【摘要】：目的探討頸內(nèi)動脈重度狹窄或閉塞患者側(cè)支循環(huán)與搏動指數(shù)(PI)及持續(xù)注意功能的相關(guān)性。方法對135例頸內(nèi)動脈重度狹窄或閉塞患者進(jìn)行DSA檢查并根據(jù)側(cè)支循環(huán)開放情況分組。另選擇30名健康老年人作為對照組。采用TCD檢查檢測雙側(cè)大腦中動脈收縮期和舒張期血流速度(Vs和Vd)、平均血流速度(Vm)和PI。采用持續(xù)性操作測驗的遺漏數(shù)、認(rèn)錯數(shù)、平均反應(yīng)時評估持續(xù)注意功能。對結(jié)果進(jìn)行比較分析。結(jié)果 (1)135例頸內(nèi)動脈重度狹窄或閉塞患者根據(jù)側(cè)支循環(huán)開放情況分為前交通動脈(AcoA)開放組(31例)、后交通動脈(PcoA)開放組(20例)、AcoA+PcoA開放組(19例)、初級側(cè)支循環(huán)開放組(即AcoA、PcoA、AcoA+PcoA開放)(70例)、次級側(cè)支循環(huán)開放組(主要包括眼動脈、軟腦膜吻合支和新生供血血管)(15例)、初級+次級側(cè)支循環(huán)開放組(13例)和無側(cè)支循環(huán)開放組(37例)。(2)與對照組比較,其余各組患者的Vs、Vd、Vm和PI均顯著降低(均P0.05)。與無側(cè)支循環(huán)開放組比較,AcoA開放組、初級側(cè)支循環(huán)開放組的Vd及AcoA+PcoA開放組的Vd、Vm均明顯升高,AcoA開放組、AcoA+PcoA開放組、初級側(cè)支循環(huán)開放組及初級+次級側(cè)支循環(huán)開放組的PI均明顯降低(均P0.05)。與PcoA開放組比較,AcoA開放組、AcoA+PcoA開放組的PI均明顯降低(均P0.05)。與次級側(cè)支循環(huán)開放組比較,初級側(cè)支循環(huán)開放組的Vs、Vd、Vm和初級+次級側(cè)支循環(huán)開放組的Vd、Vm均明顯升高,初級側(cè)支循環(huán)開放組和和初級+次級側(cè)支循環(huán)開放組的PI均明顯降低(均P0.05)。(3)與對照組比較,其余各組患者的遺漏數(shù)、認(rèn)錯數(shù)和平均反應(yīng)時均顯著增加(均P0.05)。與無側(cè)支循環(huán)開放組比較,AcoA開放組、AcoA+PcoA開放組及初級側(cè)支循環(huán)開放組的遺漏數(shù)、認(rèn)錯數(shù)和平均反應(yīng)時均明顯減少;初級+次級側(cè)支循環(huán)開放組的遺漏數(shù)和認(rèn)錯數(shù)均明顯減少(均P0.05)。與PcoA開放組比較,AcoA開放組的遺漏數(shù)和認(rèn)錯數(shù)均明顯減少;AcoA+PcoA開放組的遺漏數(shù)、認(rèn)錯數(shù)和平均反應(yīng)時均明顯減少(均P0.05)。與AcoA+PcoA開放組比較,AcoA開放組的遺漏數(shù)、認(rèn)錯數(shù)和平均反應(yīng)時均明顯增加(均P0.05)。與次級側(cè)支循環(huán)開放組比較,初級側(cè)支循環(huán)開放組的遺漏數(shù)、認(rèn)錯數(shù)和平均反應(yīng)時均明顯減少;初級+次級側(cè)支循環(huán)開放組的遺漏數(shù)和認(rèn)錯數(shù)均明顯減少(均P0.05)。(4)AcoA開放組、初級側(cè)支循環(huán)開放組和次級側(cè)支循環(huán)開放組的PI與平均反應(yīng)時呈正相關(guān)(r=0.441,r=0.364,r=0.552;均P0.05)。PcoA開放組和無側(cè)支循環(huán)開放組的PI與遺漏數(shù)呈正相關(guān)(r=0.668,r=0.397;均P0.05);與認(rèn)錯數(shù)呈正相關(guān)(r=0.509,r=0.480;均P0.05)。結(jié)論頸內(nèi)動脈重度狹窄或閉塞患者患側(cè)高PI可反映其持續(xù)注意功能受損。
[Abstract]:Objective to investigate the correlation between collateral circulation and pulsatility index (PI) and continuous attention function in patients with severe stenosis or occlusion of internal carotid artery. Methods DSA was performed in 135 patients with severe stenosis or occlusion of internal carotid artery and divided into groups according to the opening of collateral circulation. Another 30 healthy elderly were selected as control group. Measurement of systolic and diastolic blood flow velocity (Vm) and PI.) of bilateral middle cerebral artery (Vs and Vd),) by TCD Continuous attention function was assessed by the number of omissions, the number of errors identified, and the mean response time of the continuous operation test. The results were compared and analyzed. Results (1) the patients with severe stenosis or occlusion of internal carotid artery were divided into anterior communicating artery (AcoA) group (31 cases) and posterior communicating artery (PcoA) group (20 cases of), AcoA PcoA open group (19 cases) according to the opening of collateral circulation). The primary collateral circulation (AcoA,PcoA,AcoA PcoA) group (70 cases), the secondary collateral circulation open group (mainly including ophthalmic artery, meningeal anastomotic branch and neovascularization) (15 cases), the primary collateral circulation open group (70 cases), and the secondary collateral circulation open group (15 cases). Compared with the control group, the Vs,Vd,Vm and PI in the primary and secondary collateral circulation open group (13 cases) and the non-collateral circulation