微血管舒张功能障碍及体外反搏的改善作用

Microvascular Diastolic Dysfunction and Its Improvement with Enhanced External Counterpulsation

目的：通过测定微血管血流灌注来反映微血管的舒张功能，同时观察体外反搏治疗改善冠心病患者微血管舒张功能障碍的效果。方法：应用激光多普勒血流量计（ＬＤＦ） ，测量５８ 个被观察者的前臂皮肤在反应性充血前后微血管血流灌注增加比值，评价血流介导的微血管舒张功能。结果：冠心病组、高胆固醇血症组及吸烟组微血管舒张功能明显低于对照组，比值分别为１．８３±０．３７、２．６３±０．５１、３．１９ ±０．５６ 比３．５６±０．３６ ；Ｐ分别＜ ０．０１，＜０．０１，＜ ０．０５。冠心病组反搏治疗前后比，其微血管的舒张功能明显提高，比值为１．８３±０．３７ 比２．５４±０．４３； Ｐ＜０．０１。结论：ＬＤＦ可检测冠心病患者明显的微血管舒张功能障碍及高胆固醇血症者和吸烟者微血管功能的异常；体外反搏治疗可改善冠心病患者的微血管舒张功能。

Objectives: Microvascular blood perfusion detected by Laser Doppler Flowmetry (LDF) during reactive hyperaemia was applied to reflect the microvascular diastolic dysfunction and to assess the therapeutic effect of enhanced external counterpulsation(EECP) on the dysfunction in patients with coronary artery disease(CAD). Methods: Laser Doppler Flowmetry (LDF) was used to measure the microvascular blood perfusion of forearm skin in subjects (n=58) with known coronary artery disease, hypercholesterolaemia and smoking before and during reactive hyperaemia (with increased flow causing endothelium-dependent dilation). The increased microvasular perfusion against basic level during reactive hyperaemia was used to evaluate microvacular diastolic function. Results: The microvascular diastolic function was much reduced in patients with known CAD and decreased in hypercholesterolaemic subjects and smokers for comparison with control group(1 83±0 37, 2 63±0 51,3 19±0 56 to 3 56±0 36 P<0 01, 0 01, 0 05) The dysfunction was improved in patients with CAD after the treatment of EECP than that before the treatment (2 45±0 43 to 1 83±0 37, P<0 01). Conclusion: The results showed that LDF could test the different microvascular dysfunction in patients with CAD, hypercholesterlaemic subjects and smoker. The treatment of EECP could improve microvascular diastolic dysfunction in patients with CAD.