椎动脉狭窄性病变对锁骨下动脉盗血程度的影响  

Effection of degree in subclavian artery steal caused by vertebral artery stenosis

作　　者：李秋萍[1] 华扬[1] 王力力[1] 段春[1] 赵新宇[1] 高明杰[1] 

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中华医学超声杂志（电子版）》2015年第9期702-706,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的分析椎动脉（vA）狭窄性病变对锁骨下动脉（SA）重度狭窄盗血程度的影响。方法回顾性分析2013年8月至2015年5月经首都医科大学宣武医院血管超声检查诊断为单侧SA重度狭窄（70％～99％）患者148例，其中VA重度狭窄（70％～99％）组53例，非VA重度狭窄组95例；同侧VA重度狭窄组23例，对侧VA重度狭窄组30例。根据彩色多普勒血流成像检查VA椎间隙段血流频谱形态确定SA盗血类型。采用χ2检验比较VA重度狭窄组与非VA重度狭窄组、同侧VA重度狭窄组与对侧VA重度狭窄组单侧SA重度狭窄患者SA盗血类型差异。结果VA重度狭窄组单侧SA重度狭窄患者SA盗血类型表现为隐匿型50．9％（27／53），部分型47．2％（25／53），完全型1．9％（1／53）；非VA重度狭窄组单侧SA重度狭窄患者SA盗血类型表现为部分型73．7％（70／95），完全型26．3％（25／95）。VA重度狭窄组与非VA重度狭窄组单侧SA重度狭窄患者SA盗血类型差异有统计学意义（χ2=63．679，P=0．000）。同侧vA重度狭窄组与对侧VA重度狭窄组单侧SA重度狭窄患者SA盗血类型差异无统计学意义（χ2=0．782，P=0．676）。VA重度狭窄组单侧SA重度狭窄患者同侧VA血流频谱异常，以隐匿型伴血流速度降低及低阻力为特征性改变。结论VA起始段重度狭窄可能导致SA盗血程度降低。VA重度狭窄病变是SA盗血程度与SA狭窄程度不一致性的重要影响因素。Objective To analyze the effect of degree in subclavian artery steal （SAS） caused by vertebral artery stenosis （VAS）. Methods Totally 148 patients with serious stenosis （70%-99%） of unilateral subclavian artery （SA） diagnosed by vascular ultrasonography during August 2013 to May 2015 were studied retrospectively. According to the degree of VAS, patients were classified as vertebral artery severe stenosis （VASS） group （53 cases） and non-VASS （degree of stenosis less than 70%） group （95 cases）. The cases in VASS group were classified into two sub-groups： the patients （23 cases） with lesions of VA and SA ipsilateral and the patients （30 cases） with contralateral vertebral artery （VA） lesions. The degree of SAS were classified by the blood flow waveform examined by color dopplor flow imaging （CDFI） of intertransverse segment of the VA. The difference of the degree of SAS between the two major groups and sub-groups were compared and analyzed by χ2 test. Results The degree of SAS in patients with severe stenosis of unilateral SA were occult steal accounted for 50.9% （27/53）, partial steal accounted for 47.2% （25/53） and complete steal accounted for only 1.9% （1/53） in VASS group; while in non-VASS group, partial steal accounted for 73.7% （70/95） and complete steal accounted for 26.3% （25/95）. There were statistical significances of the degree of SAS between VASS group and non-VASS group （3（2=63.679, P=0.000）. The degree of SAS of the two subgroups according to the ipsilateral or contralateral side of the lesion had no statistical significant difference （χ2=0.782, P=0.676）. The blood flow spectrum of VA were mainly characterized as occult steal and the decrease of blood flow velocity and low resistance in the SAS patients with VASS. Conclusions The severe stenosis in vertebral artery might possibly lead to a decrease in SA steal. VASS is an important influential factor for the mismatching between the SA stenosis and SA steal.

关 键 词：超声检查 锁骨下动脉窃血综合征 椎底动脉供血不足 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学]