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【关键词】 劲动脉血管;斑块;超声诊断;脑梗死的关系
The relationship between differential diagnosis of carotid artery plaque and cerebral infarction was analyzed by ultrasound
Liu ping
(B ultrasound room of huangpi district people's hospital affiliated to jianghan university, wuhan 430300, China)
【 abstract 】 objective: to examine the relationship between the diagnosis of carotid artery plaque and cerebral infarction by ultrasound. Methods: 70 cases of patients with confirmed cerebral infarction admitted to huangpi district people's hospital affiliated to jianghan university and 70 cases of medical staff in our hospital were selected as research objects. The former is the observation group, the latter is the control group. The two groups of subjects were examined by carotid artery ultrasound, and patients in the observation group were examined by CT to compare the diagnosis rate of carotid artery plaques by CT and ultrasound. The relationship between the diagnosis of carotid artery plaque and cerebral infarction by ultrasound. Results: the total diagnosis rate of sclerotic plaques in the observation group was 66.20%, which was significantly higher than that of 32.4% in the CT scan group (P<0.05). The number of sclerotic plaques in the observation group at bilateral carotid artery, carotid artery intersection and the beginning of internal carotid artery was significantly lower than that in the CT scan group (P >0.05). The detection rate of ultrasonic plaques in the observation group was significantly higher than that in the control group, and the detection rate of "1mm intra-arterial thickness" plaques in the observation group was also significantly higher than that in the control group (P<0.05). Conclusion: the differential diagnosis of carotid artery plaque by ultrasound is higher, and the detection rate is higher. When the mixed spots and soft spots are detected by ultrasound, the patient should be reminded of precautions to prevent the occurrence of cerebral infarction.
【key words】 strong artery; Plaque; Ultrasonic diagnosis; The relationship between cerebral infarction
急性脑梗死也被称为缺血性脑卒中,是由于脑动脉粥样硬化,血管内膜损伤使脑动脉管腔狭窄,进而因多种因素使局部血栓形成一种以脑组织缺血,缺氧为主要症状的神经内科疾病[1],我们探寻一种简便快捷且准确率高的诊断方法尤为重要。研究表明,颈动脉粥样硬化斑块是引发急性脑梗死的主要原因,早期诊断多为影像学方法,其中最为常见的即为CT扫描,但其清晰度和综合诊断率还有较大的上升空间[2]。随着颈部血管超声技术的成熟,CT扫描检查逐渐被超声取代,为了进一步探讨超声对颈动脉血管斑块的诊断价值以及与脑梗死的关系,我院特做此研究,现将所得结果报道如下。
1 资料和方法
1.1 临床资料
选择我院自2019年1月--2020年2月收治的70例确诊为脑梗死的患者及同期健康体检的70例志愿者作为研究对象,前者为观察组,经临床诊断为脑梗死,后者为对照组,两组患者均意识清晰,签署知情同意书,排除合并其他严重脏器官疾病的患者。观察组患者男43例,女30例,年龄49~75岁,平均(64.11±2.41)岁;对照组男36例,女34例,年龄50~76岁,平均(64.02±2.54)岁。此次研究经院伦理委员会批准,两组患者的资料相比,差异无统计学意义。
1.2 研究方法 为两组患者均先进行颈动脉超声检查:患者取平卧位,将头部稍偏向检查对侧,充分显露出颈部。使探头频率维持在7~12MHz,分别检测患者的左右颈动脉区域,自锁骨内侧开始,采取横扫模式依次检测其颈总动脉和颈动脉分支,以及颈内动脉与颈外动脉部位。两组患者均检查3次,取平均值。与此同时,观察组患者还需进行CT扫描:扫描范围为双侧颈动脉及颈内动脉起始处等区域,记录扫描的斑块个数和位置分布,以颈动脉内膜中层厚度在1.2mm以上为标准,区分斑块和正常组织。
1.3 观察指标 1.比较观察组患者硬化斑块诊出平均个数;2.比较观察组患者不同位置硬化斑块的平均分布情况;3.比较两组患者超声检查结果。
1.4 统计学方法 通过SPSS19.0统计软件分析,计数资料的组间比较采用x2检验,P<0.05为差异有统计学意义。
2 结果
2.1 两种方法下观察组患者硬化斑块诊出平均个数对比
超声检查观察组患者硬化斑块的总诊出率为66.20%,显著高于CT扫描检查的32.4%(P<0.05)。
2.2 两种方法下观察组患者不同位置硬化斑块的平均分布情况对比
超声检查观察组患者在双侧颈动脉、颈动脉涨大处、颈内动脉起始处的硬化斑块数对于CT扫描组(P >0.05)。
2.3 两组患者超声检查结果对比
观察组患者超声斑块的检出率显著高于对照组,且观察组患者检出“动脉内-中模厚度1mm”斑块检出率也显著高于对照组(P<0.05)。
3 讨论
本文结果提示,超声检测颈动脉血管斑块有利于临床诊断,而颈动脉斑块的诊断检出率也较高[3]。与此同时,与正常人相比,观察组患者超声斑块的检出率显著高于对照组,且观察组患者检出“动脉内-中模厚度1mm”斑块检出率也显著高于对照组,提示超声检测颈动脉斑块灵敏度高,符合脑梗死患者相关病理学特征,在颈动脉血管斑块诊断中价值较高,且颈动脉分叉处为机体斑块形成主要区域。与此同时,正常人颈动脉斑块以扁平斑块和硬质斑块为主,而脑梗死患者则以回声强弱不定溃疡型斑块和低回声性脂质型软斑块为主,这充分说明了在临床诊断中若患者超声检测混合斑、软斑诊出率较高时需格外引起注意预防,从而避免诱发脑梗死。
综上所述,超声对颈动脉血管斑块中的鉴别诊断结果更高,诊断检出率更高,当超声检测混合斑、软斑诊出率较高时可提醒患者相关注意事项,提前预防脑梗死。
参考文献
[1] 谢昊等.脑梗死患者血压与变异性研究进展[J].现代医药.2018,34(19).
[2] 王倩,张亮.颈动脉粥样硬化斑块与脑梗死关系的高分辨磁共振研究[J].中国实用神经疾病杂志,2017,20(17):85-88.
[3] 赵丹丹.超声在测定颈动脉硬化与脑梗死关系中的作用[J].中国现代药物应用,2016, 10(11):47-48.
论文作者:刘萍
论文发表刊物:《医师在线》2020年6期
论文发表时间:2020/4/21
标签:超声论文; 患者论文; 颈动脉论文; 检出论文; 脑梗死论文; 动脉论文; 血管论文; 《医师在线》2020年6期论文;