搏动性耳鸣患者的颈内静脉血流动力学超声研究

The hemodynamic study of internal jugular vein in patients with pulsatile tinnitus by color doppler sonography

目的:探讨超声在搏动性耳鸣诊断中的应用价值以及搏动性耳鸣与颈内静脉优势引流的关系。方法:搏动性耳鸣患者221例,运用彩色多普勒超声扫查双侧颈内静脉,行患侧颈内静脉压迫试验(压颈试验),按压颈试验结果分成阳性组及阴性组。对比阳性组患侧及健侧颈内静脉上、中、下各段的血流动力学数据。分析耳鸣与颈内静脉优势引流的相关性。结果:221例搏动性耳鸣的患者中,压颈试验阳性组125例(56.6%),阴性组96例(43.4%)。压颈试验阳性组中109例(87.2%)颈内静脉压迫至闭合后耳鸣消失;16例(12.8%)压迫颈内静脉至部分闭合后耳鸣消失。颈内静脉截面积缩小程度分别为:颈内静脉上段(75.41±9.39)%,中段(80.25±13.16)%,下段(86.58±7.53)%。压颈试验阳性组患侧颈内静脉流量明显高于健侧(P=0.001),阴性组患侧流量与健侧差异无统计学意义。压颈试验阳性组中患侧颈内静脉优势引流者54例(43.2%),非优势引流者71例(56.8%);阴性组中患侧颈内静脉优势引流者24例(25%),非优势引流者72例(75%)。结论:彩色多普勒超声下颈内静脉压迫试验阳性及颈内静脉流量患侧明显高于健侧,有助于静脉源性搏动性耳鸣的鉴别诊断。静脉源性搏动性耳鸣多发生于颈内静脉非优势引流侧。

Objective:To investigate the hemodynamic changes of internal jugular vein(IJV)in patients with pulsatile tinnitus(PT)detected by color doppler sonography(CDS).To explore the correlation of PT with IJV drainage dominance and the value of CDS in the diagnosis of PT.Method:Two hundred and twenty-one patients with PT were examined with the CDS and IJV compression test.The hemodynamic data of the upper,middle and lower IJV were compared with both PT side and unaffected side.The correlation of the PT with the IJV drainage dominance was analyzed.Result:A total of 125 cases(56.6%)of 221 patients with PT underwent ultrasonic IJV compression test with positive results,96 cases(43.3%)with negative results.In the positive compression test group,the tinnitus disappeared after IJV being completely compressed in 109 cases(87.2%),and in 16 cases(12.8%)after IJV being partial closure.The extent of sectional area reduction was:upper jugular vein(75.41±9.39)%,middle jugular vein(80.25±13.16)%,lower jugular vein(86.58±7.53)%.The blood flow volume on the tinnitus side was obviously higher than that on the unaffected side(P=0.001).In the negative compression test group,there was no significant difference in blood flow volume between tinnitus side and unaffected side.In the IJV positive compression test group,54 cases(43.2%)were IJV drainage dominance combined,and 71 cases(56.8%)were non-dominant combined.In the IJV negative compression test group,24 cases(25%)were IJV drainage dominance combined,and 72 cases(75%)were non-dominant combined.Conclusion:The positive result of IJV compression test using CDS and the flow volume of IJV on the affected side significantly higher than that on the unaffected side contributed to the diagnosis of venous PT.In this study,the IJV non-dominant side was more common in the venous PT.