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背景:颈椎退行性变等造成的骨质增生可能会压迫椎动脉,引起椎基底动脉供血不足。尤其在头位改变时更易于出现症状,迫使患者处于强迫头位。目的:用经颅多普勒超声连续观察与头位改变相关的椎基底动脉供血不足症状与后循环血流改变的关系。设计:随机分组对照观察,自身前后对照。单位:广西壮族自治区民族医院神经科和北京大学第一医院神经科。对象:2003-03/2004-05收集广西壮族自治区民族医院神经科的椎基底后动脉供血不足患者20例及正常对照组10例。方法:以头中位大脑后动脉前段血流速度为基值。比较头左转、右转、前屈、后仰时血流速度变化,并观察出现椎基底动脉供血不足的症状,进行个体本身,组内、组间显著性比较。主要观察指标:各组对象不同头位改变时血流速度变化差值,并观察出现椎基底动脉供血不足的症状。结果:在监测中出现症状者9例,无症状11例。正常对照组头左转、右转与后仰时血流改变与自身头中位比较差异无显著性意义,头前屈时显著下降(P<0.05),无1例出现临床症状。监测时转头出现症状组患者头前屈时血流下降与自身头中位比较差异有显著性意义(P<0.05),头后仰时血流下降与自身头中位比较差异有显著性意义(P<0.001)。监测时转头无症状组头左转和后仰血流下降差值与自身头中位比较差异有显著性意义(P<0.05)。结论:连续观察大脑后动脉血流在不同头位改变时出现的改变,可以客观评价颈部活动引起椎动脉血流下降程度及与临床的关系。
Background: Bone hyperplasia caused by degenerative cervical spine may compress vertebral artery and cause vertebrobasilar insufficiency. In particular, head changes more prone to symptoms, forcing the patient in forced head position. OBJECTIVE: To observe the relationship between vertebrobasilar insufficiency symptoms and changes of posterior circulation blood flow by transcranial Doppler ultrasound. Design: randomized controlled observation, before and after their own control. Unit: Department of Neurology, National Hospital of Guangxi Zhuang Autonomous Region and Department of Neurology, Peking University First Hospital. PARTICIPANTS: Twenty patients with vertebrobasilar insufficiency and 10 normal controls were enrolled in the Department of Neurology, National Hospital of Guangxi Zhuang Autonomous Region from March 2003 to May 2004. Methods: The head of the posterior cerebral artery blood flow velocity as the base value. Compare the head and left turn, right turn, flexion, backwards when the blood flow velocity changes, and observed vertebrobasilar insufficiency symptoms, the individual itself, within the group, the significant difference between the groups. MAIN OUTCOME MEASURES: Differences in blood flow velocity between different groups with different head positions were observed, and the symptoms of vertebrobasilar insufficiency were observed. Results: 9 cases showed symptom in monitoring and 11 cases were asymptomatic. No significant difference was found between the changes of blood flow and the median head position in the control group (left turn, right turn and backwards), and significant decrease in head flexion (P <0.05). No clinical symptoms were found in 1 case. There was a significant difference in blood flow decline between the symptom onset group and the median head position (P <0.05), and there was significant difference between the head blood pressure reduction and the median head position (P <0.001). There was a significant difference between the left head turn and the backward head blood flow in the asymptomatic head group and the median head position during the monitoring (P <0.05). CONCLUSION: Continuous observation of changes of posterior cerebral artery blood flow in different head positions can objectively evaluate the degree of decline of vertebral artery blood flow induced by cervical activity and its clinical relationship.