经颅多普勒超声在大脑中动脉支架植入术中的应用进展
隋晓雯1 李福荣1 张美艳1 潘心1 赵红玲1 刘金洁2 赵红1
1.大连市中心医院神经内科,辽宁大连 116000;
2.大连市中心医院全科病房,辽宁大连 116000
Application progress of transcranial Doppler ultrasound in stent assisted angioplasty for middle cerebral artery stenosis
SUI Xiaowen1 LI Furong1 ZHANG Meiyan1 PAN Xin1 ZHAO Hongling1 LIU Jinjie2 ZHAO Hong1
1.Department of Neurology, Dalian Municipal Central Hospital, Liaoning Province, Dalian 116000, China;
2.General Department, Dalian Municipal Central Hospital, Liaoning Province, Dalian 116000, China
摘要 大脑中动脉(MCA)狭窄是导致脑梗死的常见原因,且能影响到重要的功能区,目前经皮血管成型并支架植入术已广泛应用于MCA狭窄的治疗中,基于经颅多普勒超声(TCD)的无创、无痛、廉价等优点,在经皮血管成型并支架植入术的监测及随诊中广泛应用,本文从TCD在术前、术后评估参数的选择、术中微栓子监测、术后识别高灌注综合征、血管痉挛及再狭窄几个方面的应用进行综述,以期TCD作为一种检查手段能尽早识别手术并发症,更好地服务于临床。
关键词 :
大脑中动脉狭窄 ,
经皮血管成型并支架植入术 ,
经颅多普勒超声 ,
数字减影血管造影
Abstract :Middle cerebral artery(MCA) stenosis is a common cause of cerebral infarction and can affect important functional areas. At present, stent assisted angioplasty have been widely used in the treatment of MCA stenosis. Based on the advantages of transcranial Doppler ultrasound, such as non-invasive, painless and cheap, it has been widely used in surveillance and follow-up before and after stent assisted angioplasty. This article reviews the application of TCD in preoperative and post-operative evaluation parameters, intraoperative microembolic monitoring, identification of hyperperfusion syndrome, vasospasm and restenosis, in order to identify surgical complications by TCD as early as possible and better serve the clinic.
Key words :
Middle cerebral artery stenosis
Percutaneous angioplasty and stent implantation
Transcranial Doppler ultrasound
Digital subtraction angiography
基金资助: 辽宁省大连市医学科学研究计划项目(1711015)。
通讯作者:
赵红玲(1970.7-),女,主任医师;研究方向:脑血管病、头痛、经颅多普勒超声等。
引用本文:
隋晓雯1 李福荣1 张美艳1 潘心1 赵红玲1 刘金洁2 赵红1. 经颅多普勒超声在大脑中动脉支架植入术中的应用进展[J]. 中国医药导报, 2020, 17(5): 46-49.
SUI Xiaowen1 LI Furong1 ZHANG Meiyan1 PAN Xin1 ZHAO Hongling1 LIU Jinjie2 ZHAO Hong1. Application progress of transcranial Doppler ultrasound in stent assisted angioplasty for middle cerebral artery stenosis. 中国医药导报, 2020, 17(5): 46-49.
链接本文:
http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I5/46
[1] Suh DC,Sung KB,Cho YS,et al. Transluminal angioplasty for middle cerebral artery stenosis in patients with acute is chemic stroke [J]. AJNR,1999,20:553-558.
[2] 米玉霞,张广玉,张彩霞,等.症状性大脑中动脉狭窄血管内支架成形术治疗的临床研究[J].中国卒中杂志,2017, 12(3):239-243.
[3] 刘义,杨丽华,王艳玲,等.血管内支架治疗症状性颅内动脉粥样硬化性狭窄的疗效比较研究[J].中国全科医学,2018,21(23):2867-2870.