open group (37 cases). (2) were significantly lower than those in the control group (P 0.05). Compared with non-collateral circulation open group, Vd and Vd,Vm in AcoA open group, primary collateral circulation open group and AcoA PcoA open group were significantly higher than those in AcoA open group, AcoA PcoA open group in AcoA open group, and, AcoA PcoA open group in AcoA open group. The PI of primary collateral circulation open group and primary secondary collateral circulation open group were significantly lower than those of primary collateral circulation open group (P0.05). Compared with PcoA open group, PI of, AcoA PcoA open group in AcoA open group was significantly lower than that of, AcoA PcoA open group (P0.05). Compared with the secondary collateral circulation open group, the Vs,Vd,Vm in the primary collateral circulation open group and the Vd,Vm in the primary collateral circulation open group were significantly higher than those in the secondary collateral circulation open group. The PI of the primary collateral circulation open group and the primary secondary collateral circulation open group were significantly lower than that of the control group (P0.05). (3), and the number of omissions in the other groups was significantly lower than that of the control group. The number of errors and the average reaction time were significantly increased (P0.05). Compared with the open group without collateral circulation, the number of omissions, the number of errors and the mean reaction time in AcoA open group and, AcoA PcoA open group and primary collateral open group were significantly decreased. The number of omissions and errors in the primary and secondary collateral circulation open group were significantly decreased (P0.05). Compared with the open group of PcoA, the number of omissions and the number of errors admitted in the open group of AcoA significantly decreased, and the number of errors and the mean response time decreased significantly in the open group of; AcoA PcoA (P0.05). Compared with the open group of AcoA PcoA, the number of omissions, the number of errors and the mean reaction time in the open group of AcoA were significantly increased (P0.05). Compared with the secondary collateral circulation open group, the number of omissions, the number of errors and the mean reaction time were significantly decreased in the primary collateral circulation open group. The number of omissions and errors in the primary and secondary collateral circulation open group were significantly decreased (P0.05). (4). The PI in the primary collateral circulation open group and the secondary collateral circulation open group was positively correlated with the mean reaction time (r = 0.441, P < 0.05). R = 0.364, r = 0.552, r = 0.364, r = 0.552; There was a positive correlation between PI and the number of omissions in PcoA open group and no collateral circulation open group (r = 0.668, r = 0.397; both P 0.05), and positively correlated with the number of errors (r = 0.509, r = 0.480; both P 0.05). Conclusion High PI on the affected side of patients with severe stenosis or occlusion of internal carotid artery can reflect the impairment of continuous attention function.
【作者單位】： 西南醫(yī)科大學(xué)附屬醫(yī)院神經(jīng)內(nèi)科;
【基金】：瀘州醫(yī)學(xué)院附屬醫(yī)院青年基金項目(2015-QS-034)
【分類號】：R743.3

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