Abstract:

Objective To explore the effectiveness of noninvasive detection method of the effective cerebral perfusion pressure (CPPe) and the relationship between the CPPe and the internal carotid artery (ICA) stenosis in patients with acute cerebral infarction. Methods For the prospective study, this study collected 41 cases patients with acute cerebral infarction within 1 week in the Second Affiliated Hospital of Guangzhou University from January 2010 to January 2012. We used digital subtraction angiography (DSA) and transcranial Doppler ultrasonography (TCD) to prospectively detect the internal carotid artery stenosis degree, noninvasive blood pressure, invasive blood pressure and cerebral artery blood flow velocity of 41 patients. After calculating CPPe according to tested results, we compared the specificity and accuracy of invasive and noninvasive CPPe in all of the patients with acute cerebral infarction. At the same time according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) standard, all of the patients with acute cerebral infarction were divided into mild stenosis group, moderate stenosis group and severe stenosis group. And we also compared vascular risk factors, CPPe and National Institutes of Health Stroke Scale (NIHSS) score among three groups, and analyzed the correlation between CPPe, NIHSS score and intracranial artery stenosis degree. Results Compare all of the patients with acute cerebral infarction of invasive and noninvasive CPPe, the results showed that the invasive CPPe had a median of 56.6 mmHg, the noninvasive CPPe had a median of 57.8 mmHg, and there was no significant difference between the two evaluation methods by TCD and DSA. The invasive CPPe of three groups of patients with acute cerebral infarction had a median of 60.6 mmHg, 42.5 mmHg and 1.6 mmHg; the noninvasive CPPe of three groups of patients with acute cerebral infarction had a median of 62.2 mmHg, 42.7 mmHg and 0.27 mmHg; while the NIHSS score of three groups of patients with acute cerebral infarction had a median of 4, 3 and 8. The differences of CPPe and NIHSS score among three groups were statistically significant, and the H value was 26.906, 26.906 and 11.233 (P <0.01). Correlation analysis showed that the CPPe with ICA stenosis degree of NASCET stenosis rate was closely related in patients with acute cerebral infarction with significant difference (P <0.01), and the correlation coefficient was -0.782 and -0.814, respectively. While the NIHSS scores had no statistical relationship compared with ICA stenosis degree of NASCET stenosis rate, and the correlation coefficient was 0.222. Conclusion The noninvasive method gained CPPe by TCD was similar to the invasive method to detect CPPe. CPPe was closely related to the degree of ICA stenosis of patients with cerebral infarction. The CPPe maybe could provide reliable evidence for noninvasive detection of the cerebral blood flow and guide the individual blood pressure regulation and control of cerebrovascular disease patients

Key words: Acute cerebral infarction; Effective cerebral perfusion pressure; Digital subtraction angiography; Ultrasonography detection, Doppler, Transcranial

摘要：

目的 探索脑血流有效灌注压（effective cerebral perfusion pressure，CPPe）的无创检测方法的有效性 以及急性脑梗死患者CPPe与颈内动脉血管狭窄程度的相关性。 方法 本研究为前瞻性研究，收集2010年1月～2012年1月在广州医科大学附属第二医院神经内科住院 的41例发病1周内的急性脑梗死患者，所有患者均经数字减影血管造影（digital subtraction angiography， DSA）和经颅多普勒超声（transcranial Doppler ultrasonography，TCD）评估颈内动脉狭窄程度及大脑中动 脉无创血压、有创血压及血流速度，根据上述检测结果计算CPPe，比较TCD、DSA评价CPPe的有效性。 同时根据北美症状性颈动脉狭窄内膜切除研究（North American Symptomatic Carotid Endarterectomy Trial，NASCET）标准分为轻度狭窄组、中度狭窄组和重度狭窄组，比较各组间的血管狭窄危险因素、 CPPe和美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分，以及CPPe 和NIHSS评分与颈内动脉血管狭窄程度的相关性。 结果 所有急性脑梗死患者的有创和无创CPPe比较，结果发现有创CPPe的中位数为56.6 mmHg，无 创CPPe的中位数为57.8 mmHg，两者之间的差异无显著性（P＞0.05）。轻度狭窄组、中度狭窄组和重度 狭窄组3组急性脑梗死患者的有创CPPe的中位数分别为60.6 mmHg、42.5 mmHg和1.6 mmHg；无创CPPe 的中位数分别为62.2 mmHg、42.7 mmHg和0.27 mmHg；NIHSS评分的中位数分别为4、3和8；比较CPPe、 NIHSS评分在各组间的差异有显著性，H值分别为26.906、26.906及11.233（P＜0.01）。相关分析显示急 性脑梗死患者CPPe与DSA显示的血管狭窄程度密切相关，相关系数分别为－0.782和－0.814，差异有显 著性（P＜0.01）；而NIHSS评分与DSA显示的血管狭窄程度无相关性，相关系数为0.222，差异无显著性 （P＞0.05）。 结论 通过TCD无创检测并计算CPPe的新方法可以获得较为准确的CPPe，而且CPPe与急性脑梗死患 者的颈内动脉狭窄程度密切相关，这使得CPPe可能可以为脑血管病患者无创脑血流检测、指导个体 化血压调控提供可靠证据。

关键词: 急性脑梗死; 脑血流有效灌注压; 数字减影血管造影; 超声检查; 多普勒; 经颅