\u9888\u52a8\u8109\u5185\u819c\u5265\u8131\u672f (carotid endarterectomy\uff0cCEA) \u5df2\u88ab\u8bc1\u5b9e\u662f\u6cbb\u7597\u9888\u52a8\u8109\u72ed\u7a84\u3001\u9884\u9632\u8111\u5352\u4e2d\u7684\u6709\u6548\u65b9\u6cd5\u3002CEA\u7ecf\u8fc7\u51e0\u5341\u5e74\u7684\u53d1\u5c55\u6280\u672f\u5df2\u7ecf\u6bd4\u8f83\u6210\u719f\uff0c\u4f46\u4ecd\u7136\u5b58\u5728\u8bb8\u591a\u6f5c\u5728\u7684\u5e76\u53d1\u75c7\uff0c\u5176\u4e2d\u6700\u4e25\u91cd\u7684\u5c31\u662f\u8111\u9ad8\u704c\u6ce8\u7efc\u5408\u5f81(cerebral hyperperfusion syndrome\uff0cCHS)\u3002\u5145\u5206\u8ba4\u8bc6CHS\u5e76\u7ed9\u4e88\u6709\u6548\u7684\u9884\u9632\u3001\u76d1\u6d4b\u548c\u53ca\u65f6\u7684\u6cbb\u7597\u53ef\u6709\u6548\u6539\u5584\u60a3\u8005\u7684\u9884\u540e\u3002\u672c\u7814\u7a76\u5c31 CEA\u672f\u540eCHS\u7684\u53d1\u75c5\u673a\u7406\u3001\u9884\u9632\u3001\u76d1\u6d4b\u53ca\u6cbb\u7597\u7b49\u7b49\u95ee\u9898\u8fdb\u884c\u8ba8\u8bba\u3002<\/p>\n
\u6d41\u884c\u75c5\u5b66\u8c03\u67e5\u663e\u793a\uff0c\u6211\u56fd\u5e74\u9f84\u8d85\u8fc765\u5c81\u7684\u4eba\u7fa4\u4e2d\u67095%\u7684\u4eba\u9888\u52a8\u8109\u72ed\u7a84\u7a0b\u5ea6\u8d85\u8fc750%\u3002\u72ed\u7a84\u540c\u4fa7\u8111\u5352\u4e2d\u7684\u53d1\u751f\u7387\u4e0e\u72ed\u7a84\u7a0b\u5ea6\u5448\u6b63\u76f8\u5173\u3002\u72ed\u7a84\u7a0b\u5ea6>70% \u7684\u75c7\u72b6\u6027\u9888\u52a8\u8109\u72ed\u7a84\u60a3\u80052 \u5e74\u8111\u5352\u4e2d\u53d1\u751f\u7387\u53ef\u9ad8\u8fbe26%[1]\u30021953\u5e74Eastcott\u7b49\u7387\u5148\u5f00\u5c55CEA[2]\uff0c\u5e76\u9010\u6b65\u6210\u4e3a\u6cbb\u7597\u9888\u52a8\u8109\u72ed\u7a84\u6700\u6709\u6548\u7684\u65b9\u6848\u4e4b\u4e00\uff0cCEA\u901a\u8fc7\u5916\u79d1\u65b9\u5f0f\u5c06\u9888\u52a8\u8109\u9885\u5916\u6bb5\u7684\u6591\u5757\u5265\u79bb\u53d6\u51fa\uff0c\u89e3\u9664\u4e86\u7ba1\u8154\u7684\u72ed\u7a84\uff0c\u540c\u65f6\u89e3\u9664\u4e86\u4e0d\u7a33\u5b9a\u6591\u5757\u8131\u843d\u7684\u98ce\u9669\uff0c\u80fd\u5c06\u8111\u5352\u4e2d5\u5e74\u53d1\u75c5\u7387\u964d\u4f4e5%\uff5e16%[3]\uff0c\u5177\u6709\u660e\u663e\u9884\u9632\u610f\u4e49\u3002CEA\u5b58\u5728\u7684\u4e3b\u8981\u5e76\u53d1\u75c7\u6709\u8111\u5352\u4e2d\u3001\u820c\u4e0b\u795e\u7ecf\u635f\u4f24\u3001\u6025\u6027\u5fc3\u808c\u6897\u6b7b\u3001CHS\u3001\u8111\u51fa\u8840\u3001\u5207\u53e3\u5185\u8840\u80bf\u3001\u672f\u540e\u518d\u72ed\u7a84\u7b49[4-5]\u3002\u795e\u7ecf\u7cfb\u7edf\u7684\u5e76\u53d1\u75c7\u5927\u591a\u4e3a\u7f3a\u8840\uff0c\u53d1\u751f\u7387\u5927\u7ea6\u4e3a5.6%(95%CI\uff1a4.4\uff5e6.9)[6]\uff0c\u800c\u6700\u4e25\u91cd\u7684\u662fCHS\u3002<\/p>\n
CHS\u662f\u6307\u9888\u52a8\u8109\u72ed\u7a84\u88ab\u53bb\u9664\u540e\u8111\u7ec4\u7ec7\u8840\u6d41\u91cf(Cerebral blood flow\uff0cCBF)\u53d1\u751f\u53d8\u5316\uff0c\u8d85\u51fa\u8111\u7ec4\u7ec7\u4ee3\u8c22\u7684\u9700\u8981\u91cf\u800c\u5f15\u8d77\u7684\u4e00\u7cfb\u5217\u4e34\u5e8a\u75c7\u72b6\u7fa4\u3002\u6587\u732e\u62a5\u9053CEA\u672f\u540eCHS\u53d1\u751f\u7387\u6ce2\u52a8\u57280.4%\uff5e14%[7]\u3002\u53d1\u75c5\u65f6\u95f4\u5dee\u5f02\u8f83\u5927\uff0c\u53ef\u4ee5\u5728\u672f\u540e\u7acb\u5373\u51fa\u73b0\u4e5f\u53ef\u5ef6\u8fdf\u52301\u4e2a\u6708\u624d\u53d1\u75c5\uff0c\u5e73\u5747\u65f6\u95f4\u4e3a5 d[8-9]\u30021975 \u5e74sundt\u7b49\u9996\u5148\u5c06 CEA \u672f\u540e\u51fa\u73b0\u7684\u4e00\u79cd\u4e25\u91cd\u5934\u75db\u5f52\u548e\u4e8e\u8111\u8840\u6d41\u8fc7\u5ea6\u704c\u6ce8[10]\u30021981\u5e74Sundt \u7b49\u9996\u6b21\u63d0\u51fa\u4e86CHS\u7684\u6982\u5ff5[8]\uff0c\u5176\u4e34\u5e8a\u4e3b\u8981\u8868\u73b0\u4e3a\u540c\u4fa7\u5934\u75db\u3001\u5c40\u90e8\u766b\u75eb\u53d1\u4f5c\u3001\u5c40\u7076\u6027\u795e\u7ecf\u529f\u80fd\u7f3a\u5931\u4e09\u8054\u5f81\uff0c\u5927\u591a\u4f34\u6709\u8840\u538b\u5347\u9ad8\uff0c\u5c11\u91cf\u60a3\u8005\u8fd8\u5b58\u5728\u8ba4\u77e5\u529f\u80fd\u51cf\u9000\u3001\u89c6\u89c9\u969c\u788d\u3001\u9885\u5185\u51fa\u8840\u7b49\u75c7\u72b6\uff0c\u751a\u81f3\u53d1\u751f\u6b7b\u4ea1[11-12]\u3002<\/p>\n
