本文選題：經(jīng)顱多普勒超聲 + 雙頻超聲��； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：[目的]椎動(dòng)脈是后循環(huán)系統(tǒng)重要的供血血管,隨著社會(huì)步入老齡化,動(dòng)脈硬化斑塊所致的椎動(dòng)脈狹窄也日漸增多,而椎動(dòng)脈狹窄以起始段較為常見(jiàn),近20年來(lái),隨著介入治療的迅速發(fā)展,腦血管成形術(shù)已逐步成為椎動(dòng)脈起始段重度狹窄的主要治療方法,因而迫切需要一種準(zhǔn)確、方便的檢查方法進(jìn)行評(píng)估支架植入術(shù)后的效果及遠(yuǎn)期隨訪。經(jīng)顱多普勒超聲(TCD)及頸部血管超聲超聲技術(shù)是無(wú)創(chuàng)、方便、可重復(fù)、經(jīng)濟(jì)等優(yōu)點(diǎn)的檢測(cè)手段,目前在臨床廣泛應(yīng)用,本文為探討TCD聯(lián)合雙頻超聲技術(shù)在椎動(dòng)脈起始段支架植入術(shù)前后的血流動(dòng)力學(xué)改變,研究其在椎動(dòng)脈起始段支架植入術(shù)前后的應(yīng)用價(jià)值。 [方法]2013年1月至2014年2月我院行椎動(dòng)脈起始段支架植入術(shù)的30例患者為研究組,均在術(shù)前1天及術(shù)后3天行頸部血管超聲及TCD檢查,另選取門診健康體檢者60例為對(duì)照組,行TCD及頸部血管超聲檢查,評(píng)估：1.術(shù)前研究組狹窄側(cè)與對(duì)照組的椎動(dòng)脈起始段的內(nèi)徑、椎動(dòng)脈起始段、椎間段、顱內(nèi)段的血流速度、阻力指數(shù)、搏動(dòng)指數(shù)及頻譜形態(tài)；2.術(shù)前研究組狹窄側(cè)與健側(cè)、健側(cè)與對(duì)照組的椎動(dòng)脈的內(nèi)徑及血流動(dòng)力學(xué)的對(duì)比；3.術(shù)前TCD、雙頻超聲及TCD聯(lián)合雙頻超聲評(píng)估椎動(dòng)脈起始段狹窄結(jié)果與DSA的比較；4.對(duì)比研究組狹窄側(cè)及健側(cè)在支架植入術(shù)后椎動(dòng)脈起始段的內(nèi)徑及椎動(dòng)脈起始段、椎間段、顱內(nèi)段的血流動(dòng)力學(xué)改變。 [結(jié)果]1、支架植入術(shù)前,研究組與對(duì)照組年齡差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。雙頻超聲示研究組狹窄側(cè)椎動(dòng)脈起始段內(nèi)徑(1.71±0.40mam)較對(duì)照組內(nèi)徑(3.77±0.60mam)窄,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；健側(cè)椎動(dòng)脈起始段內(nèi)徑(4.10±0.45mam)較對(duì)照組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；狹窄側(cè)椎動(dòng)脈起始段收縮期峰值血流速度(236.43±60.03cm/s)較對(duì)照組(68.92±9.36cm/s)增快,阻力指數(shù)(0.82±0.12)較對(duì)照組(0.64±0.19)升高,椎間段血流速度(44.34±12.15cm/s)較對(duì)照組(55.18+12.83cm/s)減慢,阻力指數(shù)(0.41±0.10)較對(duì)照組(0.62±0.15)降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.01)；而健側(cè)椎動(dòng)脈起始段流速(73.98+12.08cm/s)、椎間段血流速度(68.73±18.27cm/s)、阻力指數(shù)(0.59±0.09)分別與對(duì)照組相比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；2、經(jīng)顱多普勒超聲(TCD)示研究組狹窄側(cè)椎動(dòng)脈顱內(nèi)段血流速度(31.56±11.65cm/s)較對(duì)照組(77.47±11.35cm/s)減慢,搏動(dòng)指數(shù)(0.62±0.23)較對(duì)照組降低(0.91±0.18),差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；而研究組健側(cè)與對(duì)照組相比較,椎動(dòng)脈顱內(nèi)段血流速度及搏動(dòng)指數(shù)均較健側(cè)無(wú)明顯差異(P0.05)。研究組基底動(dòng)脈PSV、PI與對(duì)照組相比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3、以DSA為檢測(cè)椎動(dòng)脈起始段狹窄的標(biāo)準(zhǔn),單用雙頻超聲檢測(cè),靈敏度為81.7%,特異性為92.8%,單用TCD檢測(cè),靈敏度為83.3%,特異性為89.7%；聯(lián)合使用TCD及雙頻超聲檢查,靈敏度為91.7%,特異性為96.2；4、研究組中,患者行支架植入術(shù)前后對(duì)比,術(shù)后狹窄側(cè)椎動(dòng)脈起始段內(nèi)徑增寬至(3.75±0.56mm),較術(shù)前平均增寬133.0%,差異有統(tǒng)計(jì)學(xué)意義(P0.01)；椎動(dòng)脈起始段血流速度降至(73.98±12.08cm/s),較術(shù)前平均減慢了71.8%,阻力指數(shù)降低至(0.69±0.18),較術(shù)前平均降低了17.1%,椎動(dòng)脈椎間段血流速度增快至(56.37±9.84cm/s),較術(shù)前增快了31.3%,阻力指數(shù)升高至(0.61±0.19),較術(shù)前升高了46.1%,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；椎動(dòng)脈顱內(nèi)段血流速度增快至(76.12±15.30cm/s),較術(shù)前平均增快了162.0%,血管搏動(dòng)指數(shù)增高至(0.90±0.23),較術(shù)前平均增高了54.9%,差異也均有統(tǒng)計(jì)學(xué)意義(P0.01)；而健側(cè)椎動(dòng)脈椎動(dòng)脈起始段內(nèi)徑、血流速度及阻力指數(shù),椎間段、顱內(nèi)段血流速度及搏動(dòng)指數(shù)均較術(shù)前無(wú)顯著差異(P0.05),基底動(dòng)脈血流速度及搏動(dòng)指數(shù)也均較術(shù)前無(wú)顯著差異(P0.05)。 [結(jié)論]利用TCD聯(lián)合超聲檢測(cè)椎動(dòng)脈起始段支架植入術(shù)血流動(dòng)力學(xué)改變,其中椎動(dòng)脈起始段血流速度改善了71.9%,阻力指數(shù)降低了17.1%,且TCD聯(lián)合超聲檢測(cè)靈敏度為91.7%,特異性為96.2%,提示TCD聯(lián)合頸部血管超聲是一種準(zhǔn)確評(píng)價(jià)椎動(dòng)脈起始段狹窄支架植入術(shù)前血流動(dòng)力學(xué)改變及術(shù)后效果評(píng)價(jià)的重要檢測(cè)手段。
[Abstract]:[Objective] the vertebral artery is an important blood supply vessel for the posterior circulation system. With the aging of the society, the stenosis of the vertebral artery caused by atherosclerotic plaque is increasing, and the stenosis of the vertebral artery is more common. In the last 20 years, with the rapid development of interventional therapy, cerebral angioplasty has gradually become a severe stenosis of the initial segment of the vertebral artery. As a result, an accurate and convenient method is urgently needed to evaluate the effect and long-term follow-up of stent implantation. Transcranial Doppler ultrasound (TCD) and cervical vascular ultrasound technique are non invasive, convenient, repeatable, economical and so on, and are widely used in clinical practice. This paper is to explore the combination of TCD and two. The hemodynamic changes before and after implantation of vertebral artery initial segment were studied by frequency ultrasound.
[Methods] 30 patients with vertebral artery initial stent implantation in our hospital from January to February 2014]2013 were selected as the study group. The cervical vascular ultrasound and TCD examination were performed 1 days before and 3 days after the operation, and 60 patients in the outpatient health examination were selected as the control group. The TCD and cervical vascular ultrasound examinations were performed, and the stenosis side and the control group before the 1. operation group were evaluated. The internal diameter of the initial segment of the vertebral artery, the initial segment of the vertebral artery, the intervertebral segment, the velocity of the blood flow, the resistance index, the pulsation index and the spectrum shape; 2. the comparison of the internal diameter and hemodynamics of the vertebral artery in the stenosis side and the healthy side in the study group before the operation; and 3. before operation TCD, double frequency ultrasound and TCD combined double frequency ultrasound to evaluate the origin of vertebral artery. The results of segmental stenosis were compared with that of DSA; 4. the hemodynamic changes in the initial segment of the vertebral artery, the initial segment of the vertebral artery, the intervertebral segment and the intracranial segment were compared in the stenosis side and the healthy side of the study group after the stent implantation.
