锁骨下动脉盗血综合征的临床表现与盗血程度及类型的关系  

The association between the clinical performance and steal phenomena in patients with subclavian artery occlusive disease: a transcranial Doppler and digital substract angiography study

作　　者：高山[1] 黄一宁[2] 刘俊艳[3] 汪波[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经内科,100730 [2]北京大学第一医院神经内科 [3]河北医学院第三附属医院神经内科

出　　处：《中华神经科杂志》2004年第2期139-143,共5页Chinese Journal of Neurology

摘　　要：目的　应用经颅多普勒超声 (TCD)和数字减影血管造影 (DSA)分析锁骨下动脉 (Sub A)起始段严重狭窄或闭塞导致的锁骨下动脉盗血综合征 (SSS)的盗血程度和类型与椎基底动脉供血不足 (VBI)的关系。方法　回顾性总结 15 2例经TCD检查诊断的Sub A严重狭窄或闭塞患者 (其中 4 5例进一步行DSA检查 )。根据同侧椎动脉 (Ip VA)TCD检测的血流方向 ,将盗血程度分为 :无盗血 (Ip VA完全正向 )、Ⅰ度盗血 (Ip VA收缩期有切迹 )、Ⅱ度盗血 (Ip VA收缩期反向 ,舒张期正向 )和完全盗血 (Ip VA完全反向 )。盗血途径 :基底动脉参与盗血 (基底动脉呈盗血频谱 )或不参与盗血两种。根据DSA管径大小将Sub A狭窄程度区分为 5 0 %～ 74 % ,75 %～ 95 %和闭塞三种情况。结果 (1) 96例有临床缺血表现 ,其中VBI占 76 % ,同侧上肢缺血症状占 9% ,两种症状均有占 14 %。 83%患者两侧收缩压差≥ 2 0mmHg(1mmHg =0 133kPa) ,而仅有 33%患者舒张压差≥ 2 0mmHg ,两者比较差异有显著意义 (P <0 0 5 )。 (2 ) 4 5例进一步行DSA检查患者的Sub A狭窄严重性与椎动脉盗血程度成正比(P <0 0 5 )。 (3)TCD检查无盗血 34 2 % ,Ⅰ度盗血 19 9% ,Ⅱ度盗血 15 8% ,完全盗血 30 1%。VBI与盗血程度无关 (P =0 5 4 )。 15 2例患者中 5 2例 (34 2 %Objective To analyse the association between the clinical performance and degree of steal phenomena with transcranial Doppler (TCD) and digital substract angiography (DSA) in patients with subclavian artery (Sub-A) occlusive disease. Methods Totally 152 patients with Sub-A occlusive disease in the proximal segment before vertebral artery (VA) origin with TCD (45 patients performed with both TCD and DSA) were studied. Sub-A stenosis was defined if the systolic flow velocity was more than 120 cm/s with disturbed flow and murmur, and also the Sub-A occlusion was defined if there was no flow in proximal Sub-A and the low flow found in distal segment. According to the direction of ipsilateral VA (ip-VA), the subclavian steal syndrome (SSS) were defined as no steal (normal direction), stage Ⅰ (deceleration in systole), stage Ⅱ (alteration flow with reversed flow in systole and normal flow in diastole) and stage Ⅲ (reversed flow completely). The steal pathway was defined as basilar artery steal pathway (with steal waveform in basilar artery (BA)) or non-basilar artery steal pathway (normal direction in BA). The severity of occlusive disease of Sub-A on DSA was classified as 50%-74%, 75%-95%, and >95% according to the reduction of lumen area. Results (1) Among the 152 patients, 96 (64%) had symptoms (76% with VBI, 9% with ischemic symptom on ipsilateral arm and 14% with both). 83% of patients had systolic blood pressure difference more than 20 mm Hg between bilateral arms, but only 33% of patients had diastolic blood pressure difference more than 20 mm Hg (P< 0.05). (2)TCD vs DSA: there was a significant association between the severity of subclavian artery stenosis and degree of VA steal in 45 patients performed with both TCD and DSA. (3) Association between vertebrobasilar ischemia (VBI) and severity of VA steal phenomena or basilar artery steal pathway: subclavian artery stenosis were found in 86% vessels (177/206) and the occlusion were found in 14% (29/206 vessels). 34.2% of patients had no steal phenomena

关 键 词：锁骨下动脉 盗血综合征 TCD 数字减影血管造影 DSA 动脉造影 Sub-A 

分 类 号：R543[医药卫生—心血管疾病]