全麻下颈动脉内膜剥脱术的麻醉体会

目的:评价颈动脉内膜剥脱术(CEA)麻醉疗效,以及经颅多普勒超声(TCD)、微血管多普勒超声(MVD)应用的价值,以及适合颈动脉内膜剥脱术的适合麻醉方法。方法:回顾性分析苏州大学附属一医院脑卒中中心2012年5月至2013年5月所进行的颈动脉内膜剥脱术治疗的19名颅外颈动脉狭窄患者的资料。患者临床症状均伴有不同程度的脑缺血症状。颈动脉狭窄程度2例中度狭窄,17例重度狭窄。所有手术操作均全麻下在显微镜下操作。1例采用补片成形。18例术中采用TCD及MVD监测下完成,1例未采用超声监测。结果:手术成功率为100%,无死亡率。术前脑缺血症状术后患者均有恢复。未发现过度灌注的并发症。麻醉效果达到预期目的。结论:颈动脉内膜剥脱术在多普勒超声MVD及TCD监测下治疗颅外颈动脉狭窄是一种安全、有效的措施;全身麻醉下行CEA手术安全可靠。     

Comparison between carotid stenting and carotid endarterectomy in early outcome

Carotid artery stenting (CAS) is a widely used method in prevention of stroke for carotid artery stenosis as an alternative to surgical treatment. Initial studies reveal higher morbidity and mortality rates for CAS than acceptable standards for carotid endarterectomy (CEA). The aim of this study was to compare results in a series of CAS with concurrent risk-matched group of CEA patients. The study included two groups of 50 patients with internal carotid artery stenosis. We compared early outcome (30 days after procedure) in risk-matched groups of patients that underwent these procedures. Post procedural complications were equally frequent in both groups. There was no significant difference in perioperative complication rates (P = 0.871). Comparison of these two methods shows that CAS and CEA are competitive methods for treatment of carotid artery stenosis. Particularly in symptomatic patients with high risk for surgery CAS is alternative treatment.     

Symptomatic carotid ischaemic events: safest and most cost effective way of selecting patients for angiography,before carotid endarterectomy.

OBJECTIVE: To determine the safest, least costly, and most effective way to select patients with symptomatic carotid ischaemic events for carotid angiography before carotid endarterectomy. DESIGN: Prospective cohort study. SETTING: University departments of clinical neurosciences and clinical neurology. PATIENTS: 485 Patients with carotid territory transient ischaemic attacks of the brain (n = 224) or eye (n = 162) or retinal infarction (n = 99) were referred to a single neurologist between 1976 and 1986. INTERVENTIONS: Clinical examination by auscultation over the precordium, supraclavicular fossae, and neck vessels (all patients). Cerebral angiography of patients suitable for carotid endarterectomy. MAIN OUTCOME MEASURES: Financial cost and number of disabling strokes after angiography. RESULTS: 296 Patients were investigated by cerebral angiography. Ischaemic symptoms had occurred in the distribution of 298 internal carotid arteries (symptomatic) that were imaged, two patients having bilateral symptoms. The presence or absence of a carotid bruit and the maximum percentage diameter stenosis of the origin of the symptomatic internal carotid artery were correlated. The prevalence of mild disease (diameter stenosis greater than or equal to 25%) of the symptomatic internal carotid artery was 57%, and if an ipsilateral carotid bruit was heard the probability of mild stenosis rose to 92%. The prevalence of moderate disease of the symptomatic internal carotid artery (stenosis greater than or equal to 50%) was 39%, and if a bruit was heard the probability doubled to 78%. The prevalence of severe internal carotid disease (stenosis greater than or equal to 75%) was 22%, and if a bruit was heard the probability was more than double, at 49%. The direct cost to both the NHS and the private health sector of investigating patients with symptomatic carotid ischaemia was estimated for several strategies of carotid artery imaging and expressed in terms of financial cost and number of strokes after angiography incurred in detecting all patients with diameter stenosis of the symptomatic internal carotid artery of greater than or equal to 25%, 50%, or 75%. To detect diameter stenosis of the internal carotid artery of greater than or equal to 25% it is most cost effective to proceed directly to cerebral angiography in patients with a carotid bruit over the symptomatic carotid bifurcation and to screen patients without a carotid bruit by duplex carotid ultrasonography; patients in whom duplex ultrasonography discloses stenosis of greater than or equal to 25% are then referred for cerebral angiography. To detect only more severe internal carotid disease (stenosis of greater than or equal to 50%) the same policy applies, unless the local duplex ultrasonographic service is particularly efficient and reliable, when it is probably most cost effective and safer to screen all patients by this method irrespective of the findings on cervical auscultation. To detect stenosis of 75% or greater it is most cost effective to screen all patients with duplex ultrasonography, whether a carotid bruit is present or not, because this approach reduces the number of angiograms required, is the least expensive, and results in the least number of strokes after angiography. CONCLUSIONS: Patients selection for cerebral angiography before carotid endarterectomy needs to be appropriate and cost effective. Sound clinical evaluation and duplex carotid ultrasound are required. The findings of this study should not be applied to other medical centres without first considering possible differences in the prevalence of carotid artery disease, the efficiency and reliability of duplex ultrasonography, the local complication rates of cerebral angiography, and the local costs of the imaging procedures.     

螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值

目的:探讨螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。方法:选取2014年1月至2016年1月期间来我院就诊的60例急性脑梗死患者作为观察组,另选同期来我院就诊的非急性脑梗死患者60例作为对照组。两组患者均进行螺旋CT头颈部血管成像检查,比较两组患者的颈动脉狭窄程度及各段血管斑块分布情况,并根据检查结果评价螺旋CT头颈部血管成像对急性脑梗死患者颈动脉狭窄的诊断价值。结果:观察组轻度狭窄与中度狭窄检出率均显著高于对照组(P0.05),重度狭窄与闭塞检出率与对照组比较无统计学差异(P0.05),观察组总检出狭窄率高于对照组(P0.05)。观察组与对照组在颈动脉分叉处、颈总动脉、颈内动脉及颈外动脉均有斑块检出,观察组斑块总检出率为69.4%,显著高于对照组的41.2%(P0.05)。结论:临床上应用128层螺旋CT头颈部血管成像技术对急性脑梗死患者颈动脉狭窄情况可进行有效评估,该方法对患者轻、中度狭窄以及双侧颈动脉斑块检出率更高,在临床诊断及预后防治中具有应用推广价值。     

视网膜静脉阻塞与颈动脉狭窄的相关性研究

目的:探究视网膜静脉阻塞与颈动脉狭窄的相关性研究,并为其临床检测、治疗与预后提供参考。方法:选择我院55例视网膜静脉阻塞患者(55只眼)为研究组,对其裸眼视力、矫正视力、眼压、眼底血管荧光造影(FFA)等检查资料进行分析,并进行多普勒彩超检查,记录其颈动脉狭窄情况,并对两种疾病之间的关系进行分析。同时选取55例健康人作为对照组。结果:研究组55例患者确诊为视网膜静脉阻塞(RVO),多普勒结果显示患者患侧与健侧劲动脉血流动力学各项差异不明显(P0.05);其IMT值较之对照组显著增高(P0.05);其PSV与EDV值有所降低,差异具有统计学意义(P0.05)。结论:视网膜静脉阻塞患者大多存在颈动脉狭窄,因此检测颈动脉血流动力学对于诊断与预防视网膜静脉阻塞有着重要作用。     

颈内动脉支架置入术对颈动脉狭窄患者认知功能影响的研究

目的：研究颈动脉狭窄对认知功能的影响,探讨颈动脉支架置入术（CAS）患者术后不同时期认知功能的变化及其可能的机制。方法：选取2010年1月至2012年12月我院神经内科收住的急性脑梗死（前循环）患者75例,按颈内动脉狭窄程度,分成无狭窄组,轻度狭窄组（狭窄程度〈30％）,中度狭窄组（30-69％）和治疗组（70．99％）,前三组给予药物治疗,治疗组同时给予颈内动脉支架置入术,应用蒙特利尔认知评估量表（MoCA）、简易精神状态检查表（MMSE）、搭火柴测验（stickTest）,对患者进行认知功能评估,比较术前、术后不同时期认知功能的变化,同时利用SPECT／CT对治疗组20例患者术后局部脑血流改善状况进行评价。结果：治疗组和对照组在术前比较MoCA总分、MMSE评分、StickTest评分,发现治疗组评分低于对照组,且随着颈动脉狭窄程度的加重,认知功能受损越明显;治疗组在术后1周与术前比较,评分反而降低,差异有统计学意义;术后3个月、术后6个月与术前比较,评分均有所提高,差异有统计学意义;通过SPECT／CT对治疗组术前感兴趣区血流量与同侧小脑平均脑血流量比较,术后再与同侧小脑比较,结果显示术后脑灌注明显改善。结论：颈动脉狭窄与血管性认知功能障碍有关,而且认知功能障碍的程度与颈动脉狭窄程度呈正相关,颈内动脉支架置入术可最终改善认知功能,尤其表现在视空间／执行能力,延迟回忆能力,注意力等方面。     

