应用灌注磁共振技术评价缺血性脑血管病的外科治疗

目的:应用灌注磁共振技术,评价缺血性脑血管病的外科治疗疗效。方法:回顾性分析23例接受外科治疗的缺血性脑血管病患者的临床及影像资料。结果:患者术前均以TIA、RIND发病,CT及MRI未见大面积脑梗塞,灌注磁共振(PWI)均显示rCBF正常或降低,MTT增大,血管造影显示颅内或颈动脉狭窄或闭塞,分别给与颈动脉内膜切除术、支架血管成形术或颈内、外动脉吻合术予以治疗,术后PWI改善达82.6％,随访发现87％的患者有不同程度的改善。结论:PWI能够准确地评价缺血性脑血管病的外科治疗疗效。     

CT灌注成像在缺血性脑血管病中的应用进展

CT灌注成像通过显示缺血病灶的部位、范围和程度,能够诊断超急性期脑梗死,指导溶栓治疗;能够评估梗死脑组织的预后及溶栓疗效、预测出血性转化。还能够通过显示脑梗死前期的血流动力学变化对脑梗死进行预警;评估短暂性脑缺血发作患者的脑血流灌注情况,提高脑血管狭窄、闭塞患者外科治疗的有效性和安全性。在缺血性脑血管病的诊疗中具有重要的应用价值。     

CT灌注成像联合血管成像在老年急性缺血性脑血管病中的应用价值

目的观察临床应用CT灌注成像联合血管成像对老年急性缺血性脑血管病的应用价值。方法选取2012-04—2015-12在我院进行诊治的77例急性缺血性脑血管病患者给予CT灌注成像联合血管成像检查,并根据CT、MRI检查分为短暂性脑缺血发作及脑梗死2组,分析2组患者的发病情况及血管成像检查结果、CT灌注成像参数。结果 CI组患者的CBV、CBF较健侧明显下降(P0.05),TTP和MTT较健侧明显延长(P0.05);TIA组与健侧相比仅有TTP及MTT明显延长(P0.05),CBV和CBF无明显变化(P0.05);总血管狭窄发生率为66.23%;发生血管狭窄患者CTPI阳性率明显高于无出现血管狭窄患者,差异有统计学意义(P0.05)。结论临床应用CT灌注成像联合血管成像能够为临床医师及时诊断、治疗老年急性缺血性脑血管病提供客观依据。     

CT灌注成像在超早期缺血性脑血管病的应用研究

目的　探讨CT灌注成像 (CTPI)在超早期缺血性脑血管病中的应用价值。方法　对4 6例缺血性脑血管病患者在发病后 6h内先行普通头颅CT平扫 ,再进行CTPI检查。结果　普通CT平扫显示 :4 6例缺血性脑血管病患者在发病后 6h内 ,显示低密度灶者 5例 ,诊断为脑梗死。未见异常者 4 1例 ,经临床追踪和复查CT证实 ,12例为短暂性脑缺血发作 (TIA) ,2 9例为脑梗死。 4 6例缺血性脑血管病发作 6h内的患者在CTPI显示 :①灌注正常者 16例 ,其中 12例临床诊断为TIA ,4例小体积脑梗死。②灌注异常者 30例 ,其中 2 5例普通CT未显示病灶 ,5例在CTPI显示的病灶范围较普通CT显示的病灶范围增大。CTPI异常的 30例患者rCBF、TP、MTT改变明显 ,病灶侧与健侧、病灶中心区与周边区比较 ,差异有显著意义 (P <0 .0 5 )。结论　CTPI能够超早期诊断脑梗死 ,并可鉴别诊断TIA。通过分析病灶内的血流灌注状态 ,明确病灶的部位、大小及范围 ,显示了半暗带的存在 ,对于超早期缺血性脑血管病患者选择治疗方案和判断预后具有重要意义。     