CHS\u7f3a\u4e4f\u7edf\u4e00\u7684\u8bca\u65ad\u6807\u51c6\uff0c\u800c\u76ee\u524dschaafsma\u7b49[13]\u63d0\u51fa\u7684\u8bca\u65ad\u6807\u51c6\u5728\u4e34\u5e8a\u4e0a\u5e94\u7528\u8f83\u5e7f\u6cdb\uff0c\u8bca\u65ad\u8981\u70b9\u4e3b\u8981\u6709\u4ee5\u4e0b\u56db\u70b9\uff1a(1)\u8840\u6d41\u52a8\u529b\u5b66\u68c0\u6d4b\u53d1\u73b0\u540c\u4fa7(\u6216\u5bf9\u4fa7)\u5927\u8111\u4e2d\u52a8\u8109\u8840\u6d41\u901f\u5ea6\u5f02\u5e38\u5347\u9ad8\u3002\u5927\u8111\u4e2d\u52a8\u8109\u5e73\u5747\u8840\u6d41\u901f\u5ea6\u8f83\u672f\u524d\u6c34\u5e73\u589e\u52a0\u91cf\u8d85\u8fc7100%\uff0c\u8fd9\u662fCHS\u6700\u65e9\u3001\u6700\u654f\u611f\u7684\u6307\u6807\u3002\u53ef\u5728CEA\u672f\u540e\u7acb\u5373\u53d1\u751f,\u5f80\u5f80\u5148\u4e8e\u4e34\u5e8a\u75c7\u72b6\uff1b(2)\u8840\u538b\u6025\u5267\u5347\u9ad8,\u53ef\u8fbe\u5230\u6076\u6027\u9ad8\u8840\u538b\u6c34\u5e73(\u6536\u7f29\u538b>200 mmHg,\u8212\u5f20\u538b>100 mmHg )\uff1b(3)\u5934\u75db\u3002\u5934\u75db\u5f80\u5f80\u53d1\u751f\u5728\u624b\u672f\u540c\u4fa7,\u7279\u5f02\u6027\u8f83\u4f4e\uff1b(4)\u5c40\u90e8\u766b\u75eb\u53d1\u4f5c\u3001\u5c40\u9650\u6027\u795e\u7ecf\u529f\u80fd\u7f3a\u5931\u3001\u5f71\u50cf\u5b66\u68c0\u67e5\u53d1\u73b0\u9885\u5185\u6c34\u80bf\u548c\/\u6216\u9885\u5185\u51fa\u8840\u3002\u4e34\u5e8a\u786e\u8bcaCHS\u7684\u6807\u51c6\u4e3a\u7b26\u5408(1)\u4ee5\u53ca(2)\uff5e(4)\u4e2d\u7684\u4efb\u610f\u4e00\u6761\u3002<\/p>\n
\u53e6\u5916\uff0c\u9700\u8981\u6ce8\u610f\u7684\u662f\u82e5\u53ea\u7b26\u5408\u4e0a\u8ff0\u6807\u51c6(1)\uff0c\u800c\u65e0\u4e34\u5e8a\u75c7\u72b6\u53ca\u5f71\u50cf\u5b66\u5f02\u5e38\u7684\u60a3\u8005\uff0c\u8003\u8651\u4e3a\u201c\u9ad8\u704c\u6ce8\u73b0\u8c61(HP hyperperfusion phenomenon)\u201d\u800c\u4e0d\u8bca\u65ad\u4e3aCHS[14]\u3002\u6709\u4e00\u90e8\u5206\u60a3\u8005\u8840\u538b\u6b63\u5e38\uff0c\u5927\u8111\u4e2d\u52a8\u8109\u8840\u6d41\u4ec5\u6bd4\u672f\u524d\u5347\u9ad820%\uff5e40%\uff0c\u4ecd\u51fa\u73b0CHS\u4e34\u5e8a\u75c7\u72b6\u53ca\u5f71\u50cf\u5b66\u8868\u73b0\uff0c\u6211\u4eec\u4e5f\u8981\u8003\u8651CHS\u7684\u53ef\u80fd\u3002<\/p>\n
CHS\u51fa\u73b0\u7684\u75c5\u7406\u751f\u7406\u5b66\u673a\u5236\u5341\u5206\u590d\u6742\uff0c\u76ee\u524d\u7814\u7a76\u8003\u8651\u4e3b\u8981\u4e0e\u4ee5\u4e0b\u51e0\u79cd\u673a\u5236\u6709\u5173\uff0c\u8111\u8840\u7ba1\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u53d7\u635f\u3001\u6b63\u5e38\u704c\u6ce8\u538b\u7a81\u7834\u7406\u8bba\u3001\u9ad8\u8840\u538b\u75c5\u3001\u9888\u52a8\u8109\u7aa6\u90e8\u635f\u4f24\u3001\u672f\u4e2d\u7f3a\u8840\u53ca\u518d\u704c\u6ce8\u635f\u4f24\u7b49\u3002<\/p>\n
8.1 \u5b9e\u65bd\u89c4\u8303\u7ba1\u7406\u7684\u7279\u6b8a\u8981\u6c42\u3002\u533b\u9662\u98df\u5802\u82e5\u91c7\u7528\u627f\u5305\u7ecf\u8425\u65b9\u5f0f\uff0c\u533b\u7597\u673a\u6784\u5e94\u59d4\u6258\u6301\u6709\u672c\u5e02\u300a\u98df\u54c1\u7ecf\u8425\u8bb8\u53ef\u8bc1\u300b\uff08\u542b\u9910\u996e\u670d\u52a1\u8bb8\u53ef\u8bc1\uff09\u548c\u300a\u5de5\u5546\u8425\u4e1a\u6267\u7167\u300b\uff0c\u4e14\u65e0\u98df\u54c1\u5b89\u5168\u4e0d\u826f\u4fe1\u7528\u8bb0\u5f55\u7684\u5355\u4f4d\u627f\u5305\u7ecf\u8425\u98df\u5802\u3002\u5021\u5bfc\u91c7\u53d6\u9002\u5b9c\u7684\u52a0\u70ed\u4fdd\u6e29\u63aa\u65bd\uff0c\u996d\u83dc\u6e29\u5ea6\u5b9c\u7ef4\u6301\u572860\u2103\u4ee5\u4e0a\uff1b\u98df\u54c1\u52a0\u5de5\u4e0e\u5c31\u9910\u65f6\u95f4\u95f4\u9694\u4e0d\u8d85\u8fc72\u5c0f\u65f6\u3002 <\/p>\n
3.1 \u8111\u8840\u7ba1\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u53d7\u635f[15]<\/p>\n
\u8111\u8840\u7ba1\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u662f\u6307\u8111\u8840\u7ba1\u53ef\u4ee5\u968f\u7740\u52a8\u8109\u8840\u538b\u7684\u53d8\u5316\uff0c\u81ea\u52a8\u8c03\u8282\u5fae\u52a8\u8109\u548c\u6bdb\u7ec6\u8840\u7ba1\u524d\u62ec\u7ea6\u808c\u7684\u8212\u7f29\u6765\u6539\u53d8\u8111\u7ec4\u7ec7\u8840\u6d41\u963b\u529b\uff0c\u6700\u7ec8\u7ef4\u6301CBF\u7684\u7a33\u5b9a\u3002\u8c03\u8282\u7684\u56e0\u7d20\u9664\u4e86\u52a8\u8109\u8840\u538b\uff0c\u8fd8\u6709\u5c40\u90e8\u7ec4\u7ec7\u7684\u5185\u73af\u5883\u5982CO2\u3001pH\u7b49\u90fd\u8d77\u7740\u91cd\u8981\u8c03\u8282\u4f5c\u7528\u3002\u5f53\u4e3b\u8981\u4f9b\u8840\u52a8\u8109\u4e25\u91cd\u72ed\u7a84\u65f6\u76f8\u5e94\u4f9b\u8840\u533a\u8111\u704c\u6ce8\u538b\u660e\u663e\u4e0b\u964d\uff0c\u5176\u5fae\u52a8\u8109\u548c\u6bdb\u7ec6\u8840\u7ba1\u62ec\u7ea6\u808c\u6301\u7eed\u6269\u5f20\u4ee5\u589e\u52a0CBF\uff1b\u957f\u65f6\u95f4\u7684\u8840\u7ba1\u6269\u5f20\u9020\u6210\u8840\u7ba1\u5e73\u6ed1\u808c\u6536\u7f29\u529f\u80fd\u969c\u788d\u3001\u8840\u7ba1\u91cd\u6784\uff0c\u4f7f\u8840\u7ba1\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u4e25\u91cd\u53d7\u635f\uff0c\u53d7\u635f\u7684\u7a0b\u5ea6\u4e0e\u7f3a\u8840\u6301\u7eed\u65f6\u95f4\u548c\u4e25\u91cd\u7a0b\u5ea6\u6210\u6b63\u6bd4\u3002CHS\u7684\u60a3\u8005CBF\u901a\u5e38\u5728\u672f\u540e3\uff5e4 