大脑中动脉狭窄脑梗死颅内血流动力学及侧支循环研究

目的 探讨大脑中动脉(MCA)狭窄或闭塞的脑梗死患者颅内血流动力学改变和侧支循环的代偿及神经功能缺损的关系.方法 通过经颅多普勒(TCD)检查,计算双侧大脑前动脉(ACA)、大脑后动脉(PCA)峰流速及其比值(RVACA、RVPCA),并与正常对照组比较.结果 共观察38例单侧MCA狭窄或闭塞的脑梗死患者.(1)病例组ACA、PCA血流速度代偿性增快,以ACA代偿为主(76.3%);(2)病例组RVACA明显较对照组高﹙P<0.01﹚;(3)MCA主干及皮层支梗死患者的RVACA明显较对照组及深穿支梗死组高﹙P<0.01,P<0.05﹚;MCA重度狭窄或闭塞脑梗死患者的RVACA较对照组及中度狭窄组高﹙P<0.05﹚;(4)病例组RVACA及RVPCA与NIHSS呈负相关(P<0.01﹚.结论 皮质软脑膜侧支吻合血管开放成为MCA狭窄或闭塞脑梗死侧支循环的主要途径,其代偿程度与预后相关.     

203例急性脑梗死患者脑供血动脉分布特点与分析

目的运用数字减影血管造影(Digital subtraction angiography DSA)技术,探讨急性脑梗死患者脑供血动脉狭窄的特点及侧枝循环代偿情况。方法回顾性分析203例急性脑梗死患者的DSA检查结果,明确脑供血动脉狭窄发生率、狭窄部位、程度及侧枝循环建立情况。结果 203例患者中发现单纯颅内动脉狭窄78例(43.09%),单纯颅外动脉狭窄46例(25.41%),颅内、颅外动脉均存在狭窄者57例(31.49%)。198处颅内动脉狭窄中,大脑中动脉狭窄72处(36.55%);214处颅外动脉狭窄中,颈内动脉颅外段狭窄77处(35.98%),椎动脉颅外段狭窄71处(33.18%)。分析可能引起同一侧枝循环途径的病变共174处,发现侧枝循环118例,Willis环代偿所占比例较高,其次为软脑膜吻合支。重度狭窄及闭塞组侧枝循环代偿发生率明显高于轻、中度狭窄组(P<0.05)。结论急性脑梗死患者颅内动脉狭窄发生率高于颅外,颅内动脉狭窄好发于大脑中动脉,颅外动脉狭窄好发于颈内动脉颅外段及椎动脉颅外段。侧枝循环途径以Willis环最常见,软脑膜吻合支次之,严重的脑供血动脉狭窄更易发生侧枝循环代偿。     

侧支循环评价对大脑中动脉重度狭窄的急性缺血性脑卒中功能结局的预测作用

目的探讨大脑中动脉重度狭窄或闭塞的急性缺血性脑卒中(AIS)患者侧支循环代偿评价对临床功能结局的预测作用。方法收集伴大脑中动脉重度狭窄或闭塞的AIS患者79例,采用DSA评估患者颅内侧支循环代偿情况,根据侧支循环代偿途径分为Willis动脉环开放组和未开放组,根据侧支循环代偿程度分成侧支循环代偿良好组、代偿中等组和代偿差组;对患者入院及出院时进行神经功能缺损评分(NIHSS),90d随访时用改良Rankin(mRS)量表衡量AIS患者神经功能恢复状况。结果 Willis环开放患者37例,未开放患者42例,两组患者入院和出院时NIHSS评分及90d mRS评分比较差异无统计学意义(P0.05);侧支循环代偿较好组患者入院和出院时NIHSS评分及90d mRS评分显著低于侧支循环代偿差组(P0.05)。结论大脑中动脉重度狭窄或者闭塞的AIS患者,侧支循环代偿程度与神经功能缺损程度相关,能够预测90d临床功能结局。     

