (0.91 + 0.18). The difference was statistically significant (P0.05). Compared with the control group, the blood flow velocity and pulsation index of the intracranial segment of the vertebral artery were not significantly different from the healthy side (P0.05). The basilar artery PSV and PI were compared with the control group, the difference was not statistically significant (P0.05).3, with DSA as the standard for detecting the stenosis of the vertebral artery, the sensitivity was 81.7%, the specificity was 92.8%, the sensitivity was 83.3%, the specificity was 89.7%, the sensitivity was 91.7%, the specificity was 91.7%, and the specificity was 91.7%, and the specificity was 91.7%. Sex was 96.2; 4, in the study group, the patients were compared before and after the stent implantation, and the diameter of the initial segment of the vertebral artery in the narrow side was widened to (3.75 + 0.56mm), and the average width was 133% compared with that before the operation. The difference was statistically significant (P0.01); the velocity of the initial segment of the vertebral artery decreased to (73.98 + 12.08cm/s), the average slowed down by 71.8%, and the resistance index decreased to (0.). 69 + 0.18), compared with the preoperative average of 17.1%, the velocity of the intervertebral artery in the vertebral artery increased to (56.37 + 9.84cm/s), 31.3%, and the resistance index increased to (0.61 + 0.19), compared with the preoperative increase of 46.1%. The difference was statistically significant (P0.05); the velocity of the cranial segment of the vertebral artery increased to (76.12 + 15.30cm/s), and was 1 faster than that before the operation. 62%, the vascular pulsation index increased to (0.90 + 0.23), higher than the preoperative average of 54.9%, and the difference was statistically significant (P0.01), while the initial segment of the vertebral artery, the velocity and resistance index of the vertebral artery in the healthy side, the velocity of the blood flow and the pulsation index of the intervertebral segment, the intracranial segment were not significantly different (P0.05), the velocity of blood flow of the basilar artery and the beat of the basilar artery There was no significant difference in dynamic index (P0.05).
[Conclusion] the hemodynamic changes of the stenting of the initial segment of vertebral artery were detected by TCD combined with ultrasound, in which the velocity of the initial segment of the vertebral artery was improved by 71.9%, the resistance index was reduced by 17.1%, and the sensitivity of the TCD combined ultrasonic detection was 91.7% and the specificity was 96.2%. It was suggested that the TCD combined with the cervical vascular ultrasound is a kind of accurate evaluation of the vertebral artery origin. Hemodynamic changes before and after stent placement and the important means of postoperative evaluation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R743

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