摘要
目的探讨急性缺血性脑卒中(AIS)患者脑血流与脑灌注的相关性,评估经颅多普勒(TCD)和磁共振灌注加权成像(PWI)在AIS患者诊治中的价值。方法选取AIS患者52例,分别进行PWI和TCD检查,评估脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP),责任血管收缩期峰值流速(Vp)、平均流速(Vm)、舒张期末流速(EDV)、血管搏动指数(PI);根据TCD检查结果进行溶栓脑缺血(TIBI)分级,根据PWI的检查结果分为储备组和脑梗死组,比较2组Vp、Vm、EDV、PI。结果(1)脑灌注分期如下Ⅰ脑局部微血管尚无代偿性扩张1例(1.92%);Ⅱ脑局部微血管代偿性扩张13例(25.00%);Ⅲ缺血压迫局部微血管15例(28.85%);Ⅳ微循环障碍期20例(38.46%);Ⅴ再灌注3例(5.77%);(2)选择颞窗透声良好的患者37例TIBI分级如下0级1例(2.70%),1级1例(2.70%),2级14例(37.83%),3级5例(13.51%),4级9例(24.32%),5级7例(18.92%);(3)与储备组比较,脑梗死组Vp、Vm、EDV减低,差异有统计学意义,PI无明显变化,差异无统计学意义。结论脑血流速度减低时,患者脑灌注减低,更易出现脑梗死;脑灌注微循环障碍期患者及TIBI分级评分2级患者更易出现脑梗死,TCD与PWI二者联合更有利于AIS患者临床的诊治。
Objective To investigate the correlation between cerebral blood flow and cerebral perfusion in patients with acute ischemic stroke(AIS),and to evaluate the value of transcranial doppler(TCD)and MR perfusion weighted imaging(PWI)in the diagnosis and treatment of AIS.Methods 52 AIS patients were selected for PWI and TCD examination,to evaluate cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)by PWI,peak systolic velocity(Vp),mean velocity(Vm),end diastolic velocity(EDV),and pulsatility index(PI)were recorded by TCD.According to the results of TCD,thrombolytic cerebral ischemia(TIBI)was graded.According to the results of PWI,the patients were divided into the reserve group and the cerebral infarction group and compared Vp,Vm,EDV and PI of the two groups.Results The stages of cerebral perfusion were as followsⅠno compensatory dilatation of local cerebral microvessels1 case(1.92%);ⅡPartial cerebral microvascular compensatory dilatation13 cases(25.00%);Ⅲischemic compression of local microvessels15 cases(28.85%);Ⅳmicrocirculation disorder20 cases(38.46%);Ⅴreperfusion3 cases(5.77%).The TIBI grade of 37 patients with good temporal window sound transmission was selected as followsgrade 01 case(2.70%);Grade 11 case(2.70%);Grade 214 cases(37.83%);Grade 35 cases(13.51%);Grade 49 cases(24.32%);Grade 57 cases(18.92%).Compared with the reserve group,Vp,Vm and EDV were reduced in the cerebral infarction group,with statistically significant differences,while PI was not significantly changed,with no statistically significant differences.Conclusion When cerebral blood flow velocity is decreased,cerebral perfusion is decreased and the patient is more likely to have cerebral infarction.Cerebral infarction is more likely to occur in patients with cerebral perfusion microcirculation disorder and patients with TIBI grading score of grade 2.The combination of TCD and PWI is more conducive to the clinical diagnosis and treatment of AIS patients.
作者
李兆妍
张晓曼
王军杰
吕爱红
LI Zhaoyan;ZHANG Xiaoman;WANG Junjie;LYU Aihong(The First People's Hospital of Zhengzhou,Zhengzhou 450000,China)
出处
《中国实用神经疾病杂志》
2020年第22期1956-1960,共5页
Chinese Journal of Practical Nervous Diseases
基金
河南省科技攻关项目(编号:LHGJ20190985)。
关键词
急性缺血性脑卒中
脑灌注
脑血流
经颅多普勒
磁共振灌注加权成像
Acute ischemic stroke
Cerebral perfusion
Cerebral blood flow
Transcranial Doppler
MR perfusion weighted imaging