急性大脑中动脉闭塞患者侧支循环开放程度与神经功能损害及氧化应激反应程度的关系

目的 探讨急性大脑中动脉(MCA)闭塞患者侧支循环开放程度与神经功能损害及氧化应激反应程度的关系。方法 选择本院2017年1月-2019年6月收治的MCA闭塞患者,根据数字减影血管造影(DSA)检查对侧支血流的判断分为侧支循环代偿良好(A)(TIMI 2～4级)组、侧支循环代偿不佳(B)(TIMI 0～1级)组,比较2组的临床资料及血清相关神经系统标志物、氧化应激标志物水平。结果 A组有吸烟史、糖尿病史的例数以及脑梗死体积、NIHSS评分明显低于B组(P<0.05),2组有饮酒史的例数比较无明显差异(P>0.05); A组血清NSE,S100B,GFAP,MDA,8-iso-PGF2α,8-OHdG水平明显低于B组(P<0.05),BDNF,NGF,GSH-Px,SOD水平明显高于B组(P<0.05)。结论 急性MCA闭塞患者侧支循环良好代偿能够减轻神经功能损害及氧化应激反应,改善患者的临床结局。     

血同型半胱氨酸与伴重度颅内动脉狭窄或闭塞的脑卒中患者侧支循环建立的关系

目的探讨伴颅内动脉重度狭窄或闭塞的急性缺血性脑卒中(CIS)患者血同型半胱氨酸(Hcy与侧支循环代偿以及患者恢复情况的的关系。方法检测116例伴颅内动脉重度狭窄或闭塞的急性患者血Hcy,根据表达水平分为高同型半胱氨酸血症(Hhcy)组和正Hcy组;采用DSA评估患者颅内侧支循环代偿情况,根据侧支循环代偿程度分成代偿差组,代偿中等组和代偿好组;根据入院及出院时进行NIHSS评分,分为恢复良好组(分值减少≥4)和恢复不良组(分值减少<4)。结果 Willis动脉环开放组Hcy水平低于未开放组;侧支循环代偿好组Hcy水平低于代偿差组;恢复良好组Hcy水平低于恢复不良组。结论 Hhcy水平不利于侧支循环的代偿,Hhcy是伴颅内动脉重度狭窄或者闭塞患者卒中恢复的影响因素。     

临床-ASPECTS评分不匹配在急性颈内动脉或大脑中动脉主干闭塞8～14 h再通治疗中的探讨

目的 探讨对急性颈内动脉或大脑中动脉主干闭塞8～14 h的患者采用临床-Alberta卒中项目早期CT评分(Alberta stroke programme early CT score,ASPECTS)不匹配指导血管内介入再通治疗的可行性。方法 将2012年1月～2017年12月确诊的41例急性颈内动脉或大脑中动脉主干闭塞的住院患者分为治疗组(24例)和对照组(17例),行ASPECTS评分、改良的脑梗死溶栓(modified Thrombolysis in Cerebral Infarction,mTICI)分级、侧枝代偿评估及症状性颅内出血(symptomatic intracranial hemorrhage,SICH)风险评估; 于入院时和入院治疗后24 h、7d分别进行美国国立卫生研究院卒中量表评分(National Institutes of Health stroke Scale,NIHSS),治疗后90 d用改良Rankin量表(Modified Rankin Scale,mRS)评定临床预后,采用Logistic回归预测良好临床预后的相关因素。结果 与基础NIHSS评分比较,治疗组患者血管再通治疗后24 h和7 d NIHSS评分呈显著性下降(P<0.05),治疗后24 h、7 d NIHSS评分治疗组较对照组显著下降(P<0.05); 治疗后90 d治疗组良好预后较对照组明显改善(P<0.05),治疗组出血转化率较对照组显著下降(P<0.05)。治疗组良好临床预后与临床-ASPECTS不匹配、良好的侧枝代偿等相关。结论 对急性颈内动脉或大脑中动脉主干闭塞8～14 h的患者采用临床-Alberta卒中项目早期CT评分不匹配结合侧枝代偿、mTICI分级可能有利于筛选时间窗外血管再通受益患者。     

单侧大脑中动脉病变患者侧支循环对脑梗死体积及预后的影响

目的 观察单侧大脑中动脉不同程度慢性狭窄或闭塞后侧支循环形成及对脑梗死体积及预后的影响.方法 2016年1月至2018年10月河北省人民医院神经内科诊治单侧大脑中动脉狭窄或闭塞合并急性脑梗死(ACI)患者51例.记录临床资料,脑血管造影评价侧支循环,采用PACX软件计算脑梗死体积,随访患者预后.结果 大脑中动脉狭窄组较...     

