老年尿毒症患者脑血流动力学的分析

Analysis on hemodynamics of cerebral vessels in senile patients with uremia

目的 探讨老年尿毒症患者脑血管血流动力学的变化及其影响因素。方法 采用经颅多谱勒超声 ,分别于血液透析 (血透 )和腹膜透析前后测量收缩期和舒张末期脑血管血流速度 (CABFV) ;监测血压变化 ;微盘测定法和放射免疫法分别检测血清一氧化氮 (NO)和内皮素 (ET)含量的变化 ,对CABFV与血压、血清NO和ET的关系进行分析。结果 老年尿毒症患者CABFV显著低于同龄正常老年人和中青年尿毒症患者 (收缩期 ,P <0 .0 1,舒张末期 ,P <0 .0 5 ) ;血透后CABFV在短期内进一步下降 (P <0 .0 1) ,腹膜透析前后CABFV没有显著变化 ;透析前后血压的变化没有统计学意义 ;血透可使血清NO和ET含量明显下降 (P <0 .0 0 1) ,但血透前血清NO和血透前后血清ET水平均明显高于正常老年人 (P <0 .0 0 1) ,而腹膜透析则对其没有影响 ;血透前收缩期CABFV的变化与血压和血清ET显著负相关 ,与血清NO显著正相关 (P <0 .0 0 1或 P <0 .0 1)。结论 老年尿毒症患者CABFV显著低于同龄正常老年人和中青年尿毒症患者 ,血透后短期内进一步下降 ;尿毒症患者血压、血清NO和ET水平均明显高于正常老年人 ;血透后血清NO和ET水平在一定时间内显著降低 ,而血压无明显改变 ;腹膜透析对上述指标无显著影响 ;血压。

Objectives To investigate the changes of hemodynamics of cerebral vessels and the effects of dialysis on it in senile uremic patients,and to analyse the factors affecting the hemodynamics.Methods Fifty-six senile uremic patients were investigated.Their cerebral artery blood flow velocity(CABFV)during systole and diastasis were weasured with transcranial Doppler,and the CABFV of normal old people or young uremic patients was also measured.Blood pressure(BP) was monitored,changes in serum nitric oxide (NO)were examined with micro tray mensuration,and changes of endothelin(ET) were examined with radioimmunoassay.Correlation analysis between CABFV and BP,serum NO or ET was carried out respectively.Results Compared with that in normal old people and young uremic patients,CABFV in senile uremic patients decreased distinctly( P<0.01 and P<0.05 during systole and diastasis respectively).After hemodialysis(HD),CABFV decreased further in a short period(P<0.01),but continuous ambulatory peritoneal dialysis(CAPD) did not affect CABFV(P>0.05).Changes of BP before and after dialysis had no statistical significance in uremic patients(P>0.05).Serum levels of NO and ET in uremic patients before HD were markedly higher than those in normal old people and decreased notably(P<0.001)after HD,and the level of serum NO after HD decreased significantly as compared with that in normal old people(P<0.001 ).On the other hand,CAPD had no such effects(P>0.05).Before dialysis,the changes of CABFV negatively correlated to BP and serum ET during systole,but positively correlated to serum NO(P<0.001 or P<0.01).Conclusions Compared with that in normal old people and young uremic patients,CABFV in senile uremic patients decreased distinctly.The BP and the levels of serum NO and ET in uremic patients were distinctly higher than those in normal old people.After HD,CABFV decreased further in a short period,but BP had no marked changes.CAPD had no such effects.BP,serum NO and ET are the important factors leading to the decrease in CABFV in senile uremic patients.