颈内动脉重度狭窄或闭塞患者侧支循环与搏动指数及持续注意功能的相关性研究

发布时间：2019-03-07 09:18

【摘要】：目的探讨颈内动脉重度狭窄或闭塞患者侧支循环与搏动指数(PI)及持续注意功能的相关性。方法对135例颈内动脉重度狭窄或闭塞患者进行DSA检查并根据侧支循环开放情况分组。另选择30名健康老年人作为对照组。采用TCD检查检测双侧大脑中动脉收缩期和舒张期血流速度(Vs和Vd)、平均血流速度(Vm)和PI。采用持续性操作测验的遗漏数、认错数、平均反应时评估持续注意功能。对结果进行比较分析。结果 (1)135例颈内动脉重度狭窄或闭塞患者根据侧支循环开放情况分为前交通动脉(AcoA)开放组(31例)、后交通动脉(PcoA)开放组(20例)、AcoA+PcoA开放组(19例)、初级侧支循环开放组(即AcoA、PcoA、AcoA+PcoA开放)(70例)、次级侧支循环开放组(主要包括眼动脉、软脑膜吻合支和新生供血血管)(15例)、初级+次级侧支循环开放组(13例)和无侧支循环开放组(37例)。(2)与对照组比较,其余各组患者的Vs、Vd、Vm和PI均显著降低(均P0.05)。与无侧支循环开放组比较,AcoA开放组、初级侧支循环开放组的Vd及AcoA+PcoA开放组的Vd、Vm均明显升高,AcoA开放组、AcoA+PcoA开放组、初级侧支循环开放组及初级+次级侧支循环开放组的PI均明显降低(均P0.05)。与PcoA开放组比较,AcoA开放组、AcoA+PcoA开放组的PI均明显降低(均P0.05)。与次级侧支循环开放组比较,初级侧支循环开放组的Vs、Vd、Vm和初级+次级侧支循环开放组的Vd、Vm均明显升高,初级侧支循环开放组和和初级+次级侧支循环开放组的PI均明显降低(均P0.05)。(3)与对照组比较,其余各组患者的遗漏数、认错数和平均反应时均显著增加(均P0.05)。与无侧支循环开放组比较,AcoA开放组、AcoA+PcoA开放组及初级侧支循环开放组的遗漏数、认错数和平均反应时均明显减少;初级+次级侧支循环开放组的遗漏数和认错数均明显减少(均P0.05)。与PcoA开放组比较,AcoA开放组的遗漏数和认错数均明显减少;AcoA+PcoA开放组的遗漏数、认错数和平均反应时均明显减少(均P0.05)。与AcoA+PcoA开放组比较,AcoA开放组的遗漏数、认错数和平均反应时均明显增加(均P0.05)。与次级侧支循环开放组比较,初级侧支循环开放组的遗漏数、认错数和平均反应时均明显减少;初级+次级侧支循环开放组的遗漏数和认错数均明显减少(均P0.05)。(4)AcoA开放组、初级侧支循环开放组和次级侧支循环开放组的PI与平均反应时呈正相关(r=0.441,r=0.364,r=0.552;均P0.05)。PcoA开放组和无侧支循环开放组的PI与遗漏数呈正相关(r=0.668,r=0.397;均P0.05);与认错数呈正相关(r=0.509,r=0.480;均P0.05)。结论颈内动脉重度狭窄或闭塞患者患侧高PI可反映其持续注意功能受损。
[Abstract]:Objective to investigate the correlation between collateral circulation and pulsatility index (PI) and continuous attention function in patients with severe stenosis or occlusion of internal carotid artery. Methods DSA was performed in 135 patients with severe stenosis or occlusion of internal carotid artery and divided into groups according to the opening of collateral circulation. Another 30 healthy elderly were selected as control group. Measurement of systolic and diastolic blood flow velocity (Vm) and PI.) of bilateral middle cerebral artery (Vs and Vd),) by TCD Continuous attention function was assessed by the number of omissions, the number of errors identified, and the mean response time of the continuous operation test. The results were compared and analyzed. Results (1) the patients with severe stenosis or occlusion of internal carotid artery were divided into anterior communicating artery (AcoA) group (31 cases) and posterior communicating artery (PcoA) group (20 cases of), AcoA PcoA open group (19 cases) according to the opening of collateral circulation). The primary collateral circulation (AcoA,PcoA,AcoA PcoA) group (70 cases), the secondary collateral circulation open group (mainly including ophthalmic artery, meningeal anastomotic branch and neovascularization) (15 cases), the primary collateral circulation open group (70 cases), and the secondary collateral circulation open group (15 cases). Compared with the control group, the Vs,Vd,Vm and PI in the primary and secondary collateral circulation open group (13 cases) and the non-collateral circulation open group (37 cases). (2) were significantly lower than those in the control group (P 0.05). Compared with non-collateral circulation open group, Vd and Vd,Vm in AcoA open group, primary collateral circulation open group and AcoA PcoA open group were significantly higher than those in AcoA open group, AcoA PcoA open group in AcoA open group, and, AcoA PcoA open group in AcoA open group. The PI of primary collateral circulation open group and primary secondary collateral circulation open group were significantly lower than those of primary collateral circulation open group (P0.05). Compared with PcoA open group, PI of, AcoA PcoA open group in AcoA open group was significantly lower than that of, AcoA PcoA open group (P0.05). Compared with the secondary collateral circulation open group, the Vs,Vd,Vm in the primary collateral circulation open group and the Vd,Vm in the primary collateral circulation open group were significantly higher than those in the secondary collateral circulation open group. The PI of the primary collateral circulation open group and the primary secondary collateral circulation open group were significantly lower than that of the control group (P0.05). (3), and the number of omissions in the other groups was significantly lower than that of the control group. The number of errors and the average reaction time were significantly increased (P0.05). Compared with the open group without collateral circulation, the number of omissions, the number of errors and the mean reaction time in AcoA open group and, AcoA PcoA open group and primary collateral open group were significantly decreased. The number of omissions and errors in the primary and secondary collateral circulation open group were significantly decreased (P0.05). Compared with the open group of PcoA, the number of omissions and the number of errors admitted in the open group of AcoA significantly decreased, and the number of errors and the mean response time decreased significantly in the open group of; AcoA PcoA (P0.05). Compared with the open group of AcoA PcoA, the number of omissions, the number of errors and the mean reaction time in the open group of AcoA were significantly increased (P0.05). Compared with the secondary collateral circulation open group, the number of omissions, the number of errors and the mean reaction time were significantly decreased in the primary collateral circulation open group. The number of omissions and errors in the primary and secondary collateral circulation open group were significantly decreased (P0.05). (4). The PI in the primary collateral circulation open group and the secondary collateral circulation open group was positively correlated with the mean reaction time (r = 0.441, P < 0.05). R = 0.364, r = 0.552, r = 0.364, r = 0.552; There was a positive correlation between PI and the number of omissions in PcoA open group and no collateral circulation open group (r = 0.668, r = 0.397; both P 0.05), and positively correlated with the number of errors (r = 0.509, r = 0.480; both P 0.05). Conclusion High PI on the affected side of patients with severe stenosis or occlusion of internal carotid artery can reflect the impairment of continuous attention function.
【作者单位】：西南医科大学附属医院神经内科;
【基金】：泸州医学院附属医院青年基金项目(2015-QS-034)
【分类号】：R743.3

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