本文選題：動(dòng)脈粥樣硬化　切入點(diǎn)：腦梗塞　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的準(zhǔn)確評(píng)估顱內(nèi)動(dòng)脈粥樣硬化腦梗塞患者的血管病變范圍、狹窄程度、血流動(dòng)力學(xué)改變，對(duì)了解其發(fā)病機(jī)制、制定合理的治療方案及判斷預(yù)后起著至關(guān)重要的作用。在顱內(nèi)動(dòng)脈粥樣硬化性腦梗塞中，大腦中動(dòng)脈（middle cerebral artery, MCA）粥樣硬化的發(fā)病率最高，而經(jīng)顱彩色多普勒超聲（transcranial color-code real-timesonography, TCCS）對(duì)該處的病變?cè)\斷敏感性、特異性較高。本課題旨在研究TCCS聯(lián)合頸動(dòng)脈血管超聲對(duì)MCA粥樣硬化性腦梗塞患者的臨床應(yīng)用價(jià)值。 方法病例組為經(jīng)CT血管造影（computed tomography angiography, CTA）證實(shí)為MCA粥樣硬化性腦梗塞患者75例，對(duì)照組為年齡、性別配對(duì)的門(mén)診正常健康體檢者（頭顱CT或MRI檢查正常）40例。 腦梗塞患者均于入院一周內(nèi)行TCCS和頸動(dòng)脈彩色多普勒超聲檢查由同一檢查醫(yī)師于同一天依次進(jìn)行，TCCS檢測(cè)雙側(cè)MCA收縮期峰值血流速度（systolic velocity,Vs）、舒張末期血流速度（diastolic velocity, Vd）、搏動(dòng)指數(shù)（pulsatility index, PI）及阻力指數(shù)（resistance index, RI）；頸動(dòng)脈彩色多普勒超聲測(cè)量雙側(cè)頸總動(dòng)脈（commoncarotid artery, CCA）收縮期血管內(nèi)徑（systolic diameter, Ds）、CCA平均內(nèi)中膜厚度（intima-media thickness, IMT），觀察有無(wú)斑塊，并記錄CCA及頸內(nèi)動(dòng)脈(internalcarotid artery, ICA)斑塊的回聲強(qiáng)度、數(shù)目及斑塊累及的血管數(shù)目。 結(jié)果腦梗塞組CTA陽(yáng)性側(cè)和陰性側(cè)比較：CCA-Ds、CCA-IMT、MCA-RI、MCA-PI、頸動(dòng)脈斑塊發(fā)生率、混合回聲和低回聲斑塊發(fā)生率、多發(fā)斑塊發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。 腦梗塞組與對(duì)照組比較：腦梗塞組CTA雙側(cè)CCA-Ds、CCA-IMT、均高于對(duì)照組(P0.05)；腦梗塞組雙側(cè)MCA-RI、MCA-PI均高于對(duì)照組(P0.05)；與對(duì)照組相比，腦梗塞組頸動(dòng)脈斑塊發(fā)生率、混合回聲和低回聲斑塊發(fā)生率、多發(fā)斑塊發(fā)生率均明顯增大(P＜0.05)。 75例腦梗塞患者中，TCCS顯示CTA陽(yáng)性側(cè)MCA收縮期峰值血流速度增快者21例（28%）、收縮期峰值血流速度減慢者42例（56%）、血流速度正常范圍者12例（16%），經(jīng)TCCS檢查發(fā)現(xiàn)MCA血流速度異常率為84%（63/75）。 結(jié)論對(duì)于同一組顱內(nèi)動(dòng)脈粥樣硬化患者的CCA-Ds、CCA-IMT、頸動(dòng)脈斑塊發(fā)生率、混合回聲和低回聲斑塊發(fā)生率、多發(fā)斑塊發(fā)生率基本相同，提示雙側(cè)頸動(dòng)脈粥樣硬化進(jìn)展程度基本一致，所以無(wú)論是CTA陽(yáng)性側(cè)還是CTA陰性側(cè)只要出現(xiàn)低回聲或混合回聲斑塊，，都應(yīng)進(jìn)行正規(guī)的穩(wěn)定斑塊、抗動(dòng)脈粥樣硬化治療。與對(duì)照組相比，MCA粥樣硬化性腦梗塞患者CCA-Ds、CCA-IMT、頸動(dòng)脈斑塊發(fā)生率、混合回聲和低回聲斑塊發(fā)生率、多發(fā)斑塊發(fā)生率均大于正常對(duì)照組，提示頸動(dòng)脈血管超聲可以間接地反應(yīng)顱內(nèi)血管的動(dòng)脈粥樣硬化程度。TCCS可以直觀地顯示MCA血流方向和走形，取得病變處血管及其近端、遠(yuǎn)端血管的血流動(dòng)力學(xué)參數(shù)，協(xié)助早期診斷顱內(nèi)動(dòng)脈粥樣硬化性狹窄，為臨床制定治療方案及改善預(yù)后爭(zhēng)取了寶貴時(shí)間。
[Abstract]:Objective to evaluate the extent of vascular lesions, the degree of stenosis and the changes of hemodynamics in patients with intracranial atherosclerosis and cerebral infarction. It is very important to make a reasonable treatment plan and to judge the prognosis. The middle cerebral artery (MCA) has the highest incidence of atherosclerosis in intracranial atherosclerotic cerebral infarction, the middle cerebral artery (MCA) has the highest incidence of Atherosclerosis. The sensitivity and specificity of transcranial color-code real-time imaging (TCCS) in the diagnosis of the lesions were high. The purpose of this study was to study the clinical value of TCCS combined with carotid artery ultrasound in the diagnosis of MCA patients with atherosclerotic cerebral infarction. Methods Seventy-five patients with MCA atherosclerotic cerebral infarction were diagnosed by CT angiography and 40 healthy controls were matched by age and sex (CT or MRI). Patients with cerebral infarction were examined by TCCS and carotid color Doppler ultrasonography within one week of admission. TCCS was performed on the same day to detect systolic peak systolic velocity and diastolic velocityof bilateral MCA. VDV, pulsatility index (Pi), resistance index (RI) and resistance index (RI). Carotid color Doppler ultrasound was used to measure systolic diameter of common carotid artery (CCAs), mean intima media thickness (IMT), intima media thickness (IMT). The echo intensity, the number of plaques and the number of vessels involved in CCA and internal carotid artery were recorded. Results there was no significant difference in the incidence of carotid plaque, mixed echo and hypoechoic plaque between the CTA positive side and the negative side in the cerebral infarction group. There was no significant difference in the incidence of multiple plaques between the two groups (P 0.05). Compared with the control group, the CTA of the cerebral infarction group was higher than that of the control group (P 0.05), the MCA-RI MCA-PI of the cerebral infarction group was higher than that of the control group (P 0.05), and the incidence of carotid plaque, mixed echo and hypoechoic plaque in the cerebral infarction group was higher than that in the control group. The incidence of multiple plaques increased significantly (P < 0.05). Among 75 patients with cerebral infarction, 21 cases showed that the peak systolic velocity of MCA on the positive side of CTA was increased by TCCS in 21 cases, and the peak systolic velocity was decreased in 42 cases. There were 12 cases with normal blood flow velocity in 12 cases with normal blood flow velocity. The abnormal rate of MCA blood flow velocity was 84 ~ 63 / 7575 by TCCS. Conclusion for the same group of patients with intracranial atherosclerosis, the incidence of carotid plaque, mixed echo and hypoechoic plaque were the same, suggesting that the degree of progression of bilateral carotid atherosclerosis was basically the same. So whether it is CTA positive side or CTA negative side, as long as there are hypoechoic or mixed echo plaques, we should have regular stable plaques. Compared with the control group, the incidence of carotid plaque, mixed echo and hypoechoic plaque in patients with MCA atherosclerotic cerebral infarction were higher than those in control group. The results suggest that carotid artery ultrasound can indirectly reflect the degree of atherosclerosis of intracranial vessels. TCCS can directly display the direction and shape of MCA blood flow, and obtain the hemodynamic parameters of the lesion and its proximal and distal vessels. It helps to diagnose early intracranial atherosclerotic stenosis, which can provide valuable time for clinical treatment and prognosis improvement.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉水平,張靜,張茁;缺血性腦血管病顱內(nèi)動(dòng)脈狹窄或閉塞的TCD、MRA對(duì)比研究[J];北京醫(yī)學(xué);2004年06期

