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目的:探讨单侧大脑中动脉急性闭塞和慢性进展性闭塞的颅内血流动力学变化及其侧支代偿途径的差异。方法:选取本院59例经数字减影血管造影(DSA)或核磁血管造影(MRA)证实为单侧大脑中动脉闭塞的患者,其中经颅多普勒超声(TCD)诊断为慢性进展性闭塞者34例,考虑急性闭塞者25例。采用TCD检测双侧大脑中动脉、前动脉及后动脉血流速度、血管搏动指数,分析其颅内血流动力学变化。结果:慢性进展性大脑中动脉闭塞者,患侧大脑中动脉收缩期峰值流速(41±9)cm/s,患侧大脑前动脉血流速度明显高于健侧(P=0.011),患侧大脑后动脉血管搏动指数(PI)低于健侧,其主要侧支代偿为同侧大脑前动脉和/或同侧大脑后动脉的软脑膜吻合支;急性大脑中动脉闭塞者,患侧大脑中动脉收缩期峰值流速20±3 cm/s,与慢性进展性大脑中动脉闭塞相比,差异有显著意义(P=0.000),患侧大脑前动脉、大脑后动脉血流速度及血管搏动指数与健侧相比,无统计学意义。结论:TCD对大脑中动脉急性闭塞与慢性进展性闭塞的颅内血流动力学差异的判断为患者的诊治及预后判断提供了有价值的血流动力学资料。
Objective: To investigate the intracranial hemodynamic changes of unilateral middle cerebral artery occlusion and chronic progressive occlusion and their differences in collateral compensatory pathways. Methods: Fifty-nine patients with unilateral middle cerebral artery occlusion confirmed by digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) were enrolled. TCD was diagnosed as chronic progressive occlusion In 34 cases, consider acute occlusion in 25 cases. TCD was used to detect the velocity of the middle cerebral artery, the anterior and posterior arteries of the bilateral cerebral arteries, and the index of vascular pulsatility. The intracranial hemodynamic changes were analyzed. Results: In patients with chronic progressive middle cerebral artery occlusion, the peak systolic velocity of the affected middle cerebral artery was (41 ± 9) cm / s and that of the affected frontal cerebral artery was significantly higher than that of the healthy side (P = 0.011) The posterior cerebral artery pulsatility index (PI) was lower than that of the contralateral side, with the major collateral compensations being the anastomotic pia mater of the ipsilateral anterior cerebral artery and / or ipsilateral posterior cerebral artery; the acute middle cerebral artery occlusion, The peak systolic velocity of middle artery was 20 ± 3 cm / s, which was significantly different from that of chronic middle cerebral artery occlusion (P = 0.000). The anterior cerebral artery, posterior cerebral artery blood flow velocity and vessel pulsatility index Compared with contralateral, no statistical significance. Conclusion: The judgment of the difference of intracranial hemodynamics between acute and middle occlusion of middle cerebral artery by TCD provides valuable hemodynamic data for the diagnosis and prognosis of patients.