基于TCD卧立位试验观察直立不耐受患者脑血流动力学变化以及对其临床分型的诊断意义  

Observation of cerebral hemodynamic changes in orthostatic intolerance patients based on TCD supine-standing test and its diagnostic significance for clinical classification

作　　者：郑瑶 王平 王宝月 贾琳楠 ZHENG Yao;WANG Ping;WANG Baoyue(Department of Electrodiagnosis,Jilin Province FAW General Hospital,Changchun 130013,China)

机构地区：[1]吉林省一汽总医院电诊科,长春130013

出　　处：《医师在线》2025年第1期70-73,共4页Journal of Doctors Online

基　　金：吉林省卫生健康科技能力提升项目(2023LC060)。

摘　　要：目的探究基于经颅多普勒(TCD)卧立位试验观察直立不耐受(OI)患者脑血流动力学变化以及对其临床分型的诊断意义。方法选取2023年1月~2023年12月我院神经内科收治的100例不明原因晕厥发作或具有OI症状的患者作为研究组,另选取同期健康体检者60例作为对照组。所有入组者均接受TCD卧立位试验,统计OI患者TCD卧立位试验分型例数,比较不同分型OI患者的临床资料,以及不同分型OI患者与对照组的脑血流动力学指标,分析TCD卧立位试验与直立不耐受问卷(OIQ)评分的相关性。结果TCD卧立位试验诊断前不可分型66例,可分型34例;TCD卧立位试验诊断后不可分型40例,可分型60例,包括40例正常反应、21例直立性低血压(OH)伴脑血流速度降低(OH-U)、16例OH伴脑血流速度正常(OH-C)、13例直立性心动过速综合征(POTS)、4例阵发性窦性心动过速(PST)、3例直立性高血压(OHT)和3例直立性脑低灌注综合征(OCHOS)。OH-U组舒张压(DBP)低于正常反应组,收缩压(SBP)、OIQ评分高于正常反应组(P<0.05)。OH-C组和OHT组SBP指标高于正常反应组(P<0.05)。OH-U组和OCHOS组的心血管反射测试和皮肤活检中小纤维的定量评分量表(QASAT)卧位最低脑血流速度评分(Q-LF)均高于正常反应组(P<0.05)。OH-C组、POTS组、PST组、OHT组、OCHOS组的心率(HR)均高于正常反应组(P<0.05)。OHT组DBP低于正常反应组(P<0.05)。OH-U组平均脑血流速度(mCBFv)卧立位指标低于对照组,脑动脉搏动指数(PI)卧立位指标、脑动脉阻力指数(RI)卧立位指标高于对照组(P<0.05)。OH-C组mCBFv卧立位指标低于对照组,PI卧立位指标、RI卧立位指标高于对照组。OH-U组、OH-C组、POTS组的W波回调不全比例均高于正常反应组(P<0.05)。TCD卧立位试验与OIQ评分呈正相关(P<0.05)。结论通过TCD卧立位试验观察OI患者脑血流动力学变化,发现TCD卧立位试验与OIQ评分呈正相关,对临床分型具有一定诊断意Objective To explore the changes in cerebral hemodynamics in patients with orthostatic intolerance(OI)based on the transcranial Doppler(TCD)supine-standing test and its diagnostic significance for the clinical classification.Methods A total of 100 patients with unexplained syncope or OI symptoms admitted to the neurology department of our hospital from January 2023 to December 2023 were selected as the study group.Another 60 healthy individuals who underwent physical examinations during the same period were selected as the control group.All participants underwent the TCD supinestanding test.The number of cases classified by the TCD supine-standing test in OI patients was recored.The clinical data of OI patients with different classifications were compared,as well as the cerebral hemodynamic indicators of OI patients with different classifications and the control group.The correlation between the TCD supine-standing test and the Orthostatic Intolerance Questionnaire(OIQ)score was analyzed.Results Before TCD supinestanding test diagnosis,66 cases were unclassifiable and 34 cases were classifiable;after TCD supine-standing test diagnosis,40 cases were unclassifiable and 60 cases were classifiable,including 40 cases of normal response,21 cases of orthostatic hypotension(OH)with uncompensated cerebral blood flow velocity(OH-U),16 cases of OH with compensated cerebral blood flow velocity(OH-C),13 cases of postural orthostatic tachycardia syndrome(POTS),4 cases of paroxysmal sinus tachycardia(PST),3 cases of orthostatic hypertension(OHT),and 3 cases of orthostatic cerebral hypoperfusion syndrome(OCHOS).The diastolic blood pressure(DBP)of the OH-U group was lower than that of the normal response group,while the systolic blood pressure(SBP)and orthostatic intolerance questionnaire(OIQ)scores were higher than those of the normal response group(P<0.05).The SBP of the OH-C group and the OHT group was higher than that of the normal response group(P<0.05).The quantitative scale for grading of cardiovascular reflex tests and sm

关 键 词：TCD卧立位试验 直立不耐受 脑血流动力学 临床分型 

分 类 号：R741.04[医药卫生—神经病学与精神病学]