经颅彩色多普勒超声联合颈动脉彩色多普勒超声对大脑中动脉粥样硬化性脑梗塞患者的临床研究

发布时间：2018-03-13 09:38

本文选题：动脉粥样硬化　切入点：脑梗塞　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的准确评估颅内动脉粥样硬化脑梗塞患者的血管病变范围、狭窄程度、血流动力学改变，对了解其发病机制、制定合理的治疗方案及判断预后起着至关重要的作用。在颅内动脉粥样硬化性脑梗塞中，大脑中动脉（middle cerebral artery, MCA）粥样硬化的发病率最高，而经颅彩色多普勒超声（transcranial color-code real-timesonography, TCCS）对该处的病变诊断敏感性、特异性较高。本课题旨在研究TCCS联合颈动脉血管超声对MCA粥样硬化性脑梗塞患者的临床应用价值。方法病例组为经CT血管造影（computed tomography angiography, CTA）证实为MCA粥样硬化性脑梗塞患者75例，对照组为年龄、性别配对的门诊正常健康体检者（头颅CT或MRI检查正常）40例。脑梗塞患者均于入院一周内行TCCS和颈动脉彩色多普勒超声检查由同一检查医师于同一天依次进行，TCCS检测双侧MCA收缩期峰值血流速度（systolic velocity,Vs）、舒张末期血流速度（diastolic velocity, Vd）、搏动指数（pulsatility index, PI）及阻力指数（resistance index, RI）；颈动脉彩色多普勒超声测量双侧颈总动脉（commoncarotid artery, CCA）收缩期血管内径（systolic diameter, Ds）、CCA平均内中膜厚度（intima-media thickness, IMT），观察有无斑块，并记录CCA及颈内动脉(internalcarotid artery, ICA)斑块的回声强度、数目及斑块累及的血管数目。结果脑梗塞组CTA阳性侧和阴性侧比较：CCA-Ds、CCA-IMT、MCA-RI、MCA-PI、颈动脉斑块发生率、混合回声和低回声斑块发生率、多发斑块发生率无统计学差异(P0.05)。脑梗塞组与对照组比较：脑梗塞组CTA双侧CCA-Ds、CCA-IMT、均高于对照组(P0.05)；脑梗塞组双侧MCA-RI、MCA-PI均高于对照组(P0.05)；与对照组相比，脑梗塞组颈动脉斑块发生率、混合回声和低回声斑块发生率、多发斑块发生率均明显增大(P＜0.05)。 75例脑梗塞患者中，TCCS显示CTA阳性侧MCA收缩期峰值血流速度增快者21例（28%）、收缩期峰值血流速度减慢者42例（56%）、血流速度正常范围者12例（16%），经TCCS检查发现MCA血流速度异常率为84%（63/75）。结论对于同一组颅内动脉粥样硬化患者的CCA-Ds、CCA-IMT、颈动脉斑块发生率、混合回声和低回声斑块发生率、多发斑块发生率基本相同，提示双侧颈动脉粥样硬化进展程度基本一致，所以无论是CTA阳性侧还是CTA阴性侧只要出现低回声或混合回声斑块，，都应进行正规的稳定斑块、抗动脉粥样硬化治疗。与对照组相比，MCA粥样硬化性脑梗塞患者CCA-Ds、CCA-IMT、颈动脉斑块发生率、混合回声和低回声斑块发生率、多发斑块发生率均大于正常对照组，提示颈动脉血管超声可以间接地反应颅内血管的动脉粥样硬化程度。TCCS可以直观地显示MCA血流方向和走形，取得病变处血管及其近端、远端血管的血流动力学参数，协助早期诊断颅内动脉粥样硬化性狭窄，为临床制定治疗方案及改善预后争取了宝贵时间。
[Abstract]:Objective to evaluate the extent of vascular lesions, the degree of stenosis and the changes of hemodynamics in patients with intracranial atherosclerosis and cerebral infarction. It is very important to make a reasonable treatment plan and to judge the prognosis. The middle cerebral artery (MCA) has the highest incidence of atherosclerosis in intracranial atherosclerotic cerebral infarction, the middle cerebral artery (MCA) has the highest incidence of Atherosclerosis. The sensitivity and specificity of transcranial color-code real-time imaging (TCCS) in the diagnosis of the lesions were high. The purpose of this study was to study the clinical value of TCCS combined with carotid artery ultrasound in the diagnosis of MCA patients with atherosclerotic cerebral infarction. Methods Seventy-five patients with MCA atherosclerotic cerebral infarction were diagnosed by CT angiography and 40 healthy controls were matched by age and sex (CT or MRI). Patients with cerebral infarction were examined by TCCS and carotid color Doppler ultrasonography within one week of admission. TCCS was performed on the same day to detect systolic peak systolic velocity and diastolic velocityof bilateral MCA. VDV, pulsatility index (Pi), resistance index (RI) and resistance index (RI). Carotid color Doppler ultrasound was used to measure systolic diameter of common carotid artery (CCAs), mean intima media thickness (IMT), intima media thickness (IMT). The echo intensity, the number of plaques and the number of vessels involved in CCA and internal carotid artery were recorded. Results there was no significant difference in the incidence of carotid plaque, mixed echo and hypoechoic plaque between the CTA positive side and the negative side in the cerebral infarction group. There was no significant difference in the incidence of multiple plaques between the two groups (P 0.05). Compared with the control group, the CTA of the cerebral infarction group was higher than that of the control group (P 0.05), the MCA-RI MCA-PI of the cerebral infarction group was higher than that of the control group (P 0.05), and the incidence of carotid plaque, mixed echo and hypoechoic plaque in the cerebral infarction group was higher than that in the control group. The incidence of multiple plaques increased significantly (P < 0.05). Among 75 patients with cerebral infarction, 21 cases showed that the peak systolic velocity of MCA on the positive side of CTA was increased by TCCS in 21 cases, and the peak systolic velocity was decreased in 42 cases. There were 12 cases with normal blood flow velocity in 12 cases with normal blood flow velocity. The abnormal rate of MCA blood flow velocity was 84 ~ 63 / 7575 by TCCS. Conclusion for the same group of patients with intracranial atherosclerosis, the incidence of carotid plaque, mixed echo and hypoechoic plaque were the same, suggesting that the degree of progression of bilateral carotid atherosclerosis was basically the same. So whether it is CTA positive side or CTA negative side, as long as there are hypoechoic or mixed echo plaques, we should have regular stable plaques. Compared with the control group, the incidence of carotid plaque, mixed echo and hypoechoic plaque in patients with MCA atherosclerotic cerebral infarction were higher than those in control group. The results suggest that carotid artery ultrasound can indirectly reflect the degree of atherosclerosis of intracranial vessels. TCCS can directly display the direction and shape of MCA blood flow, and obtain the hemodynamic parameters of the lesion and its proximal and distal vessels. It helps to diagnose early intracranial atherosclerotic stenosis, which can provide valuable time for clinical treatment and prognosis improvement.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3;R445.1

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