缺血性脑血管病患者颈部血管超声的临床研究

目的探究缺血性脑血管病患者颈部血管超声的疗效。方法选取2013年4月~2015年5月我院收治的缺血性脑血管病患者83例为观察组,同期选取健康人员83名为对照组。均实行颈部血管超声检查,观察两组患者颈动脉粥样硬化斑块、颈动脉狭窄和颈内动脉中膜厚度增厚等情况。结果两组患者颈动脉粥样硬化斑块发生率、颈动脉狭窄发生率、颈内动脉内中膜厚度增厚的例数组间比较,差异有统计学意义(P0.05)。结论缺血性脑血管病患者定期实行检查,可达到不会延缓病情的效果。而颈部血管超声检查能够实现预期和诊断的功效,值得应用和推广。     

缺血性脑血管病患者颈动脉粥样硬化斑块和狭窄的超声研究

目的观察缺血性脑血管病患者的颈动脉斑块性质、分布特点及狭窄情况,探讨颈动脉斑块和狭窄的分布规律。方法缺血性脑血管病患者340例,行颈部血管超声检查.其中短暂性脑缺血发作(TIA)患者105例(TIA组),脑梗死患者235例(脑梗死组);又根据年龄分为青年组(54例),中年组(137例)和老年组(149例)。结果随年龄增加,缺血性脑血管病患者危险因素:高血压、糖尿病、冠心病、吸烟、家族史显著增加(P<0.01)。脑梗死组颈动脉内膜中层厚度明显高于TIA组(P<0.01);70%～99%血管狭窄斑块发生率高于50%～69%血管狭窄和<50%血管狭窄(P<0.01);老年组斑块发生率、颈动脉狭窄的发生率高于中年组及青年组(P<0.01)。结论超声检查显示不稳定斑块与缺血性脑血管病的关系更为密切,导致颈动脉狭窄的斑块中,以软斑块和混合性斑块多见。超声检查可以用于颈动脉狭窄患者的诊断及监测。     

探讨颈部血管动脉硬化斑块与缺血性脑血管病的相关性

目的探讨颈部血管动脉硬化斑块与缺血性脑血管病的相关性,了解颈动脉学管彩超检查的临床价值。方法选取2012年6月～2014年5月我院内科收治的患者100例,其中50例患者经头部CT或MRI检查证实为脑梗死,将其纳入本研究的实验组,另外50例非脑血管病患者纳入本研究的对照组,对两组患者的临床资料进行分析,探讨颈部血管动脉硬化斑块与缺血性脑血管病的相关性。结果 50例实验组患者中,36例患者检查有颈动脉斑块,斑块发生率为72.0%,10例为稳定斑块,26例为不稳定斑块,比较两组动脉粥样硬化斑块发生率以及不稳定斑块发生率,差异均有统计学意义（P〈0.05）。结论颈部血管动脉硬化斑块与缺血性脑血管病相关性明显,彩超在脑血管病的预测中具有较高的价值。     

联合颈部血管彩超及CTA评价动脉粥样硬化与脑梗死关联性研究

目的探讨颈部血管彩超及CTA在动脉粥样硬化性脑梗死临床应用价值。方法以60例前循环动脉粥样硬化性脑梗死患者为病变组,35例未发生脑梗死患者为对照组,经颈部血管彩超及CTA检查。结果二者颈动脉粥样斑块发生率有显著差异,颈动脉斑块最常见颈总动脉分叉处,多以病灶同侧多见,易形成血管狭窄。结论颈动脉粥样硬化与脑梗死的发病关系:早期发现颈动脉粥样硬化及了解血管狭窄对预防或治疗脑梗死的发生有重要意义。     

颈动脉粥样硬化对缺血性脑血管病的影响

目的探讨颈动脉粥样硬化斑块对缺血性脑血管病的影响。方法选择我院神经内科住院的缺血性脑血管病患者68例，分为脑梗死组（CI组）43例和短暂性脑缺血组（TIA组）25例，另选同期门诊及病房非脑血管病患者32例（对照组），采用彩色多普勒血流显像技术对两组患者颈动脉粥样硬化斑块进行比较。结果68例缺血性脑血管病患者中，48例（70．6％）有动脉粥样硬化斑块，对照组5例（15．6％）有动脉粥样硬化斑块，两组患者粥样硬化斑块检出率间差异有显著性意义（P〈0．05）。68例缺血性脑血管病患者无症状侧颈动脉斑块检出率高于症状侧斑块检出率。CI、TIA两组患者无症状侧斑块检出率与症状侧斑块检出率间差异亦均有显著性意义（P〈0．05）。结论颈动脉粥样硬化是脑梗死的重要危险因素。对缺血性脑血管病患者，除常规检查颅脑影像学外，还应重视检查颈部血管。     

