颈内动脉重度狭窄或闭塞患者的侧支循环与神经功能的单因素分析

目的 探讨颈内动脉重度狭窄或闭塞患者侧支循环的代偿作用与临床神经功能缺损程度的关系. 方法对52例连续颈内动脉狭窄或闭塞所致的脑梗死患者入院时行神经功能缺损评分(NIHSS)评分,利用数字减影脑血管造影技术(DSA)评估颅内动脉的侧支循环代偿情况.应用统计学方法探讨两者之间的关系.结果 DSA发现52例患者18例出现颈内动脉闭塞,单侧颈内动脉重度狭窄28例,6例双侧重度狭窄.52例患者中出现前交通动脉代偿18例,后交通动脉代偿8例,前后交通动脉同时代偿12例,14例患者未出现Willis环血管的代偿.无Willis环代偿组与Willis环代偿组NIHSS评分平均秩次分别为35.75和23.09,两组差异有统计学意义(P<0.05).前交通代偿组与后交通代偿组NIHSS评分平均秩次分别为12.42和15.94,两组差异无统计学意义(P<0.05).结论颈内动脉狭窄或闭塞时可通过多种方式进行有效的代偿.NIHSS评分与血管代偿及阻塞位置显著有关.DSA对侧支循环的判定在治疗干预中显得尤为重要.

Univariate analysis of collateral circulation and nerve function in patients with severe stenosis or occlusion of internal carotid artery

Objective To investigate the relation between compensation of collateral circulation and the severity of clinical neurologic deficit in patients with severe stenosis or occlusion of the internal carotid artery (ICA). Methods National Institutes of Health Stroke Scale (NIHSS) examination was performed in 52 patients with cerebral infarction caused by consecutive stenosis or occlusion of ICA during admission and digital subtraction angiography (DSA) was employed to evaluate the compensation of collateral circulation to analyze the results through statistical methods. Results DSA demonstrated occlusion oflCA in 18 patients, severe stenosis of unilateral ICA in 28, and severe stenosis of bilateral ICA in 6. Anterior communicating artery (ACoA) compensation was presented in 18 patients;posterior communicating artery (PCoA) compensation appeared in 8;both ACoA and PCoA compensations were showed in 12. Only 14 patients have no compensation by Willis circle. Significant differences of average ranks of the NIHSS were found in non Willis circle (35.75) and Willis circle (23.09) (P<0.05);while no significant differences were noted in ACoA (12.42) and PCoA (15.94) compensations (P>0.05). Conclusions Effective collateral circulation can be established spontaneously through multiple ways when occlusion or severe stenosis of ICA appears. The NIHSS scores and the compensation, the location of vessel occlusion are significantly correlative. It is extremely important to investigate the collateral circulation carefully through DSA before treatment intervention.