颈动脉内膜切除术后对侧颈动脉、椎动脉血流速度的改变

发布时间：2018-04-05 23:34

  本文选题：颈动脉狭窄　切入点：颈动脉内膜切除术　出处：《大连医科大学》2017年硕士论文

【摘要】：研究背景:脑血管病是一种常见疾病,主要与颅内血管或与颅内血管相关的颈部血管发生病变有关。有关资料统计,因疾病造成人类死亡的原因中,脑血管病的排位非常靠前,一直稳定在前三位,严重影响着人类的正常生活和身体健康。因现代人饮食摄入,生活习惯发生改变,人口老龄化不断加重,导致脑血管病的发生率在不停升高。脑血管病包括两种,第一种称为缺血性脑血管病,第二种称为出血性脑血管病。其中以缺血性脑血管病在临床较多见,约占全部患者的84%。缺血性脑血管病是因为脑组织血管粥样硬化,造成颅内血管管腔缩窄,相应血管内血流量下降或全部中断,血供严重减少,大脑缺乏氧气,脑组织受到损伤而出现的一系列症状。现阶段,我国医治缺血性脑血管病主要分为内科保守治疗及外科手术治疗。内科主要以扩容、溶栓、抗凝、抗血小板聚集及促进脑功能恢复等措施为主。由于神经细胞为不可再生细胞,且溶栓治疗需要把握好时间窗,脑细胞耐受缺氧的时间非常有限。因此,对已经发生缺血或梗死的脑组织行内科治疗,其疗效往往不是非常理想。外科治疗中的颈动脉内膜剥脱术(CEA)是重要手段,该手术通过直接切开病变血管,取出堵塞血管管腔的增厚内膜和斑块,从而恢复血管管腔血流,改善脑部循环。颈动脉内膜剥脱术(CEA)能够去除引发脑中风的病因,因此能够起到预防脑中风发作的重要作用。对已患有脑中风的病人,如若尽早地进行颈动脉内膜剥脱术,改善脑部血供,对因中风导致的脑损伤的恢复也是十分乐观的。因此,目前为止在国内外CEA仍被看作治疗颈动脉狭窄的金标准方法。目的:对一侧颈动脉狭窄患者行狭窄侧颈动脉内膜切除术后,对非手术的另一侧颈动脉、椎动脉血流速度变化进行分析和比较。从而探索血液动力学改变对病情的评估及对疾病诊治和预防的重要意义。方法:对2009年4月至2014年4月大连市中心医院神经外三科诊治的一侧颈动脉重度狭窄(70～99%),伴对侧颈动脉无或仅有轻度狭窄的患者50例进行回顾性数据分析。所有患者均进行了狭窄侧CEA手术。对全部病人均行随访,分别于CEA术后1周、1月、6月及12个月进行颈部血管超声诊查,并记录手术侧及对侧颈总、颈内、椎动脉的血流速度数据,并对所有数据进行比较和统计学分析。结果:所有手术均获得成功,术后狭窄侧颈动脉血流通畅,血流动力学恢复正常,且所有患者症状得到明显改善。对侧颈总、颈内、椎动脉血液流速与术前血液流速相比降低,差异显著并具有统计学意义(P0.05)。结论:重度狭窄侧颈动脉行CEA术后,狭窄对侧颈动脉、椎动脉系统血流速度呈总体下降趋势。且血流速度的改变多从CEA术后早期开始。但病变对侧血管血流速度下降后,会引起相应血管血流剪切力下降,增大斑块形成的风险。因此,在对狭窄血管施行CEA手术后,应继续控制动脉硬化危险因素,并密切观察对侧血管内膜变化情况。
[Abstract]:Background: cerebrovascular disease is a common disease, mainly with intracranial vessels or associated with intracranial vascular neck vascular lesions occur. The statistics, because of the disease cause of human death, cerebrovascular disease ranked very near the top, has been stable in the top three, seriously affected people's normal life intake and body health. Because of modern diet, lifestyle changes, increasing aging population, resulting in an increased incidence of cerebrovascular disease in time. Cerebrovascular disease includes two kinds, the first is called ischemic cerebrovascular disease, second for hemorrhagic cerebrovascular disease. The ischemic cerebral vascular disease in the clinic, accounting for all 84%. in patients with ischemic cerebrovascular disease is because brain tissue caused by atherosclerotic vascular sclerosis, intracranial vascular lumen narrowing, corresponding intravascular blood flow decreased or interrupted, the blood supply is severely reduced, The brain lack of oxygen, a series of symptoms of brain damage appear. At this stage, China's treatment of ischemic cerebrovascular disease is mainly divided into conservative treatment and surgical treatment. Surgical department mainly in the expansion, thrombolysis, anticoagulation, antiplatelet aggregation and the main measures to promote recovery of brain function. Because nerve cells as non renewable cells. And thrombolytic therapy requires a good grasp of the time window, brain cells, hypoxia tolerance time is very limited. Therefore, to have occurred ischemia or infarction of brain tissue for medical treatment, the curative effect is not very ideal. In the surgical treatment of carotid artery endarterectomy (CEA) is an important means of the surgical incision through direct vascular lesions remove the blockage of blood vessels, intimal thickening and plaque, lumen to restore blood flow, improve cerebral circulation. Carotid endarterectomy (CEA) to remove the cause of stroke, It can play an important role in the prevention of stroke attack. For patients suffering from stroke, if early carotid endarterectomy, improve the brain blood supply to the brain damage caused by stroke, the recovery is also very optimistic. Therefore, so far at home and abroad, CEA is still considered the gold standard for the treatment of cervical arterial stenosis. Objective: to patients with unilateral carotid stenosis carotid artery endarterectomy, carotid artery on the other side of non surgery, vertebral artery blood flow velocity were analyzed and compared. In order to explore the change of hemodynamics evaluation of the disease and the significance of the treatment and prevention of diseases. Methods: severe on April 2009 to April 2014 Dalian Central Hospital for diagnosis and treatment of neurological side of carotid artery stenosis (70 ~ 99%), with contralateral carotid artery with mild or no stenosis in 50 cases were retrospectively data Analysis. All patients underwent CEA surgery. On the narrow side of all the patients were followed up respectively in 1 weeks after CEA, January, and June were neck vascular ultrasound examination for 12 months, and recorded the operation side and the contralateral carotid, internal carotid and vertebral artery blood flow velocity data, and according to the number of all comparison and statistical analysis. Results: all the operations were successful, postoperative stenosis of carotid artery blood flow hemodynamics returned to normal, and all patients improved symptoms. The contralateral carotid, internal carotid and vertebral artery blood flow velocity and blood flow decreased compared with preoperative, and significant difference was statistically significant (P0.05) conclusion: severe stenosis of carotid artery stenosis after CEA, contralateral carotid artery, vertebral artery blood flow velocity showed an overall downward trend. And the blood flow velocity changes from the early stage after CEA. But the rate of decline of blood vascular lesions side flow, cause The corresponding blood flow and shear force will decrease and increase the risk of plaque formation. Therefore, after performing CEA operation on narrow vessels, we should continue to control the risk factors of atherosclerosis and observe intimal changes of contralateral vessels closely.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12
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本文编号：1717022