血管介入术对症状性颅内前循环动脉狭窄病人再狭窄及脑血流动力学影响的临床研究

doi:10.19854/j.cnki.1008-2425.2025.01.0005

摘要/Abstract

摘要： 目的研究血管介入术对症状性颅内前循环动脉狭窄病人再狭窄及脑血流动力学影响。方法 2021年8月至2023年8月,选取症状性颅内前循环动脉狭窄病人140例,分组方法为随机数表法,分为对照组(药物治疗,70例)和研究组(血管介入术治疗,70例),比较两组脑血流动力学、神经功能、日常生活能力和凝血功能。结果与治疗前比较,两组治疗6个月后脑血管平均血流量(Qmean)、最大血流速度(Vmax)、舒张压与临界压的差值(DP)无变化(P＞0.05),两组治疗6个月后平均血流速度(Vmean)、最小血流速度(Vmin)、可扩张度(DI)、脑血流动力学指标积分(CVHI)评分升高(P＜0.05),两组治疗6个月后脉搏波波速(Wv)、特性阻抗(Zcv)、外周阻力(Rv)、动态阻力(DR)、临界压力(CP)降低(P＜0.05),与对照组比较,研究组治疗6个月后Qmean、Vmax、DP无统计学意义(P=0.309、0.117、0.444),研究组治疗6个月后Vmean、Vmin、DI、CVHI评分更高(P=0.023、0.000、0.014、0.000),研究组治疗6个月后Wv、Zcv、Rv、DR、CP更低(P=0.001、0.012、0.004、0.009、0.009)。与治疗前比较,两组治疗6个月后美国国立卫生研究院卒中量表(NIHSS)、改良Rankin评分量表(mRS)评分降低(P＜0.05),与对照组比较,研究组治疗6个月NIHSS、mRS评分更低(P=0.000)。与治疗前比较,两组治疗6个月后血浆黏度、纤维蛋白原(FIB)、血小板聚集率(PAR)降低(P＜0.05),与对照组比较,研究组治疗6个月血浆黏度、FIB、PAR更低(P=0.003、0.018、0.000)。研究组支架内再狭窄22例,支架内再狭窄率为31.43%。研究组围术期脑梗死1例,短暂脑缺血发作1例,围术期总并发症发生率为2.86%。研究在再发卒中发生率为4.29%,和对照组的14.29%相比更低(P＜0.05)。结论血管介入术治疗症状性颅内前循环动脉狭窄病人,可改善脑血流动力学,改善神经功能,提高日常生活能力,减轻凝血状态,降低再发卒中风险。

关键词: 症状性颅内前循环动脉狭窄, 血管介入术, 脑血流动力学, 疗效

Abstract: Objective Study the effect of vascular intervention combined with surgery on restenosis and cerebral hemodynamics in patients with symptomatic intracranial anterior circulation artery stenosis. Methods From August 2021 to August 2023,140 patients with symptomatic intracranial anterior circulation artery stenosis were selected and divided into a control group (70 cases treated with medication) and a study group (70 cases treated with vascular intervention combined with surgery) using a random number table method.The restenosis,cerebral hemodynamics,neurological function,daily living ability,and coagulation function of the two groups were compared. Results Compared with the control group,the restenosis rate in the study group (8.00% vs 0.00%) was not statistically significant (P=0.059).Compared with before treatment,after 6 months of treatment,the mean cerebral blood flow (Qmean),maximum blood flow velocity (Vmax),difference between diastolic pressure and critical pressure (DP) did not change in both groups (P>0.05).However,after 6 months of treatment,the mean blood flow velocity (Vmean),minimum blood flow velocity (Vmin),expandability (DI),and integrated cerebral hemodynamic index (CVHI) scores increased in both groups (P＜0.05).After 6 months of treatment,the pulse wave velocity (Wv),characteristic impedance (Zcv),peripheral resistance (Rv),dynamic resistance (DR),and critical pressure (CP) decreased in both groups (P＜0.05).Compared with the control group,there was no statistically significant difference in Qmean,Vmax,and DP in the study group after 6 months of treatment (P=0.309,0.117,0.444).The study group had higher Vmean,Vmin,DI,and CVHI scores after 6 months of treatment (P=0.023,0.000,0.014,0.000),while the study group had lower Wv,Zcv,Rv,DR,and CP scores after 6 months of treatment (P=0.001,0.012,0.004,0.009,0.009).Compared with before treatment,the National Institutes of Health Stroke Scale (NIHSS),Rankin Rating Scale (mRS) scores of the two groups decreased (P＜0.05) after 6 months of treatment,compared with the control group,the NIHSS,mRS scores of the study group were lower (P=0.000) after 6 months of treatmen Compared with before treatment,plasma viscosity,fibrinogen (FIB),and platelet aggregation rate (PAR) decreased in both groups after 6 months of treatment (P＜0.05).Compared with the control group,the study group had lower plasma viscosity,FIB,and PAR after 6 months of treatment (P=0.003,0.018,0.000).There were 22 cases of in stent restenosis in the research group,with a restenosis rate of 31.43%.There was 1 case of perioperative cerebral infarction and 1 case of transient ischemic attack in the research group,with a total perioperative complication rate of 2.86%.The incidence of recurrent stroke in the study was 4.29%,which was lower than the control group's 14.29% (P＜0.05). Conclusion Endovascular intervention therapy for patients with symptomatic intracranial anterior circulation artery stenosis can improve cerebral hemodynamics,enhance neurological function,increase the ability to perform daily activities,alleviate the coagulation state,and reduce the risk of recurrent stroke.

Key words: Intracranial anterior circulation artery stenosis, Combined vascular intervention surgery, Cerebral hemodynamics, Curative effect

中图分类号:

R743.3R815

陈浩, 黄炎, 杜波, 朱士光, 李海亮, 程言博. 血管介入术对症状性颅内前循环动脉狭窄病人再狭窄及脑血流动力学影响的临床研究[J]. 立体定向和功能性神经外科杂志, 2025, 38(1): 21-26.

Chen Hao, Huang Yan, Du Bo, Zhu Shiguang, Li Hailiang, Cheng Yanbo. Clinical study on the effect of vascular intervention combined with surgery on restenosis and cerebral hemodynamics in patients with intracranial anterior circulation artery stenosis[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(1): 21-26.

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