[4] Miao Z,Zhang Y,Shuai J,et al. Thirty-Day outcome of a multicenter registry study of stenting for symptomatic intracranial artery stenosis in China [J]. Stroke,2015,10(46):2822-2851.
[5] 中国卒中协会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.症状性颅内动脉粥样硬化性狭窄血管内治疗中国专家共识2018[J].中国卒中杂志,2018,13(6):592-602.
[6] 高山,黄家星.经颅多普勒超声(TCD)的诊断技术与临床应用[M].北京:中国协和医科大学出版社,2004:55.
[7] 华扬,杜利勇,凌晨,等.经颅多普勒超声评估大脑中动脉狭窄的血流动力学标准研究[C].第七届全国颅脑及颈动脉超声学术会议论文汇编,2007:24-25.
[8] 隋晓雯,李福荣,解丽丽,等.经颅多普勒超声检查大脑中动脉狭窄假阳性分析[J].临床神经病学杂志,2016,29(4):320.
[9] 熊家锐,王玉斌,王本瀚,等.血管内支架形成术治疗症状性大脑中动脉狭窄[J].实用医药杂志,2007,24(1):23-25.
[10] Guo XB,Ma N,Hu XB,et al. Wingspan stent for symptomatic M1 stenosis of middle cerebral artery [J]. Eur J Radiol,2011,80(3):356-360.
[11] 王磊,谭莹,王华,等.经颅彩色多普勒在大脑中动脉狭窄经皮血管成形并支架植入术前后的应用价值[J].中国康复理论与实践,2006,12(9):797-799.
[12] 南光贤,王立平,卜淑霞,等.症状性大脑中动脉M1段狭窄支架植入10例临床分析[J].中国老年学杂志,2007, 27(18):1784-1786.
[13] 文俊,徐平,朱世津,等.大脑中动脉支架支架成形术术后12个月TCD随访[J].医学临床研究,2011,28(8):1608-1609.
[14] 苏凡凡,刘辉.血管内支架成形术治疗症状性大脑中动脉M1段狭窄17例分析[J].临床军医杂志,2012,40(2):458-459.
[15] 康卫华,王萍,张亚明,等.TCD评价血管内支架成形术治疗颅内动脉狭窄[J].中国超声诊断杂志,2005,6(8):561-563.
[16] 喻小红,张临洪.大脑中动脉支架植入术前、术后TCD监测[J].中国老年学杂志,2012,32(12):5123-5124.
[17] 李国霖,张忠玲,刘巍松,等.大脑中动脉狭窄血管内支架成形术前后经颅多普勒超声的评价作用[J].中国急救医学,2007,27(8):735-737.
[18] 刘宝南.经颅多普勒超声显像对大脑中动脉狭窄支架成形术后血流动力学改变的评价[J].安徽医学,2014, 35(9):1287-1289.
[19] 孟秀峰,华扬,夏明珏,等.经颅多普勒超声对大脑中动脉狭窄患者支架植入后的随访研究[J].中国脑血管病杂志,2013,10(9):482-487.
[20] 高宇海,石进,张英谦,等.症状性大脑中动脉狭窄患者支架植入术对脑血管反应性的影响[J].中华老年心脑血管杂志,2017,19(2):126-129.
[21] Gupta A,Chazen JL,Hartman M,et al. Cerebrovassular reserve and stroke risk in patients with carotid stenosis or occlusion:asystematic review and meta-auaalysis [J]. Stroke,2012,43(11):2884-2891.
[22] Reihard M,Schwarzer G,Briel M,et al. Cerebrovascular reactivity predicts stroke in high-grade carotid artery disease [J]. Neurology,2014,83(116):1424-1431.
[23] 徐晓彤,古家丽,姜卫健.大脑中动脉近端支架成形术中微栓子信号监测[J].中国卒中杂志,2008,3(1):11-14.
[24] 李菁,韩冰莎,李钊硕,等.症状性大脑中动脉粥样硬化性狭窄支架植入术后血流动力学研究[J].介入放射学杂志,2016,25(3):193-196.
