CAJ | 학술논문

背景:将高血压脑血管病研究中建立的6项新指标运用到短暂性脑缺血发作(Transientischemic attack,TIA)诊断研究中,能对原检测指标不能反映的全脑11条血管的整体的质与量的状况有较准确的评价.目的:探讨经颅多普勒新指标对TIA的评估价值,弥补了原指标的不足.设计:以诊断为依据的病例对照研究.地点、对象和方法:116例研究对象均为解放军第三二三医院收治的TIA患者(TIA组)和同期98例体检的健康者,采用与计算机连用的方法,对两组214例受试者2354条脑血管进行新旧指标的对照检测.主要观察指标:两组经颅多普勒检测新、原指标比较.结果:用经颅多普勒新指标检测,在无明显脑功能损坏情况下,116例中110例(94.8%)异常,20例(18.1%)为颈内动脉系统血流速度改变.正常组与TIA组原指标比较:TIA组的搏动指数增高,椎基底动脉的脑血管收缩期、舒张期流速明显减慢,颈内动脉系统血流速度减低;与正常组相比,差异有差异性意义(t=1.97～2.89,P＜0.05;t=3.1～11.59,P＜0.01);频谱形态可见收缩波圆钝,S2＞S1,峰时后延.正常组与TIA组新指标比较:TIA组中81.8%椎基底动脉血流异常者的反弹高度、紧张度、平均收缩速度、缓慢指数明显降低,压力指数、脑血管负荷指数增高.TIA组中的18.2%颈内动脉系统血流速度减低者的反弹高度、紧张度下降、平均收缩速度、缓慢指数明显减缓,压力指数、脑血管负荷指数明显增高(t=2.14～2.6,P＜0.05;t=2.85～14.4,P＜0.01).结论:经颅多普勒检测新指标较旧指标能更全面、准确地诊断TIA.
배경:장고혈압뇌혈관병연구중건립적6항신지표운용도단잠성뇌결혈발작(Transientischemic attack,TIA)진단연구중,능대원검측지표불능반영적전뇌11조혈관적정체적질여량적상황유교준학적평개.목적:탐토경로다보륵신지표대TIA적평고개치,미보료원지표적불족.설계:이진단위의거적병례대조연구.지점、대상화방법:116례연구대상균위해방군제삼이삼의원수치적TIA환자(TIA조)화동기98례체검적건강자,채용여계산궤련용적방법,대량조214례수시자2354조뇌혈관진행신구지표적대조검측.주요관찰지표:량조경로다보륵검측신、원지표비교.결과:용경로다보륵신지표검측,재무명현뇌공능손배정황하,116례중110례(94.8%)이상,20례(18.1%)위경내동맥계통혈류속도개변.정상조여TIA조원지표비교:TIA조적박동지수증고,추기저동맥적뇌혈관수축기、서장기류속명현감만,경내동맥계통혈류속도감저;여정상조상비,차이유차이성의의(t=1.97～2.89,P＜0.05;t=3.1～11.59,P＜0.01);빈보형태가견수축파원둔,S2＞S1,봉시후연.정상조여TIA조신지표비교:TIA조중81.8%추기저동맥혈류이상자적반탄고도、긴장도、평균수축속도、완만지수명현강저,압력지수、뇌혈관부하지수증고.TIA조중적18.2%경내동맥계통혈류속도감저자적반탄고도、긴장도하강、평균수축속도、완만지수명현감완,압력지수、뇌혈관부하지수명현증고(t=2.14～2.6,P＜0.05;t=2.85～14.4,P＜0.01).결론:경로다보륵검측신지표교구지표능경전면、준학지진단TIA.
BACKGROUND: It will accurately evaluate the quality and quantity of totally 11 blood vessels that the original indes can not reflect when applying the newly established 6 indes of hypertensive cerebrovascular diseases on the diagnosis of transient ischemic attack(TIA).OBJECTIVE: To explore the value of new indes detected by transcranial Doppler ultrasound which have made up the shortcomings of old indexes to the assessment of TIA.DESIGN: Case control study based on diagnosis.SETTINGS, PARTICIPANTS and INTERVENTIONS: Totally 116 patients with TIA diagnosed by the 323 Hospital of Chinese PLA and 98 healthy people were selected as TIA group and normal group respectively. Comparative detection was done to new and old indexes of 2354 brain vessels of 214 patients by using computers.MAIN OUTCOME MEASURES: Comparison of new and old indes detected by transcranial Doppler ultrasound between two groups.RESULTS: There were 110(94.8% ) out of 116 patients with anomalies of new indexes and 20 patients(18.1% ) with changes of blood flow rate of internal carotid artery when detecting by transcranial Doppler ultrasound without obvious damages of brain functions. Comparing old indes between normal group and TIA group: The pulsation index increased, the systolic and diastolic flow rates of basilar artery slowed greatly, the blood flow rate of internal carotid arteries reduced, there was difference on those indexes between the normal group and TIA group( t = 1.97 - 2.89, P ＜ 0.05; t = 3.1 -11.59, P ＜ 0.01) . The figures of frequency spectrum showed that there was circular and blunt contraction waves with time of peak delays, S2 ＞S1. Comparing new irdes between two groups: among 81.2% patients in TIA group with blood flow anomaly of basilar artery, they presented greatly decrease of bounce altitude, tensity, average contract velocity and slowness index and increase of pressure index and load index of brain blood vessels. Among the 18.2% patients with slow blood flow rate in TIA group, the bounce altitude, tensity, average contract velocity and slowness index also slower and the pressure index, load index of brain blood vessels increased (t=2.14-2.6;t=2.85-14.4, P ＜0.01).CONCLUSION: The new indes detecting by transcranial Doppler ultrasound can diagnose TIA more generally and accurately than old indexes.