大面积脑梗死血管成像及血流动力学改变研究_临床医学论文.docVIP

大面积脑梗死血管成像及血流动力学改变研究_临床医学论文 大面积脑梗死血管成像及血流动力学改变研究_临床医学论文 作者：古坤意 潘秋燕 邹良玉 付学军 徐铅辉 【摘要】 目的 探讨大面积脑梗死颅内血管成像及血流动力学变化特点。 方法 对39例大面积脑梗死患者在急性期进行颅脑MRI、MRA及TCD检查观察颅内血管成像及血流动力学变化情况。结果 39例大面积脑梗死患者中颈动脉闭塞7例，大脑中动脉闭塞17例，大脑中动脉狭窄及远端分支减少15例，大脑前动脉狭窄及闭塞5例，大脑后动脉狭窄3例，TCD显示大面积脑梗死病侧MCA Vm、ICA Vm明显低于对照组(0.05)和病灶对侧(0.05),双侧ACA Vm与对照组比较无显著差异：血管搏动指数和阻力指数(PI、RI)与对照组比较明显增大有显著差异(0.05)。结论 大面积脑梗死患者MRA可直接了解颅内闭塞情况及狭窄程度，TCD可了解颅内血流动力学改变及血管阻力，从而了解梗死区血供情况，间接了解颅内压，为判断病情及预后提供参考。 【关键词】 大面积脑梗死;MRA;TCD 　　【Abstract】 Objective To investigate the characteristics of magnetic resonance angiography (MRA) and hemodynamics in patients with massive crebral infarction. Methods Thirtynine patients with massive cerebral infarction were enrolled into our study. All the patiens were examined with MRI, MRA and TCD in the acute stage to observe the characteristics of hemodynamics and angiography.Results Among 39 patients with MRA, 7 and 17 patients were found with occlusion of internal carotid artery (ICA), middle cerebral artery (MCA).Fifteen five and three patients were found with stenosis or occlusion of MCA, anterior cerebral artery (ACA) and posterior cerebral artery (PCA). The mean velocity of ipsilateral ICA and MCA were found significantly lower than those of contralateral side (0.05) and control group (0.05). But no significant difference was found in the ACA between control group and observation group. The PI and RI were found higher in the observation group than those in the control group (0.05).Conclusion MRA is helpful to understand the occlusion or stenosis of intracranial artery in patients with massive cerebral infarction. Combination with TCD can estimate the changes of hemodynamics and vascular resistance, and furthermore to know the blood supply of brain tissue and intracranial pressure. So these results can be useful in estimating the prognosis of patients. 　　【Key words】 Massive cerebral infarction; Magnatic resonance angiography; Transcranial Doppler sonography 　　大面积脑梗死是临床上较为常见的危重性脑卒中，致残率及致死率极高，预后较差[1]。及时