颈内动脉重度狭窄或闭塞的脑梗死患者侧支循环对预后的影响

目的：分析单侧颈内动脉重度狭窄或闭塞的急性脑梗死患者侧支代偿对预后的影响。方法通过数字减影脑血管造影技术（DSA）分析113例单侧颈内动脉重度狭窄或闭塞的急性脑梗死患者侧支代偿情况，根据有无侧支代偿及代偿的类型将其分为：无侧支代偿组（A 组）、有侧支代偿组（B 组）；将 B组分为仅有初级代偿组（C 组）、仅有次级代偿组（D 组）、同时具有初级和次级代偿组（E 组）；将 E组中有软脑膜向前循环代偿供血的患者纳入组（F组）、有颈外动脉向颈内动脉代偿供血的患者纳入组（G组）。均于发病后第7天、3个月行美国国立卫生研究院卒中量表（NIHSS）评分及发病后第7天、1年后行改良Rankin（mRs）评分，分别计算3个月与第7天NIHSS评分差及1年与第7天的mRs评分差，并分析侧支循环对急性脑梗死预后的影响。结果113例患者中，狭窄78例（69.02%），闭塞35例（30.98%）。其中A组51例（45.13%），B组62例（54.87%）。B组中的C组12例（19.37%），D组13例（20.96%）， E组37例（59.67%）。F组34例（91.89%），G组20例（54.05%）。A组与B组相比较：3个月内B组NIHSS评分较A组显著降低（P＜0.05），1年后B组mRs评分较A组也明显降低（P＜0.05）。F组与G组相比较：3个月内F组NIHSS评分较G组无明显差异（P＞0.05），1年后F组mRs评分较G组无明显差异（P＞0.05）。E、C、D组相比较：3个月内3组NIHSS评分有统计学差异（P＜0.05），其中D组评分降低最不明显。1年后3组mRs评分有统计学差异（P＜0.05），其中D组评分降低最不明显。结论单侧颈内动脉重度狭窄或闭塞的急性脑梗死患者，有侧支循环预后明显优于无侧支循环患者。存在初级侧支代偿的急性脑梗死患者中，软脑膜动脉代偿及颈外动脉向颈内动脉代偿是次级侧支代偿的主要途径，而次级代偿方式对预后的影响无差异。仅有初级代偿及同时具有初级、次级代偿预示预后良好，但仅有次级代偿预示预后不良。

Effects of collateral circulation on prognosis of cerebral infarction patients with internal carotid artery stenosis or occlusion

Objective To investigate the effects of Collateral Circulation on prognosis of Acute Cerebral Infarction Patients with the unilateral Internal Carotid Artery Stenosis or Occlusion. Methods DSA was applied to evaluate the collateral circulation of One hundred and thirteen acute cerebral infarction patients with the unilateral Internal Carotid Artery Stenosis or Occlusion. According to the unilateral with collateral circulation, 113 patients were divided into group A and group B. Then group B was divided into group C（only the primary collateral circulation）, groups D（only the secondary collateral circulation） and group E（both of the primary and the secondary collateral circulation）.Incorporate cerebral pia mater collateral circulation into group F and external carotid-Internal carotid ramous anastomoticus into group G. The method of the National Institutes of Health Stroke Scale （NIHSS） score was used in every group on the seventh day and the third month after Cerebral Infarction. And then calculate their differences. The modified Rankin score （mRs） was used in every group on the seventh day and one year after Cerebral Infarction, and then calculate their difference. The results of all the groups were compared. Results DSA showed that Stenosis was 69.02%.Occlusion was 30.98%.Group B was 54.87%. Group C was 19.37%. Group D was 20.96%.Group E was 59.67%. Group F was 91.89%. Group G was 54.05%.There＆amp;nbsp;was significant difference not only between the NIHSS score on the three month （P〈0.05）, but also the score of mRs on the one year between group A and B（P〈0.05）. There was no significant difference between the group F and G about NIHSS scores in three month and mRs in a year（P〉0.05）. There was significant difference among group E, C and D about score of NIHSS in three month and mRs in a year（P〈0.05）. Group D reducing was the most obvious. Conclusions The prognosis show that the collateral circulation is obviously better than the acute Cerebral infarction patients with the unilateral internal carotid artery stenosis or occlusion who is without collateral circulation.Pia mater compensatory and external carotid-Internal carotid ramus anastomoticus are the main ways of collateral circulation among the acute cerebral infarction patient with primary collateral circulation. But there is no difference influence on the way of secondary collateral circulation. The primary collateral circulation and both of the primary and the secondary collateral circulation indicated good prognosis,but the secondary collateral circulation indicated bad prognosis.