经颅多普勒检测新指标对短暂性脑缺血发作的评估价值

背景将高血压脑血管病研究中建立的6项新指标运用到短暂性脑缺血发作(Transientischemicattack,TIA)诊断研究中,能对原检测指标不能反映的全脑11条血管的整体的质与量的状况有较准确的评价.目的探讨经颅多普勒新指标对TIA的评估价值,弥补了原指标的不足.设计以诊断为依据的病例对照研究.地点、对象和方法116例研究对象均为解放军第三二三医院收治的TIA患者(TIA组)和同期98例体检的健康者,采用与计算机连用的方法,对两组214例受试者2354条脑血管进行新旧指标的对照检测.主要观察指标两组经颅多普勒检测新、原指标比较.结果用经颅多普勒新指标检测,在无明显脑功能损坏情况下,116例中110例(94.8%)异常,20例(18.1%)为颈内动脉系统血流速度改变.正常组与TIA组原指标比较TIA组的搏动指数增高,椎基底动脉的脑血管收缩期、舒张期流速明显减慢,颈内动脉系统血流速度减低;与正常组相比,差异有差异性意义(t=1.97～2.89,P＜0.05;t=3.1～11.59,P＜0.01);频谱形态可见收缩波圆钝,S2＞S1,峰时后延.正常组与TIA组新指标比较TIA组中81.8%椎基底动脉血流异常者的反弹高度、紧张度、平均收缩速度、缓慢指数明显降低,压力指数、脑血管负荷指数增高.TIA组中的18.2%颈内动脉系统血流速度减低者的反弹高度、紧张度下降、平均收缩速度、缓慢指数明显减缓,压力指数、脑血管负荷指数明显增高(t=2.14～2.6,P＜0.05;t=2.85～14.4,P＜0.01).结论经颅多普勒检测新指标较旧指标能更全面、准确地诊断TIA.

Evaluative value of new indes detected by transcranial Doppler ultrasound to transient ischemic attack

BACKGROUND: It will accurately evaluate the quality and quantity of totally 11 blood vessels that the original indes can not reflect when applying the newly established 6 indes of hypertensive cerebrovascular diseases on the diagnosis of transient ischemic attack(TIA).OBJECTIVE: To explore the value of new indes detected by transcranial Doppler ultrasound which have made up the shortcomings of old indexes to the assessment of TIA.DESIGN: Case control study based on diagnosis.SETTINGS, PARTICIPANTS and INTERVENTIONS: Totally 116 patients with TIA diagnosed by the 323 Hospital of Chinese PLA and 98 healthy people were selected as TIA group and normal group respectively. Comparative detection was done to new and old indexes of 2354 brain vessels of 214 patients by using computers.MAIN OUTCOME MEASURES: Comparison of new and old indes detected by transcranial Doppler ultrasound between two groups.RESULTS: There were 110(94.8% ) out of 116 patients with anomalies of new indexes and 20 patients(18.1% ) with changes of blood flow rate of internal carotid artery when detecting by transcranial Doppler ultrasound without obvious damages of brain functions. Comparing old indes between normal group and TIA group: The pulsation index increased, the systolic and diastolic flow rates of basilar artery slowed greatly, the blood flow rate of internal carotid arteries reduced, there was difference on those indexes between the normal group and TIA group( t = 1.97 - 2.89, P ＜ 0.05; t = 3.1 -11.59, P ＜ 0.01) . The figures of frequency spectrum showed that there was circular and blunt contraction waves with time of peak delays, S2 ＞S1. Comparing new irdes between two groups: among 81.2% patients in TIA group with blood flow anomaly of basilar artery, they presented greatly decrease of bounce altitude, tensity, average contract velocity and slowness index and increase of pressure index and load index of brain blood vessels. Among the 18.2% patients with slow blood flow rate in TIA group, the bounce altitude, tensity, average contract velocity and slowness index also slower and the pressure index, load index of brain blood vessels increased (t=2.14-2.6;t=2.85-14.4, P ＜0.01).CONCLUSION: The new indes detecting by transcranial Doppler ultrasound can diagnose TIA more generally and accurately than old indexes.