原发性高血压患者脑部与颈部血流动力学的变化

Cerebral Arteries and Carotid Artery Hemodynamics in Essential Hypertension Patients

目的探讨原发性高血压(EH)患者脑部和颈部血流动力学的变化,为脑卒中的一级预防提供临床依据。方法确诊为EH患者225例,根据高血压病程长短分为≤5年组(n=62);5～10年组(n=72);10～15年组(n=43)和15～20年组(n=48)。按《2005中国高血压防治指南》的高血压分级,根据血压控制水平分为3级,分别为1级(n=30),2级(n=61)和3级(n=129),选择同期检测的无高血糖、高血脂及血压正常的患者作为对照组(n=94)。采用经颅多普勒超声(TCD)检测大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)以及椎动脉(VA)的平均血流速度(Vm)和搏动指数(PI),采用颈部B超检测颈总动脉(CCA)、颈内动脉(ICA)以及VA的Vm和PI,比较EH各组和对照组的脑部和颈部血流动力学指标的差异。结果血压水平愈高,脑血管和颈部血管的Vm愈低,而PI愈高(P<0.05)。高血压级别与颈部和脑部血管的Vm呈负相关(P<0.05),与PI呈正相关(P<0.05)。EH病程愈长,脑血管和颈部血管的Vm愈低,而PI愈高(P<0.05)。EH病程与颈部和脑部血管的Vm呈负相关(P<0.05),与PI呈正相关(P<0.05)。结论随着血压水平增加和EH病程的延长,EH患者的脑部和颈部血流动力学改变越来越明显,Vm降低,PI升高,提示脑灌注不足。

Objective To investigate the changes of cerebral and carotid hemodynamics in essential hypertension patients. Methods Two hundred twenty-five patients with essential hypertension（EH） were enrolled. Based on duration of hypertension, patients were divided into group A（ 〈5 years, n = 62 ）, group B（ 5-10 years, n = 72 ）,group C（10-15 years, n=43） and group D （15-20 years, n=48）. According to the BP level, patients were graded as grade 1（n=30）, grade 2（n=61） and grade 3（n=129） with healthy subjects as control（n=94）. The average blood flow rate（Vm） and pulsatility index （PI） of middle cerebral artery（MCA）, anterior cerebral artery（ACA）, posterior cerebral artery（PCA） and vertebral artety （VA） were detected by transcranial Doppler sonography（TCD） and colour Doppler ultrasonography. The Vm and PI of common carotid artery（CCA）, internal carotid artery （ICA） and VA were detected by colour Doppler ultrasonography. Results The Vm of cerebrovascular vessels and carotid artery were decreased, while PI were increased in parallel with increasing BP （P〈0.05）. There were negative correlations between blood pressure level and Vm in cerebral hemodynamics and carotid hemodynamics （P〈0.05）, and positive correlation between blood pressure level and PI（P〈0.05）. The Vm of cerebrovascular vessels and carotid artery were decreased, PI were concomitantly increased with the increasing duration of hypertension（P〈0.05）. There were negative correlations between the duration of EH and Vm in cerebral hemodynamics and carotid hemodynamics（P〈0.05）, and positive correlation between the duration and PI（P〈0.05）. Conclusion Alteration in cerebral and carotid hemodynamics in hypertension patients are closely related with the severity and duration of hypertension, demonstrated by decreases in blood flow velocity and decreases in pulse index.