颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中的应用效果

摘要/Abstract

摘要： 目的探讨与分析颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中的应用效果。方法 2018年2月—2022年5月选择在镇巴县人民医院诊治的早期颈内动脉闭塞患者88例作为研究对象,所有患者都给予颈动脉超声检查,记录超声特征。同时所有患者都给予脑血管数字减影检查,记录侧支循环形成并判断诊断价值。结果在88例患者中,脑血管数字减影判断为侧支循环形成38例(形成组),占43.18%。形成组性别、身体质量指数、收缩压、舒张压病程、性别、空腹血糖等与非形成组对比差异无统计学意义（P>0.05）。形成组颈部血管超声椎动脉与基底动脉血流速度明显高于非形成组（P<0.05）。形成组入院时国立卫生研究院卒中量表（National Institute of Health Stroke Scale,NIHSS）评分明显低于非形成组（P<0.05）。在88例患者中,颈部血管超声判断为侧支循环形成36例,Kappa=0.907（P<0.001）。颈部血管超声在早期颈内动脉闭塞患者侧支循环形成诊断的敏感性与特异性为92.11%（35/38）和98.00%（49/50）。结论早期颈内动脉闭塞患者多伴随有侧支循环形成,可改善患者的病情,提高椎动脉与基底动脉血流速度,颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中具有重要价值。

关键词: 侧支循环, 基底动脉, 颈内动脉闭塞, 颈部血管超声, 敏感性, 特异性

Abstract: Objective To investigate and analysis the application values of cervical vascular ultrasound in the diagnosis of collateral circulation in patients with early internal carotid artery occlusion. Methods From February 2018 to May 2022, 88 cases of patients with early internal carotid artery occlusion diagnosed and treated in Zhenba County People's Hospital were selected as study subjects. All patients were given carotid artery ultrasound examination and recorded the ultrasonic characteristics. At the same time, all patients were given digital subtraction angiography, all the cases were to record the formation of collateral circulation and judge the diagnostic value. Results There were 38 (43.18%) cases were diagnosed as collateral circulation formation by digital subtraction angiography (DSA) in the 88 cases. There were no significant difference in sex, age, course of disease, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose compared between the formed group and the non formed group (P>0.05). The ultrasonic blood flow velocity of vertebral artery and basilar artery in the formed group were significantly higher than that in the non formed group (P<0.05). The score of National Institute of Health Stroke Scale (NIHSS) in the formed group were significantly lower than that in the non formed group at admission (P<0.05). Among the 88 patients, 36 of them were judged to have collateral circulation by ultrasound, Kappa=0.907 (P<0.001). The sensitivity and specificity of cervical vascular ultrasound in diagnosing collateral circulation formation in patients with early internal carotid artery occlusion were 92.11% (35/38) and 98.00% (49/50). Conclusion Most patients with early internal carotid artery occlusion are accompanied by collateral circulation formation, which can improve the patient's condition and increase the blood flow velocity of vertebral artery and basilar artery. Cervical vascular ultrasound has important value in judging collateral circulation in patients with early internal carotid artery occlusion.

Key words: cervical vascular ultrasound, internal carotid artery occlusion, collateral circulation, basal artery, sensitivity, specificity

中图分类号:

R445.1

刘丹, 张良成. 颈部血管超声在早期颈内动脉闭塞患者侧支循环判断中的应用效果[J]. 中华养生保健, 2023, 41(12): 23-27.

LIU Dan, ZHANG Liang-cheng. Application of Cervical Vascular Ultrasound in the Evaluation of Collateral Circulation in Patients with Early Internal Carotid Artery Occlusion[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(12): 23-27.