2 王桂紅,王擁軍,姜衛(wèi)劍,黃家星;顱內(nèi)大動(dòng)脈狹窄及其治療[J];中華神經(jīng)醫(yī)學(xué)雜志;2004年01期

3 武玉坤;鞠發(fā)軍;;MRA與DSA在腦血管疾病中的對(duì)照研究[J];實(shí)用醫(yī)技雜志;2008年02期

4 于德林;張瑋;;頸部血管彩色超聲和經(jīng)顱多普勒超聲聯(lián)合檢查評(píng)價(jià)前循環(huán)腦動(dòng)脈粥樣硬化[J];中國(guó)現(xiàn)代神經(jīng)疾病雜志;2007年05期

5 蘇維海;;經(jīng)顱多普勒超聲檢測(cè)在腦梗死診斷、評(píng)估中的臨床價(jià)值[J];中國(guó)臨床研究;2011年03期

6 劉榮桂,錢(qián)蘊(yùn)秋,何光彬,周曉東;高頻超聲對(duì)腦梗死患者頸動(dòng)脈結(jié)構(gòu)與功能改變的評(píng)價(jià)[J];中國(guó)超聲醫(yī)學(xué)雜志;2005年07期

7 周衡,王擁軍,王素香,趙性泉;急性缺血性腦卒中的TOAST亞型分析[J];中華內(nèi)科雜志;2004年07期

8 石建宏;李偉;;老年顱內(nèi)動(dòng)脈狹窄或閉塞的TCD、MRA對(duì)比[J];中國(guó)老年學(xué)雜志;2012年01期

9 王虹虹;曾紅;;缺血性腦血管病概述[J];中國(guó)臨床醫(yī)生;2011年06期

10 李瑤宣;李呂力;鐘維章;王小燕;寧加玲;董艷玲;薛富英;;頸動(dòng)脈內(nèi)-中膜厚度和斑塊對(duì)顱內(nèi)動(dòng)脈狹窄嚴(yán)重程度的預(yù)測(cè)價(jià)值[J];中國(guó)神經(jīng)精神疾病雜志;2010年04期

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