椎动脉优势与眩晕及基底动脉弯曲的关系

发布时间：2018-06-25 07:54

本文选题：椎动脉优势 + 椎动脉　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：评价椎动脉优势与眩晕及基底动脉弯曲的关系，探讨椎动脉优势导致眩晕的机制。方法：收集在辽宁省人民医院以眩晕为主要表现的住院患者的临床资料，根据MRA检查结果将患者分为椎动脉优势组及非椎动脉优势组，通过眩晕程度评分比较两组患者眩晕的程度，包括眩晕恢复需要的时间；根据MRA影像，对比两组基底动脉弯曲的发生率、弯曲的方向、形态；基底动脉的直径、长度以及双侧椎动脉直径差异，并分析椎动脉直径差异与基底动脉弯曲长度的相关性。结果: （1）共收集眩晕患者183例，其中椎动脉优势组与非优势组分别为98例、85例，椎动脉优势的发生率为98/183（53.55%）；两组患者的性别、年龄、高血压史、糖尿病史、吸烟史、饮酒史、颈椎病、颈动脉狭窄等血管危险因素均无统计学差异（P＞0.05）。（2）椎动脉优势组眩晕严重程度评分为3.31±1.28，非椎动脉优势组2.54±1.46，差异有统计学意义（P=0.000）。椎动脉优势组眩晕恢复时间（4.52±1.77）天，明显较非优势组（3.28±1.45）天延长，差异有统计学意义（P=0.008）（3）98例椎动脉优势组中左侧优势者69例（69/98，70.41%）、右侧优势29例（29/98，29.59%）,左侧优势明显高于右侧优势（70.41%vs29.59%）。 (4)椎动脉优势患者中基底动脉弯曲者为53例，基底动脉弯曲发生率为54.08%(53/98),显著高于非优势组16.47%(14/85),差异有统计学意义（2=27.75，P=0.000）。椎动脉优势组中左侧弯曲者12例、右侧弯曲者41例，提示基底动脉以向椎动脉优势对侧弯曲为主。基底动脉的弯曲形状优势组与非优势组均以C型弯曲者多见（69.81%，64.29%）。（5）椎动脉优势组基底动脉弯曲长度（BL，3.27±3.13）mm，明显高于非优势组（1.70±2.59）mm，差异有统计学意义（P=0.021）。椎动脉优势组基底动脉直径、基底动脉理论长度（BAL）与非优势组对比差异无统计学意义(P＞0.05)。（6）椎动脉直径左侧为（3.86±0.48）mm、右侧为（2.94±1.01）mm，统计学处理两者相差有意义，即左侧较右侧增粗。使用Pearson相关检验，结果发现椎动脉直径差异与BAL相关（r=0.097，P＞0.05），与BL呈正相关(r=0.780，P=0.000)，与眩晕严重程度呈正相关（r=0.615，，P=0.000）。结论:（1）眩晕患者椎动脉优势发生率高，且椎动脉优势者眩晕程度严重，眩晕恢复时间延长，提示椎动脉优势与眩晕相关；（2）椎动脉优势者基底动脉弯曲的发生率高，其基底动脉的弯曲方向一般朝向椎动脉优势的对侧，以C型弯曲多见；（3）双侧椎动脉的直径差异与基底动脉弯曲长度（BL）呈正相关，椎动脉优势越明显，基底动脉弯曲长度越长，眩晕的程度越严重。提示椎动脉优势可能通过导致基底动脉弯曲而引起眩晕发作。
[Abstract]:Objective: to evaluate the relationship between vertebral artery dominance and vertigo and basilar artery curvature, and to explore the mechanism of vertigo caused by vertebral artery dominance. Methods: the clinical data of the inpatients with vertigo as the main manifestation in Liaoning Provincial people's Hospital were collected. According to the MRA results, the patients were divided into two groups: the dominant vertebral artery group and the non-vertebral artery dominant group. The degree of vertigo in the two groups was compared by the score of vertigo degree, including the time needed for the recovery of vertigo. According to MRA images, the incidence, direction, shape, diameter of the basilar artery were compared between the two groups. The length of vertebral artery and the diameter of bilateral vertebral artery were different, and the relationship between the diameter difference of vertebral artery and the length of basilar artery bending was analyzed. Results: (1) A total of 183 patients with vertigo were collected, including 98 cases of vertebral artery dominance group and 85 cases of non-dominant group, the incidence of vertebral artery dominance was 98 / 183 (53.55%), the sex, age, history of hypertension, history of diabetes, history of smoking, sex, age, history of hypertension, history of diabetes, history of smoking, and the incidence of vertebral artery dominance were 98 / 183 (53.55%), respectively. There was no significant difference in the risk factors of alcohol consumption, cervical spondylopathy and carotid artery stenosis (P > 0. 05). (2). The score of vertigo severity in the dominant vertebral artery group was 3. 31 卤1. 28, and that in the non-vertebral artery dominant group was 2. 54 卤1. 46. The difference was statistically significant (P < 0. 05). The recovery time of vertigo in the dominant vertebral artery group was (4.52 卤1.77) days, which was significantly longer than that in the non-dominant group (3.28 卤1.45) days. The difference was statistically significant (P < 0. 008) (3) among 98 patients with vertebral artery dominance, 69 (69 / 98) were left dominant (69 / 980.41%), 29 were right (29 / 98) 29.59%, the left was significantly higher than that of right (79. 41 vs 29. 59%). (4). 53 cases of basilar artery curvature were found in the patients with vertebral artery dominance (79. 41 vs 29. 59%). (4). The incidence of basilar artery curvature was 54.08% (53 / 98), which was significantly higher than that of non-dominant group (16.47%) (14 / 85). In the vertebral artery dominant group there were 12 cases with left curvature and 41 cases with right curvature suggesting that the basilar artery was predominantly contralateral bent to the vertebral artery. The curve length of basilar artery in the dominant group (69.81%, 64.29%). (5) was significantly higher than that in the non-dominant group (1.70 卤2.59 mm, P 0.021), and the length of the basilar artery in the dominant group was (3.27 卤3.13) mm, significantly higher than that in the non-dominant group (P 0.021). There was no significant difference in the diameter of basilar artery and the theoretical length of basilar artery between the dominant group and the non-dominant group (P > 0. 05). (6). The diameter of the vertebral artery was (3. 86 卤0. 48) mm on the left side and (2. 94 卤1. 01) mm on the right side. That is, the left side is thicker than the right. Using Pearson correlation test, it was found that the diameter of vertebral artery was correlated with BAL (r = 0.097, P > 0.05), BL (r = 0.780, P = 0.000), and with the severity of vertigo (r = 0.615, P = 0.000). Conclusion: (1) the incidence of vertebral artery dominance in patients with vertigo is high, and the degree of vertigo is serious and the recovery time of vertigo is prolonged in patients with vertebral artery dominance, which indicates that the advantage of vertebral artery is related to vertigo, (2) the incidence of basilar artery curvature is high in patients with vertebral artery dominance. The bending direction of the basilar artery is generally oriented to the opposite side of the dominant vertebral artery, and the C-type curvature is more common. (3) the diameter difference of the bilateral vertebral artery is positively correlated with the length of the basilar artery curvature (BL), and the more obvious the vertebral artery dominance is, The longer the basilar artery bends, the more severe the vertigo is. The results suggest that vertebral artery dominance may cause vertigo by bending the basilar artery.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741

【参考文献】