大脑中动脉慢性闭塞后脑膜支代偿对颅外段颈内动脉血流动力学的影响

目的探讨大脑中动脉（MCA）慢性闭塞后大脑前动脉（ACA）脑膜支代偿对颅外段颈内动脉（EICA）血流动力学的影响。方法2005年5月-20HD8年7月，连续纳入经颅多普勒超声（TCD）检测并经脑血管造影（DSA）证实的MCA慢性闭塞患者122例。根据DSA显示的ACA脑膜支代偿情况，分为ACA代偿组（72例）和无代偿组（50例）。采用彩色多普勒超声（CDFI）检测两组患者双侧EICA的峰值流速（PSV）、舒张期末流速（EDV）、血管搏动指数（PI）、血流量（BFV）；TCD检测双侧ACA的PSV、EDV、平均流速（MFV）及PI值。结果①122例MCA闭塞者患侧EICA的PSV、EDV及BFV分别为（67±17）、（27±8）cm/s及（397±154）ml／min，低于健侧的（76±18）、（30±8）cm／s和（454±158）ml／min，P〈0．01。②无代偿组患侧EICA的PSV、EDV及BFV分别为（63±18）cm／s、（24±8）cm／s及（365±153）ml／min，低于代偿组患侧及同组内健侧P〈0．01；无代偿组患侧EICA的PI为1．09±0．20，高于代偿组患侧及同组内健侧（P〈0．01）。③代偿组患侧ACA的PSV、EDV、MFV分别为（142±32）、（67±19）及（92±23）cm／s，均高于组内健侧及无代偿组患侧；代偿组患侧ACA的PI为0．83±0．15，低于健侧均P〈0．01。尤代偿组双侧ACA血流动力学参数差异均无统计学意义（P〉0．05）。结论MCA慢性闭塞患侧大脑前动脉脑膜支无代偿者的同侧颅外段颈内动脉血流动力学参数降低。

Influence of meningeal branch compensation on the hemodynamics of extracranial internal carotid artery after detecting chronic middle cerebral artery occlusion detected with transcranial Doppler ultrasonography

Objective To investigate the influence of anterior cerebral artery （ACA） meningeal branch compensation on the hemodynamies of extraeranial internal carotid artery （EICA） after chronic middle cerebral artery （MCA） occlusion. Methods One hundred twenty-two consecutive patients with chronic MCA occlusion detected by transcranial Doppler nltrasonography （TCD） and confirmed by digital subtraction angiography （DSA） were included. According to the DSA images, the conditions of ACA meningeal branch compensation were divided into either ACA compensation （n = 72） or no compensation （n = 50） groups. Color Doppler flow imaging （CDFI） was used to compare the peak systolic velocity （ PSV）, end diastolic velocity （ EDV）, pulsatility index （ PD, and blood flow volume （BFV） of the bilateral EICA, as well as the differences of PSV, EDV, mean velocity （MFV） , and PI value of ACA in both groups. Results ① PSV, EDV, and BFV of EICA on the ipsilateral side of 122 patients with chronic MCA occlusion were 67 ± 17 cm/s, 27± 8 cm/s, and 397 ±154 ml/min, respectively, and they were lower than those on the eontralateral side（P 〈0. 01 ）.② PSV, EDV, and BFV of EICA on the ipsilateral side in the no compensation group were 63±18 cm/s, 24±8 cm/s, and 365 ±153 ml/min, respectively, and they were lower than those on the ipsilateral side in the compensation group and on the contralateral side in the same group （P 〈0. 01 ） ; PI of EICA on the ipsilateral side in the no compensation group was 1.09 ± 0. 20, and it was higher than that on the ipsilateral in the compensation group and on the contralateral sides in the same group. ③ PSV, EDV, and MFV of ACA on the ipsilateral side in the compensation group were 142± 32 cm/s, 67± 19 cm/s, and 92± 23 cm/s, respectively, and they were higher than those on the contralateral side in the group and on the ipsilateral side in the no compensation group; PI of ACA on the ipsilateral side in the compensation group was 0. 83 ± 0. 15, and it was lower than that on the contralateral side （P 〈 0. 01 ）. There were no significant differences in the hemodynamic parameters of the bilateral ACA in the no compensation group （P 〉 0. 05）. Conclusion The ipsilateral EICA hemodynamic parameters decreased in patients with ACA meningeal branch no compensation on the affected side in chronic MCA occlusion.