摘要
目的探讨锁骨下动脉盗血综合征患者椎动脉颅内段与颅外段盗血频谱差异性的原因及其临床意义。方法对41例锁骨下动脉盗血综合征患者行颈部血管彩色多普勒超声及经颅彩色双功能超声(TCCS)检查,分别记录2种检查的盗血频谱分级并进行对比分析,1周内行数字减影血管造影或CT血管造影检查。结果 TCCS检出颅内段Ⅰ级盗血8例(20%,8/41),Ⅱ级盗血23例(56%,23/41),Ⅲ级盗血10例(24%,10/41);颈部血管彩色多普勒超声检出颅外段无盗血3例(7%,3/41),Ⅰ级盗血12例(29%,12/41),Ⅱ级盗血17例(42%,17/41),Ⅲ级盗血9例(22%,9/41)。共有14例患者椎动脉颅内与颅外段盗血程度不同,其中12例经血管造影明确盗血途径,10例颅内段盗血程度高于颅外段者盗血途径为最常见的对侧椎动脉→同侧椎动脉,2例颅内段盗血程度低于颅外段者盗血途径为同侧枕动脉→同侧椎动脉。另外27例盗血程度相同者,5例Ⅰ级及7例Ⅲ级盗血者颅内、外段椎动脉收缩期峰值流速比较,差异均无统计学意义[(31.9±18.7)cm/s vs(32.3±18.9)cm/s,t=0.034,P>0.05;(-69.3±20.7)cm/s vs(-68.8±20.3)cm/s,t=0.046,P>0.05];15例Ⅱ级盗血者颅内、外段椎动脉收缩期峰值流速分别为(-47.3±19.3)cm/s、(-32.6±18.4)cm/s,差异有统计学意义(t=2.136,P<0.05)。结论锁骨下动脉盗血患者椎动脉颅内段与颅外段盗血频谱存在差异者其原因与盗血路径有关,评定锁骨下动脉盗血程度时,多数患者椎动脉颅内段多普勒频谱较颅外段敏感。
Objective To analyze the subclavian steal syndrome（SSS） in patients with extracranial vertebral artery（VA） and intracranial segment steal spectrum difference of reason and its clinical significance.Methods In 41 cases of SSS patients with neck vascular color Doppler ultrasound and transcranial color-coded duplex sonography（TCCS） examination were recorded,steal spectral classification of two kinds of examination were compared,digital subtraction angiography（DSA） or CT angiography（CTA） examination was performed within one week.Results Detection of TCCS levelⅠ steal in 8 cases（20%,8/41）,level Ⅱ steal in 23 cases（56%,23/41）,level Ⅲ steal in 10 cases（24%,10/41）;Cervical vascular color Doppler ultrasound detected no steal in 3 cases（7%,3/41）,level Ⅰ steal in 12 cases（29%,12/41）,levelⅡ steal in 17 cases（42%,17/41）,level Ⅲ steal in 9 cases（22%,9/41）.In 14 cases of VA with different degree of intracranial and extracranial steal.Steal pathways were confirmed by angiography clearly in 12 cases,in 10 cases,the intracranial segment of the steal degree was higher than extracranial,the most common contralateral steal pathway was VA into the ipsilateral VA,in 2 cases,the intracranial steal degree was less than extracranial,the steal way was the ipsilateral occipital artery into the ipsilateral VA.Another 27 cases with the same steal degree,the VA peak systolic velocity（PSV） of 5 cases was in grade Ⅰ steal in comparison with the intracranial and extracranial segment,without statistically significant difference,（31.9±18.7） cm/s vs（32.3±18.9） cm/s（t=0.034,P 〉0.05）;The same situation happened in 7 cases of grade Ⅲ steal,（-69.3±20.7） cm/s vs（-68.8±20.3） cm/s（t=0.046,P 〉0.05）;And 15 cases of grade Ⅱ steal,between intracranial and extracranial segment of the VA PSV,the difference was statistically significant,（-47.3±19.3） cm/s vs（-32.6±18.4） cm/s（t=2.136,P〈0.05）.Conclusions The reason of different steal waveforms between extracranial VA and intracranial VA was the different steal pathway.In the evaluation of subclavian artery steal degree,the majority of the subclavian artery steal syndrome in patients with intracranial VA Doppler spectral sensitivity is higher than that of extracranial VA.
出处
《中华医学超声杂志（电子版）》
2014年第11期36-39,共4页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
浙江省丽水市科技计划资助项目(2012JYZB14)
