经颅多普勒超声检测一侧颈内动脉闭塞患者血流动力学的分析

目的探讨一侧颈内动脉闭塞患者患侧大脑半球血流速度及血管搏动指数的改变与颅内Willis环主干、颈内-外动脉侧支循环开放的相关性.方法选用彩色多普勒血流显像（CDFI）及经颅多普勒超声（TCD）诊断一侧颈内动脉颅外段闭塞,而另一侧正常或狭窄50%以下且颅内动脉无狭窄的患者112例作为闭塞组;以颈内动脉颅外段和颅内动脉检测结果均正常的112例非脑血管病患者作为对照组.采用TCD检测双侧大脑中动脉（MCA）、大脑前动脉（ACA）及大脑后动脉（PCA）的收缩期峰值流速（PSV）和MCA的血管搏动指数（PI）,比较两组患者双侧MCA、ACA、PCA的PSV和PI的差异,计算并分析患侧MCA的PSV、PI差值（PSVD、PID）.结果①闭塞组患者双侧MCA的PSV和PI差值明显高于对照组（PSV相差61 cm/s,PI相差≥70%,P=0.000、P=0.000）.②闭塞组患者患侧MCA、ACA的PSV和PI较健侧明显降低（P=0.000）,患侧PCA的PSV较健侧增高,PI相对降低（P=0.000）,患侧MCA的PSV下降率明显高于ACA的PSV下降率.③闭塞组患者患侧MCA的PSV与双侧ACA及患侧PCA的PSV直接相关（P=0.000、P=0.000、P=0.006）.结论对双侧MCA的PSV、PI及ACA、患侧PCAPSV的差值分析,可以提高TCD对一侧颈内动脉闭塞性病变患者血流动力学异常的认识和鉴别.

Hemodynamic examination by transcranial Doppler in patients with unilateral carotid artery occlusion

Objective To explore the relationship between the changing of peak blood velocity and pulsatility index in the side of internal carotid artery occlusion with opening of Willis circle and intra-(extracranial) arterial communication.Methods This study group includes 112 patients with extracranial segments of internal carotid arterial occlusion in one side and the other side normal or stenosis less than 50%,and 112 control patients without cerebrovascular disease and both extracranial and intracranial segment of internal carotid arteries were normal by color Doppler flow imaging.The peak systolic velocity(PSV) and pulsatility index(PI) of the bilateral middle cerebral artery(MCA),anterior cerebral artery(ACA) and posterior cerebral artery(PCA) were measured,the difference of PSV and PI of bilateral MCA,ACA,PCA in the occlusion group and control group were compared respectively.The PSV difference(PSVD) and PI difference(PID) of the occluded side were counted.Results The PSVD and PID of bilateral MCA in occlusion group were significantly higher than control group(PSVD(61 cm/s),P=0.000;(PID>)70%,P=0.000).There was obviously asymmetry between bilateral MCA,ACA,and PCA in occlusion group.The PSV and PI of MCA and ACA in the occluded side were significantly lower than the normal side(P=0.000).The PSV of PCA in the occuded side was significantly higher and the PI was significantly lower than normal side((P=)0.000 respectively).PSV of MCA in the occluded side correlated with bilateral ACA and PCA(P=0.000,(P=)0.000,(P=)0.006 respectively).(Conclusion) Aggregate analysis of PSV and PI,and PSVD and PID in bilateral MCA by TCD will increase recognition of abnormal hemodynamic in the patients with unilateral internal carotid occlusion.