摘要
目的利用功能磁共振及经颅多普勒超声评价急性重症脑梗死的血流灌注及侧支循环状态。方法选择首次发病的急性重症脑梗死患者10例,在4d内做PWI、DWI、MRA、MRI及TCD检查,同时进行美国国立卫生院卒中量表(NIHSS)评分及Glasgow昏迷评分,记录死亡者。功能磁共振结果采用Stroketool(v1·6)软件包进行处理。结果90%的患者显示患侧局部脑血流量(rCBF)和局部脑血容量(rCBV)呈明显下降,较对侧脑组织分别降低64·1%和49·7%,两侧比较差别有显著性意义(t=-4·174,P=0·001;t=-2·835,P=0·011);而健侧脑组织也处于相对缺血状态,较同侧小脑组织rCBF减少41·4%,rCBV减少33·0%,但差别无显著性意义(P>0·05)。本组MRA及TCD结果分析:患者患侧大血管(颈内动脉或大脑中动脉)闭塞者占100%,同时合并对侧狭窄或闭塞者占70%,患者均存在着多发而广泛的不同程度的血管狭窄。结论首次发病即表现为重症脑梗死的患者有血管病变基础;对于急性脑缺血发作的患者应同时进行影像学、血管形态学及血流动力学检查,以便有针对性地进行治疗及判断预后。
Objective To evaluate the blood flow filling and collateral circulation condition in patients with acute severe cerebral infarction by using functional magnetic resonance and transcranial Doppler sonography. Methods Ten cases with primary acute severe cerebral infarction were chosen. The examinations of PWI, DWI, MRA, MRI and TCD were taken and the marks of NIHSS and Glasgow were given at the same time in 4 days. The death cases were recorded. Stroketool （v1. 6） software package was used to analyze the results of functional MR. Results 90% cases showed that the regional cerebral blood flow （rCBF） and regional cerebral blood volume （rCBV） in the trouble side decreased significantly. Their reduced percents can reach to 64. 1% and 49. 7% respectively compared with the other side. The significant difference existed in two opposite sides （ t = - 4. 174, P =0. 001 ; t = -2. 835, P =0. 011）. The results showed that the brain tissue in uninjured side also occupied a relative ischemic condition and its average rCBF and rCBV reduced by 41.4 % and 33.0% respectively. The statistic difference did not exist （ P 〉 0. 05 ）. MRA and TCD results also showed that the patients with aorta occlusion in the trouble side and patients simultancously combining vessel narrow or occlusion in the opposite side could reach to 100% and 70% respectively, and all patients had multiple extensive vessel stenosis in different levels. Conclusion Vascular lesion is a main reason for severe cerebral infarction at the first time. The examinations of imageology, vessel morphology and haemodynamics should be done to patients with acute cerebral ischemia, which may help treat and judge prognosis directly.
出处
《中国全科医学》
CAS
CSCD
2006年第16期1318-1320,共3页
Chinese General Practice
关键词
重症脑梗死
侧支循环
磁共振成像
超声检查
多普勒
经颅
Severe cerebral infarction
Collateral circulation
Magnetic resonance imaging
Ultrasonography, doppler, transcranial
