应用超声评估Stanford A型主动脉夹层患者继发颈部动脉夹层合并血栓对脑血供的影响。

连续性纳入2015年4月至2018年12月经空军军医大学西京医院急诊超声诊断及计算机断层扫描血管造影（CTA）确诊的Stanford A型主动脉夹层累及颈部动脉的住院患者49例，依据患者是否伴有颈部动脉血栓将其分为无血栓组26例和血栓组23例。收集患者的超声心动图、颈部血管超声及临床资料，将椎动脉及颈内动脉按血流频谱形态分为正常频谱、高阻力频谱、低速低阻频谱和窃血频谱4类。分析2组间超声心动图及颈部动脉血流频谱参数，并对2组的外科手术时间、术后神经系统症状及死亡率进行对比分析。

血栓组与无血栓组患者的超声心动图参数比较，差异均无统计学意义（P均>0.05）。血栓组颈部动脉血流频谱异常率为46.15%（12/26），高于无血栓组的86.96%（20/23），2组比较差异有统计学意义（χ²=9.561，P=0.006）。各频谱类型进行2组间比较，结果显示除高阻力频谱外，其他3种频谱类型发生率组间差异均有统计学意义（P均<0.05）。2组患者的外科手术时间、死亡率及术后神经系统症状发生率差异均有统计学意义（t=4.985，χ²=4.506、5.014，P均<0.05），2组患者新发脑梗死发生率差异无统计学意义（P>0.05）。

主动脉夹层患者继发颈部动脉夹层合并血栓时，患者的颈部动脉血供明显受影响，且死亡风险也增加，血管超声能够评估颈部动脉血流频谱的变化，为患者脑血供状况评估及预后判断提供依据。

To analyze the cerebral blood flow and related neural symptoms in type A aortic dissection (AD) patients with carotid artery thrombosis (CAT) by vascular ultrasound.

From April 2015 to December 2018, 49 consecutive AD patients with CAD diagnosed by cardiovascular ultrasound and CT angiography (CTA) at Xijing Hospital were included. According to the presence or absence of CAT, the patients were divided into two groups: no CAT group (n=26) and CAT group (n=23). The patients' echocardiography, cervical vascular ultrasound, and clinical data were collected, and the vertebral artery and internal carotid artery were divided into four types according to the blood flow spectrum: normal spectrum, high resistance spectrum, low resistance spectrum, and stolen blood spectrum. The data of emergency echocardiography and carotid Doppler spectrum parameters between the two groups were analyzed, and the general data of neurologic symptoms, operation time, and mortality were also compared.

Comparison of echocardiography parameters between the two groups showed no statistically significant difference (P>0.05). The abnormal rate of cervical artery flow spectrum in the CAT group was 46.15% (12/26), which was significantly higher than that of the non-thrombosis group (86.96%; 20/23) (χ²=9.561, P=0.006). Except for the high resistance spectrum, the incidence of the other three spectrum types differed significantly between the two groups (P<0.05). There were statistically significant differences in the duration of surgery, mortality, and incidence of postoperative neurological symptoms between the two groups (t=4.985, χ²=4.506, and χ²=5.014, P<0.05), but there was no statistically significant difference in the incidence of new cerebral infarction (P>0.05).

Blood supply of the carotid artery is obviously impaired in AD patients with CAT, and the risk of death is higher in AD patients with CAT than in those without. The changes of blood flow spectrum of the carotid artery can be evaluated by cardiovascular ultrasound, which can provide a basis for the evaluation of cerebral blood supply and prognosis.