脑梗死患者颅内侧支循环与预后的关系探讨

摘要

Objective To explore the relationship between prognosis and the collateral circulation of cerebral infarction patients with severe unilateral internal carotid artery stenosis or occlusion. Methods TCD was applied to evaluate the collateral circulation of 80 patients with severe internal carotid artery stenosis or occlusion. The method of treament National Institutes of Health Stroke Scale (NTHSS) score was used both on the first time when the patients were delected and on the sixth month. 80 patients were divided into two groups (unilateral with collateral circulation, unilateral without collateral circulation). The result of the two groups were compared. Results TCD showed collateral patency of anterior communicating artery in 70%, posterior communicating artery was 39%, and ophthalmic artery was 35%. Absence of collateral circulation was found in 11 patients (14%.). The group with collateral circulation scored (12.66±6.64) and (6.38±3.34); the group without, collateral circulation scored (1 6.82±6.87) and (14.45+6.39). There was significant difference not only between the score of the first time (P < 0.05), but also the score on the sixth month of the two groups (P < 0.01). There was significant difference between the scores of the first time and that on the sixth month of the group with collateral circulation (P < 0.01). There was no significant difference between the scores of the first time and that on the sixth month of the group without collateral circulation (P > 0.05). Conclusion Collateral circulation is closely associated with prognosis of cerebral infarction patients.%目的 探讨单侧颈动脉重度狭窄或闭塞的脑梗死患者颅内侧支循环与预后的关系.方法 对80例单侧颈动脉重度狭窄(狭窄率≥70%)以上或闭塞患者行经颅多普勒(TCD)检查,了解侧支循环开放情况;初次检查及经神经内科正规治疗6个月后依据美国国立卒中量表(NIHSS)分别进行评分;有侧支循环开放者为一组,无任一侧支循环开放者为一组,每组治疗前后、两组治疗后评分进行对比.结果 80例患者,56例(70%)前交通枝(ACOA)开放,31例(39%)后交通枝(PCOA)开放,28例(35%)眼动脉侧支开放,11例(14%)无任一侧支循环开放.有侧支循环开放组两次评分分别为:(12.66±6.64)、(6.38±3.34)分;无任一侧支循环开放组两次评分分别为:(16.82±6.87)、(14.45±6.39)分.两组治疗前评分存在明显差异(P<0.05),两组治疗后评分差别亦显著(P<0.01);有侧支循环开放组治疗前后评分比较差异显著(P<0.01),而无任一侧支循环开放组治疗前后评分比较差异不明显(P>0.05).结论 脑梗死患者颅内侧支循环与预后关系密切,对判断患者预后具有重要意义.