影像学检查对缺血性脑血管病患者颈动脉粥样硬化斑块的研究

目的采用双源CT血管造影(CTA)和高分辨MRI,探讨缺血性脑血管病患者颈总动脉分叉处粥样硬化斑块的性质、成分和动脉管腔狭窄程度与缺血性脑血管病的关系。方法选择缺血性脑血管病患者40例,经颈部CTA检测出颈总动脉分叉处粥样硬化斑块并伴管腔狭窄,再接受MRI扫描;分析颈动脉粥样斑块的性质、成分及管腔狭窄程度。结果 40例患者中,CTA检出斑块61个,其中混合性斑块31个;钙化性斑块18个;软斑块12个。高血压30例,检出斑块49个;无高血压10例,检出斑块12个。MRI检出斑块61个,其中Ⅲ型14个;Ⅳ～Ⅴ型23个,Ⅵ型6个;Ⅶ型18个。斑块内溃疡6例;颈动脉粥样硬化斑块造成同侧急性脑梗死14例,双侧颈动脉斑块造成双侧脑梗死10例,一侧颈动脉检出粥样斑块而对侧发生脑梗死2例。结论缺血性脑血管病患者颈动脉粥样硬化斑块主要以混合性斑块为主,双侧好发;高血压患者斑块发生率高于无高血压患者;颈动脉粥样硬化斑块造成同侧脑梗死发生率较高。     

缺血性脑血管病彩色多普勒、经颅多普勒联合检测结果分析

目的 研究缺血性脑血管病发病与颈部动脉粥样硬化狭窄程度和斑块性质的关系.方法 采用彩色多普勒和经颅多普勒技术对缺血性脑血管病患者100例及健康者40例（对照组）进行检测,观察颈动脉解剖形态、内膜情况,有无斑块形成及斑块大小、形态、回声特征,颅内外动脉管腔是否狭窄和狭窄程度.结果 缺血性脑血管病组颈动脉不均质、不规则斑块的检出率及其颅内外动脉狭窄的比例均明显高于对照组,且颅内动脉狭窄的比例高于颅外动脉.结论 颈动脉粥样硬化斑块的性质及颅内外动脉狭窄与缺血性脑血管病的发生密切相关.     

颈动脉斑块和狭窄与缺血性脑卒中的相关性研究

对120例缺血性脑血管病及60例非脑血管病患者进行颈动脉超声检查，结果显示，缺血性脑血管病组颈动脉粥样斑块检出率为64．2％，以不规则、不均质回声斑块多见；颈动脉狭窄发生率为19．2％，以中、重度为主。非脑血管病组动脉粥样斑块检出率为11．7％，以等回声、强回声斑块多见；颈动脉狭窄发生率为3．3％。两组均有显著差异（P〈0.01）。提示颈动脉狭窄可致缺血性卒中的危险性升高，超声显示不均质回声斑块与缺血性脑卒中的发生有关。     

中老年人颈动脉硬化斑块与缺血性脑血管病相关性分析

目的分析中老年(年龄≥45岁)颈动脉硬化斑块与缺血性脑血管病的相关性。方法选择缺血性脑梗死病人58例作为观察组,同期正常体检者62名作为对照组。采用颈部血管彩超比较两组病人斑块性质、分布及数量。结果观察组病人颈部血管动脉硬化斑块检出率为87.93%,对照组为35.48%,两组比较差异有统计学意义(P0.01)。观察组不稳定性斑块阳性率为81.44%,显著高于对照组不稳定性斑块阳性率16.66%,两组比较差异有统计学意义(P0.01)。结论中老年人群颈部血管动脉硬化斑块性质、分布、数量与缺血性脑血管病存在相关性,可作为该病发生的评估指标。     