d\u8fbe\u5230\u6700\u5927\uff0c7 d\u4e4b\u540e\u80fd\u5f62\u6210\u7a33\u5b9a\u7684\u72b6\u6001\uff0c\u800c\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u7684\u6062\u590d\u5374\u9700\u89816\u5468\u751a\u81f3\u66f4\u957f[16-17]\u3002\u5728\u8111\u8840\u7ba1\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u7f3a\u5931\u7684\u60c5\u51b5\u4e0b\u8840\u7ba1\u7ef4\u6301\u6700\u5c0f\u963b\u529b\u72b6\u6001\uff0cCBF\u53d7\u5168\u8eab\u8840\u538b\u6ce2\u52a8\u5f71\u54cd\u5de8\u5927\u3002\u9888\u52a8\u8109\u7684\u4e25\u91cd\u72ed\u7a84\u88ab\u89e3\u9664\u4e4b\u540eCBF\u6025\u5267\u589e\u52a0\uff0c\u8fdb\u800c\u5bfc\u81f4\u8111\u6c34\u80bf\u3001\u751a\u81f3\u8111\u51fa\u8840\u3002<\/p>\n
3.2 \u6b63\u5e38\u704c\u6ce8\u538b\u7a81\u7834\u7406\u8bba<\/p>\n
\u8fd1\u5e74\u6765\u56e0\u8425\u517b\u8fc7\u5ea6\u800c\u81f4\u5de8\u5927\u80ce\u513f\u9010\u6e10\u589e\u591a\u3002\u5de8\u5927\u80ce\u513f\u5c31\u662f\u80ce\u513f\u4f53\u91cd\u8fbe\u5230\u6216\u8d85\u8fc74\u5343\u514b\u3002\u5de8\u5927\u80ce\u513f\u5bf9\u51c6\u5988\u5988\u548c\u5b9d\u5b9d\u90fd\u6709\u4e0d\u5229\u5f71\u54cd\uff1a\u5de8\u5927\u80ce\u513f\u5bb9\u6613\u5f15\u8d77\u51c6\u5988\u5988\u7684\u96be\u4ea7\u3001\u4ea7\u540e\u51fa\u8840\uff0c\u589e\u52a0\u5256\u5bab\u4ea7\u7684\u6bd4\u4f8b\uff1b\u5de8\u5927\u80ce\u513f\u5bb9\u6613\u5f15\u8d77\u5b9d\u5b9d\u9aa8\u6298\u3001\u9885\u5185\u51fa\u8840\u3001\u8840\u7cd6\u5f02\u5e38\uff0c\u5373\u4f7f\u5256\u5bab\u4ea7\u5b9d\u5b9d\u7684\u4ea7\u4f24\u98ce\u9669\u4e5f\u660e\u663e\u589e\u52a0\u3002\u51c6\u5988\u5988\u4eec\u8bb0\u4f4f\u54e6\uff0c\u5b9d\u5b9d\u4e0d\u662f\u8d8a\u5927\u8d8a\u597d\uff0c\u800c\u662f\u4e0d\u5927\u4e0d\u5c0f\uff082.5\uff5e4\u53430\u514b\uff09\u6700\u597d\uff01 <\/p>\n
Spetzler\u7b49\u57fa\u4e8e\u8111\u8840\u7ba1\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u53d7\u635f\u63d0\u51fa\u4e86\u6b63\u5e38\u704c\u6ce8\u538b\u7a81\u7834\u7406\u8bba[18]\uff0c\u9888\u52a8\u8109\u91cd\u5ea6\u72ed\u7a84\u5f15\u8d77\u6301\u4e45\u6027\u8111\u7ec4\u7ec7\u4f4e\u704c\u6ce8\uff0c\u5bfc\u81f4\u5c40\u90e8\u7f3a\u8840\uff0c\u4f7fCO2\u3001NO\u7b49\u8840\u7ba1\u8212\u5f20\u7269\u8d28\u957f\u671f\u84c4\u79ef\u800c\u5bfc\u81f4\u5185\u76ae\u529f\u80fd\u969c\u788d\u3001\u8840\u7ba1\u7ed3\u6784\u7834\u574f\u3001\u6bdb\u7ec6\u8840\u7ba1\u8106\u6027\u589e\u52a0\u3001\u8840\u8111\u5c4f\u969c\u76f8\u5bf9\u8106\u5f31\uff0c\u5e76\u4e14\u635f\u4f24\u7684\u7a0b\u5ea6\u4e0e\u540c\u4fa7\u4f9b\u8840\u52a8\u8109\u72ed\u7a84\u7a0b\u5ea6\u53ca\u4fa7\u652f\u5faa\u73af\u5931\u4ee3\u507f\u7684\u7a0b\u5ea6\u5448\u6b63\u6bd4\uff0c\u8106\u5f31\u7684\u8840\u8111\u5c4f\u969c\u5728\u518d\u704c\u6ce8\u671f\u95f4\u66f4\u5bb9\u6613\u88ab\u7a81\u7834\uff0c\u8fd9\u53ef\u4ee5\u89e3\u91ca\u4e3a\u4ec0\u4e48\u6709\u4e9b\u60a3\u8005\u6ca1\u6709\u4e25\u91cd\u9ad8\u8840\u538b\u75c5\u6216HP\u5374\u53d1\u751f\u8840\u7ba1\u6e90\u6027\u8111\u6c34\u80bf\u3002<\/p>\n
3.3 \u9ad8\u8840\u538b\u75c5<\/p>\n
\u9ad8\u8840\u538b\u75c5\u5728CHS\u7684\u8d77\u75c5\u548c\u8fdb\u5c55\u4e2d\u90fd\u8d77\u7740\u91cd\u8981\u7684\u4f5c\u7528\u3002\u867d\u7136\u6ca1\u6709\u8bc1\u636e\u8868\u660e\u9ad8\u8840\u538b\u75c5\u4f1a\u8bf1\u53d1\u51fa\u8840\uff0c\u4f46\u51e0\u4e4e\u6240\u6709CHS\u60a3\u8005\u672f\u540e\u90fd\u51fa\u73b0\u9ad8\u8840\u538b\u75c5[19-20]\uff0c74%\u7684\u60a3\u8005\u5728CEA\u540e24 h\u5185\u51fa\u73b0\u8840\u538b\u4e0d\u7a33[21]\uff0c19%\uff5e35%\u60a3\u8005\u7684CEA\u672f\u540e\u51fa\u73b0\u6076\u6027\u9ad8\u8840\u538b(\u6536\u7f29\u538b>200 mmHg\u6216\u8212\u5f20\u538b>100 mmHg)[22-23]\u3002\u7531\u4e8e\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u53d7\u635f\uff0cCEA\u672f\u540eCBF\u6025\u5267\u589e\u52a0\uff0c\u9ad8\u8840\u538b\u53c8\u4f7f\u4e4b\u8fdb\u4e00\u6b65\u6076\u5316\uff0c\u6700\u7ec8\u5bfc\u81f4CHS\u7684\u53d1\u751f\u3002\u672f\u524d\u9ad8\u8840\u538b\u662f\u672f\u540e\u9ad8\u8840\u538b\u6700\u91cd\u8981\u7684\u5371\u9669\u56e0\u7d20[14]\u3002\u5bf9\u4e8e\u672f\u524d\u9ad8\u8840\u538b\u7684\u60a3\u8005\u6211\u4eec\u8981\u9ad8\u5ea6\u8b66\u60d5\u672f\u540e\u51fa\u73b0CHS\u3002<\/p>\n
