Nitrogen monoxide vector of ultrasonic atomizing inhalation improves vertebro-basilar artery insufficiency Hemodynamic changes are detected by transcranial Doppler test

BACKGROUND: Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide (NO) in vivo. OBJECTIVE: To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency (VBI) through transcranial Doppler (TCD) detection and serum NO content and indirect effect of TCD on cerebral blood flow changes. DESIGN: Randomized grouping and controlled clinical study. SETTING: Department of Neurology, the Fourth People's Hospital of Jinan. PARTICIPANTS: A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People's Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confirmed consent. They were randomly divided into low-dose treatment group (n =60), high-lose treatment group (n =30) and control group (n =40). METHODS: Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition, ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment.　According to the TCD test, VBI patients were divided into two groups (high-low flow velocity). The vertebral artery (VA) and basal artery (BA) of left or right sides were detected by 2 Hz detector via occipital window. MAIN OUTCOME MEASURES: ① Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD before treatment, after treatment for one course; ② content of serum NO indirectly measured by using nitric acid disoxidation technique. RESULTS: All 130 VBI patients were involved in the final analysis. ① Changes of hemodynamic indexes: Systolic phase of VA and diastole phase of BA were higher in low-dose treatment group than that in the control group after first treatment, and there was significant difference (P < 0.05); meanwhile, systolic phase and diastole phase of VA and systolic phase of BA were also higher in treatment group than that in the control group after one course (P < 0.05). However, both systolic phase and diastole phase of VA and BA were lower in high-dose treatment group than that in the control group after first treatment and one course, and there was significant difference (P < 0.05). ② Content of serum NO: After first treatment, there was no significant difference between low-dose treatment group and high-dose treatment group (P > 0.05); but both groups were higher than control group, and there was significant difference (P < 0.05, 0.01). CONCLUSION: NO vector of ultrasonic atomizing inhalation can improve VBI so as to improve cerebral blood-supply state.     

超声雾化吸入一氧化氮载体对椎-基底动脉供血不足病人脑血流动力学的影响

目的 探讨超声雾化吸入一氧化氮（NO）载体对椎一基底动脉供血不足（VBI）病人脑血流动力学的影响。方法 对60例VBI病人给予硝酸甘油3mg或5mg超声雾化吸入，动态观察经颅多普勒超声（TCD），并检测血清NO含量变化。结果 治疗后治疗组低流速型、高流速型首次治疗后和疗程结束时椎动脉（VA）、基底动脉（BA）血流动力学指标及N0含量变化均有显著改善（P〈0．01或P〈0．001），与对照组比较有统计学意义（P〈0．001）。结论 超声雾化吸入N0载体治疗VBI可明显改善脑血流量。