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

发布时间：2018-03-26 14:34

本文选题：椎动脉闭塞　切入点：后循环缺血　出处：《中国脑血管病杂志》2017年08期

【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P0.05]。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。
[Abstract]:Objective to evaluate the type of vertebral artery occlusion by color Doppler flow imaging (CDFI) combined with transcranial color Doppler ultrasonography (TCDU). Methods 108 patients with vertebral artery occlusion confirmed by DSA or CT angiography from June 2015 to June 2016 were retrospectively included according to the results of diffusion weighted Mr imaging (DWI). There were 78 cases of posterior circulation infarction group and 30 cases of TIA group without posterior circulation infarction. The diameter of extracranial segment of contralateral vertebral artery and the extracranial segment of bilateral vertebral artery were examined by color Doppler flow imaging (CDFI) and transcranial color Doppler ultrasound (TCD). Peak systolic velocity of intracranial segment (PSV) and end-diastolic flow velocity (EDV) were compared between the two groups, the type of vertebral artery occlusion and the establishment of collateral circulation were compared between the two groups. Results there were 69 patients with single vertebral artery occlusion in infarction group and TIA group, 26 patients with bilateral vertebral artery occlusion, and 9 patients with double-branch vertebral artery occlusion. There was no difference in the number of branches of vertebral artery occlusion between the two groups. The proportion of patients with intracranial segment occlusion of vertebral artery in the infarction group was higher than that in the TIA group [70.555 / 78) vs 36.70.30%; 蠂 ~ (2 +) 10.444% P ~ (0.001)], the proportion of collateral circulation was lower than that in the TIA group [14.11178] vs 43.331330m; 蠂 ~ (2 +) 10.711P / P ~ (0.001); in the TIA group, it was higher than that in the infarct group [65 卤21)cm/s]. Compared with 20 卤7 cm / s, 25 卤8)cm/s, 57 卤15 cm 路s ~ (-1) 路s ~ (-1) / 8)cm/s was 2.043 卤2.606, respectively (P0.05). Conclusion the establishment of posterior collateral circulation of vertebral artery occlusion and the hemodynamic compensation of healthy vertebral artery can improve the occurrence of posterior circulation ischemia.
【作者单位】：首都医科大学宣武医院血管超声诊断科;
【分类号】：R445.1;R743.3

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