颈动脉分叉部解剖结构对颈动脉血流动力学的影响及其与颈动脉粥样硬化斑块形成的关系

摘要

目的 探讨颈动脉分叉部解剖结构对血流动力学的影响及其与颈动脉粥样硬化斑块形成的关系.方法 检查86例(172侧)疑似颈动脉粥样硬化患者颈总动脉(CCA)远心段至颈内动脉(ICA)起始部的血管形态、管腔结构,了解颈动脉分叉部解剖结构,并检测有无粥样硬化斑块形成.检测并比较不同颈动脉分叉类型患者CCA、ICA收缩期峰值流速(PSV)、舒张期末期流速(EDV)、阻力指数(RI)、HR、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)和肺毛细血管嵌压(PCWP)水平.结果 86例(172侧)患者中,颈动脉分叉呈直弯分叉型96侧(55.81％),弯分叉型58侧(33.72％),直分叉型18侧(10.47％),直弯分叉型构成比高于其他两种类型(P＜0.05).3种不同颈动脉分叉类型患者CCA、ICA的PSV、EDV和RI比较,差异均无统计学意义(P均＞0.05),但直弯分叉、弯分叉类型其PSVIcA/PSVccA明显高于直分叉(P＜0.05).不同颈动脉分叉类型的HR、MAP、CVP和PCWP比较,差异均无统计学意义(P＞0.05),但弯分叉的CI明显低于直分叉(P＜0.05).直分叉类型患者动脉粥样硬化斑块发生率明显高于直弯分叉、弯分叉患者(P＜0.05).结论 颈动脉分叉部解剖结构可对颈动脉血流速度及动力学参数产生影响,且与动脉粥样硬化斑块形成有关联.%Objective To investigate the influence of anatomical structure of carotid bifurcation on the hemodynamics and its relationship with the formation of carotid atherosclerotic plaque.Methods A total of 86 patients (172 sides) with suspected carotid atherosclerosis were detected for the vascular morphology and lumen structure from the distal segment of carotid artery(CCA) to the initial part of internal carotid artery (ICA) to learn the anatomical structure of carotid bifurcation and atherosclerotic plaque formation.Peak systolic velocity (PSV),end diastolic velocity(EDV) and resistance index(RI) in CCA and ICA,and HR,mean arterial pressure (MAP),central venous pressure (CVP),cardiac index(CI) and pulmonary capillary wedge pressure (PCWP) were determined and compared among different types of carotid bifurcation.Results Among 86 patients (172 sides),there were 96 sides with carotid artery bifurcations of the straight and curved type (55.81％),58 of the curved type(33.72％) and 18 of the straight type(10.47％),and the proportion of the straight and curved type were higher than those of another two types (P ＜ 0.05).There were no significant differences in PSV,EDV or RI among three different types of carotid bifurcation in the CCA and ICA(P ＞ 0.05),but the PSVICA/PSVCCA ratios of the straight and curved type and the curved type were significant higher than that of the straight type (P ＜ 0.05).No significant difference was observed in the HR,MAP,CVP or PCWP among different types of carotid bifurcation(P ＞ 0.05),but CI of the curved type was significantly lower than that of the straight type (P ＜ 0.05).The straight and curved type had significantly higher incidencc rate of atherosclerotic plaque compared to the straight and curved type and the curved type (P ＜ 0.05).Conclusion The anatomical structure of carotid artery bifurcation might have an impact on the blood flow velocity and dynamic parameters of carotid artery,and it's closely related to the formation of atherosclerotic plaque.