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目的分析Stanford A型主动脉夹层(AD)累及颈动脉时对血流的影响,为探讨A型主动脉夹层与脑梗死的相关性提供参考依据。方法连续收集急诊超声诊断并经CT血管造影术(CTA)确诊的41例急性Stanford A型主动脉夹层患者,分为夹层未累及颈动脉组(A组,n=20)和累及颈动脉组(B组,n=21),分析两组颈动脉频谱及血流量差异并比较脑梗死发生率及病死率。结果 Stanford A型AD患者头臂血管累及率高达51.20%。A、B两组间的颈动脉频谱形态和血流量间差异有统计学意义(P<0.05),B组中频谱形态异常者明显高于A组(P<0.05),双侧颈内动脉(ICA)和椎动脉(VA)血流量比较,B组明显低于A组(P<0.05);比较两组间新发脑梗死发生率(20.00%vs 42.86%,P=0.115 9)、病死率(20.00%vs 38.10%,P=0.203 1)无统计学差异。结论 Stanford A型夹层头臂血管累及率高,虽然脑梗死发生率和病死率未显示明显差别,但累及颈动脉时频谱形态及入颅血流量明显受到影响,应及时对急性A型主动脉夹层患者颈动脉进行评估,为主动脉夹层患者脑梗死防治及改善预后提供重要依据。
Objective To analyze the influence of Stanford type A aortic dissection (AD) on the blood flow in carotid artery, and to provide a reference for exploring the correlation between type A aortic dissection and cerebral infarction. Methods A total of 41 patients with acute Stanford type A aortic dissection diagnosed by emergency ultrasonography and confirmed by CT angiography (CTA) were enrolled and divided into two groups: uninvolved carotid artery (group A, n = 20) and carotid artery involved Group B, n = 21). The differences of carotid artery spectrum and blood flow between the two groups were analyzed and the incidence of cerebral infarction and mortality were compared. Results The rate of brachial vessels in Stanford type A AD patients was 51.20%. There was a significant difference in carotid artery frequency spectrum and blood flow between A and B groups (P <0.05). The frequency of abnormal morphology in group B was significantly higher than that in group A (P <0.05), bilateral internal carotid artery (P <0.05). The incidence of new-onset cerebral infarction (20.00% vs 42.86%, P = 0.115 9), the mortality of ICA and vertebral artery (VA) were significantly lower in group B than in group A (20.00% vs 38.10%, P = 0.203 1) No significant difference. Conclusions The incidence rate of vascular occlusion in Stanford type A mechinus arm is high. Although the incidence of cerebral infarction and mortality are not significantly different, the frequency spectrum and the inflow of blood into the cranial artery are obviously affected. The acute type A aortic dissection Evaluation of carotid artery in patients with aortic dissection in patients with cerebral infarction prevention and control and provide an important basis for improving prognosis.