急性脑梗死患者经颅多普勒检查异常与预后关系的研究

目的 探讨急性脑梗死患者经颅多普勒超声(Transcranial Doppler,TCD)检查异常与预后的关系;方法对36例经头颅CT及MRI(Magnetic Resonance Imaging)证实为急性大脑中动脉(Middle Cerebral Artety,MCA)脑梗死患者在发病早期(1～3天)进行TCD及磁共振血管造影(Magnetic Resonance Angiography,MRA)检测,根据双侧大脑中动脉平均流速相差的百分数高低分成流速对称组与不对称组,每组18例.随访6个月,记录6个月内发生的任何脑血管事件,并进行巴塞尔指数(Barthel Index,BI)评估,分析两组预后的差异.结果 6个月后,36例患者中6例死亡,5例再发脑梗塞.5例再发脑梗塞患者中80%(4/5)为两侧MCA流速不对称的,80%(4/5)为MCA中-高度狭窄.双侧大脑中动脉流速不对称组BI评分明显低于对称组(p＜0.05).结论 TCD异常可预示急性脑梗死患者的预后;两侧MCA流速不对称性越大及狭窄程度越高发生脑血管事件的危险性越大,其预后愈差.

Study of the Relation Between TCD Abnormality and Prognosis in Patients With Acute Infarction

Objective To study the relation between TCD abnormality and prognosis in patients with acute infarction.Methods Transcranial Doppler(TCD)and MRA were performed in 36 patients with acute infarction in the middle cerebral artery territory confirmed by CT scan and cranial MRI within 3 days from stroke onset.All patients were divided into normal MCA group and MCA asymmetry group(each 18 cases),according to the side-to-side velocity difference.They were followed for 6 months during which we recorded any cerebral vascular events and evaluated Barthel Index(BI),and then analysed the difference of prognosis between the two groups.Results After six months,thirty-six patients were all followed up,six patients were dead,five patients had another ischemic events in the territory supplied by the stenosed MCA.80%(4 out of 5)patients were asymmetry and had moderate-severe stenoses in middle cerebral arteries.The BI scores of MCA asymmetry group were obviously lower than that of the normal group(p<0.05).Conclusions Abnormal TCD may be used to predict the prognosis of the patients with acute infarction.The severer the MCA asymmetry and the degree of MCA stenosis is,the higher the risk of recurrence of cerebrovascular disease is.And the more different the side-to-side velocity of middle cerebral arteries is,the worse the prognosis is.