急性脑梗死患者血清尿酸水平与颅内动脉重度狭窄或闭塞的侧支循环关系分析

目的探讨伴颅内动脉重度狭窄或闭塞的急性脑梗死(ACI)患者血清尿酸水平与侧支循环及病情恢复的关系。方法采用数字减影脑血管造影技术(DSA),根据颅内动脉狭窄程度将297例ACI患者分为轻度或无狭窄组、中度狭窄组和重度狭窄或闭塞组;收集患者临床资料,检测血清总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白及尿酸水平,进行比较;评估重度狭窄或闭塞患者颅内侧支循环代偿情况,分析与血尿酸水平的关系;根据入院及出院时进行NIHSS评分,将重度狭窄或闭塞患者分为恢复良好组(分值减少≥4)和恢复不良组(分值减少<4)。结果与轻度或无狭窄组相比,重度狭窄或闭塞组患者高血压、糖尿病病史及吸烟史比例较高,血清尿酸、总胆固醇及低密度脂蛋白水平也显著较高;侧支循环开放组血尿酸水平显著低于未开放组;恢复良好组尿酸水平低于恢复不良组。结论血清尿酸水平与ACI患者颅内动脉狭窄程度有关,并且重度颅内动脉狭窄或闭塞患者中,尿酸水平与侧支循环代偿相关,而且是影响ACI病情恢复的因素。     

DSA对单侧颈内动脉系统大动脉狭窄或闭塞后侧支循环建立的应用价值

目的 探讨DSA对单侧颈内动脉系统大动脉狭窄或闭塞后侧支循环建立的应用价值,探讨三级侧支循环在单侧颈内动脉开口部位狭窄或闭塞及大脑中动脉M1段狭窄或闭塞中的特点.方法 分别对56例颈内动脉开口处狭窄或闭塞及94例大脑中动脉M1段狭窄或闭塞的患者进行脑血管造影检查,根据其狭窄程度分析其侧支循环建立的情况.结果 颈内动脉开口部位闭塞组大脑动脉环开放率约38.5%,颅内外沟通开放率30.8%,软脑膜吻合支开放率约30.8%;重度狭窄组大脑动脉环开放率35.1%,软脑膜吻合支开放率16.2%,颅内外沟通开放率约5.4%;中轻度狭窄组无侧支循环建立.大脑中动脉M1段闭塞组大脑动脉环开放率5%,软脑膜吻合支开放率95%;重度狭窄组仅软脑膜吻合支开放,开放率约61%;轻中度狭窄组无侧支形成.结论 在颈内动脉开口部位重度狭窄或闭塞的病例中,一级侧支循环的开放代偿最为重要,二级侧支循环起着重要的辅助作用.在大脑中动脉M1段重度狭窄或闭塞的病例中,二级和三级侧支循环的开放起主要的代偿作用.     

脑动脉狭窄伴脑梗死患者侧支循环建立情况的探讨

目的探讨急性缺血性脑梗死患者颅内脑动脉狭窄或闭塞后侧枝循环形成情况。方法 235例经影像学发现存在颅内动脉狭窄或闭塞的急性缺血性脑梗死患者,依据有无侧支循环分为两组,对可能与侧支循环建立有关的影响因素进行单因素及logistic多因素回归分析。结果 (1)侧支循环形成的检出率DSA最高,MRA次之;(2)Logistic回归分析显示:以侧支循环开放作为因变量时大脑中动脉狭窄、颈内动脉闭塞、基底动脉狭窄进入回归方程,OR分别为0.598、2.395、3.494;P值分别为0.104、0.081、0.015。结论大脑中动脉狭窄、颈内动脉闭塞、基底动脉狭窄可能促进侧支循环开放。     

颅脑损伤后炎症反应与脑水肿

创伤性脑水肿是创伤性脑损伤（traumatic brain iniury，TBI）后的主要继发性病理生理过程之一，也是导致颅内压增高的主要原因。目前国内外多数学者主张将脑水肿分为血管源性、细胞毒性、渗透压性和脑积水性（间质性）四类。过去几十年，根据冷冻性脑损伤模型的研究结果，普遍认为创伤性脑水肿以血脑屏障（BBB）破坏后的血管源性脑水肿为主。但新近研究发现，创伤性脑水肿是血管源性和细胞毒性的混合性水肿，并且以细胞毒性脑水肿为主。[第一段]     

Quantitative measurement of cerebral blood flow and cerebral blood volume after cerebral ischaemia