\u5206\u522b\u8bb0\u4e0d\u8003\u8651\u81ea\u91cd\u3001\u8003\u8651\u81ea\u91cd\u4f46\u4e0d\u8003\u8651\u5206\u9636\u6bb5\u53d7\u529b\u3001\u540c\u65f6\u8003\u8651\u81ea\u91cd\u4e0e\u7ed3\u6784\u5206\u9636\u6bb5\u53d7\u529b\u7b493\u79cd\u8ba1\u7b97\u72b6\u51b5\u4e3aA\u3001B\u3001C\uff0c\u540c\u65f6\uff0c\u5bf9\u4e8eFEA\u4eff\u771f\u6a21\u62df\uff0c\u52a0\u56fa\u5c42\u6240\u6709\u8282\u70b9\u8fb9\u754c\u6761\u4ef6\u5206\u4e3a\u4e0e\u539f\u7ed3\u6784\u5c42\u76f8\u540c\u7684\u56fa\u5b9a\u7ea6\u675f\u4e0e\u52a0\u56fa\u5c42\u6240\u6709\u8282\u70b9\u4e0d\u7ea6\u675f\u4e24\u79cd\u5904\u7406\u65b9\u5f0f\uff0c\u5206\u522b\u8bb0\u4e3a*\u3001#\uff0c\u5bf9\u5e94\u529b\u8bfb\u53d6\u70b9\u4f5c\u4ee5\u4e0b\u6807\u8bb0\uff1a\u539f\u7ed3\u6784\u5c42\u8de8\u4e2d\u4e0a(\u4e0b)\u8fb9\u7f181(2)\u3001\u52a0\u56fa\u5c42\u8de8\u4e2d\u4e0a(\u4e0b)\u8fb9\u7f183(4)\u3001\u539f\u7ed3\u6784\u5c42\u652f\u5ea7\u4e0a(\u4e0b)\u8fb9\u7f185(6)\u3001\u52a0\u56fa\u5c42\u652f\u5ea7\u4e0a(\u4e0b)\u8fb9\u7f187(8)\uff0c\u6309\u7ea6\u5b9a\u6807\u8bb0\u65b9\u5f0f\u6574\u7406\u6570\u636e\u3002\u03c3X\u3001\u03c33\u4e0e\u6807\u8bb0\u70b9\u5173\u7cfb\u56fe\u5206\u522b\u5982\u56fe1\u3001\u56fe2\u6240\u793a\u3002 <\/p>\n
3.4 \u9888\u52a8\u8109\u7aa6\u635f\u4f24<\/p>\n
CEA\u672f\u4e2d\u53ef\u80fd\u4f1a\u635f\u4f24\u9888\u52a8\u8109\u7aa6\u90e8\uff0c\u7531\u4e8e\u53d7\u4f53\u53bb\u795e\u7ecf\u5316,\u5bfc\u81f4\u538b\u529b\u611f\u53d7\u5668\u529f\u80fd\u53d7\u635f\uff0c\u4ece\u800c\u5f71\u54cd\u8840\u538b\u8c03\u63a7\u529f\u80fd[24]\u3002\u5f53\u56e0\u9888\u52a8\u8109\u7aa6\u53d7\u635f\u5bfc\u81f4\u8840\u538b\u964d\u4f4e\u800c\u5e94\u7528\u5347\u538b\u836f\u7ef4\u6301\u8840\u538b\u65f6\uff0c\u7531\u4e8e\u4e2a\u4f53\u654f\u611f\u6027\u5dee\u5f02\uff0c\u8840\u538b\u76d1\u6d4b\u4e0d\u4e25\u5bc6\u7684\u60c5\u51b5\u4e0b\u60a3\u8005\u8840\u538b\u968f\u65f6\u53ef\u80fd\u53cd\u5f39\u6027\u6076\u6027\u5347\u9ad8\uff0c\u4e0d\u80fd\u53ca\u65f6\u63a7\u5236\u800c\u5bfc\u81f4CHS\u3002\u7279\u522b\u662f\u8fde\u7eed\u884c\u53cc\u4fa7\u9888\u52a8\u8109\u5185\u819c\u5207\u9664\u672f\u53ef\u51fa\u73b0\u538b\u529b\u53cd\u5c04\u8870\u7aed\u7efc\u5408\u5f81[25]\uff0c\u5bfc\u81f4\u672f\u540e\u6e10\u8fdb\u6027\u96be\u6cbb\u6027\u7684\u9ad8\u8840\u538b\u3002\u9888\u52a8\u8109\u72ed\u7a84\u89e3\u9664\u540eCBF\u7684\u6025\u5267\u589e\u52a0\u4f1a\u5f15\u8d77\u8111\u6c34\u80bf\u3001\u9885\u5185\u538b\u589e\u9ad8\uff0c\u8fd9\u53c8\u523a\u6fc0\u4e2d\u67a2\u548c\u5468\u56f4\u795e\u7ecf\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u7684\u91ca\u653e\uff0c\u4f7f\u6536\u7f29\u538b\u8fdb\u4e00\u6b65\u5347\u9ad8\uff0c\u5f62\u6210\u6076\u6027\u5faa\u73af\uff0c\u6700\u7ec8\u5f15\u8d77 CHS\u3002<\/p>\n
Ascher\u7b49[26]\u53d1\u73b076\u4f8b\u8fde\u7eed\u884c\u53cc\u4fa7CEA\u7684\u60a3\u8005\uff0cCHS\u53d1\u751f\u7387\u4e3a6.6%\uff0c\u800c379\u4f8b\u884c\u5355\u4fa7CEA\u7684\u60a3\u8005CHS\u53d1\u751f\u7387\u4e3a1.1%\u3002\u8fd9\u8868\u660e\u5bf9\u4fa7\u9888\u52a8\u8109\u57283\u4e2a\u6708\u5185\u8fdb\u884cCEA\u662f\u53d1\u751f\u672f\u540eCHS\u7684\u91cd\u8981\u5371\u9669\u56e0\u7d20\u3002<\/p>\n
3.5 \u672f\u4e2d\u7f3a\u8840\u53ca\u518d\u704c\u6ce8\u635f\u4f24<\/p>\n
\u672f\u4e2d\u7f3a\u8840\u4ee5\u53ca\u672f\u540e\u518d\u704c\u6ce8\u8fc7\u7a0b\u4e2d\u4f34\u968f\u7740\u6c27\u5316\u5242\u751f\u6210\u3001\u8865\u4f53\u6fc0\u6d3b\u548c\u5fae\u8840\u7ba1\u901a\u900f\u6027\u589e\u52a0\u4e5f\u53ef\u4ee5\u5bfc\u81f4\u8840\u8111\u5c4f\u969c\u53d7\u635f\uff0c\u52a0\u5267\u4e86\u672f\u540e\u8111\u7ec4\u7ec7\u635f\u4f24\u3002 \u6709\u7814\u7a76\u8868\u660e\uff0c\u56f4\u624b\u672f\u671f\u8111\u7f3a\u8840\u7684\u6307\u6807\u5982\u9885\u5185\u8840\u6c27\u9971\u548c\u5ea6\u964d\u4f4e\u3001S-100B\u86cb\u767d\u5347\u9ad8\u3001\u4e2d\u5fc3\u4f53\u611f\u8bf1\u53d1\u7535\u4f4d\u7f3a\u4e4f\u662f\u672f\u540eCHS\u548c\u795e\u7ecf\u529f\u80fd\u969c\u788d\u7684\u72ec\u7acb\u5371\u9669\u56e0\u7d20[27-28]\u3002CEA\u540e\u518d\u704c\u6ce8\u4ea7\u751f\u7684\u6c27\u81ea\u7531\u57fa\u53ef\u80fd\u4ecb\u5bfc\u4e86\u8fd9\u79cd\u6548\u5e94\uff0c\u5e94\u7528\u81ea\u7531\u57fa\u6e05\u9664\u5242\u53ef\u80fd\u6709\u52a9\u4e8e\u9884\u9632\u518d\u704c\u6ce8\u635f\u4f24\u7684\u53d1\u751f\u3002<\/p>\n
