彩超评价原发性高血压对老年肾脏血流动力学参数的影响

Evaluation of the influence of essential hypertension upon hemodynamics of renal arteries in elderly patients by color Doppler imaging

目的应用多普勒超声技术观察、分析老年原发性高血压患者肾脏血流动力学的改变,为临床进行早期干预、治疗提供参考指标。方法将我院住院的45例老年原发性高血压患者分成2组,即血压控制不佳组(A组)和血压控制尚好组(B组),并选取20例正常老年人作为对照组(C组),均进行肾动脉彩色多普勒超声检查,分别获得三级肾动脉(肾主动脉、肾段动脉、叶间动脉)的收缩期最大流速(PSV)、舒张末期最低流速(EDV)、收缩期加速时间(AT)和阻力指数(RI),在此基础上将2组高血压患者分别与C组进行对比研究。结果老年人在非空腹状态下检查,肾动脉的显示满意率为94.6%。A组中发现3例肾动脉狭窄疑似病例。A组三级肾动脉的EDV较C组减低,RI较C组增高,差异显著(P均<0.05),而PSV、AT比较无显著差异(P>0.05)。B组肾动脉的各项血流参数与C组间均无显著差异(P>0.05)。结论对于条件合适的老年人,可以适度放宽超声检查前的准备要求。对于长期血压波动的老年人,应定期做肾动脉检查,及时排除动脉粥样硬化性肾动脉狭窄。老年人控制高血压对于预防高血压肾病有重要意义;肾动脉的RI可作为高血压引起肾功能损害的监测指标之一。

Objective To evaluate the influence of long-term essential hypertension upon hemodynamics of renal arteries in elderly patients by color Doppler imaging,so as to provide reference index for early clinical intervention and treatment. Methods Forty-five elderly hospitalized patients with long-term essential hypertension were enrolled in this study and were divided into two groups.In group A,the blood pressure was poorly controlled,and in group B,the blood pressure was controlled within normal range.Another 20 age-matched people without hypertension were selected as the control group（group C）.Their renal arteries,including renal artery（RA）,segmental renal artery（SRA）,interlobar renal artery（IRA）,were detected by color Doppler flow imaging and were analyzed to get the peak systolic velocity（PSV）,end diastolic velocity（EDV）,accelerating time（AT） and resistant index（RI）.Then those findings of these groups were compared. Results Though all the detections were not performed on an empty stomach,94.6% of the renal arteries showed with satisfaction.Three suspected cases of renal artery stenosis were found in group A.The display of the EDV of renal arteries was significantly lower and the RI was significantly higher in group A than those in group C（all P0.05）.No significant difference was found in all the indexs between group B and group C（P0.05）. Conclusions For those aged people with suitable condition,it is advisable for them not so strictly to achieve to the requirements of preparation before taking sonography.While for those with badly controlled blood pressure,it is necessary to take renal artery examination regularly in order to exclude atherosclerotic renal artery stenosis in time.Elderly patients should attach great importance to preventing the progress of hypertension and doing damage to their kidneyes;And it is possible for people to take RI as one of the indexes to monitor the damage to kideny caused by hypertension.