灌注及弥散磁共振成像在急性缺血性脑卒中的应用

目的　评估磁共振 (MRI)弥散加权成像 (DWI)及灌注加权成像 (PWI)在急性缺血性卒中指导溶栓治疗的应用价值。方法　对 44例急性 (≤ 6h)缺血性卒中患者行DWI、PWI扫描 ,DWI及PWI的不匹配区为缺血半暗带 ,根据半暗带是否存在确定患者是否适合溶栓治疗。结果　脑梗死患者 33例 ,其中 2 3例 (52 3 % )有明显半暗带存在 (PWI >DWI) ;1 0例 (2 2 7% )无明显半暗带 (PWI=DWI)。临床表现为短暂性缺血发作 (TIA)者 1 1例 (2 5 0 % )。结论　PWI及DWI对照研究有助于发现超早期脑梗死半暗带 ,指导溶栓治疗 ;临床表现结合DWI有助于除外TIA     

CT平扫、血管造影及血流灌注成像对缺血性脑血管病的诊断价值

目的　评价头部CT、CTA、CTP3项联合检查对缺血性脑血管病诊断价值。方法　对70例患者进行3项联合检查。结果　12例TIA患者中,半球腔隙性梗死3例,9例血管病变,4例CTP显示血流灌注异常。2 9例椎基底动脉供血不全患者,1例枕叶梗死,4例基底节腔隙性梗死,椎基底动脉系血管病变2 7例,6例血流灌注异常。2 9例脑梗死患者中,2例超早期CT未见异常,检出MCA闭塞和供血区血流灌注减低,余2 7例(含腔隙性脑梗死12例)中,检出动脉病变2 5例,血流灌注减低区15例。结论　对TIA及椎基底动脉供血不全的患者,3项联合检查可提供有价值的诊断资料,并能指导溶栓治疗。     

重视缺血性脑血管病的外科与介入治疗

本总结了缺血性脑血管病的传统药物治疗的疗效。指出引入新的治疗方法的必要性。简要介绍了颈动脉内膜切除术和经皮腔内血管成形 支架置入的临床应用,最后呼呈重视应用外科与血管内治疗方法预防中风的发生。     

磁共振弥散成像诊断急性缺血性脑血管病的观察

急性脑血管病早期正确的诊断对制定治疗方案和对改善患者的预后有十分重要的意义。近年来，随着神经影像技术的发展，MRI弥散成像(DWI)，使急性缺血性脑血管病的早期快速、准确诊断成为可能。现将我院子2003—02～2003—12收治的16例急性缺血性脑血管病患者的磁共振弥散成像结果报道如下。     

CT灌注成像联合CT血管造影诊断超早期缺血性脑血管病的价值

目的 研究CT灌注成像(CTPI)联合CT血管造影(CTA)对超早期缺血性脑血管病(ICVD)的诊断价值。方法 对46例ICVD患者，在发病6h内进行头颅CT平扫、CTPI及CTA检查。结果 (1)CT平扫：显示低密度灶5例，未见异常41例；(2)CTPI：脑血流灌注正常16例，异常30例；(3)CTA：27例患者大脑中动脉(MCA)、大脑前动脉(ACA)不同程度狭窄，2例MCA明显变细，17例CTA图像正常；(4)25例大、中体积脑梗死患者CTPI图像均显示相应灌注缺损区，CTA均显示血管狭窄或闭塞。9例小体积脑梗死患者中，CTPI显示灌注缺损区5例，正常4例；CTA显示血管狭窄2例，正常7例。12例短暂性脑缺血发作(TIA)患者CTPI均正常，2例CTA显示MCA明显变细，远侧血管网增多；其余10例正常。结论 CTPl联合CTA能够超早期诊断ICVD，并可鉴别TIA及不同梗死体积的脑梗死。     

CT血管成像及血流灌注对脑动脉狭窄及缺血性脑血管病的诊断价值

目的:应用多层螺旋CT(MSCT)采用CT血管成像(CTA)与CT灌注成像(CTPI)相结合的技术探讨对脑动脉狭窄及缺血性脑血管病的诊断价值及超早期治疗的价值。方法:30例急性缺血性脑血管病(AICVD)患者行CT平扫,CTA和CTPI检查。对比观察梗死区和对侧对照区,梗死病灶中心区与周边区的血流动力学参数数值;分析AICVD与CTA变化的关系。结果:30例AICVD患者,CT平扫10例短暂性脑缺血发作(TIA)患者均未见异常,20例脑梗死(CI)患者有1例有小灶性低密度。CTA显示10例TIA患者中正常8例,狭窄2例;20例CI患者中19例均有不同程度的动脉狭窄,1例正常,为脑干梗死。CTPI显示未见异常者12例,其中10例TIA,2例CI(1例基底节区腔隙梗死,1例脑干梗死)。灌注异常者18例中,梗死侧与健侧、病灶中心与周边区rCBF、rCBV、TTP的差异有统计学意义。结论:CTA联合CTPI对早期AICVD有诊断价值,并能指导临床进行合理治疗。     

