70例锁骨下动脉盗血综合征患者的临床特点分析

The analysis of clinical characteristics in 70 patients with subclavian steal syndrome

目的分析锁骨下动脉盗血综合征(subclavian steal syndrome,SSS)患者的临床特点。方法回顾分析2012年3月~2016年6月就诊于哈尔滨医科大学附属第一医院血管外科的70例锁骨下动脉盗血综合征患者的临床特点,这些患者均经彩色多普勒超声证实为锁骨下动脉盗血,并根据椎动脉血流频谱特征将SSS分为3型,即隐匿型、部分型、完全型。结果 (1)病因为动脉粥样硬化的患者为63例,大动脉炎为7例;(2)44例后循环供血区缺血的SSS患者中出现头晕为38例(86%);34例患侧上肢缺血的SSS患者中表现为麻木20例(59%);(3)51例测得双上肢血压差的患者中双上肢收缩压差≥20 mm Hg为48例(94%),而双上肢舒张压差≥20 mm Hg为34例(67%);(4)30例术后进行随访的患者1~3年后再通率分别为93%、87%和80%;发生再狭窄的患者中遵医嘱进行规律服药的患者仅40%。结论动脉粥样硬化为锁骨下动脉盗血的首要病因;SSS患者临床症状以后循环供血区缺血和患侧上肢缺血为主,其中以头晕和患侧上肢麻木最常见;双侧收缩压差≥20 mm Hg较双侧舒张压差≥20 mm Hg提示SSS更敏感;未遵医嘱进行合理二级预防可能是再狭窄的重要原因。

Objective To analyse the clinical characteristics of the patients with subclavian steal syndrome （SSS）.Methods The clinical characteristics of 70 patients with subclavian steal syndrome,treated in the vascular surgery department of the first affiliated hospital of Harbin medical university from the March of 2012 to the June of 2016,were analyzed retrospectively.These patients were all proved as subclavian artery steal blood with the results of the Color Doppler ultrasonography,and were classified into 3 types on the basis of their retrograde flow in the vertebral arteries： the insidious type,the partial type and the complete type.Results （1） There were 63 patients with atherosclerosis and 7 patients with Takayasu arteritis among the patients.（2） There were 38 patients（86%） with dizziness among 44 patients with posterior circulation ischemia,and there were 20 patients（59%） with numbness among 34 patients with upper limb ischemia.（3） Among the patients whose blood pressure difference between bilateral arms were available,48 patients＇＇ （94%） systolic blood pressure difference was greater than 20 mmHg,while 34 patients＇＇ （67%） diastolic blood pressure difference was more than 20mmHg.（4） The vascular reperfusion rate of the 30 patients who were followed up after surgery which had been taken 1 to 3 years was 93%,87% and 80%,respectively.Among the patients with vascular restenosis,the rate of patients who were given regular medication according to the doctor＇＇s advice was just 40%.Conclusion The leading cause of subclavian steal syndrome was atherosclerosis.The clinical symptoms of posterior circulation ischemia and the upper limb ischemia were the major symptoms in SSS,and the dizziness and the upper limb numbness were the most common symptom among them.The systolic blood pressure difference exceeding 20 mmHg was more susceptible to SSS than the diastolic blood pressure difference.Failing to follow the doctor＇＇s advice for reasonable two-level prevention might be an important cause of restenosis.