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背景:颈动脉粥样硬化患者中脑梗死发生率较高,但缺少大样本的研究,尤其缺少血流动力学变化的研究。目的:研究脑梗死患者颅外段脑动脉血管结构和血流动力学变化特点,并与健康人进行差异比较。设计:以诊断为依据,病例对照研究。地点和对象:1999-01/2002-05中国铁道建筑总公司总医院住院患者300例(脑梗死组),其中男242例,女58例。2000-02/2001-10在本院体检健康者105例(健康组),男50例,女55例。主要观察指标:血管内径及颈总动脉内壁(内膜与中膜之和);血流参数:测定收缩期最大血流速度(Vmax)、舒张期最小血流速度(Vmin)、血管阻力指数(RI)、收缩期颈内动脉血流速度与颈总动脉血流速度的比值(VICA/VCCA)。结果:脑梗死患者梗死侧血管粥样硬化斑发生率(55.8%)明显高于非梗死侧(46.3%),差异有显著性意义(χ2=4.487,P<0.05),侧向符合率高;其血流参数的改变以Vmin,VICA/VCCA及RI最为明显,差异均有高度显著性意义(P<0.01～0.001)。结论:脑梗死患者梗死侧血管粥样硬化斑的发生率明显高于非梗死侧,侧向符合率高;血流参数的改变以MIN明显减慢、RI明显增高为主要特点。
BACKGROUND: Carotid atherosclerosis in patients with a higher incidence of cerebral infarction, but the lack of large sample studies, especially the lack of hemodynamic changes in the study. Objective: To study the characteristics of extracranial cerebral arteries structure and hemodynamics in patients with cerebral infarction, and to compare with those in healthy subjects. Design: Based on diagnosis, case-control study. Venue and object: 300 patients (cerebral infarction group) were hospitalized in China Railway Construction Corporation General Hospital from January 1999 to May 2002, including 242 males and 58 females. In the hospital from 2000-02 / 2001-10, 105 cases were healthy, including 50 males and 55 females. MAIN OUTCOME MEASURES: Vascular diameter and internal carotid artery wall (the sum of intima and media); blood flow parameters: the maximum systolic velocity (Vmax), diastolic minimum velocity (Vmin), vascular resistance index RI), the ratio of carotid artery systolic velocity to common carotid artery velocity (VICA / VCCA). Results: The incidence of vascular atherosclerotic plaques in the infarcted patients was significantly higher than that in the noninfarcted ones (55.8% vs 46.3%, χ2 = 4.487, P <0.05) Vmin, VICA / VCCA and RI were the most obvious changes of blood flow parameters, the differences were highly significant (P <0.01 ~ 0.001). Conclusion: The incidence of infarction-side vascular atherosclerotic plaque in patients with cerebral infarction was significantly higher than that in non-infarcted side, and the coincidence rate was high. The changes of blood flow parameters were characterized by a marked decrease of MIN and a significant increase of RI.