4.1 \u53d1\u75c5\u9ad8\u5371\u56e0\u7d20<\/p>\n
\u76ee\u524d\u4e3a\u6b62\u5df2\u62a5\u9053\u7684\u53d1\u75c5\u9ad8\u5371\u56e0\u7d20\u6c47\u603b\u5982\u4e0b\uff1a\u9ad8\u8840\u538b\u75c5\u3001\u91cd\u5ea6\u72ed\u7a84\u4f34\u4fa7\u652f\u5faa\u73af\u5dee\u3001\u8111\u5faa\u73af\u963b\u529b\u4e0b\u964d\u3001\u5cf0\u503c\u6d41\u901f\u589e\u52a0\u3001\u5bf9\u4fa7\u9888\u52a8\u8109\u95ed\u585e\u30013\u4e2a\u6708\u5185\u5bf9\u4fa7\u884cCEA\u3001\u672f\u4e2d\u9888\u52a8\u8109\u8fdc\u7aef\u8840\u538b<40 mmHg\u3001\u672f\u4e2d\u8111\u7f3a\u8840[14\uff0c19]\u3002\u5176\u4ed6\u53ef\u80fd\u7684\u5371\u9669\u56e0\u7d20\u6709\u5e74\u9f84>72\u5c81\u3001\u8111\u5352\u4e2d\u53f2\u3001Willis \u73af\u4e0d\u5b8c\u6574\u3001\u8840\u7ba1\u53cd\u5e94\u6027\u548c\u50a8\u5907\u4e0b\u964d\u3001\u5927\u5242\u91cf\u5e94\u7528\u542b\u6325\u53d1\u6027\u5364\u5316\u6c22\u7c7b\u7684\u9ebb\u9189\u836f\u3001\u6297\u51dd\u836f\u3001\u6297\u8840\u5c0f\u677f\u805a\u96c6\u836f\u7b49\u7b49\u3002\u4e34\u5e8a\u4e0a\u9047\u5230\u4e0a\u8ff0\u60c5\u51b5\u9700\u9ad8\u5ea6\u8b66\u60d5CHS\u7684\u53d1\u751f\u3002<\/p>\n
4.2 \u7ecf\u9885\u591a\u666e\u52d2(TCD)<\/p>\n
TCD\u53ef\u4ee5\u6d4b\u91cf\u5927\u8111\u4e2d\u52a8\u8109(MCA)\u7684\u8111\u8840\u6d41\u901f\u5ea6\uff0c\u5e76\u80fd\u5bf9\u672f\u524d\u4f4e\u704c\u6ce8\u3001\u8111\u8840\u7ba1\u53cd\u5e94\u6027\u3001\u672f\u540e\u9ad8\u704c\u6ce8\u3001\u8111\u8840\u7ba1\u6813\u585e\u7b49\u63d0\u4f9b\u6709\u6548\u7684\u68c0\u6d4b\uff0c\u5728\u4e24\u9879\u7814\u7a76\u4e2d\uff0c\u672f\u4e2d\u9888\u52a8\u8109\u8fdc\u7aef\u4f4e\u8840\u538b(<40\u6beb\u7c73\u6c5e\u67f1)\u3001TCD\u68c0\u6d4b\u53d1\u73b0\u9888\u52a8\u8109\u5f00\u653e\u4e4b\u540e\u5cf0\u503c\u8840\u6d41\u901f\u5ea6\u589e\u52a0\u3001\u640f\u52a8\u6307\u6570>100%\u90fd\u53ef\u4ee5\u6709\u6548\u5730\u9884\u6d4b\u672f\u540eHP\uff0cHP\u60a3\u8005\u9885\u5185\u51fa\u8840\u7684\u98ce\u9669\u6bd4\u6b63\u5e38\u60a3\u8005\u9ad810\u500d\uff0c\u5bf9\u4e8e\u4e34\u5e8a\u4e0a\u6709\u6761\u4ef6\u7684\u533b\u9662\u6211\u4eec\u5efa\u8bae\u5bf9\u884cCEA\u7684\u60a3\u8005\u5728\u56f4\u624b\u672f\u671f\u5e38\u89c4\u884cTCD\u76d1\u6d4b[30-31]\u3002\u53d1\u73b0\u9ad8\u5371\u60a3\u8005\u5e94\u8fdb\u884c\u66f4\u52a0\u4e25\u5bc6\u7684\u76d1\u62a4\uff0c\u53ca\u65f6\u884c\u5fc5\u8981\u7684\u5904\u7406\uff0c\u4f7f\u5176\u9884\u540e\u5f97\u5230\u6539\u5584\u3002<\/p>\n
\u65b9\u6848\u4e8c\uff1a\u5728\u539f\u75c5\u5bb3\u6258\u67b6\u65c1\u589e\u8bbe\u4e00\u4e2a\u65b0\u6258\u67b6\uff0c\u6276\u6b63\u539f\u75c5\u5bb3\u6258\u67b6\u5e76\u4e0e\u65b0\u6258\u67b6\u710a\u63a5\u4e3a\u4e00\u4f53\uff0c\u4f7f\u4eba\u884c\u9053\u8377\u8f7d\u7531\u65b0\u65e7\u6258\u67b6\u5171\u540c\u627f\u62c5\u3002 <\/p>\n
4.3 \u8111\u8840\u7ba1\u53cd\u5e94\u6027(CVR)<\/p>\n
\u4ece\u56fe1\u53ef\u4ee5\u770b\u51fa\uff0c\u6307\u793a\u8bcd\u51fa\u73b0\u7684\u6bd4\u8f83\u5c11\uff0c\u8fd9\u8868\u660e\u5e7f\u897f\u7684\u91d1\u878d\u7ffb\u8bd1\u6bd4\u8f83\u6ce8\u91cd\u4e66\u9762\u8868\u8fbe\uff0c\u4f46\u540c\u65f6\u4e5f\u53ef\u770b\u51fa\uff0c\u9999\u6e2f\u7684\u91d1\u878d\u7ffb\u8bd1\u51fa\u73b0\u8f83\u591a\u6307\u793a\u8bcd\uff0c\u7ffb\u8bd1\u8f83\u751f\u6d3b\u5316\u3002\u65e0\u8bba\u662f\u5e7f\u897f\u8fd8\u662f\u9999\u6e2f\u7684\u91d1\u878d\u7ffb\u8bd1\uff0c\u4ecd\u6709\u4e00\u90e8\u5206\u65e7\u8bcd\u6c47\u8fc7\u4e8e\u6ce8\u91cd\u8868\u8fbe\u5b57\u9762\u610f\u4e49\uff0c\u610f\u601d\u542b\u7cca\uff0c\u5e7f\u897f\u66f4\u660e\u663e\u3002\u5728\u8868\u8fbe\u610f\u4e49\u7684\u5bf9\u7b49\u65b9\u9762\uff0c\u5e7f\u897f\u7ffb\u8bd1\u4e0e\u9999\u6e2f\u7ffb\u8bd1\u90fd\u80fd\u5f88\u4f18\u8d8a\u5730\u7ffb\u8bd1\u51fa\u672c\u6765\u7684\u539f\u610f\uff0c\u9999\u6e2f\u7ffb\u8bd1\u7a0d\u4f18\u4e8e\u5185\u9646\u7ffb\u8bd1\u3002 <\/p>\n
