大面积脑梗死脑血流动力学动态变化研究

目的探讨大面积脑梗死后颅内血流动力学动态的变化特点。方法对58例大面积脑梗死患者采用影像学供血模型分为完全MCA型和MCA皮质型,利用床旁经颅彩色多普勒（TCD）于入院当天和1周内隔日1次及第14天动态检测颅内血流情况,通过测定脑底动脉血流速度、搏动指数及血流速度比值（RVACA）,观察颅内血管血流动力学变化。结果大面积脑梗死病灶侧大脑中动脉（MCA）平均血流速度（Vm）、颈内动脉（ICA）平均血流速度均明显低于对照组（P〈0.05）,完全MCA型组较MCA皮质型组MCA血流速度明显减慢;完全MCA型与MCA皮质型梗死后动态观察MCA血流变化不明显,NIHSS评分及Pi在第3、5、7天较第1天明显增高（P〈0.05）,NIHSS评分变化最明显。结论大面积脑梗死患者可通过床旁TCD动态检测,及时发现侧支循环代偿及血管再通情况,评价颅内压动态变化,结合神经功能缺损评分,观察脱水降颅压治疗反应,为患者选择合适的治疗方案提供依据。

Study of the dynamic change of cerebral blood flow in large area of cerebral infarction

Objective To investigate the characteristics of vascular hemodynamics in patients with large area cerebral infarction. Methods Total 72 patients with large area cerebral infarction were divided into full MCA type and MCA cortical type on the basis of imaging of blood model. In the acute stage, the intracranial blood flow dynamic change was tested on the first, second day, fifth, seventh and fourteenth day by the method of bed transcranial color Doppler （TCD）, and the blood flow change was observed by testing the flow velocity of brain artery blood, throb index and blood flow velocity ratio （RVACA and RVPCA）. Results The mean blood flow velocity （Vm） in the brain disease sides artery （MCA） of large area cerebral infarction and internal carotid artery （iCA） were significantly lower than those in control group （P〈0.05）. Compared with MCA cortical type group, MCA blood flow velocity slowed down obviously in MCA group. MCA blood flow change in MCA group was not serious compared with MCA cortical type group. The scores of NIHSS and the PI were signifieantly higher at the 3rd, 5th and 7th day than 1st day （P〈0.05）. Conclusion Through the bed TCD, we can understand intraeranial hemodynamic changes and vascular resistance of large area cerebral infarction, learn the blood situation in infarction area, evaluate cranial pressure, observe the treatment response of dehydration drop cranial pressure combined with neural function defect scale, and choose the right treatment plan.