Factors influencing ischemic cerebrovascular disease complicated by hyperhomocysteinemia★

BACKGROUND： Hyperhomocysteinemia, as an important risk factor for ischemic cerebrovascular disease is receiving increasing attention. OBJECTIVE： To analyze whether differences of gender, age, cerebrovascular disease typing, and disease conditions exist when ischemic cerebrovascular disease occurs together with hyperhomocysteinemia. DESIGN： A controlled observation. SETTING： Department of Neurology, Tianjin Huanhu Hospital. PARTICIPANTS： A total of 601 acute ischemic cerebrovascular disease inpatients, comprising 386 males and 215 females, aged 33-90 years old, were admitted to the Department of Stroke, Tianjin Huanhu Hospital between August 2005 and April 2007, and were recruited for this study. All included patients consisted of 342 aged patients （≥ 60 years old） and 92 middle-aged and young patients （〈 60 years old）. Among these patients, 48 suffered from transient cerebral ischemic attack, 138 from lacunar cerebral infarction, 273 from atherosclerotic stroke, 38 from cardiogenic cerebral infarction, 44 from agnogenic ischemic stroke, and 6 from other factor-induced ischemic strokes. All included inpatients corresponded to the diagnosis criteria of acute ischemic cerebrovascular disease, formulated in the 4^th National Working Conference of Cerebrovascular Disease, and were confirmed as acute ischemic cerebral infarction by CT and/or MRI examinations. Informed consents of laboratory measurements were obtained from all subjects, and this study was approved by the Hospital＇s Ethics Committee. METHODS： Following admission, 2 mL venous blood was collected from each fasting patient on the third morning. Plasma homocysteine level was measured by an enzymatic cycling assay with a CX5 reader （Beckman, USA）. Plasma homocysteine levels ≥ 16μ mol/L were defined as hyperhomocysteinemia. Clinical neurological function deficit scoring was also performed for each ischemic stroke patient using Chinese stroke scales. Scores ranged from 0 45 （0-15： mild neurological function deficits, 16-30?     

数字减影血管造影在缺血性脑血管病检查及治疗中的价值

目的探讨数字减影血管造影(DSA)在缺血性脑血管病检查及治疗中的价值。方法回顾性分析325例反复发作的短暂脑缺血发作或脑梗死患者的脑血管造影检查结果,结合临床症状及磁共振血管成像(MRA)进行对比。结果DSA未见明显异常18例,单纯颅外动脉狭窄163例,单纯颅内动脉狭窄76例,同时存在颅内外多发狭窄和(或)闭塞68例,83例接受了介入治疗。支架成形术后脑实质染色增加、循环时间缩短。结论全脑DSA检查是缺血性脑血管病诊断的"金标准",与MRA相比更能明确病变部位、形态、性质及侧枝循环情况,是介入干预前的必备手段,对评估支架成形术前术后血液动力学变化优于其他影像检查。     

缺血性脑血管病患者颈动脉粥样硬化与血浆炎性细胞因子的关系

目的探讨缺血性脑血管病(ICVD)患者颈动脉粥样硬化与血浆炎性细胞因子的关系。方法采用酶联免疫吸附法测定64例ICVD患者血浆白介素(IL)-6、基质金属蛋白酶(MMP)-8及可溶性白细胞分化抗原配体-40(sCD40L)的水平;彩色超声检测双侧颈部动脉血管硬化程度,并与非ICVD患者(对照组)进行比较;分析血浆IL-6、MMP-8及sCD40L水平与颈动脉粥样硬化程度的关系。结果与对照组相比,ICVD组血浆IL-6、MMP-8、sCD40L水平明显升高(均P<0.01);血浆IL-6、MMP-8、sCD40L水平与颈动脉粥样硬化程度关系密切。结论血浆炎性细胞因子水平与颈动脉粥样硬化程度以及颈动脉斑块进展有密切关系。     

