老年原发性高血压患者颈内动脉系和椎-基底动脉系颅内外血管血流动力学变化

Hemodynamic changes in the internal and external segments of the internal carotid artery and vertebral basilar artery system in elderly patients with essential hypertension

目的探索不同级别的老年原发性高血压(EH)患者颈内动脉系和椎-基底动脉系颅内外血管血流动力学特点。方法选择200例老年EH患者,将其分为1级高血压组(56例)、2级高血压组(75例)和3级高血压组(69例),另选取70例健康体检者为对照组,均采用经颅多普勒超声和多普勒血流显像检测其颈内动脉系和椎-基底动脉系颅内外血管血流动力学指标并进行比较分析。结果颈内动脉系颅内外段血管血流动力学指标检测结果显示,1级高血压组患者大脑中动脉(MCA)、大脑前动脉(ACA)、颈内动脉(ICA)各项指标与对照组比较均无显著差异(P>0.05);2级高血压组患者MCA、ACA、ICA的收缩期峰值流速(PSV)较对照组和1级高血压组明显减少,舒张末期流速(EDV)较对照组明显减少,差异均有统计学意义(P<0.05);3级高血压组患者MCA、ACA、ICA的PSV较对照组和1级高血压组均明显减少(P<0.05),EDV较对照组、1级高血压组和2级高血压组均明显减少,血管搏动指数(PI)较对照组和2级高血压组明显增加,血管阻力指数(RI)较对照组明显增加,差异均有统计学意义(P<0.05)。椎-基底动脉系颅内外段血管血流动力学指标检测结果显示,1级高血压组患者大脑后动脉(PCA)、椎动脉1(VA1)、基底动脉(BA)、椎动脉2(VA2)的EDV较对照组明显减少,RI较对照组明显增加,差异均有统计学意义(P<0.05);2级高血压组患者PCA、VA1、BA、VA2的EDV、PSV较对照组和1级高血压组均有明显减少,PI和RI较对照组有明显增加,差异均有统计学意义(P<0.05);3级高血压组患者PCA、VA1、BA、VA2的EDV、PSV较对照组、1级高血压组和2级高血压组均有明显减少,PI较对照组、1级高血压组和2级高血压组均有明显增加,RI较对照组和1级高血压组有明显增加,差异均有统计学意义(P<0.05)。结论2,3级高血压患者颈内动脉系PSV、EDV降低,椎-基底动脉系PSV、EDV降低,PI、RI增加,均有重要的临床应用价值。

Objective To explore the ultrasonography of hemodynamic changes in the internal and external segments of the internal carotid artery and vertebral basilar artery system in elderly patients with different grades of essential hypertension. Methods A total of 200 cases of elderly patients with essential hypertension were divided into grade 1 hypertension group（ 56 cases）,grade 2 hypertension group（ 75 cases） and grade 3 hypertension group（ 69 cases）,and 70 healthy cases were selected as control group. The hemodynamic index in internal carotid artery and extracranial and intracranial vertebral basilar artery were compared and analyzed using transcranial doppler ultrasonography and color doppler flow imaging. Results There was no significant difference between grade 1hypertension group and the control group in the hemodynamic parameters of medial cerebral arteria（ MCA）,anterior cerebral arterial（ ACA） and internal carotid artery（ ICA）（ P〉0. 05）; The levels of PSV of MCA,ACA and ICA in grade 2 hypertension group were significantly lower than those in the control group and grade 1 hypertension group（ P〈0. 05）,and the level of EDV in grade 2 hypertension group was significantly lower than that in the control group（ P〈0. 05）. The levels of PSV of MCA、ACA and ICA in grade 3 hypertension group were significantly lower than those in the control group and grade 1 hypertension group（ P〈0. 05）; The levels of EDV in grade 3 hypertension group wassignificantly lower than that in the control group and grade 1hypertension group and grade 2 hypertension group（ P〈0. 05）,and the levels of PI of MAC,ACA and ICA were significantly higher than those in the control group and grade 2hypertension group（ P〈0. 05）,and the levels of RI of MCA,ACA and ICA were significantly higher than those in the control group（ P〈0. 05）. The levels of EDV posterior cerebral arteria（ PCA）,vertebral artery 1（ VA1）,basilar arteria（ BA） and VA2 in grade 1 hypertension groups were significantly lower than those in the control group,and the level of RI were significantly higher than those in the control group（ P〈0. 05）. The levels of EDV,PSV and PI in grade 2 hypertension group were significantly lower than those in the control group and grade 1 hypertension group,the levels of PI and RI were significantly higher than those in the control group（ P〈0. 05）; the levels of EDV and PSV in grade 3 hypertersion group were significantly lower than those in the control group,grade 1 hypertension group and grade 2 hypertension group,and the level of RI was significantly higher than that in the control group and grade 1hypertension group（ P〈0. 05）. Conclusions PSV and EDV decrease in grade 2 and grade 3 hypertensive patients,and PSV,EDV decreased and PI,RI increased,which has important clinical application value.