[1]代鸣明 苏庆杰 龙发青 吴映曼 王德生 陈斌 王布飞 张余辉 肖英 高畅.颈动脉支架置入术对脑梗死患者脑血流动力学变化的随访观察及与临床预后的相关性分析[J].卒中与神经疾病杂志,2019,26(01):51-54.[doi:10.3969/j.issn.1007-0478.2019.01.012]
　Dai Mingming,Su Qingjie,Long Faqing,et al.Follow-up observation of hemodynamic changes in patients with carotid artery stenting and their correlation with clinical prognosis[J].Stroke and Nervous Diseases,2019,26(01):51-54.[doi:10.3969/j.issn.1007-0478.2019.01.012]
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颈动脉支架置入术对脑梗死患者脑血流动力学变化的随访观察及与临床预后的相关性分析()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第26卷
期数:
2019年01期
页码:
51-54
栏目:
论 著
出版日期:
2019-02-26

文章信息/Info

Title:
Follow-up observation of hemodynamic changes in patients with carotid artery stenting and their correlation with clinical prognosis
文章编号:
1007-0478(2019)01-0051-04
作者:
代鸣明 苏庆杰 龙发青 吴映曼 王德生 陈斌 王布飞 张余辉 肖英 高畅
570311 海口,海南医学院第二附属医院神经内科[代鸣明 苏庆杰(通信作者)龙发青 吴映曼 王德生 陈斌 王布飞 张余辉 肖英); 海南省医学院病理生理学教研室(高畅)
Author(s):
Dai Mingming; Su Qingjie; Long Faqing; et al.
Department of Internal Neurology,Hainan Medical University,The Second Affiliated Hospital,Haikou 570311
关键词:
颈动脉狭窄 支架 彩色多普勒血流显像 经颅多普勒超声 随访
Keywords:
Carotid artery stenosis Stenting Color Doppler flow imaging Transcranial doppler ultrasound Follow-up
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2019.01.012
文献标志码:
A
摘要:
目的 随访观察颈动脉狭窄脑梗死患者支架置入术后的颅内血流动力学及脑血管反应性(cerebral vascular reactivity,CVR)的变化,比较介入治疗对颈动脉狭窄患者临床预后的影响。方法 选取本院收治的103例颈动脉狭窄的脑梗死患者,根据患者及家属的治疗意愿分为手术组50例和药物组53例; 手术组均接受颈动脉支架置入术(carotid artery stenting,CAS)及药物的治疗,药物组仅接受药物治疗,记录2组的NIHSS评分变化、脑卒中和死亡事件; 所有手术患者均在术前、术后3 d、1、3、6、12个月进行CDFI和TCD检查,测量颈动脉狭窄局部管径、狭窄段收缩期峰值流速(peak systolic velocity,PSV)、阻力指数(resistance index,RI)及同侧大脑中动脉(MCA)的PSV、搏动指数(pulsatilityt index,PI)及CVR,比较手术前后的血流动力学变化。结果 2组NIHSS评分变化均呈下降趋势(P<0.05),术后3、6、12个月手术组NIHSS评分明显低于药物组(P<0.05); 术后颈动脉原狭窄处内径明显增宽,PSV及RI低于术前,患侧大脑中动脉PSV、PI及CVR 高于术前(P均<0.05); 手术组手术前后的CVR与美国国立卫生研究院卒中量表评分呈负相关(r=-0.84,-0.75,-0.66,-0.78,-0.61,P<0.05)。结论 CAS治疗后颈动脉狭窄患者颈部血管结构及血流动力学明显改善,可有效改善脑梗死患者的中远期预后,且术后CVR的改变可用于预测CAS治疗后的中远期疗效。
Abstract:
ObjectiveTo follow-up of the changes of cervical vessel,intracranial hemodynamics and cerebral vascular reactivity(CVR)of the patients after carotid artery stent implantation.To compare the effect of interventional therapy on the prognosis of patients with cerebral infarction with carotid stenosis.Methods 103 patients with carotid stenosis were selected and then divided into 50 cases of surgery group and 53 cases of drug group according to the willingness of patients and their families.The surgical group received carotid stenting(CAS)and drug therapy.The drug group only received drug treatment.The NIHSS scores,stroke and death were recorded in both groups.surgical group were examined by CDFI and TCD at the preoperative,postoperative 3th day,1th,3 th,6 th,12 th month.The local diameter of stenosis carotid artery,peak systolic velocity(PSV)and resistance index(RI)were measured.The PSV,pulsatility index(PI)and CVR of the ipsilateral middle cerebral artery(MCA).Hemodynamic changes were compared before and after treatment.Results The NIHSS scores in both groups showed a decreasing trend(P<0.05).The NIHSS scores at the 3rd,6 th,and 12 th month were significantly lower in the surgery group than those in the drug group,and the difference was statistically significant(P<0.05).After the carotid artery stenting the internal diameter was significantly wider,PSV and RI were lower than those at the preoperative.The PSV,PI and CVR of affected middle cerebral artery were higher than those at the preoperative(P<0.05).The CVR before and after stenting was negatively correlated with the NIH Stroke Scale score(r=-0.84,-0.75,-0.66,-0.78,-0.61,P<0.05).Conclusion The vascular structure and cerebral hemodynamics of the patients with carotid artery stenosis in the surgical group were significantly improved.The NIHSS score was significantly lower than that in drug therapy group alone.Therefore,CAS could effectively improve the prognosis of patients with cerebral infarction.Changes in CVR could be used to predict the long-term efficacy after CAS treatment.

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备注/Memo

备注/Memo:
基金项目:海南省卫计委行业科研项目(1601032054A2001); 国家自然科学基金(编号为81660270)
作者单位:570311 海口,海南医学院第二附属医院神经内科[代鸣明 苏庆杰(通信作者)龙发青 吴映曼 王德生 陈斌 王布飞 张余辉 肖英); 海南省医学院病理生理学教研室(高畅)
更新日期/Last Update: 2019-02-20