降血压治疗对脑血流动力学影响的初步研究

Preliminary Study on the Effect of Antihypertensive Therapy on Cerebral Hemodynamics

目的 :探讨降血压治疗是否影响脑血流动力学。方法 :应用经颅多普勒超声 (TCD)诊断仪监测原发性高血压患者 32例以硝苯地平及 17例以硝苯地平 +卡托普利降血压前后的脑血流参数 ,以及 11例血压大于 2 0 0 / 130mmHg的脑出血患者不同梯度地降血压前后的TCD血流参数的变化。结果 :三组药物降血压效果均有显著性意义。高血压患者双侧大脑中动脉血流速度 (MFV)降低无统计学意义 ,PI值升高有统计学意义 ;脑出血患者不同梯度降血压健侧和患侧MFV降低、PI升高 ,均有统计学意义 ,而两组药物之间TCD参数差异无统计学意义。结论 :原发性高血压患者脑血管仍有一定的调节功能 ,脑出血患者降血压治疗可能会更降低脑灌注压 ,应慎重应用降压药。

Objective: To investigate the effects of antihypertensive therapy on cerebral hemodynamics in hypertensive patients. Methods: 32 patients with primary hypertension were monitored with TCD before and after the treatment of nifedipine; among them, 17 patients received additional captopril, 11 patients with cerebral hemorrhage whose blood pressure were more than 200/130 mmHg were monitored with TCD before and after antihypertensive therapy by nimodipine or sodium nitroprusside. Results: Blood pressure was reduced significantly in all 3 groups. Decreased mean blood flow velocity (MFV) had no significant difference, and increased pulsatility index (PI) had significant difference in patients with primary hypertension who were treated by both two medicines; but in patients with cerebral hemorrhage, MFV was significantly decreased and PI was significantly increased. TCD parameters had no statistic differences between groups treated by single or two drugs. Conclusion: Cerebrovascular autoregulation remained partially in primary hypertensive patient. Antihypertensive therapy will decrease the brain perfusion dramatically in patients with cerebral hemorrhage, therefore, antihypertensive therapy should be administrated with caution.