经颅多普勒对颅内动脉狭窄诊断的临床应用

目的：探讨颅内动脉狭窄经颅多普勒（TCD）检测特点,筛选对于诊断有价值的检测指标。方法：TCD检测86例缺血性脑血管病（ICVD）患者收缩期峰流速（Vp）、舒张末期流速（Vd）、平均血流速度（Vm）、阻力指数（RI）及脉动指数（PI）,着重对血管反应性进行观察。结果：86例患者颅内动脉狭窄为中轻度31例,中度17例,重度12例,大脑中动脉闭塞5例,共计65例为颅内动脉狭窄组（狭窄组）,无动脉狭窄21例为无狭窄组。狭窄组患者大脑中及前动脉血管反应性明显低于非狭窄组（P〈0.05）;轻、中度患者Vp、Vd、Vm、RI及PI与非狭窄组比较无明显改变,重度患者则可见Vp低于非狭窄组（P〈0.01）。结论：TCD是诊断颅内动脉狭窄的有效手段;与MRI及血管造影取长补短,可提高颅内动脉狭窄的诊断率,并可作为ICVD高发人群筛选工具。血管反应性是诊断颅内动脉狭窄的敏感指标,血流速度只能起参考作用,不能作为颅内动脉狭窄的诊断依据及分级标准。

The Clinical Application of TCD in the Diagnosis of Intracranial Arterial Stenoses

Objective: To study the characteristics of TCD in intracranial artery stenoses and screen the valuable diagnosis indexes.Methods: Eighty-six cases of insufficiency cerebral vascular diseases were examined with TCD,and the detection indexes included: peak systolic velocity(Vp),end diastolic peak velocity(Vd),mean blood flow rate(Vm),resistance index(RI),pulsatility index(PI).Vascular response was emphatically observed.The patients were divided into stenosis group(65 cases) and non-stenosis group(21 cases) according to the results from TCD.Results: In 86 cases detected by TCD,there were 31 cases of mild stenosis,17 cases of moderate stenosis and 12 cases of severe stenosis,and 5 cases of MCA occlusion.In the stenosis group,the vascular responses of MCA and ACA were significantly decreased as compared with non-stenosis group(P<0.05).There was no significant difference in Vp,Vd,Vm,RI and PI in mild cases and moderate cases between stenosis group and non-stenosis group,but in severe cases,the Vp in stenosis group was lower than that in non-stenosis group(P<0.01).Conclusion: TCD is a valuable means in diagnosing intracranial artery stenosis.Vascular response is a sensitive index. The indexes of blood flow can not be used as diagnostic and grading criterion.