椎动脉内频谱反向血流与病变部位的关系及血流动力学分析

目的 探讨椎动脉内频谱存在反向血流成分时可能存在的病变部位。方法 选取经彩色多普勒超声检查发现椎动脉椎间段内血流频谱出现反向血流成分、并准确诊断病变部位的106例患者，对比观察锁骨下动脉盗血综合征（SSS）和非SSS患者的血流特点。结果 106例中，SSS 75例，病变侧锁骨下动脉或无名动脉均存在狭窄或闭塞病变；非SSS 31例，病变侧椎动脉均存在严重狭窄或闭塞病变。同型盗血频谱者中，SSS患者血流速度高于非SSS患者（P<0.05）；以收缩期流速<20 cm/s诊断非SSS的敏感度为83.87%（26/31），特异度为90.67%（68/75）。结论 椎动脉内以反向血流为特点的盗血样频谱大多为锁骨下动脉或无名动脉狭窄或闭塞所致，少数为椎动脉本身狭窄或闭塞所致。

Analysis of blood dynamics and relationship between vertebral artery dynamics of reverse spectrum blood flow and affected location

Objective To identify the probably affected location when reverse spectrum blood flow exists in vertebral artery(VA). Methods Totally 106 patients with reverse spectrum blood flow in VA diagnosed by color Doppler ultrasound were recruited. The affected locations of 106 patients were identified. Flow characteristics were compared between subclavian steal syndrome (SSS) patients and non-SSS patients. Results Block and stricture of subclavian artery (SA) and innominate artery (IA) were found in 75 SSS patients, while severe stricture and obstacle lesions in VA were identified in 31 non-SSS patients. Under similar spectrum hemodynamics, blood flow velocity of SSS patients was faster than that of non-SSS patients (P<0.05). Taking blood flow velocity of systole less than 20 cm/s as diagnose standard for non-SSS, the sensitivity and specificity was 83.87% (26/31) and 90.67% (68/75). Conclusion The main cause of reverse flow of blood in vertebral artery are stricture and block of subclavian artery and innominate artery, when a few of them were caused by stricture and obstruction of the vertebral artery itself.