椎动脉闭塞类型及其代偿性血流动力学变化对后循环缺血的影响  

Types of vertebral artery occlusion and their compensatory hemodynamic changes influence to posterior circulation ischemia

作　　者：周瑛华[1] 华扬[1] 贾凌云[1] 王力力[1] 段春[1] 侯伟红[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：《中国脑血管病杂志》2017年第8期424-428,433,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的通过彩色多普勒血流显像与经颅彩色多普勒超声联合检测评价椎动脉闭塞的类型、代偿性血流动力学变化与后循环缺血的相关性。方法回顾性纳入2015年6月至2016年6月经血管超声、DSA或CT血管成像(CTA)证实的椎动脉闭塞患者108例,根据MR扩散加权成像(DWI)结果,分为后循环梗死组(78例)和无后循环梗死组(TIA组,30例),采用彩色多普勒血流显像和经颅彩色多普勒超声联合检查健侧椎动脉颅外段管径和双侧椎动脉颅外段、颅内段收缩期峰值流速(PSV)及舒张期末流速(EDV)。比较两组间椎动脉闭塞类型、侧支循环建立、健侧椎动脉血流动力学变化的差异性。结果梗死组与TIA组单支椎动脉闭塞者分别为69例(88.5%)、26例(86.7%),双支椎动脉闭塞者分别为9例(11.5%)、4例(13.3%),组间椎动脉闭塞支数差异无统计学意义(χ~2=0.000,P=1.000)。梗死组的椎动脉颅内段闭塞者比例高于TIA组[70.5%(55/78)比36.7%(11/30);χ~2=10.444,P=0.001],侧支循环建立者比例低于TIA组[14.1%(11/78)比43.3%(13/30);χ~2=10.711,P=0.001]。TIA组单支椎动脉闭塞患者的健侧椎动脉颅外段PSV、EDV均高于梗死组[(65±21)cm/s比(57±15)cm/s;(25±8)cm/s比(20±7)cm/s;t值分别为2.043、2.606,均P<0.05]。结论椎动脉闭塞后侧支循环的建立和健侧椎动脉的血流动力学代偿可改善后循环缺血的发生情况。Objective To evaluate the correlation between the types of vertebral artery occlusion and their compensatory hemodynamic changes and posterior circulation ischemia using color Doppler flow imaging combined with transcranial color-coded sonography.Methods From June 2015 to June 2016,A total of 108 patients with vertebral artery occlusion confirmed by vascular sonography,digital subtraction angiography （DSA） or CT angiography （CTA） were enrolled retrospectively.According to the magnetic resonance imaging （MRI）-diffusion weighted imaging （DWI） findings,they were divided into posterior circulation infarction （n=78 in infarction group） and non-posterior circulation infarction （n=30 in TIA group）.Color Doppler flow imaging and transcranial color Doppler ultrasonography were used to examine the contralateral vertebral artery extracranial diameter, peak systolic velocity（PSV） and end diastolic velocity（EDV） of bilateral extracranial and intracranial vertebral arteries.The differences of the vertebral artery occlusion types,establishment of collateral circulation and hemodynamic changes of the contralateral vertebral artery were compared between the two groups.Results The patients with single vertebral artery occlusion in the infarction group and TIA group were 69 （88.5%） and 26 （86.7%） respectively;those with bilateral vertebral artery occlusion were 9 （11.5%） and 4 （13.3%） respectively.There was no significant difference in the number of vertebral artery occlusion between the two groups （χ^2=0.000,P=1.000）.The proportion of patients with vertebral artery occlusion in intracranial segment in the infarction group was higher than that in the TIA group （70.5% [55/78] vs.36.7% （11/30）;χ^2=10.444,P=0.001）.The proportion of patients with the establishment of collateral circulation in the infarction group was lower than that in the TIA group （14.1% [11/78] vs.43.3% （13/30）;χ^2=10.711,P=0.001）.The peak systolic velocity （PSV） and the end diastolic velocit

关 键 词：椎动脉闭塞 后循环缺血 血流动力学 侧支建立 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]