TCD对青年椎基动脉供血不足的检测分析

椎基底动脉供血不足是指椎基底动脉系统血管发生缺血性的血液循环障碍。病因有椎基底动脉硬化、颈椎病、颈肩部肌肉劳损及无菌性炎症等。临床表现为头疼、头晕、突发性晕厥等。是老年人常发病症。     

前列地尔联合倍他司汀治疗椎-基底动脉供血不足的疗效分析

目的观察前列地尔联合倍他司汀治疗椎-基底动脉供血不足的临床疗效。方法将136例椎-基底动脉供血不足患者随机分为前列地尔联合倍他司汀治疗组(68例)和倍他司汀对照组(68例),观察临床疗效及治疗前后椎-基底动脉平均血流速度的改善情况。结果治疗组治愈率及总有效率高于对照组(P<0.05);治疗组各动脉平均血流速度均明显较对照组改善(P<0.05)。结论前列地尔联合倍他司汀治疗椎-基底动脉供血不足疗效显著。     

椎-基底动脉供血不足78例临床观察及护理体会

椎-基底动脉供血不足是中老年患者好发的一组临床症状群,是由于椎-基底动脉系统的狭窄、痉挛等原因所导致的椎基底动脉供血区域的神经系统功能障碍。临床表现主要为发作性眩晕、恶心、呕吐、耳鸣和行走不稳以及焦虑、睡眠形态紊乱等。短时间者持续数秒钟,长时间者可导致椎-基底动脉血栓形成。我科自2006年10月至2009年10月共收治椎-基底动脉供血不足患者78例,经过综合治疗和精心护理,取得了良好的疗效,现报告如下。     

椎基底动脉供血不足156例病因分析

椎基底动脉供血于大脑半球后下部、丘脑、脑干和小脑，其病变常引起椎基底动脉系统的TIA或脑梗死。椎基底动脉供血不足是常见的缺血性脑血管病，我院自1999-2004年共诊治156例，现就椎基底动脉供血不足的病因予以分析和讨论。     

椎基底动脉供血不足临床与TCD结果分析

目的：探讨椎基底动脉供血不足病人脑血流动力学改变与临床的相关性，提供临床医生在治疗过程的用药依据。方法：应用经颅彩色多谱勒[TCD]检测椎基底动脉供血不足的病人椎基度动脉系统的血流动力学。结果：临床诊断为椎基底动脉供血不足的病人，经TCD检查大多数有异常改变，可表现脑血流速度的变化[血流速度增快或减慢]，频谱形态及频谱性质的改变，以及转颈试验时峰值流速的变化。结论：TCD是一种无损伤性检查，简单、快速，可为医生诊断椎基底动脉脉供血不足提供重要的诊断依据，对医生选择用药有实际意义。     

盐酸倍他司汀治疗眩晕的临床观察

目的探讨盐酸倍他司汀粉针剂治疗椎-基底动脉供血不足引发眩晕临床疗效。方法对45例椎-基底动脉供血不足引发眩晕的患者给予盐酸倍他司汀治疗10d。于治疗前后应用TCD观察椎动脉(VA)和基底动脉(BA)的平均血流速度(Vm)、血管搏动指数(PI)、血管阻力指数(RI),与用丹参治疗的对照组45例患者进行比较。结果治疗前后TCD显示血流速度有明显改善。PI及RI值显著低于治疗前,临床症状明显改善。结论盐酸倍他司汀对椎-基底动脉供血不足引发的眩晕有显著疗效,是一种安全有效的药物。     

星状神经节阻滞治疗颈性眩晕的护理

颈性眩晕是颈部病变引起的椎-基底动脉供血不足,以眩晕为主要症状的一种综合征,也称椎-基底动脉压迫综合征。我科在常规治疗基础上加用星状神经节阻滞治疗和有效的护理,疗效满意,现报告如下。     

复杂性椎-基底动脉重度狭窄介入治疗临床分析

目的 探讨支架置入血管成形术治疗复杂性椎-基底动脉狭窄的可行性、安全性及疗效.方法 2003年11月至2007年12月对5例复杂性多发椎-基底动脉重度狭窄患者进行了支架置入血管成形术治疗.结果 5例患者中,一侧椎动脉闭塞4例,另1例双侧椎动脉起始部重度狭窄.治疗侧椎动脉起始部重度狭窄合并椎动脉颅内段及基底动脉狭窄4例,另1例椎动脉颅内段及基底动脉多发重度狭窄.狭窄率80%～95%,狭窄段长度10～20 mm.支架植入手术全部成功,血管残余狭窄均小于20%,技术成功率为100%.术后全部患者椎-基底动脉供血不足症状均消失.本组5例患者术后6～12个月分别行DSA检查随访,均未发现再狭窄,近期疗效满意.结论 支架置入血管成形术是治疗椎-基底动脉供血不足,预防椎-基底动脉系统卒中的安全、有效方法,近期预后良好.     

