摘要
目的 探讨经颅多普勒超声(TCD)在监测老年脑血流自动调节中的应用及临床价值.方法 选取我院2011年5月至2014年12月确诊为老年高血压的患者200例(高血压组),同时选取体检血压正常且无其他疾病的老人200名(对照组).用TCD方法监测两组的脑供血动脉收缩期峰值血流速度、卧位-立位大脑中动脉(MCA)脑血流差值(CBFV)、X-W波时程、脑循环动力学参数并进行比较.结果 高血压组动脉血管左椎动脉(LVA)、右椎动脉(RVA)、左冠状动脉(LCS)、右冠状窦(RCS)的峰值Vp、卧位CBFV和立位脑血液差值(CBFV)均显著低于对照组[(38.01±12.42)cm/s与(45.21±8.95)cm/s、(35.54±13.25) cm/s与(43.52±7.06) cm/s、(66.12±9.52) cm/s与(76.54±8.19) cm/s、(71.24±11.25) cm/s与(77.98±10.74) cm/s、(55.34±14.52) cm/s与(61.24±12.58) cm/s、(48.12±15.24)cm/s与(58.46±18.85) cm/s],差异均有统计学意义(t值分别为4.6821、5.6987、6.2589、4.3671,2.2854、4.9875,P均＜0.01),动脉血管[左颈内动脉(LICA)、右颈内动脉(RICA)、左大脑中动脉(LMCA)、右大脑中动脉(RMCA)、左大脑前动脉(LACA)、右大脑前动脉(RACA)、左眼动脉(LOA)、右眼动脉(ROA)]的峰值Vp、卧位-立位CBFV差值及X-W波时程、参数DR、Cp、C、Co、Zc及Wv均显著高于对照组[(96.38±18.85) cm/s与(83.56±13.41) cn/s、(103.04±35.42) cm/s与(85.62±29.63) cm/s、(99.85±23.54) cm/s与(83.12±22.67) cm/s、(102.84± 16.42) cm/s与(86.23±21.34) cm/s、(85.06±15.36) cm/s与(73.16±10.35) cm/s、(85.64±15.34) cm/s与(70.52±18.56) cm/s、(34.85±8.74)cm/s与(28.56±7.85) cm/s、(35.12±11.20) cm/s与(30.05±6.88) cm/s、(7.22±2.54) cm/s与(2.78±1.87) cm/s、(23.74±5.23) cm/s与(20.85±4.35) cm/s、(378.35±35.12) Pa· s/cm与(314.53±36.21)Pa.s/cm、(8.16±0.62) P/kPa与(7.25±0.68) P/kPa、(0.41 ±0.05) ml/kPa与(0.33±0.06) ml/kPa、(1.15 ±0.16) ml/kPa与(0.84±0.13) ml/kPa、(346.13±42.63) dyn· s/cm5与(241.68±50.21) dyn·s/cm5、(21.47±3.85) V/(cml·s)与(11.24±3.67) V/(cml·s),差异均有统计学意义(t值分别为5.8954、4.2589、4.8792、6.3985、6.3874、6.9852、5.6387、4.6892、6.0387、4.8562、11.475、8.041、12.422、11.820、12.854、20.412,P均＜0.01).结论 高血压患者脑血流自动调节功能明显异常,采用TCD技术可以反映脑血流自动调节功能,对临床诊断和治疗脑梗死、脑卒中等心脑血管疾病具有重要的临床应用价值.
Objective To study the clinical application and value of transcranial Doppler (TCD) monitoring senile cerebral blood flow autoregulation in elderly.Methods Two hundred cases patients with elderly hypertension and 200 cases normal eldly from May 2011 to December 2014 in the Second People 's Hospital of Fengrun District of Tangshan were chosen as hypertension group and control group.Cerebral artery peak systolic velocity,supine with a vertical artery in the brain(MCA) cerebral blood flow difference (CBFV) and X-W wave duration, cerebrovascular hemodynamic parameters of two group were monitored by TCD method and compared.Results The peak values of left vertebral artery (LVA), right vertebral artery (RVA), the left coronary artery(LCS), and right vertebral artery(RCS) of hypertension group were significantly lower than those in the control group((38.01±12.42) cm/s vs (45.21±8.95) cm/s, (35.54±13.25) cm/s vs (43.52±7.06) cm/s, (66.12±9.52) m/s vs (76.54±8.19) cm/s, (71.24± 11.25) cm/s vs (77.98± 10.74) cm/s, (55.34 ±14.52) cm/s vs (61.24±12.58) cm/s,(48.12±15.24) cm/s vs (58.46±18.85) cm/s;t=4.6821, 5.6987,6.2589,4.3671,2.2854,4.9875;P＜ 0.01).The peak Vp, the difference between the horizontal and vertical position CBFV, X-W wave duration, the parameter of DR, Cp, C, Co, Zc, Wv of arterial blood vessels (left internal carotid artery (LICA), right internal carotid artery (RICA), left middle cerebral artery (LMCA), right middle cerebral artery(RMCA) ,left anterior cerebral artery(LACA), right anterior cerebral artery(RACA), left anterior cerebral artery (LOA), right middle cerebral artery (ROA)) of hypertension group were significantly higher than those of control group((96.38±18.85) cm/s vs (83.56±13.41) cm/s, (103.04±35.42) cm/s vs (85.62±29.63) cm/s, (99.85±23.54) cm/s vs (83.12±22.67) cm/s, (102.84± 16.42) cm/s vs (86.23 ±21.34) cm/s, (85.06± 15.36) cm/s vs (73.16± 10.35) cm/s, (85.64± 15.34) cm/s vs (70.52± 18.56) cm/s, (34.85±8.74) cm/s vs (28.56±7.85) cm/s, (35.12± 11.20) cm/s vs (30.05± 6.88) cm/s, (7.22 ± ±2.54) cm/s vs (2.78± 1.87) cm/s, (23.74±5.23) cm/s vs (20.85±4.35) cm/s, (378.35±35.12) Pa? s/cm vs (314.53±36.21) Pa? s/cm, (8.16± 0.62) P/kPa vs (7.25± 0.68) P/kPa, (0.41 ± 0.05) ml/kPa vs (0.33±0.06) ml/kPa, (1.15±0.16) mL/kPa vs (0.84±0.13) ml/kPa, (346.13±42.63) dyn? s/cm5 vs (241.68±50.21) dyn? s/cm5, (21.47± 3.85) V/(cml? s) vs (11.24 ± 3.67) V/(cml? s);t =5.8954, 4.2589,4.8792,6.3985,6.3874,6.9852,5.6387,4.6892,6.0387,4.8562, 11.475,8.041,12.422, 11.820, 12.854,20.412;P＜0.01).Conclusion The function of automatic adjustment shows obvious abnormal cerebral blood flow in patients with hypertension, andthe TCD technology can response of cerebral blood flow autoregulation,which has important clinical value for diagnosis and treatment of cerebral infarction, stroke and other cardiovascular and cerebrovascular diseases.
出处
《中国综合临床》
2016年第1期-,共4页
Clinical Medicine of China
关键词
经颅多普勒超声
脑血流自动调节
高血压
脑梗死
Tanscranial Doppler
Cerebral blood flow autoregulation
Arterial hypertension
Cerebral infarction
