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临床上主动脉瓣关闭不全(aortic regurgitation,AR)的研究主要集中在对心功能及冠状动脉灌注的评估上,而对外周血管的影响研究较少,对颈动脉、桡动脉、腹主动脉血流的影响有见报道,对椎动脉的血流影响则未见报道。我们认为椎动脉位置深在,尤其肥胖及老年病人二维图像不如颈动脉清晰,且影响椎动脉血流频谱变化因素较多,所以对椎动脉血流频谱变化进行正确分析,早期明确病变部位,采取准确、合理治疗方法对病人预后有着重要意义。本文旨在探论单纯主动脉瓣反流对椎动脉血流频谱的影响。
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两峰值相近或相等的重搏波在主动脉瓣轻、中、重度反流病人中出现的例数分别为5例、13例、17例,分别占该亚组的24%、62%、81%,重搏波出现的例数占主动脉瓣反流总数的55%(见图 1)。
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轻度AR组中未见出现舒张期血流达基线或反向;中度AR组有5例达基线, 3例反向;重度AR组有4例达基线,11例反向。中、重度AR组出现舒张期血流频谱异常分别占该亚组的38%、71%(见图 2)。
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3组共有14例重搏波与舒张期血流达基线或舒张期血流反向同时出现,其中中度AR组3例,重度AR组11例(见图 3)。
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与对照组相比,轻度AR组椎动脉PSV、EDV、RI差异均无统计学意义(P>0.05);观察组PSV和EDV均随着主动脉瓣反流程度的增加而降低(P < 0.01),而RI随着主动脉瓣反流程度的增加而升高(P < 0.01)(见表 1)。
分组 n PSV/(cm/s) EDV/(cm/s) RI 对照组 21 52.75±2.40 19.38±1.78 0.63±0.02 轻度AR组 21 52.72±3.69 18.77±1.59 0.64±0.03 中度AR组 21 49.07±2.02**△△ 12.50±1.48**△△ 0.75±0.02**△△ 重度AR组 21 65.15±6.12**△△## 6.32±1.72 0.82±0.24**△△## F — 68.23 290.95 11.80 P — < 0.01 < 0.01 < 0.01 MS组内 — 15.228 2.711 0.015 q检验:与对照组比较** P < 0.01;与轻度AR组比较△△P < 0.01;与中度AR组比较## P < 0.01 表 1 各组间椎动脉血流参数的比较(x±s)
单纯主动脉瓣反流对椎动脉血流频谱影响的分析
Analysis of the effects of pure aortic regurgitation on the vertebral artery blood flow spectrum
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摘要:
目的探讨单纯主动脉瓣反流对椎动脉血流频谱的影响。 方法选择2015年1月至2018年4月63例主动脉瓣反流病人作为观察组,其中,轻、中、重度主动脉瓣关闭不全(AR)组各21例;同期选取21例作为对照组,经胸超声心动图及颈椎动脉超声检查均无明显异常。分别记录观察组和对照组双侧椎动脉频谱曲线,观察频谱形态,分析血流动力学参数,包括收缩期最大流速(PSV)、舒张期末血流速度(EDV)、阻力指数(RI)。 结果两峰相近或相等的收缩期重搏波可在轻、中、重度AR组中出现,出现率分别为24%、62%、81%;中度AR组有5例舒张期血流达基线,3例反向,重度AR组有4例达基线,11例反向;收缩期重搏波与舒张期血流达基线或舒张期血流反向同时出现14例;与对照组相比,轻度AR组椎动脉PSV、EDV、RI差异均无统计学意义(P>0.05);观察组EDV随着主动脉瓣反流程度的增加而降低(P < 0.01),而RI随着主动脉瓣反流程度的增加而升高(P < 0.01)。 结论收缩期重搏波可出现在主动脉瓣轻、中、重度反流病人中,舒张期血流达基线或反向仅在中度和重度主动脉瓣反流中出现。当椎动脉出现上述血流频谱改变时高度怀疑AR。 Abstract:ObjectiveTo investigate the effects of pure aortic regurgitation on the vertebral artery blood flow spectrum. MethodsSixty-three patients with aortic regurgitation from January 2014 to April 2017 were set as the observation group, and subdivided into the mild, moderate and severe aortic insufficiency(AR) (21 cases in each group).Twenty-one cases with normal transthoracic echocardiography and cervical artery ultrasound were set as the control group.The bilateral vertebral artery spectrum curves and spectrum morphology in two gorups were observed, and the hemodynamic parameters(including PSV, EDV and RI) in two groups were analyzed. ResultsThe systolic heavy wave with similar or equal peaks appeared in the mild, moderate and severe AR groups, the occurrence rates of which were 24%, 62% and 81%, respectively.Five cases with diastolic blood flow reaching baseline and 3 cases with reverse in moderate AR group, and 4 cases with diastolic blood flow reaching baseline and 11 cases with reverse in severe AR group were identified.Fourteen cases with systolic heavy wave complicated with diastolic blood reaching baseline or diastolic blood flow reverse were found.The differences of the PSV, EDU and RI of vertebral artery were not statistically significant between the control group and mild AR group(P>0.05).In observation group, the EDV decreased, and RI increased with the increase of AR(P < 0.01). ConclusionsThe systolic heavy wave can occur in patients with mild, moderate and severe AR, and the diastolic blood flow reaching baseline or reverse only occurs in moderate and severe AR.AR is highly suspected when the vertebral artery presents the above changes in the blood flow spectrum. -
Key words:
- aortic regurgitation /
- vertebral artery /
- Doppler spectrum
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表 1 各组间椎动脉血流参数的比较(x±s)
分组 n PSV/(cm/s) EDV/(cm/s) RI 对照组 21 52.75±2.40 19.38±1.78 0.63±0.02 轻度AR组 21 52.72±3.69 18.77±1.59 0.64±0.03 中度AR组 21 49.07±2.02**△△ 12.50±1.48**△△ 0.75±0.02**△△ 重度AR组 21 65.15±6.12**△△## 6.32±1.72 0.82±0.24**△△## F — 68.23 290.95 11.80 P — < 0.01 < 0.01 < 0.01 MS组内 — 15.228 2.711 0.015 q检验:与对照组比较** P < 0.01;与轻度AR组比较△△P < 0.01;与中度AR组比较## P < 0.01 -
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