刘菊华

摘要：目的：探討经颅多普勒超声（TCD）在颈内动脉颅外段（ICAex）重度狭窄或闭塞中的诊断价值。方法：选取2020年3月-2020年9月我院经过数字减影血管造影检查确诊患有单侧ICAex重度狭窄或闭塞的60例患者作为观察组，另外选取同期经检查证实ICAex无明显病变的60例健康人员作为对照组，两组均行TCD检查。结果：TCD检查结果显示：对照组双侧MCA、ACA、PCA血流速度相近（P>0.05）;频谱形态陡直，频窗明显，PI相近;双侧OA血流呈正向频移，频谱形态为外周血管高阻力波。观察组患侧MCA及ACA血流速度明显降低，健侧（MCA）、ACA、PCA的PI均高于患侧（P<0.05）;前交通都开放患侧ACA血流方向逆转，MCA及ACA频谱呈低平圆钝状;眼动脉侧支开放患侧OA血流方向逆转，频谱形态颅内化，呈低搏动性改变。观察组和对照组健侧、患侧MAC、ACA、PCA的PSV和PI比较均有统计学意义（P<0.05）。TCD诊断ICAex重度狭窄的敏感性为85.71%，特异性为90.91%，阳性预测值为97.67%，阴性预测值为58.82%，有效性为86.67%;诊断ICAex闭塞的敏感性为90.91%，特异性为87.76%，阳性预测值为62.50%，阴性预测值为97.73%，有效性为88.33%。结论：TCD在ICAex重度狭窄或闭塞中的诊断价值较高。

关键词：经颅多普勒;颈内动脉颅外段重度狭窄或闭塞;诊断;临床研究

中图分类号：R445.1;R543.4文献标识码：BDOI：10？郾3969/j.issn.1001-0270.2021.02.10

The Diagnostic Value of Transcranial Doppler in Severe Stenosis or Occlusion of the Extracranial Segment of Internal Carotid Artery

LIU Ju-hua

（Department of Neurophysiology， The Peoples Hospital of Gaozhou， Guangdong 525200， China）

Abstract： Objective： To explore the diagnostic value of TCD in severe ICAex stenosis or occlusion. Methods： Select 60 patients diagnosed with severe unilateral ICAex stenosis or occlusion in our hospital from March 2020 to September 2020 as the observation group. In addition， 60 healthy people who had no obvious lesions in ICAex during the same period were selected as the control group. Both groups were performed TCD check. Results： TCD examination results showed that the blood flow velocities of bilateral MCA， ACA， and PCA in the control group were similar（P>0.05）; the spectrum shape was steep， the frequency window was obvious， and the bandwidth was similar; the blood flow of bilateral OA showed a positive frequency shift. The frequency spectrum is a high resistance wave of peripheral blood vessels. The blood flow velocity of MCA and ACA on the affected side of the observation group was significantly reduced， and the PI of MAC， ACA and PCA on the unaffected side were higher than those of the affected side （P<0.05）; The front traffic is open to reverse the direction of the ACA blood flow on the affected side， and the MCA and ACA spectrum are low， flat and round; The collateral branches of the ophthalmic artery were open to reverse the direction of the blood flow of the affected side OA， the blood flow speed increased， and the spectral shape was intracranial， showing low-pulsation changes. The PSV and PI of the healthy side and the affected side of the observation group and the control group were statistically significant （P<0.05）. The sensitivity of TCD in diagnosing ICAex severe stenosis was 85.71%， the specificity was 90.91%， the positive predictive value was 97.67%， the negative predictive value was 58.82%， and the validity was 86.67%;The sensitivity for diagnosing ICAex occlusion was 90.91%， the specificity was 87.76%， the positive predictive value was 62.50%， the negative predictive value was 97.73%， and the validity was 88.33%. Conclusion： TCD has a higher diagnostic value for severe ICAex stenosis or occlusion.

Key words： Transcranial Doppler; severe stenosis or occlusion of the extracranial segment of the internal carotid artery; diagnosis; clinical research

颈内动脉颅外段（Extracranial internal carotid artery，ICAex）重度狭窄或闭塞是缺血性脑卒中发生的重要病因，其当前防治措施主要有控制危险因素、药物治疗以及颈动脉内膜剥脱术、颈动脉支架植入术等治疗方式[1-3]。因此，临床上对于颈动脉狭窄程度及部位的准确判断对脑卒中病因正确诊断具有非常重要的意义[4]。数字减影血管造影是目前临床诊断脑血管狭窄的“金标准”，但由于费用昂贵及操作风险较大，临床推广仍存在较多限制[5-6]。经颅多普勒超声（Transcranial doppler ultrasound，TCD）是利用人类颅骨自然薄弱的部位为窗口评价颅底动脉血流动力学的一种影像学检查方法，具有无创、便捷、廉价、实时等特点[7-8]。我院采用TCD作为临床诊断ICAex重度狭窄或闭塞性病变获得了较好的应用效果，现将TCD检查结果与数字减影血管造影检查进行比较，旨在进一步明确TCD在ICAex重度狭窄或闭塞性病变中的诊断价值。报道……