Significance of ultrasound evaluation of carotid atherosclerotic plaque for diagnosing ischemic cerebrovascular disease

BACKGROUND: Carotid artery is the main source for craniocerebral blood supply. Its intimal plaque formation and arterial stenosis degree both are the risk factors for ischemic cerebrovascular disease. Therefore, the close relationship of carotid atherosclerotic plaque and ischemic cerebrovascular disease, and ultrasound evaluation of carotid atherosclerotic plaque have become the hot spot in studying ischemic cerebrovascular disease. OBJECTIVE: This study was to detect the degree of carotid atherosclerosis of ischemic cerebrovascular disease patients by ultrasonography, and to analyze the situation of carotid atherosclerosis and its relationship with clinic. DESIGN: Clinical randomized concurrent control experiment. SETTING: Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA. PARTICIPANTS: Totally 60 outpatients and inpatients with ischemic cerebrovascular disease, 42 males and 18 females, admitted to Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA between January 2006 and December 2006 were involved in the patient group. They met the diagnosis criteria of ischemic cerebrovascular disease constituted by the 4th Cerebrovascular Disease Conference in 1996, and were confirmed to suffer from ischemic cerebrovascular disease by skull CT and MRI. Another 20 subjects who received healthy examination concurrently in the same hospital, 12 males and 8 females, were involved in the control group. Informed consents of detected items were obtained from involved subjects. METHODS: The plaque thickness of mid portion, distal end and crotch of common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and vertebral artery (VA) of involved subjects, who received health examination was separately detected with color Doppler ultrasonograph (HDI-5000). Then, total integral of plaque was calculated. The intima-media thickness (IMT) was measured with two-dimensional ultrasonography. The inner diameter stenosis degree of subjects who had plaque was measured. Blood flow parameters were recorded, and stenosis degree and plaque area were calculated. Blood flow volume of bilateral carotid artery and VA was separately measured with ultrasound equipment software, and brain blood flow volume was calculated. MAIN OUTCOME MEASURES: Atherosclerotic degree and blood flow volume of patients of two groups. RESULTS: Sixty patients with ischemic cerebrovascular disease and twenty subjects who received health examination participated in the final analysis. ①The IMT thickness, total plaque score, and total plaque area of patient group was significantly superior to that of control group, respectively（t=5.216–10.158，P < 0.05）. ② There were significant differences in the stenosis degree of CCA, ICA and VA between patient group and control group （t=6.720–12.816，P < 0.05）. ③ The blood flow volume of CCA, ICA, VA and brain of patient group was significantly lower than that of control group, respectively (t=2.872–10.860, P < 0.05). CONCLUSION: Ischemic cerebrovascular disease patients have different degrees of changes in atherosclerosis and arterial blood flow.     

缺血性脑血管病腔内成形术围手术期并发症的预防及处理

目的:探讨缺血性脑血管病腔内成形术围手术期并发症的预防及处理。方法:采用血管腔内成形术治疗52例缺血性脑血管病患者,其中症状性颅内动脉狭窄29例,颈动脉狭窄患者23例。结果:52例患者中共有51例成功置入56枚支架,技术成功率达98.1%。48例患者术后均未再发生脑缺血发作,1例因支架置入困难仅行PTA术,术后症状明显改善;基底动脉支架成形术后1例出现动眼神经麻痹;1例出现再灌注损伤;1例出现颅内出血;7例患者出现血压下降。结论:缺血性脑血管病腔内成形术围手术期可能发生严重的并发症,正确预防和处理这些并发症,是避免患者致残、致死的关键。     

磁共振灌注成像在烟雾病血管重建术中的临床应用价值

目的 探讨磁共振灌注成像（PWI）在烟雾病血管重建术中的应用价值。方法 回顾性分析2015年1月到2018年1月血管重建术治疗的33例成年缺血型烟雾病的临床资料。术前、术后3个月,采用DSA检查评估血管重建术效果;采用PWI评估脑灌注。结果 33例中,术后27例临床表现明显好转。术后3个月,DSA显示脑部供血状况良好;PWI显示相对脑血容量增加不明显（P>0.05）,但是额叶和颞叶相对脑血流量显著增加（P<0.05）,相对平均血流通过时间和相对达峰时间均明显缩短（P<0.05）。结论 PWI可以定量地分析烟雾病血管重建术前后的脑血流动力学参数的变化,有效地评估手术效果。     