[25] 刘红英,何艳.经颅多普勒在颅内狭窄支架成形术前后及再狭窄监测中的应用[J].临床医学,2009,29(1):7-9.
[26] 刘海平,朱辉.多普勒技术检测药物与支架成形术治疗大脑中动脉狭窄疗效研究[J].中国卒中杂志,2016,11(9):778-782.
[27] 贺雄军,廖中荣,凌峰,等.症状性大脑中动脉狭窄患者支架植入术后再狭窄影响因素分析[J].中国脑血管病学杂志,2008,5(1):5-9.
[28] 张广,朱仕逸,季智勇,等.脑过度灌注综合征研究进展[J].中国现代神经疾病杂志,2017,17(12):869-873.
[29] Liu AY,Do HM,Albers GW,et al. Hyperfusion syndrome with hemorrhage after angioplasty for middle cerebral artery stenosis [J]. Neuroradiol,2001,22(8):1597-1601.
[30] 王桂红,姜卫剑,王拥军,等.大脑中狭窄支架成形术后狭窄段血流动力学异常的可能机制[J].中风与神经疾病杂志,2007,24(5):567-569.
[31] 张繁荣.高灌注综合征的临床观察[J].中国实用神经疾病杂志,2016,19(8):104-105.
[32] Sloan MA,Alexandrov AV,Tegeler CH,et al. Assessment:transcranial Doppler uhrasonography:report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology [J]. Neurology,2004, 62(9):1468-1481.
[33] 王桂红,姜卫剑,王拥军.脑高灌注综合征的研究进展[J].中国卒中杂志,2006,1(5):378-382.
[34] 李铁,龚浠平,李尧,等.经颅多普勒超声在大脑中动脉狭窄血管成形术前后及随诊中的应用[J].中国临床医学影像杂志,2005,16(6):305-307.
[35] Jarus-Dziedzic K,Bogucki J,Zub W. The influence of ruptured cerebral aneurysm localization on the blood flow velocity evaluated by trans cranial Doppler ultrasonography [J]. Neurol Res,2001,23:23-28.
[36] Veyna RS,Seyfried D,Burke DG,et al. Magnesium sulfate therapy after aneurysmal subarachnoid hemorrhage [J]. J Neurosurg,2002,96:510-514.
[37] Gomez CR,Misra VK,Campbell MS,et al. Elective stenting of symptomatic middle cerebral artery stenosis [J]. AJNR,2000,21:971-973.
[38] Jiang WJ,Wang YJ,Du B,et al. Stenting of symptomatic M1 stenosis of middle cerebral artery:an initial experience of 40 patients [J]. Stroke,2004,35(6):1375-1380.
[1]
卢伟 杨超 张嘉诚 杨剑 马军朋 郑好 杜鹏 蒋富强. CO2楔入肝静脉造影在肝硬化急性上消化道出血的TIPS术中的作用 [J]. 中国医药导报, 2019, 16(10): 84-87.
[2]
付伟1 刘吉昌1 闫继栋1 岳庆红1 王贵生2. CT冠脉造影和数字减影血管造影在急性冠脉综合征临床诊断中的应用 [J]. 中国医药导报, 2018, 15(25): 137-139,143.
[3]
姬中庆 王瑾. 经颅多普勒超声及微血管多勒普超声在检测动脉瘤破裂后血管痉挛中的应用 [J]. 中国医药导报, 2018, 15(23): 100-103.
[4]
戚怀钻. 子宫前后壁贯穿缝合结合氨甲环酸对难治性产后出血的临床疗效及DSA影像表现的影响 [J]. 中国医药导报, 2018, 15(21): 98-101.
[5]
康志新. 蛛网膜下腔出血患者头痛发作时经颅多普勒超声监测指标变化的临床研究 [J]. 中国医药导报, 2017, 14(20): 94-96,112.