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[摘要] 目的：应用彩色多普勒超声技术检测脑梗死患者颈动脉血管，研究颈动脉粥样硬化病变特点和血流动力学变化，探讨颈动脉超声检测对脑梗死患者病情监测的临床意义。方法：对观察组200例患者和对照组120例同期住院的非脑梗死患者进行颈动脉彩色多普勒超声检查，检测双侧颈总动脉、颈内动脉内膜中层厚度（IMT）、斑块情况和相关血流参数。结果：观察组CA率为65.50%，以软斑和复合斑为主；对照组CA率为36.67%，以硬斑和扁平斑为主。观察组左右侧CCA的IMT均明显大于对照组；观察组双侧SPV、EDV均低于对照组，两组S/D、RI相比，观察组高于对照组，但无显著差异。结论：颈动脉病变与脑梗死的发病有着密切的关系，多普勒超声用于颈动脉粥样硬化检测可及早、尽快地发现斑块并确定其性质，为临床干预治疗提供依据并做出预报，有着重要的临床应用意义。
[关键词] 彩色多普勒超声；脑梗死；颈动脉；斑块；血流；颈内动脉内膜中层厚度
[中图分类号] R445.1 [文献标识码]A[文章编号]1674-4721（2011）05（c）-０09－０2
Clinical meaning of carotid artery examination of cerebral infarction patients with ultrasound
LIU Gan, LI Guohong, TAN Buqiao
Function section, Kaiping City Center Hospital, Guangdong Province, Kaiping 529300, China
[Abstract] Objective: To detect carotid artery of cerebral infarction patients with colorful doppler ultrasound, research carotid artery gruel kind harden pathological changes characteristics and blood dynamics variety, study clinical meaning of cerebral infarction sufferer condition monitor with carotid artery ultrasound examination. Methods: Observation set 200 non-cerebral infarction with hospitalized 120 same period to sufferer and matched controls cerebral infarction the sufferer carry on a super voice of colorful doppler ultrasound of carotid artery check, examination double the side neck total artery, film inside the artery inside the neck intermediate thickness (IMT), spot piece the circumstance was with related blood parameter. Results: The observation set CA leads to 65.50% and regards the soft spot and the compound spot as principle; The matched control CA leads to 36.67%, was aller obviously big than a matched control regarding the hard spot and the flat even spot as principle IMT of observation set or so side CCA; Observation set double side SPV and EDV was aller low than a matched control, the two sets of S/Ds and RI compares, and the observation set was higher than a matched control, but hadn"t significant differences. Conclusion: The outbreak of carotid artery pathological changes and cerebral infarction has a close relation, the colorful doppler ultrasound is used for a carotid artery gruel the kind harden examination and be within the reach of and discover a spot piece early and quickly and make sure its property, provide for the clinical intervention treatment basis and do forecast, there is important clinical application meaning.
[Key words] Colorful doppler ultrasound; Cerebral infarction; Carotid artery; Spot piece; Blood; IMT
脑梗死（cerebral infarction，CI）又称缺血性脑卒中（cerebral ischemic stroke，CIS），是指局部脑组织因血液循环障碍，缺血、缺氧而发生的软化坏死，是我国当前脑血管病中的常见病、多发病，严重者甚至危及生命。颈动脉病变是评价脑梗死的一个重要指标，彩色多普勒超声作为一种简便、准确的检查方法，是评价颈动脉病变的有价值的手段[1]。本研究应用彩色多普勒超声技术检测脑梗死患者颈动脉血管，了解和分析颈动脉粥样硬化斑块的分布特点和超声类型，旨在研究颈动脉粥样硬化病变特点和血流动力学变化，探讨颈动脉超声检测对脑梗死患者病情监测的临床意义。
1 资料与方法
1.1 一般资料
收集本院神经内科2007年2月~2010年2月住院治疗的脑梗死患者200例作为观察组，其中，男137例，女63例，年龄54~80岁，平均（64.7±11.6）岁。单侧脑梗死者89例，多灶性脑梗死者111例，合并高血压者124例，合并高血脂者77例，合并糖尿病者61例。所有患者均经CT或MRI检测，符合1996年全国第四届脑血管疾病学术会议通过的脑梗死诊断标准。另选取120例同期住院的非脑梗死患者作为对照组，其中，男84例，女36例，年龄50~78岁，平均（62.5±12.1）岁，两组在性别、年龄上比较差异无统计学意义（P>0.05），具有可比性。
1.2 仪器与方法
采用GE Voiuson730及EUB 8500彩色超声诊断仪，探头频率7~13 MHz。患者取仰卧位，头颈尽量仰伸，使受检测颈部充分暴露，检测时头转向被检查的对侧。将探头置于胸锁乳突肌前缘，自颈总动脉近心端开始，逐渐至远心端，先横切后纵切扫描，经颈动脉分叉处至颈内动脉入颅处显示不清为止；依次扫查颈总动脉（CCA）、颈动脉分叉处（BIF）及颈内动脉（ICA）彩色多普勒显示血流状态，并帮助显示管腔界限及斑块轮廓[2]。内膜中层厚度（IMT）判定标准：IMT>1.0 mm为内膜增厚，测量时选择距颈动脉膨大处1.0~1.5 cm范围内测量，内膜中层厚度测量管腔后壁，粥样斑块位置、大小、内部回声，以IMT≥1.2 mm作为诊断斑块的标准[3]。同时根据组织病理学和影像学将斑块分为扁平斑，硬斑，软斑和复合斑。双侧颈动脉任一节段发生斑块即判为颈动脉粥样硬化阳性（CA）。脉冲多普勒取样容积宽度约占管腔的1/2，置于管腔中央，调整取样角度，使血流与声束夹角
