【摘要】

摘要：目的 观察经颅多普勒超声（TCD）定量指标判断血管性痴呆继发癫痫风险的临床价值。
方法 纳入2016年6月至2018年6月于我院收治的210例血管性痴呆患者为研究对象，开展回顾性分析。按照是否继发癫痫，将其分为单纯血管性痴呆组（120例）和血管性痴呆继发癫痫组（90例），均行TCD检测，测定大脑中动脉（MCA）屏气前平均血流速度（Vm）、屏气末平均血流速（Vm′）、搏动指数（PI）、阻力指数（RI）、屏气指数（BHI）。采用多因素Logistic回归分析法分析血管性痴呆继发癫痫的独立影响因素。
结果 单纯血管性痴呆组皮层病灶所占比例显著低于血管性痴呆继发癫痫组（P＜0.05），病灶面积≤15mm所占比例显著高于血管性痴呆继发癫痫组（P＜0.05）。单纯血管性痴呆组Vm、Vm′、BHI显著高于血管性痴呆继发癫痫组（P＜0.05），PI、RI显著低于血管性痴呆继发癫痫组（P＜0.05）。多因素Logistic回归分析显示，除病灶部位、病灶面积、NIHSS评分外，Vm、PI、RI、Vm′、BHI亦是血管性痴呆继发癫痫的独立影响因素（P＜0.05）。
结论 血管性痴呆继发癫痫间期脑血流动力学有一定程度的异常改变，TCD可作为血管性痴呆继发癫痫临床诊断的客观辅助检测手段。

【Abstract】

Abstract:Objective In order to observe the clinical value of transcranial Doppler (TCD) quantitative indexes in judging the risk of secondary epilepsy in vascular dementia.
Methods 210 patients with vascular dementia admitted to our hospital from June 2016 to June 2018 were included in the study and retrospectively analyzed.According to whether the secondary epilepsy, it can be divided into pure vascular dementia group (120 cases) and vascular dementia secondary epilepsy group (90 cases), TCD detection, in the determination of middle cerebral artery (MCA) breathless before mean blood flow velocity (Vm), breathless average blood flow velocity (Vm) ', at the end of the pulse index (PI), resistance index (RI), breathless index (BHI).Multiple Logistic regression analysis was used to analyze the independent factors influencing secondary epilepsy of vascular dementia.
Results The proportion of cortical lesions in simple vascular dementia group was significantly lower than that in vascular dementia secondary epilepsy group (P<0.05), and the proportion of lesion area less than 15 mm was significantly higher than that in vascular dementia secondary epilepsy group (P<0.05).Vm, Vm', BHI in vascular dementia group were significantly higher than those in vascular dementia secondary epilepsy group (P<0.05), PI and RI were significantly lower than those in vascular dementia secondary epilepsy group (P<0.05).Multivariate Logistic regression analysis showed that Vm, PI, RI, Vm 'and BHI were also independent factors influencing secondary epilepsy of vascular dementia (P<0.05) in addition to lesion location, lesion area, and NIHSS score.
Conclusion   There are some abnormal changes in cerebral hemodynamics during the interval of secondary epilepsy in vascular dementia. TCD can be used as an objective auxiliary test for clinical diagnosis of secondary epilepsy in vascular dementia.