参考文献

[1] 刘欢颜,华扬,贾凌云,等.急性期和慢性期颈内动脉闭塞患者侧支循环类型对颅内血流灌注的影响[J].中国脑血管病杂志,2022,19(6):396-404.
[2] 马力丰,王义成,徐乐,等.超微血流成像技术评价颈内动脉闭塞的价值及斑块内新血管生成的危险因素分析[J].河北医科大学学报,2022,43(2):193-197.
[3] 文朋,李龙,张银行,等.慢性颈内动脉闭塞患者复合手术治疗中应用Supera支架的安全性和可行性分析[J].中国脑血管病杂志,2022,19(7):484-489.
[4] 朱玉萍,濮恬宁,张蕾,等.超声造影评估颅外段颈内动脉次全闭塞价值[J].中国超声医学杂志,2022,38(6):618-621.
[5] 苟显娜,赵丽莉,陈黎艳,等.TCD联合CDFI应用对颈内动脉狭窄的诊断价值[J].贵州医科大学学报,2021,46(8):949-953.
[6] 刘欢颜,华扬.颈内动脉闭塞的影像学分类与治疗方式的选择[J].中国脑血管病杂志,2021,18(5):344-348.
[7] 郝晓卓,栾树彬,谢海涛.多模态影像技术对颅外段颈内动脉闭塞病变的诊断价值[J].中国临床医学影像杂志,2021,32(4):250-253.
[8] 陈金,朱润秀,冯银铃,等.颈内动脉急性闭塞致大面积脑梗死侧支循环建立及影响因素[J].国际神经病学神经外科学杂志,2020,47(1):81-84.
[9] 辛涛,潘源,贺西亮,等.复杂类型症状性颈动脉重度狭窄的血管内治疗[J].中华航海医学与高气压医学杂志,2020,27(4):481-485,492.
[10] DOLLINGER P, BöHM J, ARáNYI Z. Combined nerve and vascular ultrasound in thoracic outlet syndrome: A sensitive method in identifying the site of neurovascular compression[J]. PLoS One,2022,17(5):e0268842.
[11] SEIKE Y, MATSUDA H, SHIMIZU H, et al.Nationwide Analysis of Persistent Type II Endoleak and Late Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Japan: A Propensity-Matched Analysis[J]. Circulation,2022,145(14):1056-1066.
[12] 何冬若,李卉,韩国超,等.颈动脉超声联合经颅多普勒超声检测颈外动脉和颈内动脉窃血[J].中华老年心脑血管病杂志,2019,21(12):1253-1255.
[13] 宁彬,张东,王立淑,等.颈动脉蹼的超声表现多样性与病理对照研究[J].首都医科大学学报,2019,40(6):824-828.
[14] CUI X, ZHANG D, ZHAO Y, et al.An open-label non-inferiority randomized trail comparing the effectiveness and safety of ultrasound-guided selective cervical nerve root block and fluoroscopy-guided cervical transforaminal epidural block for cervical radiculopathy[J]. Ann Med,2022,54(1):2681-2691.
[15] 张萍淑,吴小英,钱琳琳,等.慢性单侧颈内动脉闭塞患者脑动脉血流动力学变化观察[J].中国综合临床,2019,35(3):199-203.
[16] 张楠,华扬,周瑛华,等.颈内动脉极重度狭窄或闭塞后不全再通患者血运重建术前超声评估价值分析[J].中国脑血管病杂志,2018,15(9):466-471.
[17] 张萍淑,吴小英,宋婧源,等.慢性颈内动脉闭塞脑侧支循环血流代偿与脑梗死的关系[J].中华老年心脑血管病杂志,2018,20(11):1179-1182.
[18] 张李均,惠品晶,黄亚波,等.微型探头血管超声在颞浅动脉-大脑中动脉搭桥术中的应用[J].中华神经外科杂志,2018,34(9):915-920.
[19] 华扬. 超声对颈内动脉闭塞颈动脉内膜切除血运重建术前的精准性评估[J].中华医学超声杂志(电子版),2018,15(9):641-643.
[20] 赵新宇,华扬,高明杰,等.颈内动脉闭塞患者侧支循环类型与大脑中动脉血流速度及神经功能评分的相关性[J].中国脑血管病杂志,2018,15(8):414-419.