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Stroke:TCD 诊断再通治疗后的无复流现象

2018-11-26 杨中华 脑血管病及重症文献导读

尽管成功再通,四分之一的卒中患者存在组织灌注受损,这对临床预后产生不良影响。来自动物组织学的研究显示,短暂闭塞MCA 可见到微血管梗阻,这是无复流现象的机制。截止到目前为止,尚缺乏临床证据。

尽管成功再通,四分之一的卒中患者存在组织灌注受损,这对临床预后产生不良影响。来自动物组织学的研究显示,短暂闭塞MCA 可见到微血管梗阻,这是无复流现象的机制。截止到目前为止,尚缺乏临床证据。

Gosling 搏动指数(pulsatility index,PI)和Pourcelot 阻力指数(resistance index,RI)是 TCD 的常用参数,是脑血管阻力的指数。

2018年10月来自澳大利亚的Felix C. Ng等在 Stroke 上公布了他们的研究结果,目的在于探讨 TCD 是否可以检测再通后微血管的无复流现象。

从2013年1月到2017年12月连续的急性 MCA 闭塞后机械性再通的患者53例,发病6h 内达到 TICI IIb/III 再通,并且在3天内进行了 TCD 评价,计算PI([PSV?EDV]/MFV)和 RI([PSV?EDV]/PSV)。MFV(Mean-flow velocity),平均血流速度;PSV(peak-systolic velocity),峰收缩期速度;EDV(end-diastolic velocity),舒张末期速度。把这些患者与53例年龄/性别匹配的对照组患者相比。

在53例患者中,内部比较(interside comparison)发现MCA-PI不对称性增加(27.9% vs 4.9%;P = 0.007)的可能性更大,症状半球的 MCA-PI异常升高超过正常范围的可能性更大(46.7% vs 22%;P = 0.016)。MCA-PI 升高与更少的出血性梗死相关(9.5% vs 45.8%,P = 0.009),但是功能预后更差(mRS<=1,18.2% vs 58.1%,P = 0.035)。

最终作者认为采用 TCD PI 监测发现成功再痛后缺血区域微血管阻力增加非常常见,这可能是诊断无复流现象的一种有效可行、临床相关的标志物。

原始出处:Ng FC, Coulton B, Chambers B, Thijs V. Persistently Elevated Microvascular Resistance Postrecanalization. Stroke. 2018 Oct;49(10):2512-2515.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2083863, encodeId=f00f20838630e, content=<a href='/topic/show?id=344b1e1990b' target=_blank style='color:#2F92EE;'>#TCD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17199, encryptionId=344b1e1990b, topicName=TCD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Sat Mar 09 05:44:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355229, encodeId=f7363552293d, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Wed Dec 12 18:51:22 CST 2018, time=2018-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353703, encodeId=eda8353e0349, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Mon Nov 26 13:07:18 CST 2018, time=2018-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353702, encodeId=ed3f353e0276, content=学习了,长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 26 12:54:39 CST 2018, time=2018-11-26, status=1, ipAttribution=)]
    2019-03-09 维他命
  2. [GetPortalCommentsPageByObjectIdResponse(id=2083863, encodeId=f00f20838630e, content=<a href='/topic/show?id=344b1e1990b' target=_blank style='color:#2F92EE;'>#TCD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17199, encryptionId=344b1e1990b, topicName=TCD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Sat Mar 09 05:44:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355229, encodeId=f7363552293d, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Wed Dec 12 18:51:22 CST 2018, time=2018-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353703, encodeId=eda8353e0349, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Mon Nov 26 13:07:18 CST 2018, time=2018-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353702, encodeId=ed3f353e0276, content=学习了,长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 26 12:54:39 CST 2018, time=2018-11-26, status=1, ipAttribution=)]
    2018-12-12 wxl882001

    了解一下

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2083863, encodeId=f00f20838630e, content=<a href='/topic/show?id=344b1e1990b' target=_blank style='color:#2F92EE;'>#TCD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17199, encryptionId=344b1e1990b, topicName=TCD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Sat Mar 09 05:44:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355229, encodeId=f7363552293d, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Wed Dec 12 18:51:22 CST 2018, time=2018-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353703, encodeId=eda8353e0349, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Mon Nov 26 13:07:18 CST 2018, time=2018-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353702, encodeId=ed3f353e0276, content=学习了,长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 26 12:54:39 CST 2018, time=2018-11-26, status=1, ipAttribution=)]
    2018-11-26 1dd8a7c5m95(暂无匿称)

    好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2083863, encodeId=f00f20838630e, content=<a href='/topic/show?id=344b1e1990b' target=_blank style='color:#2F92EE;'>#TCD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17199, encryptionId=344b1e1990b, topicName=TCD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Sat Mar 09 05:44:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355229, encodeId=f7363552293d, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Wed Dec 12 18:51:22 CST 2018, time=2018-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353703, encodeId=eda8353e0349, content=好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Mon Nov 26 13:07:18 CST 2018, time=2018-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353702, encodeId=ed3f353e0276, content=学习了,长知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Mon Nov 26 12:54:39 CST 2018, time=2018-11-26, status=1, ipAttribution=)]
    2018-11-26 1ddf0692m34(暂无匿称)

    学习了,长知识

    0

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