血压水平对脑血管和颈部血管血液动力学检测指标的影响

目的 应用超声技术,探讨不同血压水平对脑血管和颈部血管血液动力学检测指标的影响.方法 对225例伴颈动脉粥样硬化斑块的高血压患者,根据血压控制水平分为轻度高血压组(n=30)、中度高血压组(n=61)和重度高血压组(n=129).选择同期检测的无高血糖、高血脂及无颈动脉粥样硬化斑块且血压正常的患者94例作为对照组.经颅多普勒超声检测大脑中动脉、大脑前动脉、大脑后动脉以及椎动脉的平均血流速度和搏动指数的变化特征.采用颈部B超检测颈总动脉、颈内动脉以及椎动脉的平均血流速度和搏动指数的变化特征.结果 (1)各高血压组24 h动态血压水平与对照组比较均显著增高(P<0.05).(2)各高血压组脑部血管的平均血流速度和搏动指数与对照组比较差异均有统计学意义(P<0.05);各高血压组之间比较,随着血压水平的增加,脑部血管的平均血流速度降低,搏动指数增大(P<0.05).(3)各高血压组颈部血管的平均血流速度和搏动指数与对照组比较差异均有统计学意义(P<0.05);各高血压组之间比较,随着血压水平的增加,颈部血管的平均血流速度降低,搏动指数增大.结论 血压水平对脑部和颈部血管血液动力学均有影响,随着血压水平的增高,血流动力学指标的异常程度呈现渐进加重的趋势.从脑血管和颈部血管的血液动力学角度看,理想的血压水平应不超过140/90 mmHg.经颅多普勒超声结合颈动脉超声可对高血压痛患者颅内外动脉血流动力学的变化进行客观评价,为临床诊治提供依据.

The Effect of Blood Pressure on Hemodynamic Indexes in Cerebral Vascular and Carotid Vascular

Aim To probe the effect of blood pressure on hemodynamic indexes in cerebral vascular and carotid vascular by vascular ultrasound. Methods 225 patients with essential hypertension who accompanied with carotid artery atherosclerotic plaque,were divided into mild hypertension group (n=30),moderate hypertension group (n=61),and severe hypertension group (n=129),according to the controlled blood pressure. Meanwhile 94 patients with normal blood pressure who were not accompanied with hyperglycaemia,hyperlipemia and carotid artery atherosclerotic plaque,were chosen as the control group. The average blood flow rate (Vm) and pulsatility index (PI) of middle cerebral artery (MCA),anterior cerebral artery (ACA),postrior cerebral artery (PCA) and vertebral artety (VA) were detected by transcranial Doppler (TCD). The average blood flow rate and pulsatility index of common carotid artery,internal carotid artery and vertebral artery were detected by colour Doppler ultrasonography. Results (1) 24 h ambulatory blood pressure showed the blood pressure in hypertension groups were significantly increased compared with control group (P<0.05). (2) TCD showed the Vm and PI of cerebral artery in hypertension groups significantly differed from control group (P<0.05); and the Vm of cerebrovascular in hypertension groups was decreased with increasing the blood pressure,but PI was increased. (3)Colour Doppler ultrasonography showed the Vm and PI of carotid artery in hypertension groups significantly differed from control group (P<0.05); and the Vm of carotid artery in hypertension groups was decreased with increasing the blood pressure,but PI was increased. Conclusion The blood pressure affected the cerebral vascular and carotid vascular hemodynamic indexes. The trend of vascular hemodynamic indexes was getting severe as blood pressure elevated. In terms of cerebral and carotid vascular hemodynamic indexes,ideal blood pressure should be lower than 140/90 mmHg. The change of cerebral and carotid vascular can be objectively evaluated using TCD and colour Doppler ultrasonography. And we can provide the evidence for the clinical diagnose and cure.