Carotid artery stenting: update

"Extracranial carotid artery stenosis is responsible for approximately 20-30% of ischemic strokes. Traditionally, carotid artery stenosis has been treated with carotid endarterectomy. However, the low periprocedural complication rate and the mid term durability of carotid artery stenting has made it a competitive alternative treatment strategy. This update reviews the technical aspects of carotid artery stenting, clinical data supporting carotid artery stenting-particularly in high risk patients, and the complications associated with carotid artery stenting."     

颈动脉狭窄的显微外科治疗

目的:评价颈动脉内膜剥脱术治疗颅外颈动脉狭窄的疗效,以及经颅多普勒超声(TCD)、微血管多普勒超声(MVD)应用的价值。方法:回顾性分析2012年5月至2013年5月采用颈动脉内膜剥脱术治疗的19例颅外颈动脉狭窄的资料。均伴有不同程度的脑缺血症状。颈动脉狭窄程度2例中度狭窄,17例重度狭窄。同时行颈动脉内膜剥脱术均在显微镜下操作。1例采用补片成形。18例术中采用TCD及MVD监测下完成,1例未采用超声监测。结果:手术成功率为100%,无死亡率。术前脑缺血症状术后患者均有不同程度的恢复。均未发现过度灌注的并发症。结论:颈动脉内膜剥脱术治疗颅外颈动脉狭窄是一种安全、有效的措施;MVD及TCD监测对于显微手术有着重要意义。     

Endarterectomy of the Internal Carotid Artery

Results of 219 operations in 171 patients for arteriosclerotic stenosis of the internal carotid artery were consistently good in patients with lateralizing, transient ischemic attacks. Although less consistent, relief of symptoms may be expected in a high proportion of patients with significant stenosis and more nonspecific symptoms. A small number of patients (10 percent) may have significant stenosis without a bruit. Asymptomatic stenosis, which has an unpredictable prognosis, may be operated upon with low mortality and morbidity. The use of local anesthesia and shunting when necessary proved to be the safest technique for the authors.     

Perioperative and early postoperative neurological deficit in older patients during carotid artery thrombendarterectomy

Cerebrovascular accidents, strokes in particular, are among the most frequent causes of death today in developed countries. In the last two decades, stroke was the second most frequent cause of death in Primorsko-Goranska Region in Croatia. In older patients, individuals older than 65 years of age have an increased risk of stroke, mainly because the degree of carotid artery stenosis increases with age. The most frequent complication of the high percent stenosis of the carotid arteries is thrombosis in the area of atherosclerotic changes of blood vessels. With the increase in the age of the population, there is also an increase in the number of risk factors of cerebrovascular accident. Doppler ultrasound sonography and Multi Slice CT scans have the most prominent role in the early detection of atherosclerotic changes and in the assessment of the degree of carotid artery narrowing. Today, in Croatia as well as worldwide, thrombendarterectomy holds the most important place in stroke prevention. Between 2006 and 2009, 209 patients underwent surgical intervention at the Clinical Hospital Center in Rijeka for high degree of carotid artery narrowing. In the group younger than 65 years of age, which consisted of 53 patients, a neurological deficit was noted in 4 patients (7.54%) in the perioperative and early postoperative course. In the group of individuals older than 65 years of age, which consisted of 156 patients, a neurological deficit was noted in 9 patients (5.76%). There was no significant statistical difference in the incidence of neurological deficit, nor in the mortality in individuals older than 65 years of age during carotid arteries thrombendarterectomy.     