\u8111\u8840\u7ba1\u5bf9CO2\u6216\u4e59\u9170\u5511\u80fa\u7684\u53cd\u5e94\u6027\u53ef\u4ee5\u7528\u6765\u8bc4\u4f30\u8111\u8840\u6d41\u52a8\u529b\u5b66\u50a8\u5907\u529f\u80fd\u3002\u6b63\u5e38\u4eba\u670d\u7528\u4e59\u9170\u5511\u80fa(\u78b3\u9178\u9150\u9176\u6291\u5236\u5242\u53ef\u4f7f\u5c40\u90e8CO2\u6c34\u5e73\u5347\u9ad8)\u4f1a\u5bfc\u81f4CBF\u8fc5\u901f\u589e\u52a020%\uff5e80%[32-33]\u3002\u901a\u5e38\u91c7\u7528\u5355\u5149\u5b50\u53d1\u5c04\u8ba1\u7b97\u673a\u65ad\u5c42\u626b\u63cf(SPECT)\u3001\u78c1\u5171\u632f\u6216TCD\u6765\u68c0\u6d4b\u3002\u6162\u6027\u8111\u7f3a\u8840\u60a3\u8005\u8111\u8840\u7ba1\u5df2\u7ecf\u6700\u5927\u9650\u5ea6\u5730\u6269\u5f20\uff0c\u5e94\u7528\u4e59\u9170\u5511\u80fa\u540eCBF\u4e0d\u4f1a\u660e\u663e\u589e\u52a0\u3001\u8111\u8840\u7ba1\u963b\u529b\u4e5f\u4e0d\u4f1a\u660e\u663e\u4e0b\u964d\u3002\u672f\u524dCVR\u8d8a\u4f4e\u7684\u60a3\u8005\u672f\u540eCHS\u7684\u98ce\u9669\u5c31\u8d8a\u9ad8[9]\u3002<\/p>\n
4.4 MRI\/CT<\/p>\n
\u4e34\u5e8a\u4e0a\u6709\u65f6\u4e5f\u91c7\u7528MRI\/CT\u6765\u8bc4\u4ef7\u51fa\u73b0CHS\u7684\u98ce\u9669[35-36]\uff0c\u5982\u679c\u672f\u524d\u5b58\u5728\u8840\u7ba1\u7578\u5f62\u7b49\u75c5\u53d8\u5219\u672f\u540e\u53d1\u751fCHS\u7684\u6982\u7387\u4f1a\u660e\u663e\u589e\u52a0\u3002\u672f\u540e\u53d1\u751fCHS\u65f6MRI \/CT\u53ef\u89c1\u8111\u6c34\u80bf\u3001\u5c40\u7076\u6027\u8111\u6897\u6b7b\u6216\u9885\u5185\u51fa\u8840\u7b49\u3002\u4e0d\u8fc7\u8fd9\u4e9b\u5f02\u5e38\u4e0eCHS\u75c7\u72b6\u5e76\u4e0d\u7edd\u5bf9\u76f8\u5173\uff0c\u6709\u4e9bCHS\u60a3\u8005MRI\/CT\u68c0\u67e5\u53d1\u73b0\u5e76\u6ca1\u6709\u660e\u663e\u5f02\u5e38\u3002\u603b\u4f53\u6765\u8bf4\uff0cMRI\/CT\u5bf9CHS\u9884\u6d4b\u53ca\u8bca\u65ad\u7684\u4ef7\u503c\u4e0d\u5927\uff0c\u4f46\u53ef\u7528\u4e8eCHS\u8111\u7ec4\u7ec7\u635f\u4f24\u7684\u68c0\u67e5\u3002<\/p>\n
5.1 \u63a7\u5236\u8840\u538b<\/p>\n
\u9884\u9632\u8be5\u75c5\u7684\u6700\u91cd\u8981\u63aa\u65bd\u662f\u65e9\u671f\u8bc6\u522b\u9ad8\u704c\u6ce8\u72b6\u6001\u5e76\u4e25\u683c\u63a7\u5236\u8840\u538b[38]\u3002\u5373\u4f7f\u8840\u538b\u59cb\u7ec8\u4e0d\u9ad8\u6216\u5df2\u63a7\u5236\u5728\u6b63\u5e38\u8303\u56f4\u5185\uff0c\u4e5f\u5e94\u8003\u8651\u5ef6\u8fdf\u9ad8\u704c\u6ce8\u7684\u53ef\u80fd\uff0c\u9632\u6b62\u5176\u53d1\u5c55\u4e3aCHS[39]\u3002 \u9009\u62e9\u964d\u538b\u836f\u7269\u6700\u597d\u91c7\u7528\u4e0d\u589e\u52a0CBF\u7684\u836f\u7269\uff0c\u03b1\u53d7\u4f53\u62ee\u6297\u5242\u5982\u53ef\u4e50\u5b9a\u53ef\u4ee5\u51cf\u5c11\u4e2d\u67a2\u4ea4\u611f\u51b2\u52a8\u4f20\u51fa\uff0c\u964d\u4f4e\u5468\u56f4\u8840\u7ba1\u963b\u529b\uff0c\u51cf\u5c11\u513f\u8336\u915a\u80fa\u91ca\u653e\uff0c\u964d\u4f4e\u8840\u538b\u3001\u5fc3\u7387\u548c\u5fc3\u8f93\u51fa\u91cf\uff0c\u540c\u65f6\u5bf9\u4e8e\u8111\u704c\u6ce8\u538b\u5f71\u54cd\u4e0d\u5927\u3002\u03b2\u53d7\u4f53\u963b\u6ede\u5242\u5728\u964d\u8840\u538b\u540c\u65f6\u5bf9\u9885\u5185\u538b\u65e0\u660e\u663e\u5f71\u54cd\uff0c\u4e34\u5e8a\u5e38\u7528\u7684\u62c9\u8d1d\u6d1b\u5c14\u540c\u65f6\u5177\u6709\u03b2\u53d7\u4f53\u963b\u6ede\u5242\u548c\u03b1\u53d7\u4f53\u963b\u6ede\u5242\u7684\u4f5c\u7528\uff0c\u5b83\u53ef\u4ee5\u964d\u4f4e\u8111\u704c\u6ce8\u538b\uff0c\u4e0d\u5f71\u54cd\u8111\u8840\u6d41\uff0c\u5e76\u4e14\u53ef\u4ee5\u628a\u5e73\u5747\u52a8\u8109\u538b\u964d\u4f4e30%,\u8fd9\u4e9b\u4e3a\u6cbb\u7597CHS\u7684\u7406\u60f3\u836f\u7269\uff1b\u4e0d\u80fd\u91c7\u7528\u8840\u7ba1\u7d27\u5f20\u7d20\u8f6c\u6362\u9176\u6291\u5236\u5242[40]\u3001\u9499\u901a\u9053\u963b\u6ede\u5242\u6216\u8840\u7ba1\u6269\u5f20\u5242\u5982\u785d\u666e\u94a0\u548c\u785d\u9178\u7518\u6cb9\u7b49\u589e\u52a0CBF\u7684\u836f\u7269[41]\u3002\u9664\u8fd9\u4e00\u7ed3\u8bba\u5916\uff0c\u6ca1\u6709\u660e\u786e\u7684\u8bc1\u636e\u652f\u6301\u4f7f\u7528\u5176\u4ed6\u836f\u7269\uff0c\u800c\u4e14\u5bf9\u4e8e\u63a7\u5236\u8840\u538b\u7684\u76ee\u6807\u6c34\u5e73\uff0c\u76ee\u524d\u4e5f\u6ca1\u6709\u660e\u786e\u7ed3\u8bba\u3002<\/p>\n
\u4e0d\u8fc7\uff0c\u5728\u4e24\u5bb6\u9632\u9707\u5668\u7ade\u4e89\u6fc0\u70c8\u7684\u540c\u65f6\uff0c\u4e0a\u4e16\u7eaa70\u5e74\u4ee3\u671f\u95f4\u77f3\u82f1\u9769\u547d\u6084\u7136\u53d1\u751f\uff0c\u5bf9\u673a\u68b0\u949f\u8868\u4e1a\u9020\u6210\u4e86\u4e25\u91cd\u5371\u673a\uff0c\u4e5f\u5371\u53ca\u4e86\u4e0a\u6e38\u7684\u96f6\u914d\u4ef6\u4ea7\u4e1a\u3002\u62e5\u6709\u4e0a\u5343\u5458\u5de5\u7684Portescap\u516c\u53f8\u7684Incabloc\u9632\u9707\u5668\u8ba2\u5355\u91cf\u9aa4\u51cf\uff0c\u65e0\u529b\u7ef4\u6301\u6574\u4e2a\u516c\u53f8\u8fd0\u8f6c\uff0c\u540e\u671f\u88ab\u8feb\u5265\u79bb\u4e86Incabloc\u9632\u9707\u5668\u751f\u4ea7\u90e8\u5206\uff0c\u8f6c\u6295\u5411\u4e86\u66f4\u5177\u6709\u201c\u524d\u666f\u201d\u7684\u77f3\u82f1\u624b\u8868\u5fae\u578b\u7535\u673a\u30021988\u5e74\uff0cEric Zutter \u6ce8\u518c\u4e86\u4e00\u5bb6\u65b0\u7684\u516c\u53f8\uff0c\u540d\u4e3a\u201cIncabloc SA\u201d\u3002\u4ed6\u7ee7\u7eed\u751f\u4ea7\u7740Incabloc\u9632\u9707\u5668\uff0c\u4fdd\u7559\u4e86\u4e4b\u524d\u751f\u4ea7\u7ebf\u548c\u4e00\u4e9b\u5458\u5de5\uff0c\u4ece\u800c\u4fdd\u6301\u4e86\u516c\u53f8\u7684\u6280\u672f\u57fa\u7840\u3002 <\/p>\n
