椎动脉支架置入术对颅内椎动脉狭窄患者血流动力学的影响及术后再狭窄的影响因素研究

摘要

Objective to investigate the impact of vertebral artery stent implantation on hemodynamics of patients with intracranial vertebral artery stenosis,to analyze the influencing factors of postoperative restenosis. Methods From February 2012 to February 2014,a total of 106 patients with intracranial vertebral artery stenosis were selected in the Department of Neurology,People′s Hospital of Daxing District,Beijing,all of them received vertebral artery stent implantation and were followed up for 1 year(average). Pulsatility index(PI),peak systolic velocity(PSV)and end diastolic velocity(EDV)of intracranial vertebral artery,arterial diameter,resistance index( RI),PSV and EDV of extracranial vertebral artery were observed before surgery,after 1 week,3 moths,6 months and 12 months of surgery. According to the follow - up result,the 106 patients were divided into A group( occurred postoperative restenosis,n = 38) and B group( did not occurred postoperative restenosis,n = 68),gender,age,smoking status and underlying disease were compared between the two groups,and the influencing factors of postoperative restenosis were analyzed. Results After 1 week,3 moths,6 months and 12 months of surgery,PI of intracranial vertebral artery was statistically significantly higher than before surgery,respectively,while PSV and EDV of intracranial vertebral artery were statistically significantly slower than those before surgery(P < 0. 05);PSV and EDV of intracranial vertebral artery reached the peak value after 6 months of surgery,while PI reached the minimum value after 3 months of surgery. After 1 week,3 moths,6 months and 12 months of surgery,arterial diameter of extracranial vertebral artery was statistically significantly larger than that before surgery,respectively,RI was statistically significantly lower than that before surgery,respectively,while PSV and EDV were statistically significantly faster than those before surgery( P < 0. 05). No statistically significant differences of age,gender or smoking rate was found between A group and B group(P > 0. 05),while incidence of coronary heart disease and diabetes mellitus of A group was statistically significantly higher than that of B group, respectively( P < 0. 05). Conclusion Vertebral artery stent implantation can effectively improve the hemodynamics and intracranial blood perfusion of patients with intracranial vertebral artery stenosis,postoperative restenosis is possibly correlated with underlying disease,not correlated with gender,age or smoking.%目的：探究椎动脉支架置入术对颅内椎动脉狭窄（IVAS）患者血流动力学的影响，并分析 IVAS 患者术后再狭窄的影响因素。方法收集2012年2月—2014年2月北京市大兴区人民医院神经内科收治的 IVAS 患者106例，均行椎动脉支架置入术治疗，术后平均随访1年，观察 IVAS 患者术前及术后1周、3个月、6个月、12个月椎动脉颅内段动脉搏动指数（PI），颅外段血管管径和阻力指数（RI），颅内段及颅外段收缩期峰值流速（ PSV）、舒张期末流速（EDV）。根据随访结果将所有患者分为再狭窄组38例和无再狭窄组68例，比较两组患者性别、年龄、吸烟情况及基础疾病，分析 IVAS 患者术后再狭窄的影响因素。结果 IVAS 患者术后1周、3个月、6个月、12个月椎动脉颅内段 PSV 和 EDV 均慢于术前，PI 均高于术前（P <0.05）；术后6个月 IVAS 患者椎动脉颅内段 PSV 及 EDV 达峰值，术后3个月 PI 最低。IVAS 患者术后1周、3个月、6个月、12个月椎动脉颅外段血管管径大于术前，PSV 及 EDV 均快于术前，RI 低于术前（P <0.05）。再狭窄组与无再狭窄组患者年龄、性别、吸烟率比较，差异无统计学意义（ P >0.05）；再狭窄组患者冠心病发生率及糖尿病发生率高于无再狭窄组（P <0.05）。结论椎动脉支架置入术能有效改善 IVAS 患者椎动脉颅内段及颅外段血流动力学，增加颅内血流灌注，而 IVAS 患者术后再狭窄可能与基础疾病有关，与性别、年龄及吸烟无关。