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目的探讨大脑中动脉(MCA)狭窄患者的发病机制及药物治疗对微栓子的影响。方法 75例符合脑血管狭窄诊断标准的缺血性卒中患者入选试验组。常规经颅多普勒超声(TCD)检查后,进入 TCD 8.0微栓子信号(MES)监测软件,取双侧 MCA 作监测血管,将多深度探头的两个取样深度分别置于狭窄处的远、近端,监测时间为40 min。结果 75例病人 MCA 狭窄105条。微栓子监测14例阳性(18.7%)。MES 阳性与MES 阴性病人欧洲卒中量表(ESS)评分比较差异无显著性(P>0.05)。抗血栓药物治疗后 MES 明显减少(P<0.05)。平均随访1.5年,MES 阳性组脑血管事件再发率高于阴性组(P<0.05)。结论 (1)MCA 狭窄是一个独立的栓子源,MES 出现预示有脑血管事件再发的危险。(2)MES 的出现与 ESS 评分的高低无关,高度狭窄的 MCA 易出现 MES。(3)抗血栓药物可以抑制 MES 的产生,MES 监测可作为评价抗凝或抗血小板聚集药物治疗是否有效的一项指标。
Objective To investigate the pathogenesis of middle cerebral artery (MCA) stenosis and the effect of medical treatment on microemboli. Methods Seventy-five patients with ischemic stroke meeting the diagnostic criteria of cerebrovascular stenosis were enrolled in the experimental group. Conventional transcranial Doppler ultrasound (TCD) examination, into the TCD 8.0 microembolization signal (MES) monitoring software, bilateral MCA for monitoring blood vessels, the multi-depth probe two sampling depth were placed in the stenosis far , Proximal, monitoring time is 40 min. Results 75 cases of MCA narrow 105. Forty-nine patients were positive for micro-emboli monitoring (18.7%). There was no significant difference in ESS scores between MES-positive and MES-negative patients (P> 0.05). MES decreased significantly after antithrombotic treatment (P <0.05). After a mean follow-up of 1.5 years, the recurrence rate of cerebrovascular events in MES positive group was higher than that in negative group (P <0.05). Conclusion (1) MCA stenosis is an independent source of emboli, MES indicates the risk of recurrence of cerebrovascular events. (2) The appearance of MES has nothing to do with the ESS score, MES appears in the highly narrow MCA. (3) Antithrombotic drugs can inhibit the production of MES, MES monitoring can be used as an evaluation of anticoagulant or anti-platelet aggregation drug treatment is an indicator of effectiveness.