老年高血压患者肾内动脉血流动力学变化及动态血压变异性临床分析

Clinical analysis of hemodynamics of intrarenal arterial and dynamic blood pressure variability in the aged hypertensive patients

目的 探讨老年高血压患者肾内 3级动脉血流动力学变化及动态血压变异性改变对高血压病肾损害程度预测及判断预后的临床意义。 方法 应用彩色超声多普勒肾血流测定法对老年高血压组 4 6例、老年前期高血压组 30例、血压正常老年人 (老年对照组 ) 4 3例分别进行左右侧主肾动脉 (MRA)、叶段动脉 (SRA)、叶间动脉 (IRA)的收缩期峰速度 (Vs)、舒张期末血流速度 (Vd)、平均血流速度 (Vm)、S/D(Vs/Vd)、脉冲指数 (PI)、阻力指数 (RI)的测定 ,同时进行 2 4h动态血压监测 ,分析其白昼夜间血压变异性 (BPV)指标。 结果 与老年对照组比较老年高血压组的Vs、Vd和Vm减慢 ,这种改变最先出现在分支较细的IRA(P <0 0 1) ,以后依次为SRA(P <0 0 5 )和MRA(P <0 0 5 ) ,S/D增加 (P <0 0 5 ) ;老年高血压组 2 4h的收缩压最低、平均、最高值和收缩压BPV以及白昼段舒张压平均、最高值和舒张压BPV高于老年对照组 (P <0 0 1,P <0 0 5 )。老年高血压组 2 4h的收缩压平均、最高值和夜间收缩压BPV以及舒张压最低、平均、最高值高于老年前期高血压组 (P <0 0 1,P <0 0 5 )。 结论 老年高血压患者肾血管损害主要特征为微小动脉收缩与舒张两期均处于低血流量、低流速状态 ,肾内血管阻力增加是早期肾功能受损的基础 ;肾?

Objective To approach the clinical effects of the changes in blood flow dynamics of intrarenal arterial and dynamic blood pressure variability(BPV) on the injury degree of early renal damage and the prognosis in the aged essential hypertension(EH). Methods Color doppler echocardiography was applied to determine the renal blood flow including Vs, Vd, Vm, S/D, PI and RI of the left and the right sides of MRA, SRA and IRA in 46 aged EH patients(EHI), 30 pre aged EH patients (EHII) and 43 normal controls respectively. BPV parameters were also analyzed. Results Vs, Vd and Vm in EHI were significantly lower than those in the contorl group( P <0 05); S/D in EHI was significanly higher than that in the control group( P <0 05); 24 h tSBP, 24 h mSBP, 24 h pSBP, 24 h SSD and dDSD in EHI were all significantly higher than those in the control group( P <0 01, P <0 05); 24 h mSBP, 24 h pSBP, nSSD, ntDBP, nmDBP and npDBP in EHI were significantly higher than those in the EHII( P <0 01, P <0 05). Conclusions The main characters of the renal damage are less blood stream volume and low velocity in both arterial systolic and diastolic phases. The increase in arterial resistance results in the renal function insufficiency. Hemodynamic abnormality of intrarenal arterial appears earlier than changes in laboratory renal function tests. The renal blood vessel compliance decreases with the prolongation of the EH course.