卒中高危人群脑血流自动调节功能分析  

Analysis of dynamic cerebral autoregulation in residents with high risk factors of stroke

作　　者：刘玉梅[1] 华扬[1] 刘贝贝 李景植[1] 张楠[1] 侯伟红[1] Liu Yumei;Hua Yang;Liu Beibei;Li Jingzhi;Zhang Nan;Hou Weihong(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中国脑血管病杂志》2020年第8期431-435,468,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：首都医科大学自然科学培育基金(PYZ19133)。

摘　　要：目的分析卒中高危人群脑血流动力学及脑血流自动调节功能(dCA)的特征。方法前瞻性连续纳入2019年1—12月首都医科大学宣武医院血管超声诊断科经宣传招募,并行脑-颈动脉超声一体化评估的健康和(或)具有卒中危险因素但控制良好的受试者60例,最终纳入符合纳排标准者44例,并根据是否存在卒中高危因素,将其分为高危组(22例)和非高危组(22例)。记录两组受试者的一般资料、血流动力学参数并进行组间比较,一般资料包括年龄、性别及既往心脑血管病相关危险因素病史,血流动力学参数包括收缩压、舒张压、平均动脉压、平均脑血流速度(CBFV)、二氧化碳分压、脑血管阻力指数(CVRi),CVRi为平均动脉压与平均CBFV的比值。采用传递函数法,在超低频(0.02~0.07 Hz)、低频(> 0.07~0.20 Hz)和高频(> 0.20~0.35 Hz)三个频率区域内,通过平均CBFV随血压变化的波动幅度、随血压变化产生波动的相位差及平均CBFV与血压变化间的相关性,分析评估两组间d CA的差异。CBFV随血压变化的波动幅度增益值越小,说明d CA越稳定;CBFV随血压变化产生波动的时间差或相位差越大,说明d CA越好;CBFV与动脉血压间的相关系数> 0.4,则说明一致性好。结果 (1)两组受试者的年龄及性别、冠心病、高脂血症、糖尿病、卒中家族史比例的差异均无统计学意义(均P> 0.05);高危组体质量指数高于非高危组[(26.6±3.4) kg/m2比(24.3±2.7) kg/m2,t=1.87],高血压病及吸烟比例高于非高危组[均为54.5%(12/22)比13.6%(3/22)],组间差异均有统计学意义(均P <0.05)。(2)高危组舒张压高于非高危组,组间差异有统计学意义[(82±10) mm Hg比(76±8) mm Hg,t=2.81,P <0.05];两组收缩压、平均动脉压、平均CBFV、呼气末二氧化碳分压、CVRi的差异均无统计学意义(均P> 0.05)。(3)在超低频区域内,高危组相位差短于非高危组,组间差异有统计学意义[(3.1±0.3)度比(4.5±0.5)�Objective To investigate the characteristics of cerebral hemodynamics and dynamic cerebral autoregulation( dCA) in patients with high risk factors of stroke.Methods A total of60 subjects were consecutively recruited prospectively in the Department of Vascular Ultrasonography of Xuanwu Hospital,Capital Medical University from January 2019 to December 2019.After completing the integrated assessment of cerebral and carotid arteries,44 cases were finally meeting the inclusion criteria.Then subjects were divided into high-risk factor( HRF) group( 22 cases) and non-high-risk factor( NHRF) group( 22 cases) according to the criteria of stroke consensus determined in the National Stroke Prevention and Treatment Commission.The distribution of risk factors,cerebral blood perfusion,hemodynamic parameters,and characteristics of d CA in both groups were compared.The general information of age,sex,and risk factors of cerebrovascular diseases were included.The hemodynamic parameters included systolic blood pressure,diastolic blood pressure,mean arterial pressure,mean cerebral blood flow velocity( CBFV),the pressure of carbon dioxide,and cerebrovascular resistance index( CVRi).The ratio of mean arterial pressure to mean CBFV was included as well.The d CA was evaluated by the transfer function analysis that measured the fluctuation amplitude of mean CBFV with blood pressure change,the time difference of phase with blood pressure change,and the correlation between mean CBFV and blood pressure change in three regions of very low-frequency( 0.02-0.07 Hz),low-frequency( > 0.07-0.20 Hz) and high-frequency( > 0.20-0.35 Hz).The d CA was more stable when the gain of CBFV with the variation of blood pressure was smaller.The d CA was better when the time difference phase of CBFV fluctuation with blood pressure changes was greater.The correlation coefficient between CBFV and arterial blood pressure was more than 0.4,indicating good consistency.Results( 1) There were no statistically significant differences in age,sex,coronary heart disease,h

关 键 词：卒中 高危人群 血流动力学 脑血流自动调节功能 超声检查 多普勒 经颅 

分 类 号：R743.3[医药卫生—神经病学与精神病学]