超声评价重症雷诺综合征患者胸交感神经链切除术后桡、尺动脉血流动力学变化  

Assessment of the radial and ulnar arteries hemodynamic changes by ultrasound in patients with severe Raynaud′s syndrome after endoscopic thoracic sympathectomy

作　　者：徐明民[1] 戚维波[2] 杨帆[2] 赵俊杰[2] 施谷平[2] 胡奕[2] 

机构地区：[1]浙江省嘉兴市第一医院超声科,314001 [2]浙江省嘉兴市第一医院心胸外科,314001

出　　处：《中华医学超声杂志（电子版）》2016年第8期617-621,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：嘉兴市科技计划项目(2014AY21027)

摘　　要：目的应用超声评估重症雷诺综合征(RS)患者胸腔镜下胸交感神经链切除术后桡动脉(RA)、尺动脉(UA)血流动力学变化。方法选择2012年12月至2015年2月浙江省嘉兴市第一医院收治的行胸腔镜下胸交感神经链T2-T3节段切除术的13例重症RS患者47支上肢动脉。采用彩色多普勒超声检查于术前1 d、术后1 d检测RA、UA的内径、收缩期峰值流速(PSV)、舒张期末流速(EDV)、阻力指数(RI),并观察频谱形态,同时测量重症RS患者患侧手部皮肤温度。采用配对样本t检验比较重症RS患者手术前后RA、UA的内径、PSV、EDV、RI及患侧手部皮肤温度差异。结果重症RS患者术后RA、UA的内径、EDV均较术前增加[内径:(2.33±0.49)mm vs(2.01±0.33)mm,(1.79±0.35)mm vs(1.61±0.30)mm;EDV:(8.35±1.81)cm/s vs(4.70±1.43)cm/s,(7.96±0.94)cm/s vs(3.82±1.13)cm/s],RI均较术前减小(0.86±0.09 vs 0.94±0.09,0.88±0.10 vs0.96±0.07),且差异均有统计学意义(内径:t=-4.17、-2.79,P均<0.01;EDV:t=-14.57、-16.42,P均<0.01;RI:t=2.97、3.07,P均<0.01);而手术前后PSV差异无统计学意义[(45.00±16.51)cm/s vs(45.37±16.10)cm/s,(45.45±21.71)cm/s vs(49.65±17.24)cm/s,t=-0.11、-1.09,P均>0.05)。术后3支动脉舒张早期反向血流消失,39支动脉舒张期末正向血流速度较术前增加。术后重症RS患者患侧手部皮肤温度较术前升高[(34.22±1.65)℃vs(32.31±2.12)℃],且差异有统计学意义(t=-7.92,P<0.01)。结论胸腔镜下胸交感链切除术能使重症RS患者RA、UA的内径增加,EDV增快,RI降低,从而缓解其手部动脉痉挛,表现为患侧手部皮肤温度较术前升高。超声测量动脉内径、EDV及RI可作为评价重症RS患者胸腔镜下胸交感神经链切除术后疗效的指标,且客观、无创、方便。Objective To assess the radial and ulnar arteries hemodynamic changes by ultrasound in patients with severe Raynaud？s syndrome（RS） after endoscopic thoracic sympathectomy.Methods Between December 2012 and February 2015,13 patients with severe RS were admitted to the First Hospital of Jiaxing City,Zhejiang Province,47 arteries of these patients who underwent endoscopic thoracic sympathectomy（T2-T3 segment） were enrolled into this study.Diameters（D）,peak systolic velocity（PSV）,end diastolic velocity（EDV） and resistive index（RI） of the radial and ulnar arteries were examined one day before and after the operation by color Doppler ultrasound.Spectral waveforms of these arteries were observed,and the affected hands？ skin temperatures of these patients were measured.Paired sample t tests were used to compare D,PSV,EDV,RI and the affected hands？ skin temperatures of patients with severe RS before and after the surgery.Results D and EDV of the radial and ulnar arteries of patients with severe RS significantly increased after surgery [D：（2.33±0.49） mm vs（2.01±0.33） mm,（1.79±0.35） mm vs（1.61±0.30） mm; EDV：（8.35±1.81） cm/s vs（4.70±1.43） cm/s,（7.96±0.94） cm/s vs（3.82±1.13） cm/s].RI of the radial and ulnar arteries significantly decreased after surgery（0.86±0.09 vs 0.94±0.09,0.88±0.10 vs 0.96±0.07）.There were significant differences between D,EDV and RI of the radial and ulnar arteries before and after surgery（D： t=-4.17 and-2.79,all P 〈0.01; EDV： t=-14.57 and-16.42,all P〈 0.01; RI： t=2.97 and 3.07,all P 〈0.01）.However,insignificant differences were found between PSV of the radial and ulnar arteries before and after surgery [（45.00±16.51） cm/s vs（45.37±16.10） cm/s,（45.45±21.71） cm/s vs（49.65±17.24） cm/s,t=-0.11 and-1.09,all P〉 0.05）.Reverse flow disappeared in 3 arteries at early diastolic stage,and forward flow velocity increased in 39 arteries at end diastolic stage after surgery.The affected hands？ sk

关 键 词：超声检查 胸交感神经链切除术 雷诺综合征 血流动力学 

分 类 号：R445.1[医药卫生—影像医学与核医学] R655[医药卫生—诊断学]