彩色多普勒超声检测老年高血压患者颈动脉重构与血流动力学变化

Carotid artery remodeling and hemodynamic change detected with color Doppler ultrasonography in aged patients with hypertension

目的探讨老年高血压患者颈动脉结构及血流动力学特征。方法老年高血压患者81例,按高血压类型分为单纯收缩期高血压组42例(A组),收缩压和舒张压均增高组39例(B组)。对照组为30名健康老年人。二维超声测量颈总动脉内膜-中层厚度(IMT)、收缩期、舒张期内径,观察颈总动脉斑块情况;脉冲多普勒超声测量颈总动脉收缩期峰速度(PSV)、舒张末期流速(EDV)、平均流速(Vmean)、阻力指数(RI)、搏动指数(PI)。结果与对照组比较,A、B组颈总动脉IMT、僵硬度、RI升高(P<0.01),扩张性、EDV、Vmean降低(P均<0.05),A组PI升高(P<0.01),B组PSV降低(P<0.05);A组颈总动脉僵硬度、PSV、RI、PI高于B组(P均<0.05),扩张性和EDV低于B组(P<0.01);A、B组斑块发生率均高于对照组(P均<0.05);收缩压、脉压与颈总动脉内径、IMT、EDV、Vmean、RI、PI密切相关。结论老年高血压患者颈动脉发生重构及血流动力学改变,单纯收缩期高血压患者血管壁顺应性差于收缩压和舒张压均增高患者。收缩压及脉压对颈动脉重构及血流动力学影响较大。

Objective To investigate the carotid artery structure and hemodynamic property in aged patients with hyperten sion. Methods Eighty-one aged patients with hypertension and 30 healthy aged subjects underwent color Doppler ultra sonography. The patients were divided into isolated systolic hypertension group （group A, n=42） and both systolic and di astolic hypertension group （group B, n=39） according to hypertension types. Intima-media thickness （IMT）, systolic diameter and diastolic diameter were respectively measured in the common carotid artery （CCA） by 2D ultrasound, and the plaque of CCA was observed simultaneously. Peak systolic Velocity （PSV）, end diastolic velocity （EDV）, mean velocity （Vmean）, resistance index （RI） and pulsatility index （PI） were measured in CCA by pulsed wave Doppler ultrasound. Results Compared with the control group, patient group showed increased IMT, rigidity and RI （P〈0.01） and reduced dilatancy, EDV and V （P〈0.01 or P〈0. 05）, while group A showed increased PI （P〈0.01） and group B showed reduced PSV （P〈0.05）. Compared with group B, the rigidity, PSV, RI and PI of group A increased （P〈0.01 or P〈0.05）, but the EDV and dilatancy reduced. The incidence of plaque was higher than that of control group both in group A （P〈0.01） and group B （P〈0.05）. Contractive pressure and pulse pressure were closely correlated with IMT, EDV, V RI, PI and inner di- ameter of CCA. Conclusion Carotid artery remodeling and hemodynamics changes occur in aged patients with hypertension. The vessel wall complaisance of patients with isolated systolic hypertension is inferior than that of systolic and diastolic hypertension. The systolic pressure and the pulse pressure have remarkable influence on carotid artery remodeling and hemody namic changes.