脑梗死并高血压病患者左心室舒张功能对脑血流动力学的影响

摘要

目的：探讨脑梗死并高血压病患者左心室舒张功能的改变对脑血流动力学的影响。方法收集单纯高血压病患者100例（高血压组）、单纯脑梗死患者100例（脑梗死组）及脑梗死合并高血压病患者100例（合并组）左心室舒张功能的相关超声学指标--二尖瓣血流图上早期充盈的E峰和晚期充盈的A峰血流速度的比值（E/A比值），及其双侧大脑前动脉（anterior cerebral artery, ACA）、大脑中动脉（middle cerebral artery, MCA）、大脑后动脉（posterior cerebral artery, PCA）和基底动脉（basilar artery, BA）经颅多普勒测定的脑血流动力学指标--平均血流速度（average blood flow rate, Vm）、血管搏动指数（blood vessel pulsatility index, PI）、阻力指数（resistance index, RI），采用logistic回归分析探讨它们的相关性。结果脑梗死组各动脉Vm、PI和RI与E/A比值的相关性均无统计学意义（P＞0.05），高血压组及合并组各动脉Vm、PI和RI与E/A比值的相关性均有统计学意义（P＜0.05），合并组的各OR值均较高血压组大，相关性更显著。结论高血压病患者的左心室舒张功能降低，导致脑动脉血流速度下降，弹性减弱，阻力增大，对于高血压合并脑梗死患者尤为显著。%Objective To study the influence of the diastolic function of left ventricular on cerebral haemodynamics in cerebral infarction combined hypertension patients. Methods The indexes of the diastolic function of left ventricular in 100 hypertension patients (group of hypertension), 100 cerebral infarction patients (group of cerebral infarction) and 100 cerebral infarction combined hypertension patients (group of combined) were collected, and ratio of blood flow velocity between early filling of E peak and late filling A peak (E/A) on flow chart of mitral was used as the indexes. The indexes of cerebral haemodynamics in patients of the three groups were also collected, these indexes were average blood flow rate (Vm), blood vessel pulsatility index (PI) and resistance index (RI) of bilateral anterior cerebral artery (ACA), bilateral middle cerebral artery (MCA), bilateral posterior cerebral artery (PCA) and basilar artery (BA) measured through transcranial Doppler (TCD). Logistic regression analysis was used to explore the correlation in themselves. Results There aren't correlations between Vm, PI and RI of every arteries and the ratio of E/A in the group of cerebral infarction (P>0.05).However there are correlations between Vm, PI and RI of every arteries and the ratio of E/A in the group of hypertension and group of combined (P<0.05). And it is more significant in the group of combined because their ratio of OR were larger than those in the group of hypertension. Conclusion The cause of slowing of bloodstream, and decreasing of elasticity and increasing of resistance in cerebral artery reduces the diastolic function of left ventricular in hypertension patients. Moreover it is more obvious in group of cerebral infarction combined hypertension patients.