大脑后动脉血流与头位改变及椎基底动脉供血不足症状的关系

背景:颈椎退行性变等造成的骨质增生可能会压迫椎动脉,引起椎基底动脉供血不足。尤其在头位改变时更易于出现症状,迫使患者处于强迫头位。目的:用经颅多普勒超声连续观察与头位改变相关的椎基底动脉供血不足症状与后循环血流改变的关系。设计:随机分组对照观察,自身前后对照。单位:广西壮族自治区民族医院神经科和北京大学第一医院神经科。对象:2003-03/2004-05收集广西壮族自治区民族医院神经科的椎基底后动脉供血不足患者20例及正常对照组10例。方法:以头中位大脑后动脉前段血流速度为基值。比较头左转、右转、前屈、后仰时血流速度变化,并观察出现椎基底动脉供血不足的症状,进行个体本身,组内、组间显著性比较。主要观察指标:各组对象不同头位改变时血流速度变化差值,并观察出现椎基底动脉供血不足的症状。结果:在监测中出现症状者9例,无症状11例。正常对照组头左转、右转与后仰时血流改变与自身头中位比较差异无显著性意义,头前屈时显著下降(P<0.05),无1例出现临床症状。监测时转头出现症状组患者头前屈时血流下降与自身头中位比较差异有显著性意义(P<0.05),头后仰时血流下降与自身头中位比较差异有显著性意义(P<0.001)。监测时转头无症状组头左转和后仰血流下降差值与自身头中位比较差异有显著性意义(P<0.05)。结论:连续观察大脑后动脉血流在不同头位改变时出现的改变,可以客观评价颈部活动引起椎动脉血流下降程度及与临床的关系。

Relationship between blood flow velocity of posterior cerebral artery and vertebrobasilar insufficiency during various head postures

BACKGROUND: Osteophyte caused by degenerative osteoarthropathy of the cervical vertebrae may compress the vertebral artery, resulting in vertebrobasilar insufficiency, especially when the patients' head postures change, making them adapt forced head position.OBJECTIVE: To investigate successively the relationship between the change of flow velocity of the posterior circulation and the symptom of vertebrobasilar insufficiency during various head postures with transcranial Doppler ultrasound.DESIGN: Randomized grouping controlled, auto-control observation.SETTING: Department of Neurology, Guangxi Minzu Hospital and Department of Neurology, First Hospital, Peking University.PARTICIPANTS: A total of 20 patients with vertebrobasilar insufficiency and 10 normal persons were enrolled from Department of Neurology,Guangxi Minzu Hospital between March 2003 and May 2004.METHODS: Regard blood flow velocity in natural position of anterior segment of posterior cerebral artery as baseline values. Blood flow velocity was compared at left rotation, right rotation, anterior inflexion and posterior inflexion. Symptoms of vertebrobasilar insufficiency were observed. The data were collected and compared in individuals, within group, and between groups.MAIN OUTCOME MEASURES: Blood flow velocity difference of various head postures in each group; Symptoms of vertebrobasilar insufficiency were observed.RESULTS:During monitoring, there were 9 cases complained of ischemic symptoms and 11 cases without symptoms. There was no significant difference in blood flow change of left rotation, right rotation and posterior inflexion in the normal control group with natural position. The reduction of flow velocity was significant in anterior inflexion (P ＜ 0.05 ), and none appeared clinical symptom. There was significant difference in reduction of blood flow at anterior inflexion and at natural position in patients with symptom (P ＜ 0.05), and there was significant difference in reduction of blood flow at posterior inflexion and natural position (P ＜ 0.001 ). There was significant difference in reduction of blood flow at left rotation and posterior inflexion in those without symptom during monitoring as compared with that at natural position (P ＜ 0.05 ).CONCLUSION: Continuously observing the blood flow in posterior cerebral artery at different head position can objectively assess the relationship between decrease of blood flow velocity of vertebral arteries induced by neck movements and clinical symptoms.