彩超检测双侧椎动脉血流总量诊断椎基底动脉供血不足的价值

目的应用彩色多普勒超声检测双侧椎动脉血流总量(S-BFV)为诊断椎基底动脉供血不足(VBI)提供可靠的量化依据。方法应用彩色多普勒超声检测VBI组51例,VBI伴颈动脉硬化组33例及健康对照组84例的S-BFV,均做配对t检验。结果 VBI组、VBI伴颈动脉硬化组与对照组的S-BFV有显著差异(P<0.001),但VBI组与VBI伴颈动脉硬化组之间无显著性差异(P>0.05)。结论彩色多普勒超声检测S-BFV可作为VBI的量化诊断依据。     

脑干听诱发电位(BAEP)对脑血管疾病诊断的探讨

本文对动脉硬化,椎基底动脉供血不足、延髓背外侧综合征、脑干梗塞的BAEP检测,发现BAEP异常与脑干神经系统组织结构改变有密切关系,对Ⅱ—Ⅲ期脑干血管病有辅助诊断价值.资料与方法对26例脑动脉硬化症(诊断标准按1978年第二届精神神经科会议制订标准)的双耳,其中17例为椎基底动脉供血不足(脑血流图枕乳导联显示供血<50%).经脑CT证实一例脑干梗塞双耳;一例延髓背外侧综合征双耳进行BAEP检测.应用丹麦DISA1500C_3型肌电图仪器.要点为主观听阈加55dB,短声重复15c/s平均处理后比较.     

Therapeutic embolization of the gastroduodenal artery in hepatic artery infusion chemotherapy

Transcatheter embolization of the gastroduodenal artery with Gelfoam was performed in 12 patients undergoing percutaneous hepatic artery catheterization for infusion chemotherapy of metastatic liver disease. The purpose of the embolization was to prevent chemotherapeutic drugs from reaching the stomach and duodenum and thereby inducing gastrointestinal toxicity in patients in whom the catheter tip could not be satisfactorily positioned beyond the gastroduodenal origin. Embolization proved safe and effective in eight cases. Three other patients experienced clinical problems that may or may not have been related to embolization. The final patient had a significant complication (necrosis of the pancreatic head and gastric mucosa) that was felt to be directly related to the embolization. Transcatheter gastroduodenal occlusion may help reduce gastrointestinal toxicity of intraarterial infusion chemotherapy. However, it may on occasion be associated with significant complications, particularly in patients who are debilitated due to metastatic disease.     

Reversal of flow in the ovarian artery during uterine artery embolization

Uterine artery embolization (UAE) is gaining increasing recognition as an effective treatment alternative to hysterectomy in select patients. As interventional radiologists gain more experience in the treatment of fibroids, new interest is being directed toward arterial communications between the uterine arteries and ovarian arteries. This case report focuses on the potentially serious complication of flow reversal up the ovarian artery into the aorta during UAE.     

冠心病伴发颈动脉狭窄的分析

目的 评估冠心病（CAD）伴发颈动脉狭窄（CS）的发生率。方法 97例经冠状动脉造影确诊的患者同时行颈动脉血管造影，以冠状动脉狭窄≥50％及累及情况，将CAD患者分为1、2、3支病变组（包括左主干受累）；以CS≥70％为切分点，比较CS在不同亚组间的伴发情况；同时将年龄、体重指数（BMI）、高血压病史及相关生化危险因素作为独立危险因素行Logistic回归分析。结果 97例CAD患者中，1支病变25例（25．8％）、2支病变34例（35．0％）、3支病变38例（39．2％）（包括左主干受累）；32例（33．0％）CS≥70％，包括颈动脉闭塞6例。CS分布情况：1支病变组4％（1／25）、2支病变组38．2％（13／34）、3支病变组47．4％（18／38）。单因素Logistic回归分析显示年龄和高血压病史与CS密切相关（P〈0．05）。结论 单支病变合并1个或多个危险因素、多支病变欲行冠状动脉搭桥术的CAD患者，冠状动脉造影的同时应行颈动脉造影。     

Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

Purpose

Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors.

