颈动脉支架置入术后颅内血管反应性动态观察

摘要

Objective To explore the changes and influencing factors of cerebral vasoreactivity (CVR) in patients after carotid angioplasty and stenting (CAS). Methods Thirty-seven patients performed CAS, admitted to our hospital from July 2008 to September 2009, were finished the follow-up and chosen in our study; the breath-holding index (BHI) of the bilateral middle cerebral artery was measured using transcranial Doppler combined with breath holding test before thc operation, and 1 d and 3-10 months after the operation. Repeated measures design analysis of variance was employed to detect the BHI changes before and after the stenting; multiple regression was employed to analyze the influencing factors of BHI. Results BHI values after stenting were significantly higher than those before stenting on the stenotic side (P＜0.05). The follow-up BHI values were negatively correlated with those of tandem stenoses (β=-0.016, P=0.002) and positively correlated with the postoperative BHI values (β=1.030, P=0.000). Conclusion CAS can immediately improve CVR on the ipsilateral side and make it close to normalization gradually. Tandem stenoses are the independent risk factors of CVR.%目的 探讨颈动脉支架置入术(CAS)后脑血管反应性(CVR)的变化规律及影响CVR的相关因素.方法 选择自2008年7月至2009年9月南京军区南京总医院神经内科行CAS并完成随访的37例患者,采用经颅多普勒超声(TCD)结合屏气试验检测术前、术后1～2d和随访3～10月时双侧大脑中动脉的屏气指数(BHI).采用重复测量设计的方差分析检测支架置入术前后BHI的变化规律,并采用多元回归法分析影响最终BHI的相关因素.结果 37例患者术后手术侧BHI均较术前明显提高(P＜0.05).随访时的BHI与术后BHI呈正相关(β=1.030,P=0.000),串联狭窄与随访时的BHI呈负相关(β=-0.016,P=0.002).结论 CAS能立即改善术侧CVR使之逐渐接近正常,串联狭窄是影响最终CVR的独立危险因素.