【摘要】 目的探讨经颅多普勒超声(TCD)评价烟雾病(MMD)患者血管吻合术前后脑血流动力学改变的可行性。方法 15例MMD患者行单侧颞浅动脉-大脑中动脉(STA-MCA)吻合术,手术前后TCD检测MCA及STA的血流动力学改变,并与CT灌注成像(CTP)结果进行分析。结果 TCD显示术后手术侧MCA起始部(狭窄处)血流速度较术前降低(P<0.05),其远段血流改善,血管搏动指数(PI)升高(P<0.05)且血流方向逆转;术后手术侧STA频谱形态由"高阻型"转变为"低阻型",PI较术前明显降低(P<0.01),血流速度较术前明显增快(P<0.05),以平均血流速度(Vm)及舒张期末血流速度(Vd)改变最为显著(P<0.01)。TCD与CTP评估吻合术前后脑血流动力学改变具有良好的一致性(Kappa=0.5918,P<0.05)。结论 TCD可无创、动态检测血管吻合术前后脑血流动力学改变,为手术疗效的评估及定期随访提供客观依据。更多还原

【Abstract】 Objective To explore the feasibility of Transcranial Doppler sonography(TCD) to the assessment of the cerebrovascular hemodynamic changes before and after the Extracranial-intracranial Bypass in patients with Moyamoya disease(MMD).Methods 15 cases of patients with Moyamoya disease underwent unilateral Superficial Temporal ArteryMiddle Cerebral Artery(STA-MCA) Bypass.Before and after the surgery,the patients received TCD examination in order to assess the hemodynamic changes of MCA and STA,and then combined with CT perfusion imaging(CTP) to analyze the results.Results TCD shows that,after the surgery,the MCA blood flow velocity at the stenosis was lower than preoperative(P <0.05),the blood flow velocity and pulsatility index(PI) of distal MCA were higher(P < 0.05) and the direction of blood flow was reversal;the spectrums of STA changed and PI was significantly lower(P < 0.01),the blood flow velocity of STA was higher(P < 0.05),especially the mean flow velocity(Vm) and the diastolic flow velocity(Vd).The results of TCD were well accordant to those of CTP(Kappa = 0.5918).Conclusion The cerebrovascular hemodynamic changes before and after STA-MCA bypass can be noninvasively detected by TCD,which can provide objective information for the assessment of the curative effect of STA-MCA bypass on the patients with Moyamoya disease.更多还原