颈动脉斑块LRNC特征可诊断2型糖尿病患者急性脑梗死的风险

2型糖尿病可能加重颈动脉斑块的易损性并增加缺血性中风的风险,关于2型糖尿病患者伴有颈动脉斑块特征的急性中风亚型鲜有研究报道。本研究旨在探讨2型糖尿病患者颈动脉斑块特征与MRI确定的急性脑梗死病变特征之间的关系。本研究以颈内动脉区急性脑血管病患者为研究对象,所有患者分为2型糖尿病组和非2型糖尿病组,分别行颈动脉和脑部MRI扫描,测定同侧颈动脉斑块的形态和特征,以及颅内和颅外颈动脉狭窄。基于中风亚型和急性脑梗塞病变模式对患者进行评估。研究结果表明,与非2型糖尿病患者相比,2型糖尿病患者颈动脉型IV-VI病变的患病率更高,斑块负荷更大,以及富脂质坏死核(LRNC)更大。在有症状的颈动脉LRNC患者中,与非2型糖尿病组相比,2型糖尿病组颈内动脉区出现较多的伴有大穿孔动脉梗塞形态和较大的急性脑梗塞。LRNC%>23.5%的颈动脉斑块是2型糖尿病患者存在颈动脉狭窄的急性脑梗塞病变的独立危险因素。颈动脉斑块特征的量化,尤其是MRI诊断的富脂质坏死核对中风风险具有潜在应用价值。     

The cardiovascular profile of soccer referees: an echocardiographic study

Background

Previous studies demonstrated a modest association between C-Reactive Protein (CRP), stenosis of carotid artery, and carotid Intima-Media Thickness (IMT) in general population. During present study, we aimed to evaluate the relationship between High Sensitivity C-Reactive Protein (hsCRP) and Common Carotid Intima-Media Thickness (CCIMT) in patients who candidate for Coronary Artery Bypass Grafting (CABG).

Methods

The study subjects were enrolled from patients with coronary arteries disease referred from Shahid Madani Hospital (Tabriz, Iran), who have been candidate for elective CABG from January 2005 to August 2007. The common carotid arteries were evaluated with high-resolution B-mode ultrasonography using a 7.5- MHz linear-array transducer to determine the IMT and grade of stenosis. Serum hsCRP level was measured using commercially available enzyme linked immunosorbent assay kit.

Results

Finally, information of 176 CABG candidates was analysed. The mean age of participants was 62.71 ± 9.45 years with 1.63 male to female ratio. The mean of CCIMT was 0.69 ± 0.54 mm. Although there was no significant correlation between serum hsCRP level and CCIMT in patients without carotid stenosis (p=0.113, r=0.186), participants with common carotid artery stenosis had higher levels of serum hsCRP than participants without stenosis (2.42+/-1.30 vs. 1.20+/-0.97 mg/dl; p=0.009).

Conclusion

Study results showed that there was no correlation between serum hsCRP level and CCIMT in patients without carotid stenosis, but patients with common carotid artery stenosis had higher levels of serum hsCRP than patients without stenosis.     

Hcy, hs-CRP与急性脑梗死患者颈动脉粥样硬化关系的研究

目的:探讨急性脑梗死患者血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)与颈动脉粥样硬化的相关性及临床意义。方法:收集确诊为急性脑梗死患者90例,对患者进行颈动脉超声检查,根据颈动脉狭窄程度将患者分成颈动脉内膜正常组、轻度狭窄组、中-重度狭窄组。比较三组患者斑块检出率、Hcy、hs-CRP水平和IMT厚度,同时对Hcy、hs-CRP与IMT进行相关性分析。结果:中-重度狭窄组斑块检出率为86.4%,显著高于轻度狭窄组和颈动脉内膜正常组(P0.05);颈动脉内膜正常组Hcy、hs-CRP水平以及IMT厚度均显著低于颈动脉轻度狭窄组、中-重度狭窄组(P0.05);hs-CRP与IMT呈正相关(r=0.71,P0.05);Hcy与IMT呈正相关(r=0.79,P0.05)。结论:血清Hcy和hs-CRP水平与颈动脉粥样硬化程度密切相关,Hcy、hs-CRP联合检测对急性脑梗死的早期诊断和预后有着重要临床意义。     

Prevalence and outcome of symptomatic carotid lesions in young adults. National Research Council Study Group.