颈部血管彩超对前循环脑梗死的评价

目的 颈部血管彩超对动脉粥样硬化引起缺血性脑血管病进行评价并讨论其临床意义.方法 选择前循环脑梗死病例和对照病例,记录颈总动脉、颈内动脉颅外段内中膜厚度,确定有无粥样硬化斑块、斑块回声,颈动脉狭窄情况.结果 前循环脑梗死病例和对照病例比较,颈总动脉及颈内动脉内中膜增厚发生率、斑块出现率差异均有统计学意义;不稳定斑块是脑梗引起严重神经功能损害的危险因素;斑块好发于颈动脉分叉及颈内动脉起始部,且易出现于双侧颈动脉及脑部病灶同侧的颈动脉.颈动脉粥样硬化至颈动脉狭窄在缺血性脑卒中有重要地位.     

应用彩色多普勒超声检测缺血性脑血管病与颈动脉粥样硬化的关系

目的探讨缺血性脑血管病与颈动脉粥样硬化病变之间的关系。方法对130例缺血性脑血管病患者进行颈动脉彩色多普勒超声检查，130例患者中56例短暂性脑缺血发作（TIA），74例脑梗死；42例非缺血件脑血管病患者为对照组。检测颈动脉内膜增厚及斑块形成等血管异常发牛率、斑块类型及斑块的分布情况。结果TIA组患者颈动脉内膜-中层厚度（IMT）增厚及颈动脉硬化斑块等异常检出率为73．2％（41／56），脑梗死组异常率为87．8％（65／74），对照组受检者异常率为28．6％（12／42），TIA组及脑梗死组与对照组比较差异有显著意义（P〈0．01）。脑梗死组患者脂质性斑块及混合性斑块的发生率高于TIA组。颈动脉硬化斑块最常见部位为颈总动脉分又处，其次为颈内动脉近段。左右侧差异无显著意义。结论颈动脉硬化与缺血性脑血管病有密切相关性，颈动脉超声有助于预测缺血性脑血管病的发病危险。     

Disease of the left main coronary artery: early surgical results and their association with carotid artery stenosis.

OBJECTIVES--To review the results of surgical revascularisation for left main coronary artery stenosis and the associated vascular pathology that is responsible for cerebrovascular complication. PATIENTS--60 patients (45 men, 15 women) (mean age 61.3 (39-79)) who underwent revascularisation for stenosis of the left main stem coronary artery (LMS) between January 1987 and August 1990 were compared with an age and sex matched control group of patients undergoing revascularisation for triple vessel disease during the same period. OUTCOME MEASURES--In-hospital morbidity and operative mortality. RESULTS--24 patients in the LMS group presented with unstable angina. The left ventricular ejection fraction was less than 50% in 30 patients and less than 30% in nine. 17 patients (28%) had large vessel extracranial carotid artery disease and 10 patients had vascular disease of the lower limbs. In six patients atheromatous plaques were noted in the ascending aorta during surgery. There was no in-hospital mortality. In-hospital morbidity included neurological deficits in five (8.3%), arrhythmias in seven (11.6%), and pulmonary complications in six (10%) patients. The incidence of carotid artery disease in the LMS group was significantly higher (p = 0.04). Atheromatous plaque in the ascending aorta and postoperative neurological complications were more common patients with LMS. CONCLUSIONS--The incidence of carotid artery disease was higher and postoperative cerebrovascular complications were more common in patients who had coronary artery revascularisation for stenosis of the left main stem coronary artery. The early surgical results were excellent. These findings suggest that for optimum perioperative management patients with stenosis of the left main coronary artery should be screened for carotid artery disease before bypass surgery.     

An ultrasonic study of the relationship between extracranial carotid atherosclerosis and ischemic cerebrovascular disease in Japanese]

