锁骨下动脉、头臂干严重狭窄或闭塞的血流动力学改变及窃血方式  

Hemodynamic changes and steal patterns in serious stenosis or occlusion of the subclavian artery or brachiocephalic arterial trunk

作　　者：张雄伟[1] 路琦 张以善[1] 马为民[3] 王翠玉[1] 李曼[1] 金文静 文欣[1] 

机构地区：[1]解放军第二炮兵总医院神经内科,北京100088 [2]北京市德胜社区卫生服务中心,100011 [3]解放军第二炮兵总医院清河门诊部,北京100085 [4]解放军第五三五医院特诊科,怀化418008

出　　处：《中华神经医学杂志》2007年第11期1155-1158,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨锁骨下动脉(SubA)或头臂干(BCAT)严重狭窄或闭塞患者的血流动力学改变及窃血方式。方法对65例经数字减影血管造影或颈动脉彩色多普勒超声证实的SubA起始段或BCAT严重狭窄或闭塞患者行经颅多普勒超声(TCD)和颈动脉连续波多普勒超声(CWD)检测。结果46例狭窄患者中25例检出SubA或BCAT局限性严重狭窄血流。19例闭寒患者未探及到病侧SubA或BCAT血流信号。30例病变远端的SubA、尺动脉和桡动脉血流波形异常,呈低流速低搏动改变;7例病侧桡动脉未探及到血流信号;28例病变远端动脉的高阻力波形仍存在,但与对侧同名动脉比较血流速度和搏动指数减低。所有患者均检出椎动脉一椎动脉窃血,30例有基底动脉一椎动脉窃血,14例有枕动脉一椎动脉窃血,5例BCAT病变患者有前循环窃血。结论TCD和CWD有助于了解SubA或BCAT严重狭窄或闭塞患者的血流动力学改变和窃血方式,为临床确定诊断、寻找椎一基底动脉供血不足的原因和更深入研究缺血性脑血管病的发病机理提供重要的客观依据。Objective To explore the cerebral hemodynamie changes and steal patterns in patients with serious stenosis or occlusion of the subclavian artery （SubA） or braehioeephalie arterial trunk （BCAT）. Methods Sixty five patients determined to be serious stenosis or occlusion in the proximal SubA or BCAT by digital substraetion angiography （DSA） or carotid color Doppler ultrasound were measured by transeranial Doppler （TCD） ultrasound and carotid continuous-wave Doppler （CWD） ultrasound. Results Among the 46 cases with stenosis, 25 were found to have serious focal stenosis flow in the SubA or BCAT. No blood flow signal of the affected side SubA or BCAT was found in 19 patients with occlusion. CWD ultrasound showed abnormal blood flow waveforms manifesting low velocity of flow and pulsatility in the distal SubA, ulnar artery and radial artery of 30 cases; no blood flow signal of the affected side radial artery was detected in 7 cases; high resistance waveforms of the distal artery remained in 28 cases, but blood flow velocity and pulsatility index were lower than the same eontralateral artery. TCD and CWD ultrasound showed vertebral artery-vertebral artery steal in all the cases, basilar artery-vertebral artery steal in 30 of all the cases, occipital artery-vertebral artery steal in 14 of all the cases and anterior circulation steal in 5 cases with pathological changes in the BCAT. Conclusion Both TCD and CWD ultrasound are helpful for the understanding of hemodynamie changes and steal patterns in patients with serious stenosis or occlusion of the SubA or BCAT. They shall provide important and objective evidence for definitely diagnosing and determining causes of vertebrobasilar insufficiency and clinically deepening into the pathogenesis of isehemie eerebrovaseular diseases.

关 键 词：锁骨下动脉 头臂干 血流动力学 窃血 

分 类 号：R543.5[医药卫生—心血管疾病]