急性脑梗死血管状态的TCD判定与临床表现的关系

目的探讨急性前循环脑梗死患者颅内外血管功能状态与神经功能缺损的关系.方法前瞻性地对106例首次发病72h内的急性前循环脑梗死患者的经颅多普勒(TCD)检查结果,分为:正常组、颅内血管狭窄组、颅外血管狭窄组、颅内颅外合并狭窄组等四组.对其临床神经功能缺损进行NIHSS评分,比较分析各组神经功能缺损评分间的差异.结果正常组临床神经功能缺损最少,第1日和第21日NIHSS评分分别为4.15和3.28分,预后较好;其次为颅内动脉狭窄组、颅外动脉狭窄组(7.03和6.55分);颅内颅外合并狭窄组神经功能缺损最严重(9.8和9.9分),预后最差.伴有颅内颅外血管狭窄的脑梗死者更易发生进展性卒中.结论对急性前循环脑梗死患者在发病72h内给予TCD检查,可以对颅内颅外血管的功能状态有一个初步的了解,与患者临床表现、治疗、预后有关.

A study of TCD examination of the acute cerebral infarction and its clinical outcome

Objective The present study aimed at evaluating the prognostic value of transcranial Doppler(TCD) in the acute phase of anterior circulation infarct, when individualized therapeutic decision must be made. Methods 106 patients with a first ischemic hemispheric stroke underwent neurological assement according to the Unified Neurological Stroke Scale(NIHSS). The clinical subgroup according to the result of TCD examinations were divided into 4 groups: the normal baseline TCD group;the intracranial artery stenosis group; the extracranial artery stenosis group; the combined completed and extracranial artery stenosis group. All these examinations were completed within 72 hours from stroke onset. Then we calculated the NIHSS and assessed the clinical outcomes were assessed. Results The normal group had the best clinical outcome and the intracranial and extracranial group had better outcome. The combined intracranial and extracranial group had the worst clinical outcome. All the progressive stroke all occurred in the patients with intracranial or extracranial artery stenosis group. Conclusions The TCD examination in the acute phase of anterior circulation infarct can predict the prognosis when individulized therapeutic decision must be made.