降压治疗对老年高血压患者不同病理阶段脑循环储备力的影响

目的研究不同程度降压对不同病理阶段老年高血压患者脑循环储备力(CCR)的影响及屏气试验对指导老年高血压个体化治疗的价值。方法选择老年原发性高血压(高血压组)及合并腔隙性脑梗死(腔梗组)患者各33例、健康老年志愿者(健康对照组)27例为观察对象,应用经颅多普勒技术测定不同血压水平下屏气试验后脑循环血流动力学参数及降压治疗后CCR下降>10%者所占比例。结果(1)高血压组及腔梗组降压前后平均峰流速(Vm)值(平静时)差异无显著性,屏气试验后屏气指数(BHI)及Vm上升率则较健康对照组明显下降(P<0.05,P<0.01)。小幅度降压(12.7%,12.8%)后BHI及Vm上升率两病例组均较降压治疗前有所提高,但差异无显著性;较大幅度降压(22.6%,22.4%)后BHI及Vm上升率两病例组均较治疗前显著提高(P<0.05,P<0.01);脉动指数(PI)下降率仅高血压组治疗前与健康对照组比较差异有显著性(P<0.05)。(2)高血压组及腔梗组降压治疗后CCR下降>10%者所占比例分别为12.1%和24.2%,差异无显著性(P>0.05)。结论合理降压治疗可部分提高不同病理阶段老年高血压患者脑血管对二氧化碳的反应性,改善其脑血管储备功能。

Effect of antihypertensive treatment on cerebral circulation reserve at different pathological stages in senile patients with hypertension

Objective To detect the effect of antihypertensive treatment on cerebral circulation reserve at different pathological stages in senile patients with hypertension and to investigate the value of breath holding test (BHT) in the guidance of antihypertensive treatment for these patients. Methods 33 senile hypertensive patients with lacunar infarction (lacunar group), 33 senile isolated-hypertensive patients (hypertension group) and 27 healthy senile people (control group) were enrolled in the study. The cerebral homodynamic parameters were measured with BHC by transcranial Doppler (TCD) sonography in all subjects in different levers of blood pressure. The patients whose cerebral circulation reserve decreased more than 10% were added up.Results There was not significant difference in the velocities of blood flow (Vm) in lacunar group and hypertension group pre and post-antihypertensive treatment ( P>0.05). The ascending rates of Vm and BHI in the two study groups were significantly lower than those in the control group ( P<0.05, P<0.01). The ascending rates of Vm and breath holding index (BHI) after BHT in the two study groups were insignificant difference between before and after slight antihypertensive therapy (the blood pressure decreased about 12.7 % and 12.8%)( P>0.05), but were significant increased after intensive antihypertensive therapy (the blood pressure decreased about 22.6% and 22.4%)( P<0.05, P<0.01). The descending rate of pulsing index (PI) in the hypertension study group was lower than that in the control group before antihypertensive therapy ( P<0.05). The incidence rate of the patients whose cerebral circulation reserve decreased >10% in the lacunars infarction group and in the hypertension group was 12.1% and 24.2%( P>0.05), respectively.Conclusion The cerebrovascular reactivity to CO_2 or the cerebral circulation reserve in senile hypertensive patients may be improved effectively by reasonable antihypertensive therapy.