急性缺血性脑血管病诊治时间分析

本文报道121例急性缺血性脑血管病患者诊治时间的临床分析，结果显示发病至就诊时间≤6h者，约占总例数的19％；6～12h者，约占总例数的10．7％；12～24h者，约占总例数的14．9％；24～48h者，约占总例数的15．7％；＞48h者，约占总例数的39．7％。不同职业及文化程度的患者，其发病至就诊时间和入院至治疗时间有显著差异。提出了缺血性脑血管病早期诊治的迫切性，认为应把缺血性脑血管病作为一医疗急症，应受到如心脏病发作那样重视的紧急处理。     

缺血性脑血管病患者颈动脉病变与糖代谢的关系

目的 探讨缺血性脑血管病(ICVD)患者颈动脉病变与糖代谢的关系.方法 122例ICVD患者根据葡萄糖耐量试验(OGTT)结果分为糖耐量正常(NGT)组(44例)、糖耐量减低(IGT)组(27例)及糖尿病(DM)组(51例),对各组患者进行颈动脉彩色多普勒超声检查,并对3组间颈动脉病变情况进行分析.结果 DM组年龄明显...     

缺血性脑血管病患者颈动脉颅外段动脉粥样硬化的临床特征

目的 探讨缺血性脑血管病(ICVD)患者颈动脉颅外段动脉粥样硬化的临床特征.方法 对102例颈内动脉系统ICVD患者及31名性别、年龄相匹配的健康对照者进行颈动脉彩色超声检测.结果 102例ICVD患者颈动脉颅外段斑块发生率(71.6%)显著高于健康对照组(45.2%)(P＜0.01),颈动脉颅外段狭窄＞50%发生率(20.6%)显著高于健康对照组(3.2%)(P＜0.01);ICVD组患者颈动脉颅外段软斑数[(1.23±2.16)个]、颈总动脉内膜-中层厚度(IMT)[(2.02±0.77) mm]、斑块总积分[(0.52±0.64) cm]、软及混合斑积分比例[(0.69±0.12) %]以及数目构成比(155/228,68.0 %)与健康对照组[(0.10±0.54)、(1.65±0.49) mm、(0.10±0.16) cm、(0.27±0.04) %、(4/23,17.4%)]的差异有统计学意义(均P＜0.01);ICVD组颈动脉颅外段血栓形成(斑块破裂)13例(12.7%),而健康对照组无1例发生(P＜0.05);两组扁平斑数、硬斑数、混合斑数及斑块内出血数差异无统计学意义(均P＞0.05);ICVD组中的患、健侧动脉粥样硬化程度相关指标差异无统计学意义(均P＞0.05).结论 ICVD组患者颈动脉颅外段斑块发生率高,狭窄主要与软、混合斑有关;斑块破裂常常与卒中事件相关;一侧的颈动脉硬化相关指标的检测,可为对侧颈动脉粥样硬化程度提供重要参考依据;常规进行颈动脉颅外段彩色超声检测,对ICVD患者颈动脉颅外段动脉粥样硬化严重程度及病因评估有重要的参考价值.     

中西医结合治疗缺血性脑血管病临床疗效观察

目的 回顾性分析中西医结合治疗缺血性脑血管病的疗效。方法 对126例缺血性脑血管病患者，在早期西医溶栓、抗凝、降低血液粘度、扩张血管和促进脑细胞代谢等治疗基础上，结合中医辩证施治治疗。结果 42例瘫肢肌力恢复达V级；48例肌力≥Ⅳ级，言语流畅；27例生活能基本自理，可依杖散步，肌力≥Ⅲ级：9例与治疗前对比肌力提高Ⅰ～Ⅱ级，但生活仍不能自理。结论 在西药治疗基础上，结合益气活血中药调理可显著提高患者的疗效。