The study is to evaluate the relationship between extracranial carotid atherosclerosis and ischemic cerebrovascular disease using noninvasive B-mode ultrasonography and X-ray computed tomography. The sensitivity of bruits for diagnosing severe carotid stenosis was also evaluated. A total of 229 consecutive Japanese patients were recruited for this study, of which 97 had chronic-stage ischemic cerebrovascular disease and remaining 132 patients had at least one risk factor for atherosclerosis. Carotid atherosclerosis was evaluated by B-mode ultrasonography. Ischemic cerebrovascular disease was assessed by history taking, neurological findings and X-ray CT examination. The severity of carotid atherosclerosis was assessed by using two indices; plaque score and maximum percentage diameter stenosis. We also evaluated whether it was ulcerated plaque or not. Plaque score was computed by summing up all carotid plaque thicknesses (mm) on both sides. According to the CT findings, cerebral infarction was divided into two types; deep subcortical infarction and cortical infarction. The incidence of cerebral infarction increased in relation to plaque score and maximum percentage stenosis. Although the incidence of cerebral infarction in patients without carotid atherosclerosis was only 33% (38/116), it in patients with moderate carotid atherosclerosis (plaque score > 5) was 59% (26/44) (p < 0.05, chi-square test). The incidence of ipsilateral infarction was revealed to be higher in patients with severe (50% or more) carotid stenosis (61%) than in cases of mild stenosis (28%) (p < 0.05). Thirteen patients had ulcerated plaques and they suffered more frequently cerebral infarction than patients without ulcerated lesions. Cortical infarction was more frequent in patients with severe carotid stenosis than in patients without carotid atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

颈动脉超声检查在缺血性脑卒中患者中的应用价值

目的：探讨颈动脉超声检查在缺血性脑卒中患者中的应用价值。方法选取2013年6—12月在我院接受颈动脉超声检查的缺血性脑卒中患者83例为观察组,同期在我院体检健康者50例为对照组。两组受试者均接受颈动脉超声检查,观察颈动脉狭窄情况、颈动脉中层内膜厚度及斑块性质等。结果对照组受试者中发现颈动脉狭窄9例（18.0％）,颈动脉内膜增厚2例（4.0％）,未发现易损斑块;观察组患者中发现颈动脉狭窄47例（56.6％）,颈动脉内膜增厚35例（42.2％）,易损斑块31例（37.3％）。观察组颈动脉狭窄、颈动脉内膜增厚及易损斑块检出率均高于对照组（ P＜0.05）。结论颈动脉超声检查对缺血性脑卒中患者颈动脉异常检出率较高,对缺血性脑卒中有一定的早期筛查价值。     

冠心病患者颈部动脉粥样硬化病变高频超声体表标识表现分析

目的：分析冠心病患者颈动脉粥样硬化（CAS）病变高频超声体表标识表现。方法：连续选择521例接受冠状动脉造影的住院患者,造影后同时进行颈部动脉体表血管彩色多普勒超声检查。结果：521例人选对象中．冠状动脉正常者81例（对照组）。确诊冠心病患者440例,其中轻度狭窄组36例、中度狭窄组90例和重度狭窄组314例。冠心病各组的内膜一中层厚度（IMT）、IMT增厚率、斑块总面积和斑块发生率均明显高于对照组,冠心病中、重度狭窄组的IMT和斑块总面积也显著多于轻度狭窄组（P〈0．05～0．01）。冠心病各组各种斑块明显多于对照组（P〈0．05～0．01）．中及重度狭窄组软斑、硬斑数显著多于轻度狭窄组（P均〈0．05）。在CAS超声分级比较中．冠心病各组狭窄超声级别均明显多于对照组．同时重度狭窄组c、D级例数明显多于后者（P〈0．05～0．01）。结论：冠心病患者颈部动脉病灶超声体表标识可作为冠状动脉粥样硬化严重程度的间接判定指标。     

脑保护装置下高龄重度颈动脉狭窄患者颈动脉支架成形术的有效性和安全性评价

目的评价脑保护装置下高龄重度颈动脉狭窄患者颈动脉支架成形术(CAS)的有效性及安全性。方法选择2009年1月—2012年1月在青岛大学医学院附属医院行CAS的高龄重度颈动脉狭窄患者37例,术中均应用脑保护装置,观察患者狭窄改善情况、围术期并发症发生情况、回收脑保护装置内脱落栓子情况,随访1年观察患者缺血性脑血管事件发生情况。结果 36例患者脑保护伞均一次性顺利通过狭窄段放置到位成功释放;术后残余狭窄率均30%,平均狭窄程度从(83.0±6.7)%降至(13.0±6.1)%;回收的脑保护装置中有26个发现脱落的组织碎片;围术期均未出现脑出血、症状性脑梗死、支架内血栓形成等严重并发症;37例患者随访1年,无短暂性脑缺血发作(TIA)、卒中、死亡发生。结论脑保护装置下对高龄重度颈动脉狭窄患者行CAS成功率和安全性较高。     

