摘要
目的探讨经颅多普勒超声(TCD)联合血流速度检测在颈内动脉支架置入术后高灌注损伤(CHS)中的应用。方法前瞻性选取2016年1月至2019年12月常熟市第二人民医院收治的80例接受颈动脉支架置入术患者为对象,均接受TCD检测。统计颈动脉支架置入术后CHS发生情况,收集患者年龄、性别、体质量指数、高血压、糖尿病、吸烟、饮酒、冠心病、高脂血症、脑梗死史、血压、颈动脉狭窄程度等资料,分析影响颈内动脉支架置入术后CHS发生的因素。并分析监测血流速度对CHS的诊断价值。结果80例接受颈内动脉支架置入术患者术后7例(8.75%)出现CHS。单因素分析显示CHS组与非CHS组患者在性别构成比、体重指数、高血压、糖尿病、吸烟、饮酒、冠心病、高脂血症、脑梗死史方面比较,差异均无统计学意义(P>0.05);CHS组患者年龄高于70岁、血压高于150 mmHg、颈动脉狭窄程度高于90%的占比高于非CHS组患者,CHS组收缩期峰值流速(PSV)、血管搏动指数(PI)水平高于非CHS组,差异均有统计学意义(P<0.05)。Logistic分析结果显示颈动脉狭窄程度(OR=6.439;95%CI:1.548~20.137)、PSV(OR=5.063;95%CI:1.271~16.062)、PI(OR=4.448;95%CI:1.190~13.863)为影响颈动脉支架置入术后CHS发生的独立危险因素;而年龄、血压与CHS无明显相关(P>0.05)。PSV诊断颈动脉支架置入术后CHS的AUC、敏感度、特异度分别为0.845(95%CI:0.747~0.917)、85.71%、78.08%;PI诊断颈动脉支架置入术后CHS的AUC、敏感度、特异度分别为0.814(95%CI:0.711~0.892)、71.43%、89.04%;颈动脉狭窄程度诊断颈动脉支架置入术后CHS的AUC、敏感度、特异度分别为0.769(95%CI:0.661~0.856)、85.71%、79.45%;联合监测诊断颈动脉支架置入术后CHS的AUC、敏感度、特异度分别为0.924(95%CI:0.842~0.971)、100.00%、72.65%。联合检测诊断颈动脉支架置入术后CHS的AUC高于PSV、PI、颈动脉狭窄程度单独检测(P<0.05)。结论颈动脉支架置入术后CHS患者大脑中动脉血流速度加快,监测PSV、PI有助于早期诊断CHS的发生。
Objective To explore the application of transcranial Doppler ultrasound(TCD)combined with blood flow velocity detection in the treatment of high perfusion injury(CHS)after internal carotid artery stenting.Methods From January 2016 to December 2019,80 patients who underwent carotid artery stent implantation admitted to the Second People's Hospital of Changshu City were prospectively selected as subjects,all of whom received TCD testing.The occurrence of CHS after carotid stent placement was counted.The patient's age,gender,body mass index,hypertension,diabetes,smoking,drinking,coronary heart disease,hyperlipidemia,history of cerebral infarction,blood pressure,degree of carotid artery stenosis,etc.were collected,factors affecting the occurrence of CHS after internal carotid artery stenting were analyzed.And the diagnostic value of blood flow velocity to CHS was analyzed.Results Among the 80 patients who received internal carotid artery stenting,7(8.75%)developed CHS.CT scan showed that the local sulcus and gyrus became shallow.Univariate analysis showed that there was no significant difference in gender,body mass index,hypertension,diabetes,smoking,drinking,coronary heart disease,hyperlipidemia and history of cerebral infarction between CHS group and non CHS group(P>0.05);The proportion of patients with age higher than 70 years old,blood pressure higher than 150 mmHg and carotid artery stenosis degree higher than 90%in CHS group was higher than that in non CHS group,peak systolic velocity(PSV),the levels of pulsation index(PI)in CHS group were higher than those in non CHS group,the differences were statistically significant(P<0.05).Logistic analysis showed the degree of carotid artery stenosis(OR=6.439;95%CI:1.548-20.137),PSV(OR=5.063;95%CI:1.271-16.062),PI(OR=4.448;95%CI:1.190-13.863)is an independent risk factor that affects the occurrence of CHS after carotid stent implantation;while age and blood pressure are not significantly related to CHS(P>0.05).The AUC,sensitivity,and specificity of PSV in diagnosing CHS after carotid stent placement were 0.845(95%CI:0.747~0.917),85.71%,78.08%,respectively;PI diagnosis of AUC,sensitivity and specificity of CHS after carotid stent placement were 0.845(95%CI:0.747~0.917),78.08%.The sensitivity and specificity were 0.814(95%CI:0.711~0.892),71.43%,and 89.04%,respectively;the AUC,sensitivity,and specificity of CHS in the diagnosis of carotid artery stenosis after carotid stenting were 0.769(95%CI:0.661~0.856),85.71%,79.45%;the AUC,sensitivity,and specificity of combined monitoring for diagnosis of CHS after carotid artery stenting were 0.924(95%CI:0.842~0.971),100.00%,72.65%,respectively.Combined detection and diagnosis of CHS after carotid artery stenting have higher AUC than PSV and PI,The degree of carotid artery stenosis was tested separately(P<0.05).Conclusion After carotid artery stent implantation,CHS patients with CHS have a faster blood flow in the middle cerebral artery.Monitoring PSV and PI is helpful for early diagnosis of CHS.
作者
李剑平
叶萍
季勇
吴涛
陈刚
龚铭杰
LI Jian-ping;YE Ping;JI Yong(Department of Ultrasound,Changshu Second People's Hospital/Changshu Hospital Affiliated to Xuzhou Medical University,Changshu Jiangsu 215500,China.)
出处
《临床和实验医学杂志》
2021年第17期1895-1898,共4页
Journal of Clinical and Experimental Medicine
基金
江苏省自然科学基金(编号:2020J11980N)。
关键词
经颅多普勒超声
血流速度
颈内动脉支架置入术
高灌注损伤
Transcranial Doppler ultrasound
Blood flow velocity
Internal carotid artery stenting
Hyperperfusion injury
