超声在老年颈动脉粥样硬化狭窄诊断中的应用

目的探讨彩色多普勒超声在颈动脉粥样硬化狭窄诊断及治疗中的意义。方法选择382例缺血性脑血管病患者,有脑卒中史1 71例,无脑卒中史41例,头晕170例。彩色多普勒超声检查斑块大小、斑块回声、是否合并溃疡;测量并记录颈动脉狭窄近端、狭窄处收缩期峰值流速(PSV),舒张末期流速(EDV)。计算颈动脉狭窄率,用颈动脉狭窄率与颈动脉狭窄处PSV、EDV、颈动脉狭窄处与狭窄近端PSV/PSV行直线回归分析,推算颈动脉狭窄的彩色多普勒血流参数分级标准。结果有脑卒中史患者在低回声斑块、等回声斑块、强回声斑块、不均匀回声斑块分别为39、10、41、81例,无脑卒中史患者分别为6、6、27、2例。血管造影和超声检查对斑块溃疡诊断分别为87、94例。颈动脉狭窄处PSV≥1 45 cm/s、EDV≥45 cm/s、颈动脉狭窄处与狭窄近端PSv/PSV≥2.0和颈动脉狭窄处PSV≥260 cm/s、E)V≥88 cm/s、颈动脉狭窄处与狭窄近端PSV/PSV≥3.6可以分别作为颈动脉狭窄≥50%和颈动脉狭窄≥70%的血流参数临界点。结论超声可以作为颈动脉狭窄的第一筛选手段,PSV、EDV、颈动脉狭窄处与狭窄近端PSV/PSV是评估颈动脉狭窄程度准确的多普勒血流动力学参数。

Application of ultrasound in diagnosing elderly carotid atherosclerotic stenosis

Objective To study the significance of ultrasound in diagnosing and treating carotid atherosclerotic stenosis.Methods 382 patients with cerebral ischemic disease were selected.The items examined by ultrasound included plaque size,echo and ulcus.The hemodynamic parameters recorded were peak systolic velocity(PSV) and end-diastolic velocity(EDV) of carotid artery at and proximal to stenosis.The rate of stenosis was calculated.Linear regression analyses of stenosis rate and PSV,stenosis rate and EDV were used to calculate the grading criteria of hemodynamic parameters of carotid stenosis.Results The cases with low echo-level plaque,equal echoplaque,high-level echo plaque,inhomogeneous echo plaque were 39,10,41,81 in cerebral ischemia patients and 6,6,27,2 in patients without cerebral ischemia history.The number of cases with plaque ulcus was 87 by DSA diagnostic criteria and 94 by ultrasound diagnostic criteria.PSV≥145 cm/s and EDV≥45 cm/s at stenosis,PSV/PSV≥2.0 at and proximal to stenosis,and PSV≥260 cm/s and EDV≥88 cm/s at stenosis,PSV/PSV≥3.6 at and proximal to stenosis were critical points of hemodynamic parameters for≥50%and≥70%carotid stenosis respectively.Conclusions It is proper to take ultrasound as first means for diagnosing carotid stenosis.PSV,EDV and PSV/PSV are the accurate hemodynamic parameters for assessing the severity of carotid stenosis.