CBF obtained by the hydrogen clearance technique and cerebral blood volume (CBV) calculated from the [14C]dextran space were measured in three groups of rats subjected to temporary four-vessel occlusion to produce 15 min of ischaemia, followed by 60 min of reperfusion. In the control animals, mean CBF was 93 +/- 6 ml 100 g-1 min-1, which fell to 5.5 +/- 0.5 ml 100 g-1 min-1 during ischaemia. There was a marked early postischaemic hyperaemia (262 +/- 18 ml 100 g-1 min-1), but 1 h after the onset of ischaemia, there was a significant hypoperfusion (51 +/- 3 ml 100 g-1 min-1). Mean cortical dextran space was 1.58 +/- 0.09 ml 100 g-1 prior to ischaemia. Early in reperfusion there was a significant increase in CBV (1.85 +/- 0.24 ml 100 g-1) with a decrease during the period of hypoperfusion (1.33 +/- 0.03 ml 100 g-1). Therefore, following a period of temporary ischaemia, there are commensurate changes in CBF and CBV, and alterations in the permeability-surface area product at this time may be due to variations in surface area and not necessarily permeability.     

Recovery from aphasia and cerebral blood flow: a comparison between cerebral hemorrhage and cerebral thrombosis

To compare cerebral circulation in aphasic patients who had cerebral hemorrhage against those who with cerebral thrombosis, we studies 50 patients with hypertensive intracranial (putaminal) hemorrhage and 20 patients with cerebral thrombosis whose diagnoses were confirmed on repeated CT scan and cerebral angiography. The measurements of regional cerebral blood flow (rCBF) by the 133Xe intraarterial injection method was carried out in 40 patients. The evolution of the aphasic syndrome was analyzed according to Hirano's classification and the patients were divided into two groups: those having a favorable recovery from aphasia; those with a poor recovery. Twelve out of 20 patients with cerebral hemorrhage showed a favorable recovery from aphasia, whose left hemispheric mean blood flow (mCBF) was 33.1 +/- 9.7 ml/100 g/min. The mCBF was 30.8 +/- 10.3 ml/100 g/min in 8 patients with a poor recovery. There was no significant difference in mCBF values between the two groups. The favorable recovery group showed slightly higher regional values in the left frontal and temporal lobes than did the poor recovery group, but no significant difference was found between the two group. Here, rCBF values failed to correlate between the two kinds of recovery from aphasia in patients with cerebral hemorrhage. The marked variability in rCBF values in the acute stage might partly account for the poor correlation in cerebral hemorrhage. In contrast, a series of rCBF studies demonstrated that rCBF values stabilized in the acute and subacute stage in cerebral thrombosis. Nine out of 20 patients with cerebral thrombosis had a favorable recovery from aphasia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Regional cerebral blood flow correlates of aphasia outcome in cerebral hemorrhage and cerebral infarction

The relationship between recovery from aphasia and regional cerebral blood flow (CBF) was compared in 87 patients, 44 with cerebral hemorrhage and 43 with non-embolic cerebral infarction. CBF values correlated poorly with aphasia outcome in patients with cerebral hemorrhage whereas a tight correlation was demonstrated in patients with non-embolic cerebral infarction. A marked variability of CBF values in the acute and subacute stage might account for the poor correlation between CBF and aphasia outcome in patients with cerebral hemorrhage. On the other hand, a sharp discrimination was achieved between those with a good recovery from aphasia and those with a poor recovery by the dimensions of the hematoma on CT. In non-embolic cerebral infarction, a relative frontal ischemia was associated with motor aphasia while a relative temporal ischemia was associated with sensory aphasia. This dichotomy was not demonstrated in the regional CBF values in patients with cerebral hemorrhage.     

Effects of ATP on cerebral circulation--morphological observation of cerebral circulation and cerebral vasculature]

Review was made on the effect of adenosine triphosphate, 1.0-3.0 mg/kg intravenously, on the cerebral circulation and the presence of the dilating action on the cerebral blood-vessels in cats. 1. The group of the normal intra-cranial pressure showed, as reported previously, the transient hypotension and its complicated decrease of cerebral blood-circulation at the initial period for 30-100 check, then demonstrating the increase of cerebral blood-flow for 200-1000 check. Its increased volume and duration were dose-dependent. 2. The group of the loaded intracranial pressure of 20-30 mmHg (slightly elevated group) showed the increase of cerebral blood-flow, like the group of the normal intracranial pressure. However, the effect of ATP showed the decrease or disappearance in accordance with the elevation of the loaded pressure. 3. Cerebral vasodilating effect of ATP was promptly observed after the administration, and its degree was 30-50% in photographical observation. 4. Increasing effect on cerebral blood-flow and cerebral vasodilating action of ATP were similar in the pattern to that of vasodilators such as papaverine hydrochloride.