[results]1, the age difference between the study group and the control group was not statistically significant before the stent implantation (P0.05). The internal diameter of the stenosis side vertebral artery in the study group (1.71 + 0.40mam) was narrower than that of the control group (3.77 + 0.60mam), and the difference was statistically significant (P0.05), and there was no difference between the initial segment of the vertebral artery (4.10 + 0.45mam) in the healthy side compared with the control group. Statistical significance (P0.05); the peak systolic velocity (236.43 + 60.03cm/s) of the initial segment of the narrow lateral vertebral artery was faster than that of the control group (68.92 9.36cm/s), the resistance index (0.82 + 0.12) was higher than that of the control group (0.64 + 0.19), and the velocity of the intervertebral segment (44.34 + 12.15cm/s) was slower than that of the control group (55.18+12.83cm/s), and the resistance index (0.41 + 0.10) was compared with the control group. In the group (0.62 + 0.15), the difference was statistically significant (P0.01), while the velocity of the initial segment of the vertebral artery (73.98+12.08cm/s), the velocity of the intervertebral body flow (68.73 + 18.27cm/s), and the resistance index (0.59 + 0.09) were compared with the control group, and the difference was not statistically significant (P0.05). 2, the transcranial Doppler ultrasound (TCD) showed the stenosis of the vertebral artery in the study group. The velocity of blood flow in the intracranial segment (31.56 + 11.65cm/s) was slower than that of the control group (77.47 + 11.35cm/s), and the pulsatile index (0.62 + 0.23) was lower than the control group (0.91 + 0.18). The difference was statistically significant (P0.05). Compared with the control group, the blood flow velocity and pulsation index of the intracranial segment of the vertebral artery were not significantly different from the healthy side (P0.05). The basilar artery PSV and PI were compared with the control group, the difference was not statistically significant (P0.05).3, with DSA as the standard for detecting the stenosis of the vertebral artery, the sensitivity was 81.7%, the specificity was 92.8%, the sensitivity was 83.3%, the specificity was 89.7%, the sensitivity was 91.7%, the specificity was 91.7%, and the specificity was 91.7%, and the specificity was 91.7%. Sex was 96.2; 4, in the study group, the patients were compared before and after the stent implantation, and the diameter of the initial segment of the vertebral artery in the narrow side was widened to (3.75 + 0.56mm), and the average width was 133% compared with that before the operation. The difference was statistically significant (P0.01); the velocity of the initial segment of the vertebral artery decreased to (73.98 + 12.08cm/s), the average slowed down by 71.8%, and the resistance index decreased to (0.). 69 + 0.18), compared with the preoperative average of 17.1%, the velocity of the intervertebral artery in the vertebral artery increased to (56.37 + 9.84cm/s), 31.3%, and the resistance index increased to (0.61 + 0.19), compared with the preoperative increase of 46.1%. The difference was statistically significant (P0.05); the velocity of the cranial segment of the vertebral artery increased to (76.12 + 15.30cm/s), and was 1 faster than that before the operation. 62%, the vascular pulsation index increased to (0.90 + 0.23), higher than the preoperative average of 54.9%, and the difference was statistically significant (P0.01), while the initial segment of the vertebral artery, the velocity and resistance index of the vertebral artery in the healthy side, the velocity of the blood flow and the pulsation index of the intervertebral segment, the intracranial segment were not significantly different (P0.05), the velocity of blood flow of the basilar artery and the beat of the basilar artery There was no significant difference in dynamic index (P0.05).
[Conclusion] the hemodynamic changes of the stenting of the initial segment of vertebral artery were detected by TCD combined with ultrasound, in which the velocity of the initial segment of the vertebral artery was improved by 71.9%, the resistance index was reduced by 17.1%, and the sensitivity of the TCD combined ultrasonic detection was 91.7% and the specificity was 96.2%. It was suggested that the TCD combined with the cervical vascular ultrasound is a kind of accurate evaluation of the vertebral artery origin. Hemodynamic changes before and after stent placement and the important means of postoperative evaluation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R743

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 韓軍良,萬(wàn)琪,王洪典;CT血管造影在診斷椎-基底動(dòng)脈供血不足中的應(yīng)用[J];腦與神經(jīng)疾病雜志;2001年05期

2 孫曉培;許晶;;椎動(dòng)脈狹窄CT血管造影與數(shù)字減影血管造影的對(duì)比研究[J];中國(guó)腦血管病雜志;2007年02期

，

本文編號(hào)：1951868