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目的 分析颈内动脉严重狭窄 (狭窄≥ 75 % )或闭塞患者 (ICASO)颅内脑血流改变与临床表现的关系。方法 经全脑数字减影血管造影 (DSA)检查证实的ICASO患者 66例 (单侧病变 5 0例 ,双侧 16例 )。临床分为脑梗死组、TIA组和无体征组。应用经颅多谱勒超声 (TCD)检测双侧大脑中动脉 (MCA)血流速度 (Vmca)并判断颅内侧枝循环的开放。结果 ①与DSA比较TCD对前交通动脉 (ACOA)判断的敏感性 97% ,特异性 93 % ;后交通动脉 (PCOA)敏感性 92 % ,特异性83 % ;眼动脉 (OA)开放的敏感性 98% ,特异性 90 %。无体征组和TIA组ACOA和PCOA同时存在的出现率高 ,而脑梗死组则仅有OA存在的出现率最高。②狭窄同侧Vmca(3 9 5 5± 13 2 8)cm/s明显低于对侧 (78 90± 2 4 15 )cm/s(P <0 0 1) ,频谱低平呈波浪状。脑梗死组低于TIA组和无症状组 (P <0 0 5 )。结论 TCD可以无创性地检测颈内动脉严重狭窄或闭塞后脑血流动力学的改变 ,并与临床表现相关。前后交通动脉代偿良好时不易出现脑梗死 ;仅有眼动脉反向存在及大脑中动脉血流速度的明显降低往往提示代偿不足 ,易发生缺血性病变。
Objective To analyze the relationship between intracranial cerebral blood flow changes and clinical manifestations in severe carotid stenosis (stenosis ≥ 75%) or occlusion (ICASO). Methods Sixty-six ICASO patients (50 unilateral lesions and 16 bilateral) confirmed by whole brain digital subtraction angiography (DSA). Clinically divided into cerebral infarction group, TIA group and no sign group. Transcranial Doppler echocardiography (TCD) was used to detect blood flow velocity (Vmca) of bilateral middle cerebral artery (MCA) and determine the opening of intracranial collateral circulation. Results ① The sensitivity and specificity of TCD in judging anterior communicating artery (ACOA) were 97% and 93% respectively. The sensitivities of posterior communicating artery (PCOA) were 92% and specificity were 83%, and the sensitivity of opening of ophthalmic artery 98%, specificity 90%. There was a high incidence of coexistence of ACOA and PCOA in the non-sign group and the TIA group, while only the presence of OA in the cerebral infarction group was the highest. ② The stenosis ipsilateral Vmca (3955 ± 1328) cm / s was significantly lower than the contralateral (78 90 ± 2 4 15) cm / s (P <0.01). Cerebral infarction group was lower than TIA group and asymptomatic group (P <0 05). Conclusion TCD can detect noninvasive changes of cerebral hemodynamics after severe stenosis or occlusion of internal carotid artery and is related to clinical manifestations. Before and after the traffic artery compensatory good not easy to appear cerebral infarction; only the reverse of the ophthalmic artery and the middle cerebral artery blood flow velocity significantly reduced often prompted inadequate compensation, prone to ischemic lesions.