Carotid Sinus Hypersensitivity in Patients Undergoing Coronary Arteriography:

Carotid Sinus Hypersensitivity and Atherosclerosis. Introduction: The purpose of the present investigation was to study the precise relationship between carotid sinus hypersensitivity (CSH) and both the severity of carotid atherosclerosis and the extent of coronary artery disease in patients who were referred for evaluation for suspected ischemic heart disease.
Methods and Results: Duplex echocardiography and coronary angiography were used to assess carotid and coronary artery atherosclerosis in 130 consecutive patients. Carotid sinus stimulation was performed before coronary arteriography with simultaneous recordings of the ECG and aortic pressure. Coronary artery disease was present in 103 patients (79%). Thirty patients (23.08%) had one-vessel disease (1-VD), 31 (23.85%) had 2-VD, 29 (22.31%) had 3-VD, and 13 patients (10%) had left main coronary artery disease. Carotid artery atherosclerosis was present in 100 patients (76.92%) and carotid disease (diameter stenosis ≥ 50%) was present in 24 patients (18.46%). CSH was found in 33 patients (25%). The incidence of CSH was 9% in patients with carotid stenosis 1%-15%, 17% in patients with stenosis 16%-49%, 85% in patients with stenosis 50%-79%, and 100% in patients with stenosis ≥ 80%. The incidence of CSH was 11%, 17%, 23%, 34%, and 62% in patients with no VD, 1-VD, 2-VD, 3-VD, and left main coronary artery disease, respectively. Stepwise multiple logistic regression analysis revealed that carotid disease and left main coronary artery disease were the most significant determinants of CSH (P < 0.001 and P = 0.013, respectively).
Conclusion: The incidence of CSH increased in proportion to the severity of carotid and coronary atherosclerosis. These data provide evidence that CSH is closely related to severe carotid atherosclerosis or left main coronary artery disease in patients being evaluated for suspected ischemic heart disease.     

颈动脉双源CT血管造影和脑CT动态灌注成像在缺血性脑血管病的应用

目的运用颈动脉双源CT血管造影(CTA)和脑CT动态灌注成像(DCTPI)扫描,探讨缺血性脑血管病患者颈动脉粥样硬化斑块造成管腔狭窄与脑缺血之间的关系。方法临床诊断短暂性脑缺血发作和超急性或急性脑梗死患者40例,急诊行头颅CT或MRI扫描后,立即行颈动脉双源CTA和脑DCTPI扫描,对颈动脉粥样硬化斑块造成管腔的狭窄程度和脑灌注血流参数进行评价。结果 40例患者中,颈动脉无狭窄9例,占22.5%;轻度狭窄9例,占22.5%;中度狭窄12例,占30.0%;重度狭窄8例,占20.0%;完全闭塞2例,占5.0%。15例超急性或急性脑梗死患者梗死中心区患侧脑血流量较对侧明显下降,同时梗死中心区脑血流量较缺血半暗带或边缘区也明显下降,差异有统计学意义(P0.05);梗死中心区与缺血半暗带或边缘区脑血容量、造影剂到达峰值时间、平均通过时间差异无统计学意义(P0.05)。结论颈动脉双源CTA和脑DCTPI联合应用可同时显示颈动脉粥样硬化斑块造成颈动脉狭窄情况和缺血脑组织的部位和范围,为临床治疗缺血性脑血管病提供影像学依据。     

颅内-外动脉搭桥术治疗缺血性脑血管病的疗效观察

目的探讨颅内-外动脉搭桥术治疗缺血性脑血管病的疗效。方法选取2007年1月—2010年5月于本院进行治疗的62例缺血性脑血管病患者为研究对象,根据手术方式将其分为对照组与观察组各31例,对照组采用颞浅动脉敷贴术进行治疗,观察组采用颅内-外动脉搭桥术进行治疗,将所有患者的有效率、并发症发生率及治疗前后大脑中动脉的血流动力学指标进行统计比较。结果观察组在有效率、并发症发生率及大脑中动脉的血流动力学指标方面均优于对照组,差异均有统计学意义(P<0.05)。结论颅内-外动脉搭桥术治疗缺血性脑血管病的疗效较好,可显著改善脑部血流。