5.2 \u624b\u672f\u65f6\u673a\u7684\u9009\u62e9<\/p>\n
\u5728\u6700\u5c0f\u5747\u65b9\u8bef\u5dee\u539f\u5219\u4e0b\uff0c\u5229\u7528\u7ed9\u5b9a\u7684\u8bd5\u9a8c\u6570\u636e\uff0c\u672a\u8bd5\u9a8c\u70b9x\u5904\u4eff\u771f\u54cd\u5e94\u7684Kriging\u9884\u6d4b\u5747\u503c\u548c\u9884\u6d4b\u65b9\u5dee\u53ef\u7531\u4e0b\u5f0f\u7ed9\u51fa\uff1a <\/p>\n
\u8111\u5352\u4e2d\u4e4b\u540e\u884cCEA\u7684\u65f6\u673a\u5c1a\u6709\u4e89\u8bae\u3002\u6709\u7684\u7814\u7a76\u53d1\u73b0\uff0cCT\u626b\u63cf\u7684\u8bc1\u636e\u8bc1\u660e\u8111\u5352\u4e2d\u540e\u77ed\u671f\u5185\u884cCEA\u4f7fCHS\u53d1\u751f\u7684\u98ce\u9669\u589e\u52a0\uff0c\u5efa\u8bae\u624b\u672f\u63a8\u8fdf\u52303\u4e2a\u6708\u4e4b\u540e\u8fdb\u884c\uff0c\u4f46\u8fd9\u4e9b\u7814\u7a76\u591a\u662f\u56de\u987e\u6027\u7684\uff0c\u4e14\u6837\u672c\u6570\u91cf\u5341\u5206\u6709\u9650\uff0c\u53ef\u4fe1\u5ea6\u8f83\u4f4e[42 ]\u3002\u6709\u5927\u578b\u52a8\u8109\u5185\u819c\u5265\u8131\u672f\u8bd5\u9a8c\u7814\u7a76\u6570\u636e\u8868\u660e\uff0cCEA\u5728\u8111\u5352\u4e2d\u540e2\u5468\u5185\u8fdb\u884c\u60a3\u8005\u80fd\u83b7\u5f97\u6700\u5927\u6536\u76ca\uff0c\u76ee\u524d\u7684\u6307\u5357\u63a8\u8350\u5728\u7f3a\u8840\u6027\u8111\u5352\u4e2d\u53d1\u751f2\u5468\u5185\u5b8c\u6210CEA[43]\u3002\u53e6\u5916\uff0c\u5bf9\u4fa7\u9888\u52a8\u8109\u57283\u4e2a\u6708\u5185\u884cCEA\u662f\u53d1\u751fCHS\u7684\u4e00\u4e2a\u5371\u9669\u56e0\u7d20[44]\uff0c\u8fd9\u5728\u505a\u624b\u672f\u51b3\u7b56\u65f6\u4e5f\u5e94\u8be5\u8003\u8651\u5230\u3002<\/p>\n
We thank the Zebrafish Model Animal Facility, Institute of Clinical and Translational Research, Sun Yat-Sen University for providing AB strain zebrafish eggs. <\/p>\n
5.3 \u81ea\u7531\u57fa\u6e05\u9664\u5242<\/p>\n
\u7f3a\u8840\u518d\u704c\u6ce8\u8fc7\u7a0b\u4e2d\u4f1a\u4ea7\u751f\u6c27\u81ea\u7531\u57fa\u3002\u81ea\u7531\u57fa\u4f1a\u5f15\u8d77\u5185\u76ae\u529f\u80fd\u969c\u788d\u3001\u8840\u8111\u5c4f\u969c\u7834\u574f\uff0c\u5bfc\u81f4\u8fc7\u5ea6\u704c\u6ce8\u3001\u6c34\u80bf\u548c\u51fa\u8840\u3002\u4e00\u9879\u7814\u7a76\u8868\u660e\uff0c\u4f9d\u8fbe\u62c9\u5949(\u81ea\u7531\u57fa\u6e05\u9664\u5242)\u53ef\u4ee5\u6291\u5236\u8102\u8d28\u8fc7\u6c27\u5316\uff0c\u51cf\u5c11\u8840\u7ba1\u5185\u76ae\u635f\u4f24\uff0c\u964d\u4f4e\u8111\u8840\u7ba1\u963b\u529b\uff0c\u6700\u7ec8\u964d\u4f4eCEA\u672f\u540e\u9ad8\u704c\u6ce8\u7684\u53d1\u751f[45]\uff0c\u7ed3\u8bba\u7684\u53ef\u9760\u6027\u6709\u5f85\u8fdb\u4e00\u6b65\u9a8c\u8bc1\uff0c\u4f46\u76ee\u524d\u4e0d\u5931\u4e3a\u4e00\u79cd\u6cbb\u7597\u624b\u6bb5\u3002<\/p>\n
5.4 \u5176\u4ed6\u6cbb\u7597<\/p>\n
\u7ef4\u4fdd\u670d\u52a1\u63d0\u4f9b\u65b9\u5728\u63d0\u4f9b\u7ef4\u4fdd\u670d\u52a1\u8fc7\u7a0b\u4e2d\u6240\u83b7\u53d6\u7684\u533b\u9662\u6216\u75c5\u60a3\u4fe1\u606f\u7684\u4f7f\u7528\u4ec5\u9650\u4e8e\u5c65\u884c\u7ef4\u4fdd\u670d\u52a1\u5408\u540c\u89c4\u5b9a\u7684\u4e49\u52a1\u6240\u5fc5\u9700\u7684\u9650\u5ea6\u5185\u3002\u672a\u53d6\u5f97\u533b\u9662\u4e66\u9762\u540c\u610f\uff0c\u7ef4\u4fdd\u670d\u52a1\u63d0\u4f9b\u65b9\u4e0d\u5f97\u516c\u5f00\u3001\u590d\u5370\u3001\u590d\u5236\uff0c\u6216\u4ee5\u5176\u4ed6\u4efb\u4f55\u65b9\u5f0f\uff0c\u8ba9\u4efb\u4f55\u7b2c\u4e09\u65b9\u83b7\u77e5\u6b64\u7c7b\u4fe1\u606f\uff1b\u6bcf\u6b21\u7ef4\u4fee\u987b\u4f7f\u7528\u7684\u6570\u636e\u4fe1\u606f\u8303\u56f4\uff0c\u7531\u533b\u9662\u4e66\u9762\u4e0e\u7ef4\u4fdd\u670d\u52a1\u63d0\u4f9b\u65b9\u786e\u8ba4\uff0c\u5e76\u8fdb\u884c\u6570\u636e\u4f7f\u7528\u5b9e\u65f6\u76d1\u7763\uff1b\u56e0\u7ef4\u4fdd\u670d\u52a1\u63d0\u4f9b\u65b9\u6cc4\u5bc6\u4ea7\u751f\u7684\u4e00\u5207\u8d23\u4efb\uff0c\u7531\u6cc4\u5bc6\u65b9\u627f\u62c5\uff0c\u7b49\u7b49\u3002 <\/p>\n