OBJECTIVE--To estimate the prevalence and outcome of symptomatic internal carotid artery lesions in young adults. DESIGN--Multicentre hospital based observational study with five year follow up. SETTING--Seven neurological departments in northern and central Italy. SUBJECTS--240 patients (115 men) aged 15-44 with a recent transient ischaemic attack or stroke in the carotid territory. MAIN OUTCOME MEASURES--(a) Prevalence of symptomatic internal carotid artery stenosis or occlusion detected by continuous wave Doppler ultrasonography at entry; (b) incidence rates of cerebral, cardiac, and non-vascular death; non-fatal stroke; and non-fatal myocardial infarction. RESULTS--Carotid stenoses of 50-99% and occlusions were found in 38 patients (15.8%). Both conditions were significantly more frequent in patients aged over 35 and in those with hypertension, diabetes mellitus, and stroke at entry. The standardised mortality ratio at five years was 10.5 (95% confidence interval 5.0 to 19.3). Survival of patients with stenoses of 0-49% and occlusions was significantly better than that of patients with stenoses of 50-99%. Carotid stenosis of 50-99% was an independent predictor of death (hazard ratio 7.9; 95% confidence interval 2.2 to 29) and non-fatal stroke (hazard ratio 7.4; 1.5 to 37.4). CONCLUSIONS--The prevalence of carotid stenosis or occlusion in young adults after a cerebrovascular event is low. Though patients with high grade symptomatic carotid stenosis are at risk of non-fetal and fetal events, patients with internal artery occlusion apparently have a benign prognosis.     

血管内介入治疗颅内动脉瘤合并缺血性脑血管疾病的临床研究

摘要 目的：探讨血管内介入治疗颅内动脉瘤（IA）合并缺血性脑血管疾病的安全性和有效性。方法：回顾性分析了2018年1月至2020年12月使用血管内介入治疗IA合并缺血性脑血管疾病的32例临床资料。结果：32例中共发现了35枚IA,37处狭窄。IA平均大小为（5.17±3.12）mm,其中位于颈内动脉有26枚（74%）,位于椎基底动脉有9枚（26%）,7例（22%）患者术前检查发现存在两枚IA。37处狭窄中,位于椎基底动脉有9处（24%）,位于颅外段有8处（22%）,其余20处狭窄（54%）均位于颈内动脉,术前平均狭窄率为75.7%。所有病例手术过程顺利,术后IA中达到完全栓塞有31枚（89%）,4枚残留颈部（11%）。37处狭窄中,术后平均狭窄率为8.8%,所有患者术后造影脑血管远端均通畅。治疗期间1例支架内再狭窄,1例脑血管痉挛,出院时所有病例改良Rankin评分量表（mRS）均小于2分。32位患者均得到术后全脑血管造影（DSA）随访,随访时间为6到18个月（平均为8.8个月）,随访期间1例出现支架内再狭窄。结论：血管内介入治疗IA合并缺血性脑血管疾病是安全有效的,值得临床借鉴应用。     

颈动脉支架置入术后患者认知功能的变化及CT灌注成像技术的疗效评估价值研究

目的:探讨颈动脉狭窄患者在行颈动脉支架置入术后认知功能的变化情况,并分析CT灌注成像(CTP)对手术疗效的评估价值。方法:选取2015年10月到2018年3月在济宁医学院附属日照市人民医院接受治疗的颈动脉狭窄患者80例,其中有症状性颈动脉狭窄患者49例作为有症状组,无症状性颈动脉狭窄患者31例作为无症状组。所有患者均接受颈动脉支架置入手术及CTP检查,采用蒙特利尔认知评估量表(MoCA)、简易智能精神状况量表(MMSE)、搭火柴测验(Stick Test)综合评价颈动脉狭窄患者的术前、术后1周、术后3个月、术后6个月认知功能的变化情况,比较有症状组和无症状组患者的CTP相对灌注参数。结果:术后1周,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所降低(P0.05);术后3个月、术后6个月,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所升高(P0.05)。术前,有症状组的相对血流达峰时间、相对平均通过时间长于无症状组,相对脑血流量低于无症状组(P0.05);术后1周,无症状组的相对血流达峰时间较术前有所缩短,且短于有症状组(P0.05);术后1周,有症状组的相对血流达峰时间、相对平均通过时间较术前有所缩短,相对脑血流量较术前有所升高(P0.05);两组术前、术后1周相对脑血容量比较均无统计学差异(P0.05)。结论:颈动脉支架置入术后患者会出现暂时的、可逆的认知功能恶化,但最终认知功能会得到明显的改善。CTP可发现异常的脑灌注情况,同时能够较好地评价颈动脉支架置入术治疗颈动脉狭窄患者的疗效。     

Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study

To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE) at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale) score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05–2.11, p<0.001). Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery.     

