乳内动脉窃血的彩色多普勒超声表现

Color Dopplor ultrasonographic diagnosis of internal mammary artery retrograde steal flow

目的探讨锁骨下动脉近段狭窄或闭塞时乳内动脉窃血的超声表现。方法对100例准备行冠状动脉搭桥术患者的200支乳内动脉行超声检查,二维超声观察血管壁有无增厚、管腔有无狭窄并测量内径,彩色多普勒血流成像(CDFI)显示血流充盈情况及方向,脉冲多普勒超声观察血流频谱形态及方向。如发现异常(如血流速减低或血流方向反向时),则进一步检查双侧颈动脉、椎动脉、锁骨下动脉及无名动脉起始部,常规记录各种血流动力学参数,并判断其狭窄程度。结果6例患者的7支乳内动脉出现异常,其中6支乳内动脉为部分或完全倒流,并伴椎动脉部分或完全倒流;1支乳内动脉虽未倒流,但伴有锁骨下动脉其他分支倒流。6例均伴有锁骨下动脉近段狭窄或闭塞。结论锁骨下动脉近心段狭窄程度需结合各分支窃血情况综合判断,窃血程度可能与狭窄程度相关;冠状动脉搭桥术前应常规检查乳内动脉血流情况。

Objective To analyze the characteristics of internal mammary artery （IMA） retrograde steal flow combined together with subclavian artery （SCA） proximal stenosis or occlusion in 100 patients before coronary artery graft bypass （CABG）. Methods IMAs were checked before CABG as a role, and the stenostic degree, blood flow and direction of SCA were observed. The blood flow parameters and direction were detected with pulsed Dopplor. SCAs were observed to identify the degree of stenosis. Results Seven abnormal IMA were found in this study. Partial or total retrograde flow were found in 6 IMA together with vertebral artery retrograde flow and 1 retrograde flow in another branch of SCA. Conclusions We should judge the severity of stenosis of subclavian and innominate arteries depending on not only the vertebral retrograde steal flow, but also other branches of subclavian arteries. In addition, we should examine IMA routinely before CABG .