摘要
目的研究大型动静脉畸形（ARM）的经颅多普勒（TCD）各项检测指标，为预判正常灌注压突破综合征（NPPB）的发生提供判断依据。方法对我院近7年来收治的70例大型AVM病人进行术前、术中和术后动态TCD观察，按照术后是否发生NPPB而分为NPPB组（12例）和对照组（58例），每组内又按AVM供血动脉系统不同分为A[颈内动脉（LCA）单纯供血]、B[椎/基底动脉（VA／BA）单纯供血]、C（LCA和VA／BA双重供血）三类，将对照组和NPPB组的各项TCD检测指标进行统计学比较。结果NPPB组中的12例病例均为ICA系统主要供血，其中A类的40例中有6例出现术中NPPB；而直径超过6例的巨大型AVM的10例（C类）中，由ICA主要供血的6例均发生术后NPPB。TCD检查结果显示12例NPPB病人术前大脑中动脉（MCA）和前动脉（ACA）的平均血流速度（vm）均〉150cm/s，收缩期峰值〉190cm/s，脉动指数（PI）〈0．5，且明显高于对照组；而大脑后动脉（PCA）和VA／BA术前、术中较对照组基本保持不变或仅略微增加。结论对于由ICA系统单纯或优势供血的大型、巨大型AVM，如果术前检测ACA和MCA的Vm值〉125cm/s。应高度警惕NPPB的发生。而TCD作为一种简便可行的检测方法，能很好的预判NPPB的发生，改善病人预后。
Objective To explore the parameters of Wanscranial Doppler （TCD） examination for giant arteriovenous malformation （AVM） so as to provide the reference for prejudging the normal perfusion pressure breakthrough syndrome （NPPB）. Methods ThegiantAVMpafients （n=70） who underwent the TCD examination before, during and after operation in our hospital within the last 7 years were divided into 2 groups, NPPB group （n=12） and control group （n=58） according to the presence of NPPB. Each group was subdivided into group A, B and C based on the difference offeeding artery [A： internal carotid artery （ICA）, B： vertebral/basal artery （VA/BA）, C： ICA and VA/BA）. The dynamic TCD examination results were collected and compared among these groups by SPSS statistic software. Results All 12 NPPB cases belonged to group A or group C （blood supply from ICA）; 6 of 40 cases with only ICA feeding developed intraoperative NPPB, 6 of 10 cases of massive AVM （diameter 〉 6 cm） with blood supply from ICA and VA/BA experienced postoperative NPPB. As the result of TCD detection, the mean flow velocities （Vm） of anterior cerebral artery （ACA） and middle cerebral artery （MCA） were beyond 150 cm/s, peak value of contraction period beyond 190 cm/s, and pulsing index （PI） low than 0.5. The Vm value of ACA and MCA in operation was higher than that of preoperation. And there was no significant different between the Vm values of ACA and MCA in operation of 6 NPPB of 40 cases in group A and 6 of 10 cases in group C. However, there was no significant different between the Vm value of posterior cerebral artery （PCA）, VA/BA of NPPB group and that of control group. Conclusion If the feeding arteries or the predominance feeding arteries of large and massive type of AVM are ICA system, and the preoperative Vm value of ACA and MCA are beyond 125 cm/s, these patients should be paid more attention to prevent the happening of NPPB. And as a convenient and feasible detecting instrument, TCD can be used to prejudge the happening of NPPB.
出处
《中华神经医学杂志》
CAS
CSCD
2007年第1期75-79,共5页
Chinese Journal of Neuromedicine
关键词
正常灌注压突破综合征
经颅多普勒
动静脉畸形
Normal perfusion pressure breakthrough syndrome
Transeranial Doppler
Anteriovenous malformation