Methods

We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS ≥ 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or ≤25%, 25-49%, and ≥50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded.

Results

ECAS < 70% in 42 patients and ECAS ≥ 70% in 141 patients. ICAS was found in 51 patients and ICAS ≥ 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS.

Conclusions

We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.     

子宫动脉血管内介入操作的技术分析

近年来,国内外已熟练开展利用子宫动脉栓塞术(uterine artery embolization,UAE)治疗子宫肌瘤,且已取得良好的临床治疗效果.但是盆腔空间相对狭窄,血管分支多,各血管分支易前后重叠,子宫动脉开口起源复杂,走行迂曲,髂内动脉与髂总动脉之间的夹角变化大,因此,子宫动脉起源、开口的清晰显示,熟练的子宫动脉内插管操作及适度的栓塞是该项技术治疗成功的关键.     

Duplex Doppler sonography of the carotid artery: false-positive results in an artery contralateral to an artery with marked stenosis

Anecdotal reports have described a false-positive "jet effect" or velocity increase in the carotid artery contralateral to an artery with significant stenosis or occlusion when using duplex Doppler sonography. In this study, the frequency, significance, and possible reasons for this finding were evaluated by a retrospective comparison of duplex sonography and angiography. Twenty-three patients with unilateral 81-100% carotid artery stenosis who underwent both duplex sonography (16 Acuson, seven Quantum) and angiography were evaluated. In 14 patients, there was an accurate or slight underestimate (less than 20%) of stenosis present in the internal carotid artery contralateral to an artery with tight stenosis/occlusion. In nine, a velocity increase in the internal carotid artery resulted in overestimation (10-80%) of the actual degree of stenosis. In one of these nine patients, real-time images were sufficient to explain the velocity increase on the basis of vessel tortuosity. In one, falsely elevated velocity resulted from inaccurate assignment of the Doppler angle of incidence in a patient in whom real-time visualization of a distal internal carotid lesion was poor. In four of the nine patients, cross filling via the circle of Willis toward the side of greater stenosis occurred. However, seven of 14 patients in whom there was duplex sonography/angiography agreement or slight duplex sonography underestimation also had cross filling. Vertebral artery patency did not correlate well with the presence of a "jet effect." These findings suggest that an increase in blood flow velocity with duplex Doppler sonography in the internal carotid artery on the side opposite an artery with a tight stenosis is a common source of error and is not readily explained by angiographic evidence of collateral flow.     

Duplex Doppler sonography of the carotid artery: false-positive results in an artery contralateral to an artery with marked stenosis

Anecdotal reports have described a false-positive "jet effect" or velocity increase in the carotid artery contralateral to an artery with significant stenosis or occlusion when using duplex Doppler sonography. In this study, the frequency, significance, and possible reasons for this finding were evaluated by a retrospective comparison of duplex sonography and angiography. Twenty-three patients with unilateral 81-100% carotid artery stenosis who underwent both duplex sonography (16 Acuson, seven Quantum) and angiography were evaluated. In 14 patients, there was an accurate or slight underestimate (less than 20%) of stenosis present in the internal carotid artery contralateral to an artery with tight stenosis/occlusion. In nine, a velocity increase in the internal carotid artery resulted in overestimation (10-80%) of the actual degree of stenosis. In one of these nine patients, real-time images were sufficient to explain the velocity increase on the basis of vessel tortuosity. In one, falsely elevated velocity resulted from inaccurate assignment of the Doppler angle of incidence in a patient in whom real-time visualization of a distal internal carotid lesion was poor. In four of the nine patients, cross filling via the circle of Willis toward the side of greater stenosis occurred. However, seven of 14 patients in whom there was duplex sonography/angiography agreement or slight duplex sonography underestimation also had cross filling. Vertebral artery patency did not correlate well with the presence of a "jet effect."(ABSTRACT TRUNCATED AT 250 WORDS)