TCD诊断锁骨下动脉盗血的临床价值——附34例病例分析

Clinical diagonstic value of transcranial Doppler in the patients with subclavian steal syndrome: An analysis of 34 cases

目的通过对锁骨下动脉盗血(SSS)病例的观察,了解锁骨下动脉盗血的常见临床表现、体征,分析影响锁骨下动脉盗血分型的因素,分析盗血不同分期的症状、体征的特点。方法回顾性总结34例经TCD检查证实有锁骨下动脉狭窄或闭塞的患者;TCD判断盗血的方法:根据同侧椎动脉血流方向及频谱特征将盗血程度区分为:1期收缩期有切迹;2期收缩期血流部分反向;3期(完全盗血)血流完全反向。结果1.34例均经TCD检出,颈部血管超声有12例漏诊,检出率64.7%。2.表现为盗血综合症的有30例,占88.2%,其中,1期盗血11例,2期盗血10例,3期盗血9例;通过辅助检查TCD表现有盗血现象的即无症状的有4例,占11.8%,其中3例为盗血1期,1例为2期。3.表现有上肢缺血症状的患者共有9例,仅占26.5%,其中有7例行DSA检查,均为严重狭窄或闭塞。盗血3期出现患侧上肢缺血症状的比例增高;盗血的不同分期,出现椎基底动脉供血不足症状的比例之间无显著性差异。4.锁骨下动脉盗血II期及III期比盗血I期其收缩压差(≥20mmHg)(P<0.05)有显著性差异。结论1.TCD是诊断SSS敏感可靠的方法,在患者尚无临床症状和体征时(我们称之为盗血现象)已能检出盗血。2.表现有上肢缺血症状时提示锁骨下动脉狭窄可能已较严重;3.盗血3期出现患侧上肢缺血症状的比例增高;是否出现椎基底动脉供血不足症状与盗血的不同分期无关。4.SSS患者双侧收缩压差较舒张压差更有意义,盗血3期均有收缩压差≥20mmHg的体征,但即使收缩压差<20mmHg也不能排除SSS。

Objective To analyse the clinical behavior and sign of the Subclavian steal syndrome （SSS） and the feature and affected factors in different stage of SSS in 34 patients. Methods The data of 34 patients with SSS were aualysed in vetrospect, and according to the narrow degree of subclavian artery the SSS were divided into 3 stages： deceleration in systole, alteration flow with reversed flow in systole and normal flow in diastole, reversed flow completely. Results Amdidst the 34 patients 12 cases missed diagnosis by uhrasonograply,so it only 64.7% were found. There are 30 patiets（88.2%） who had the clinical behavior, among them, stage Ⅰ was 11 cases, stage Ⅱ 10 cases, stage Ⅲ 9 cases. Nine 9 patiets （26.5%） had ischemia symptom of upper limbending, after DSA checred them 7 patients showed serious narrow or occlusion. In the patiemts of stage Ⅱ or Ⅲ the systocic pressure diffesence between two upper limbs was ≥ 20 mmHg , and had siginificant difference between stage Ⅰ and stage Ⅱ or stage Ⅲ （P〈0.05）. Conclusion TCD is a sensitive and reliable method for the diagnosis of SSS. As the patients have the ischemia symptom of upper limb, that shows their sabclavian artery have been serious narrow or occlusion. The systolic blood pressure difference of upper limb is more important than diastolic blood pressure difference for Patients in diagnosis of SSS.