经颅多普勒超声在锁骨下动脉窃血综合征治疗及随诊中的应用  

Transcranial Doppler ultrasound changes before and after treatment of subclavian steal syndrome

作　　者：高山[1] 黄一宁[1] 汪波[1] 

机构地区：[1]中国协和医科大学北京协和医院神经内科,北京100730

出　　处：《中华超声影像学杂志》2000年第5期297-299,共3页Chinese Journal of Ultrasonography

摘　　要：目的　探讨经颅多普勒超声 (TCD)观察在锁骨下动脉窃血综合征 (SSS)手术和介入治疗中椎基底动脉系统血流动力学的改变。方法　行手术和介入治疗的SSS患者 3 6例 ,包括经皮血管内成形术(PTA) 15例 ,颈总动脉 锁骨下动脉搭桥术 (搭桥 ) 18例 ,血管内支架置入术 (支架 ) 3例。治疗前后均行TCD检查 ,2例PTA治疗患者行术中大脑后动脉 (PCA)血流监测。结果　①术前TCD改变 :病变同侧椎动脉 (VA)完全反向 ( 2 0例 )或双向 ( 16例 ) ,无纯正向血流 ;11例基底动脉 (BA)、6例PCA呈双向或反向 ,其余均为正向血流 ;病变对侧VA呈收缩期血流速度增快的高阻力频谱。②术后TCD改变 :除失败的 1例VA为双向血流外 ,其余VA、BA和PCA均为正向 ,VA正向者中有 12例束臂试验后血流速度有部分下降 ,但不出现反向血流 ;病变对侧VA血流频谱恢复正常 ;2例PTA术中监测PCA ,随着球囊扩张次数的增加 ,残余狭窄程度的减轻 ,PCA血流由反向变为双向最后变成正向。③平均随诊 2 5个月 ,5例复发 ,TCD测到4例VA反向血流 ,1例治疗对侧VA双向血流。结论　TCD是观察SSS现象及窃血程度的敏感方法 ,且能判断颅内基底动脉、大脑后动脉受影响的情况 ,因此能准确地评价治疗效果并可用于长期随诊。Objective To observe the vertebrobasilar artery flow direction changes after common carotid artery subclavian artery by pass surgery (by pass) and percutaneous transluminal angioplasty(PTA) in subclavian steal syndrome (SSS).Methods Thirty six symptomatic SSS patients underwent by pass and PTA.Transcranial Doppler ultrasound (TCD) was performed before and after treatment.Monitoring of posterior cerebral artery (PCA) blood flow was made in two patients during PTA.Results ① TCD findings before treatment:Ipsilateral vertebral artery (VA) reversed flow was detected in 20 patients and bidirection in 16.Bidirection or reversed flow were detected in 11 patients of basilar artery (BA) and in 4 patients of PCA.High resistance waveform with increased flow velocity was seen in contralateral VA. ② TCD changes after treatment:Except for one case the others have normal blood flow.Contralateral blood flow frequency recovered to normal.PCA was performed in two cases during PTA treatment.With the increase of balloon dilatation the degree of residual stenosis reduced.PCA turned from reversed flow bidirection to normal. ③ Five patients had recurrence on follow up over 11～65 months (mean 25 months).Reversed flow of ipsilateral VA was found in 4 cases and contralateral VA bidirection flow in one patient of bilateral subclavian artery stenosis.Conclusions TCD is a sensitive means to observe the phenomena of SSS,the degree of steal blood flow,and influence of intecranial cerebral blood flow.It can be used to evaluate the results of treatment and a toll of follow up.

关 键 词：锁骨下动脉窃血综合征 经颅多普勒超声 治疗 

分 类 号：R445.1[医药卫生—影像医学与核医学]