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中华脑科疾病与康复杂志(电子版) ›› 2022, Vol. 12 ›› Issue (05) : 302 -305. doi: 10.3877/cma.j.issn.2095-123X.2022.05.009

临床研究

彩色多普勒超声观察颈动脉交感神经网切除和迷走神经孤立术对混合型脑瘫患儿颈动脉血流动力学变化的研究
陈鸿耀1,(), 曾凡华1, 马立萍2, 江远舟1, 李理想1   
  1. 1. 510030 广州,暨南大学崇爱医院脑瘫治疗中心
    2. 510030 广州,暨南大学崇爱医院超声医学科
  • 收稿日期:2022-11-03 出版日期:2022-10-15
  • 通信作者: 陈鸿耀

Observation of carotid hemodynamics in children with mixed cerebral palse treated with carotid sympathetic nerve network resection and vagus nerve isolation by color Doppler ultrasound

Hongyao Chen1,(), Fanhua Zeng1, Liping Ma2, Yuanzhou Jiang1, Lixiang Li1   

  1. 1. Cerebral Palsy Treatment Center, Chongai Hospital of Jinan University, Guangzhou 510030, China
    2. Department of Ultrasound Medicine, Chongai Hospital of Jinan University, Guangzhou 510030, China
  • Received:2022-11-03 Published:2022-10-15
  • Corresponding author: Hongyao Chen
引用本文:

陈鸿耀, 曾凡华, 马立萍, 江远舟, 李理想. 彩色多普勒超声观察颈动脉交感神经网切除和迷走神经孤立术对混合型脑瘫患儿颈动脉血流动力学变化的研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2022, 12(05): 302-305.

Hongyao Chen, Fanhua Zeng, Liping Ma, Yuanzhou Jiang, Lixiang Li. Observation of carotid hemodynamics in children with mixed cerebral palse treated with carotid sympathetic nerve network resection and vagus nerve isolation by color Doppler ultrasound[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(05): 302-305.

目的

利用彩色多普勒超声研究颈动脉交感神经网切除及迷走神经孤立术(以下简称为改良颈动脉交感神经网切除术)对混合型脑瘫患儿颈动脉血液动力学的影响。

方法

选择自2019年6月至2021年7月于暨南大学崇爱医院脑瘫治疗中心实施改良颈动脉交感神经网切除术的30例混合型脑瘫患儿为研究对象,均于术前2 d和术后9 d做颈动脉彩超。自身对照分析术前和术后的颈动脉彩超指标,包括:颈动脉的内径、动脉收缩期最大流速(PSV)、动脉收缩末期的峰值与舒张末期的峰值的比值(S/D)、动脉舒张末期的流速(EDV)、阻力指数(RI)。

结果

30例混合型脑瘫患儿术后双侧颈动脉PSV、EDV均高于术前,双侧S/D明显小于术前,左侧RI低于术前,差异均具有统计学意义(P<0.05);右侧RI低于术前,但差异均无统计学意义(P>0.05);双侧动脉内径变化差异均无统计学意义(P>0.05)。术后1个月,本组患儿中5例流涎明显减少,26例认知能力和注意力改善,14例讲话不清改善,21例运动功能提高,3例咀嚼吞咽功能改善,总改善率为79.7%。

结论

行改良颈动脉交感神经网切除术后,混合型脑瘫患儿的颈动脉血流速度明显加快,提示脑瘫受损的脑组织在血供改善的基础上得到不同程度的修复和代偿,从而改善患儿的临床症状。

Objective

To investigate the changes of carotid hemodynamics in children with mixed cerebral palsy with carotid sympathetic nerve network resection and vagal nerve isolation (referred to as modified carotid sympathectomy) by color Doppler ultrasound.

Methods

From June 2019 to July 2021, 30 children with mixed cerebral palsy who underwent modified carotid sympathectomy at the Cerebral Palsy Treatment Center of Chongai Hospital of Jinan University were selected, carotid color ultrasound was performed 2 d before and 9 d after the operation. The preoperative and postoperative carotid artery color Doppler ultrasound indexes were compared with self-contrasted method, including: Carotid artery diameter and Peak systolic velocity (PSV), end diastolic velocity (EDV), systolic to diastolic ratio (S/D), resistance index (RI).

Results

The PSV and EDV of bilateral carotid arteries in 30 children with mixed cerebral palsy after operation were higher than those before operation, the S/D was significantly lower than that before operation, and the RI of left side was lower than that before operation, The differences were statistically significant (P<0.05). RI on the right side was lower than that before operation, but the difference was not statistically significant (P>0.05). There was no significant difference in the diameter of bilateral arteries (P>0.05). One month after operation, 5 children in this group had a significant reduction in salivation, 26 had improvement in cognitive ability and attention, 14 had improvement in unclear speech, 21 had improvement in motor function, and 3 had improvement in chewing and swallowing function. The overall improvement rate was 79.7%.

Conclusion

After the modified carotid sympathectomy, the carotid blood flow velocity of children with mixed cerebral palsy was significantly accelerated, indicating that the damaged brain tissue of cerebral palsy was repaired and compensated to varying degrees on the basis of improved blood supply, thereby improving the clinical symptoms of children.

表1 30例患儿术前、术后颈动脉观察指标的比较(Mean±SD)
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