發(fā)布時間：2016-04-25 10:46

摘要：目的：探討顱外段頸動脈狹窄所致血流動力學(xué)變化對斑塊穩(wěn)定性影響；分析腦梗死分型與責(zé)任血管狹窄程度、斑塊穩(wěn)定性關(guān)系,為腦梗死發(fā)病機(jī)制、臨床診斷、治療和預(yù)防提供重要依據(jù)。方法：對168例急性腦梗死患者分別行64排CT頭頸部血管成像(computerized tomography  angiograbhy  CTA)及彩色多普勒血流顯像儀(Color  Doppler  Flow  Imaging  CDFI)檢查，部分經(jīng)CTA證實為中、重度狹窄及閉塞者于腦梗死恢復(fù)期行全腦血管造影檢查(digital subtraction anginography )(DSA)，根據(jù)其責(zé)任血管狹窄程度，將168例患者分成頸動脈正常組、輕度狹窄組、中度狹窄組，重度狹窄組及閉塞組，結(jié)合CDFI及CTA評價斑塊性質(zhì)及流場改變，對梗死灶進(jìn)行OCSP分型，再根據(jù)CTA所示腦梗死部位 ,將患者分為皮質(zhì)、基底節(jié)區(qū)、放射冠和后循環(huán)梗死4種亞型。觀察流場改變對斑塊穩(wěn)定性影響并對比不同程度頸動脈狹窄后腦梗死臨床分型特點。 結(jié)果：168條責(zé)任血管，正常17.9%，輕度狹窄22.6%，中度狹窄30.9%，，重度狹窄14.8%，閉塞14.3%，中度狹窄比例最高。狹窄程度大于50%即可導(dǎo)致流場改變，血流速度增快，湍流形成，斑塊不穩(wěn)定性增加，以脂質(zhì)斑及混合斑比例最高。臨床以PACI多見，重度狹窄及閉塞組頸動脈斑塊以混合斑多見，臨床以分水嶺梗死多見。輕度狹窄組，多為纖維斑塊，臨床以LI多見。結(jié)論：頸動脈中度狹窄因特殊的血流流場變化而導(dǎo)致斑塊不穩(wěn)定性增高，易發(fā)生動脈－動脈栓塞。

【中圖分類號】中圖分類號：R743.3                                文獻(xiàn)標(biāo)識碼：A

To analysis on the changes of the flow field in the carotid stenosis and its effect on the stability of plaque and classification of cerebral infarction 

Wu xiao ling1, Hao jian ping2，Wang shu zhen1,Yu hong xia1 chi lu xiang 3et al.1. The 251 hospital of PLA, HE BEI zhang jia kou, 075000  2.Kiang bao county hospital, HE BEI kang bao, 076650, 3.Department of Cardiology, Shouthwest Hospital , Third Military Medical University, Chongqing 400038, China

Key  words :  Carotid arteries stenosis, the changes of flow field , the stability of plaque, cerebral infarction OCSP classification

Abstract: objective To abserve  the  changes of  hemodynamic and stability of plaque in extracranial carotid stenosis ,analyse the relationship of classification of cerebral infarction and the degree of stenosis of criminal artery and stability of plaque, for evaluating nosogenesis of cerebral infarction and clinical diagnosis,treatment, prevention search evidence.  Methods: CDFI,CTA,were performed in 168 patients with acute cerebral infarction , some moderate and severe and occlusive carotid artery which were demonstrated by CTA and CDFI were further checked by DSA during convalescence . Totally 168 acute cerebral infarction patients were divided into 5 groups based on the degree of stenosis of duty vessule .To evaluate the stability of plaque and the changes of the flow field with CDFI and CTA, OCSP clinical classification and brain image classification were finish according to CTA. Lesion distributions were classified into cortical infarction, basal ganglion infarction, centrum ovale infarction and posterior infarction.. To abserve the changes of flow field and stability of plaque ,compare the relationship between different degree of stenosis and the classification of lesion of infarction. Result : 168 duty vessel were divided into 5groups.natural 17.9%,mild 22.6%, moderate 30.9%and severe14.8%, and occlusive14.3, the proportionment of moderate stenosis is most .The degrees of stenosis >50% may lead to the changes of flow field ,speedup of the blood flow,the onflow come into being.The instability of plaque is increased ,the lipid plaque and admixture plaque is most .The PACI are  the most in all moderate group. The admixture plaque are the most in the severe and occlusive group and the PACI , TACI are t are the also the most in the severe and occlusive groups.fibrous plaque are most in mild groups,LI are most in this group,Conclusions:.Moderate carotid stenosis may lead to increase of instability of plaque as a result of the changes of flow field ,It is prone to find the artery-artery embolism.

頸動脈因其特殊的解剖結(jié)構(gòu)而成為缺血性腦血管疾病的獨立危險因素。在以往的研究中[1]，更多關(guān)注頸動脈狹窄嚴(yán)重程度，>70%的頸動脈粥樣硬化性狹窄認(rèn)為是血管介入治療或CEA的指征。但近年文獻(xiàn)更多關(guān)注斑塊性質(zhì)，認(rèn)為易損斑是導(dǎo)致腦血管病發(fā)生的主要因素[2、3]，而血管狹窄程度并不能單獨預(yù)測卒中風(fēng)險[4]，心血管研究認(rèn)為：<70%甚至<50%的非限制性的血流狹窄未來引起斑塊破裂和血栓形成的病例,比更嚴(yán)重狹窄的斑塊產(chǎn)生破裂的病例多。Virmani R[5]對低級別狹窄頸動脈進(jìn)行研究，認(rèn)為狹窄程度<70%更多存在不穩(wěn)定斑塊，而更多發(fā)生在狹窄程度<50%的薄纖維帽粥樣瘤被認(rèn)為是斑塊破裂的前期病損[６]。為探討不同程度血管狹窄所引起的流場改變是否影響斑塊穩(wěn)定性及與腦梗死發(fā)生相關(guān)性，我們對168例急性腦梗塞患者顱頸血管行CDFI及DSA、CTA檢查，結(jié)果如下：

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本文編號：40839