单侧颈动脉狭窄患者血压水平对颈动脉血流的影响

The effect of blood pressure on carotid haemodynamics in unilateral carotid stenosis patients

目的:通过彩超检查分析单侧颈动脉狭窄患者血压水平对血流参数的影响,探讨脑卒中预防的理想血压水平。方法:将198例单侧颈动脉狭窄患者分别按彩超检查前测量的SBP(SBP)和舒张压(DBP)具体水平分别分为SBP3个组和DBP3个组。用彩超测量其双侧颈总动脉(CCA)、颈内动脉(ICA)及椎动脉(VA)各血流参数:收缩期峰值流速(PSV)、舒张期末流速(EDV)、血管搏动指数(PI)、血管阻力指数(RI)及血管内径(D)。结果:血压水平主要影响狭窄侧颈动脉血流,同时也影响非狭窄侧颈动脉和对侧椎动脉血流速度和内径。SBP和DBP分别增高>120mmHg及80mmHg血流速度最慢,血管内径最宽;SBP降至100～120mmHg,DBP保持60～80mm-Hg时血管内径最细,速度最快。结论:严格控制SBP和DBP水平有益于提高颈动脉血流速度,增加脑血流量;SBP100～120mmHg,DBP60～80mmHg可能是单侧颈动脉狭窄患者较理想的血压水平。

Objectives： To explore the ideal blood pressure level to prevent stroke in unilateral carotid stenosis patients, by analysis the effect of blood pressure on carotid haemodynamics. Methods： The 198 consecutive unilateral carotid stnosis patients were categorized into 3 systolic blood pressure （SBP） groups and 3 diastolic blood pressure （DBP） groups respectively, according to their SBP and DBP, respectively. Then they were checked and recorded the carotid heamodynamics by color duplex ultrasonography, including systolic peak velocities （PSV）, end diastolic velocities （EDV）, pulsatility indexes （PI）, resistant indexes （RI）, and the insider diameters （D） of bilateral common carotid artery （CCA）, internal carotid artery （ICA）and vertebral artery （VA）. Results： The blood pressure had the main effect on the confined carotid hemodynamics, and also had some effects on the hemodynamics indexes of unstenosed carotid artery and vertebral artery. The biggest D and the smallest blood flow velocities were appeared at SBP of 〉120 mm Hg and DBP of 〉80 mmHg. On the other contrary, the smallest D and the biggest blood flow velocities were appeared at SBP of 100 to 120 mmHg and DBP of 60 to 80 mmHg. Conclusion： It was necessary to control SBP and DBP at a lower level to improve the carotid blood flow velocity and cerebral blood flow. SBP of 100 to 120 mmHg and DBP of 60 to 80 mmHg were believed as the proper level for unilateral carot id stenosis patients to prevent stroke.