阿托伐他汀联合普罗布考对动脉硬化家兔血流及斑块影响

目的:探讨阿托伐他汀钙片联合普罗布考治疗对兔颈动脉斑块稳定性的影响及血液流场改变。方法:选取清洁级日本大耳白兔40只,随机分为正常组、模型组、实验组、对照组,每组10只,复制颈动脉粥样硬化模型。对照组按照阿托伐他汀钙10 mg/(kg·d)的剂量,给兔按照不同体重予以不同药量治疗,将药物以生理盐水稀释至5 mL灌胃,实验组在对照组基础上加用普罗布考片0.25 g/(kg·d),与阿托伐他汀钙一同以生理盐水稀释至5 mL灌胃,模型组及正常组予以5 mL生理盐水灌胃。干预持续4周。用动物超声影像系统对兔进行颈动脉超声检查,彩色多普勒血流显像及血管成像检测颈动脉狭窄程度,血流速度,血流动力学改变。结果:1治疗后实验组阿托伐他汀钙片联合普罗布考治疗对兔颈动脉内-中膜厚度、斑块面积与模型组相比均明显改善,稳定斑块数明显增加,与对照组比较,实验组改善明显,差异有统计学意义(P0.05);2正常组颈动脉正常,治疗后,实验组狭窄明显减轻,血流速度接近正常,对照组有所改善,模型组颈动脉狭窄程度最重,血流速度快,血流动力学发生改变,斑块不稳定性增加,差异有统计学意义(P0.05)。结论:阿托伐他汀钙片联合普罗布考治疗能够有效提高兔颈动脉粥样硬化斑块的稳定性,改善颈动脉狭窄,使血液流速接近正常水平,值得做进一步药理研究及深入探讨。     

超声检查颈动脉粥样硬化情况和肱动脉FMD对稳定性心绞痛的价值

目的：探讨无创超声检查颈动脉粥样硬化情况和肱动脉FMD对SAP的价值。方法：将选取的65例SAP患者分为轻度狭窄组、中度狭窄组和重度狭窄组,超声检测所有病例的肱动脉FMD和颈总动脉IMT,并作Califf危险评分和As积分,分析观察指标间的关系。结果：cati行危险评分和As积分都随着冠脉狭窄程度的加深而增大,且二者呈正相关（P〈0．05）;颈总动脉IMT随着狭窄程度的加深而增大,肱动脉FMD则随着狭窄程度的加深而降低,二者呈负相关（P〈0．05）。结论：无创监测颈总动脉IMT和肱动脉FMD,可指导SAP临床风险的控制。     

高血压患者血压控制水平、血脂水平及颈动脉斑块与冠脉病变的关系

目的:探讨血压控制水平、血脂水平和颈动脉斑块与高血压患者冠脉病变程度和病变支数的关系。方法:回顾性分析2014年01月至2016年05月收住于南京中医药大学附属江苏省中西医结合医院心血管科的原发性高血压患者273例,按血压控制水平分为达标组和未达标组。按颈动脉超声结果判断有无斑块,冠状动脉造影结果使用Gensini评分和病变支数表示,并检测血脂指标。结果:血压控制达标者130人(47.61%),颈动脉有斑块者193例(70.70%)。与血压控制达标患者相比,血压控制不达标者冠脉病变支数及冠脉狭窄程度得分均明显增加(P0.05)。血压不达标合并斑块患者冠脉病变支数和狭窄程度与血压达标无斑块、血压达标合并斑块及血压不达标无斑块患者相比均明显增加(P0.001)。患者HDL-C水平与冠状动脉狭窄程度呈负相关(r=-0.139,P=0.022),AI与冠状动脉狭窄程度呈正相关(r=0.136,P=0.025),LDL/HDL-C和AI与冠脉病变支数均呈正相关,分别为(r=0.128,P=0.035)和(r=0.137,P=0.023)。结论:血压控制不佳,高血脂和颈动脉斑块形成可增加高血压患者冠脉病变的严重程度。