原发性高血压病人脑动脉血流动力学改变的特征分析 - 第三军医大学学报.doc

原发性高血压病人脑动脉血流动力学改变的特征分析 孔渝菡 秦新月 王永红（重庆医科大学附属第一医院神经内科，重庆 400016） [摘 要]： 探讨高血压病患者脑血流动力学改变，为高血压脑卒中的预防提供临床依据。 从参与健康体检人群中筛选2025人分为高血压病组892例，对照组1133例，其中高血压组按是否合并糖代谢和脂代谢紊乱再分为3个亚组。对研究对象进行病史、内外科、抽血等检查及颈部TCD检测，分析高血压不同时期、不同年龄段和合并不同代谢紊乱的收缩期血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm)、阻力指数(RI)、搏动指数(PI)指标。 (1)原发性高血压病2、3级患者基底动脉Vs、Vm、Vd降低，各期RI和PI值较正常组均有升高(P0.01)，高血压3级有大脑中动脉Vm、Vd降低表现(P0.05)。(2)高血压合并糖代谢紊乱组基底动脉和大脑中动脉Vm、Vd降低，RI和PI升高(P0.01)。(3)青年高血压病患者TCD异常率为34.5%，以脑血管痉挛为主（69.2%）；老年高血压病患者TCD异常率79.0%，以动脉硬化为主(51.3%)。 原发性高血压可引起脑血流动力学改变，以基底动脉较为敏感，监测指标中以RI和PI最为敏感。TCD能较好反映原发性高血压病患者脑血流动力学改变及病变严重程度。 [关键词]：高血压 血流动力学 脑 [中图分类号] R.1；R743.3 Analysis of Cerebral Vascular Hemodynamic Changes in Patients with Essential Hypertensive KONG Yu-Han QIN Xin-Yue WANG Yong-Hong Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China [Abstract] Objective Use transcranial Doppler ultrasound(TCD) to investigate cerebrovascular hemodynamic changes in patients with essential hypertension and 通讯作者: 秦新月(1963-),女, 博士，教授, 主任医师, 博士生导师, 主要从事神经内科临床、教学和研究工作。第一作者:孔渝菡(1984-),女,在读硕士,主要从事脑血管疾病的临床研究provide clinical evidence for prevention of stroke. Methods 2025 individuals who joined in physical examination were randomly selected and classified into two groups as hypertension group of 892 cases and control group of 1133 cases. Hypertesion group is divided into 3 subgroups as normal hypertension group, complicated with glucose or lipid metabolism disorder groups. The main observational parameters through their TCD tests were systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), mean velocity (Vm), resistant index (RI), pulsatility index (PI). Results (1) The basilar artery blood flow velocity(Vs, Vm, Vd) of patients with essential Hypertension Grade 2 and Grade 3 were significantly lower than control group, while RI and PI of the patients were higher than control group (P﹤0.01). On the other hand, Vm and Vd of middle cerebral artery decreased in Hyp