\u5bf9\u4e8eCHS\u65f6\u8111\u6c34\u80bf\u7684\u9884\u9632\u548c\u6cbb\u7597\u76ee\u524d\u6ca1\u6709\u660e\u786e\u7684\u7ed3\u8bba\uff0c\u4f46\u591a\u6570\u4e13\u5bb6\u8ba4\u4e3a\u5982\u679c\u8111\u6c34\u80bf\u660e\u663e\uff0c\u751a\u81f3\u9020\u6210\u9885\u5185\u538b\u6076\u6027\u5347\u9ad8\u65f6\uff0c\u53ef\u5e94\u7528\u7518\u9732\u9187\u3001\u901f\u5c3f\u3001\u9ad8\u6e17\u76d0\u6c34\u3001\u9547\u9759\u836f\u751a\u81f3\u9ebb\u9189\u836f\u3002\u9664\u975e\u60a3\u8005\u6709\u766b\u75eb\u51fa\u73b0\uff0c\u5426\u5219\u4e0d\u5efa\u8bae\u5e38\u89c4\u9884\u9632\u6027\u4f7f\u7528\u6297\u766b\u75eb\u836f\u3002CHS\u7684\u60a3\u8005\u5728\u75c7\u72b6\u5f97\u5230\u63a7\u5236\u4e4b\u524d\u90fd\u5e94\u8be5\u5728\u533b\u9662\u7ed9\u4e88\u4e25\u5bc6\u76d1\u62a4\u3002\u9488\u5bf9CHS\u7684\u6cbb\u7597\u5e94\u6301\u7eed\u5230\u8111\u8840\u7ba1\u81ea\u52a8\u8c03\u8282\u529f\u80fd\u6062\u590d\uff0c\u4e0d\u540c\u4e2a\u4f53\u6062\u590d\u65f6\u95f4\u5dee\u5f02\u8f83\u5927\u3002\u6709\u4e9b\u53ea\u9700\u8981\u51e0\u5468\uff0c\u800c\u6709\u4e9b\u60a3\u8005\u9700\u8981\u534a\u5e74\u751a\u81f3\u66f4\u957f\uff0c\u4e34\u5e8a\u4e0a\u53ef\u4ee5\u5e94\u7528TCD\u7684\u76d1\u6d4b\u6765\u786e\u5b9a\u6240\u9700\u65f6\u95f4\u3002<\/p>\n
\u9884\u540e\u53d6\u51b3\u4e8e\u8111\u6c34\u80bf\u6216\u8111\u51fa\u8840\u53d1\u751f\u524d\u5bf9\u9ad8\u704c\u6ce8\u7684\u53ca\u65f6\u8bc6\u522b\u548c\u6cbb\u7597\u3002\u4e00\u65e6\u53d1\u5c55\u4e3a\u8111\u51fa\u8840\uff0c\u9884\u540e\u8f83\u5dee\uff0c\u75c5\u6b7b\u7387\u8fbe\u523036%\uff5e63%[46]\u3002\u8bc4\u4f30\u672a\u53d1\u751f\u8111\u51fa\u8840\u7684CHS\u60a3\u8005\u7684\u9884\u540e\u6bd4\u8f83\u56f0\u96be\uff0c\u56e0\u4e3a\u4e2a\u4f53\u5dee\u5f02\u5f88\u5927\uff0c\u4f46\u8fdc\u671f\u9884\u540e\u5927\u591a\u8f83\u597d\uff0c\u75c5\u6b7b\u7387\u4e5f\u8f83\u4f4e\u3002<\/p>\n
\u6709\u75c7\u72b6\u7684\u60a3\u8005\u666e\u904d\u5b58\u5728\u9ad8\u704c\u6ce8\uff0c\u4f46\u4e5f\u5e76\u975e\u4e00\u5b9a\u5b58\u5728\u3002CHS\u75c5\u7406\u751f\u7406\u8fc7\u7a0b\u590d\u6742\uff0c\u90e8\u5206\u60a3\u8005CBF\u4ec5\u5c11\u91cf\u589e\u52a0(\u8f83\u672f\u524d\u589e\u52a020%\uff5e44%)\uff0c\u4f46\u4ecd\u7136\u5b58\u5728\u76f8\u5173\u4e34\u5e8a\u75c7\u72b6\uff0c\u56e0\u6b64\u6709\u5b66\u8005\u63d0\u51fa\u201c\u518d\u704c\u6ce8\u7efc\u5408\u5f81\u201d\u7684\u8bf4\u6cd5[47]\u3002\u4e0d\u4ec5\u8111\u7ec4\u7ec7\uff0c\u8bb8\u591a\u5176\u4ed6\u5668\u5b98\u8840\u8fd0\u91cd\u5efa\u540e\u4e5f\u90fd\u5b58\u5728\u518d\u704c\u6ce8\u7efc\u5408\u5f81\u3002\u4f8b\u5982\u51a0\u8109\u6eb6\u6813\u6cbb\u7597\u6216\u5916\u79d1\u8840\u8fd0\u91cd\u5efa\u540e\u53d1\u751f\u7684\u518d\u704c\u6ce8\u5fc3\u5f8b\u5931\u5e38\uff1b\u80c3\u80a0\u9053\u518d\u704c\u6ce8\u635f\u4f24\u5bfc\u81f4\u80a0\u9053\u5c4f\u969c\u529f\u80fd\u4e0b\u964d\uff1b\u5728\u80be\u8840\u7ba1\u6027\u75be\u75c5\u8840\u8fd0\u91cd\u5efa\u540e\u660e\u663e\u591a\u5c3f(5 L\/d)\uff0c\u9274\u4e8e\u4ee5\u4e0a\u60c5\u51b5\uff0c\u6709\u5b66\u8005\u5efa\u8bae\u5c06CHS\u6539\u4e3a\u201c\u8111\u518d\u704c\u6ce8\u7efc\u5408\u5f81\u201d[14]\u3002<\/p>\n
3. The community college in my research offers the academic transfer, career and technical education. <\/p>\n
\u8111\u9ad8\u704c\u6ce8\u7efc\u5408\u5f81\u6216\u8005\u8bf4\u8111\u518d\u704c\u6ce8\u7efc\u5408\u5f81\u662f\u4e00\u79cdCEA\u672f\u540e\u7f55\u89c1\u4f46\u4e25\u91cd\u7684\u5e76\u53d1\u75c7\u3002\u9884\u540e\u4e3b\u8981\u53d6\u51b3\u4e8e\u4e34\u5e8a\u533b\u5e08\u5bf9\u5176\u65e9\u671f\u7684\u8bc6\u522b\u548c\u6070\u5f53\u7684\u6cbb\u7597\u3002\u5176\u5e94\u8be5\u88ab\u795e\u7ecf\u5185\u5916\u79d1\u533b\u5e08\u7684\u91cd\u89c6\uff0c\u505aCEA\u624b\u672f\u51b3\u7b56\u65f6\u5e94\u8be5\u8003\u8651\u5230\u5404\u79cd\u98ce\u9669\u56e0\u7d20\uff0c\u6709\u6761\u4ef6\u7684\u533b\u9662\u5e94\u672f\u524d\u8bc4\u4f30\u5176\u53d1\u751f\u98ce\u9669\uff0c\u56f4\u624b\u672f\u671f\u5e38\u89c4\u4f7f\u7528TCD\u7b49\u6765\u76d1\u6d4bCBF\uff0c\u4e00\u65e6\u53d1\u73b0CHS\u4e25\u5bc6\u76d1\u62a4\uff0c\u6cbb\u7597\u5e94\u8be5\u6301\u7eed\u5230\u4e34\u5e8a\u75c7\u72b6\u5b8c\u5168\u7f13\u89e3\u3002<\/p>\n
\u53c2\u8003\u6587\u732e<\/b><\/p>\n
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\u9888\u52a8\u8109\u5185\u819c\u5265\u8131\u672f (carotid endarterectomy\uff0cCEA) \u5df2\u88ab … \u7ee7\u7eed\u9605\u8bfb