正常及受损外周循环控制期间脑循环的自主控制
Autonomic control of the cerebral circulation during normal and impaired peripheral circulatory control.
作者信息
Cencetti S, Lagi A, Cipriani M, Fattorini L, Bandinelli G, Bernardi L
机构信息
Medicina Interna 1, S Maria Nuova Hospital, Florence, Italy.
出版信息
Heart. 1999 Sep;82(3):365-72. doi: 10.1136/hrt.82.3.365.
OBJECTIVE
To determine whether oscillations in the cerebrovascular circulation undergo autonomic modulation in the same way as cardiovascular oscillations.
DESIGN
Cardiovascular and cerebrovascular oscillations were monitored at rest and during sympathetic stimulation (head up tilt). The association with and transmission of the oscillations in the sympathetic (low frequency, LF) and respiratory (high frequency, HF) bands was assessed.
SUBJECTS
13 healthy volunteers, 10 subjects with vasovagal syncope, and 12 patients with complicated non-insulin dependent diabetes mellitus.
MAIN OUTCOME MEASURES
Power spectrum analysis of cerebral blood flow velocity, arterial blood pressure, and heart rate. Coherence analysis was used to study the association between each pair of oscillations. Phase analysis showed the delay of the oscillations in the cardiovascular signals with respect to the cerebrovascular signals.
RESULTS
The power in the sympathetic (LF) components in all the oscillations increased during head up tilt (p < 0.01) in the controls and in the subjects with vasovagal syncope, but not in patients with diabetes. Significant coherence (> 0.5) in the LF band was present between cerebrovascular and cardiovascular oscillations in most of the controls and in subjects with vasovagal syncope, but not in the diabetic patients (< 50% of the patients). In the LF band, cerebrovascular oscillations preceded the cardiovascular oscillations (p < 0.05) at rest in all groups: the phase shifts were reduced (p < 0.05) during head up tilt for all cardiovascular signals in healthy and syncopal subjects, but only for heart rate in diabetic patients.
CONCLUSIONS
The cerebrovascular resistance vessels are subject to autonomic modulation; low frequency oscillations in cerebral blood flow velocity precede the resulting fluctuations in other cardiovascular signals. Autonomic neuropathy and microvascular stiffness in diabetic patients reduces this modulation.
目的
确定脑血管循环中的振荡是否与心血管振荡一样受到自主神经调节。
设计
在静息状态和交感神经刺激（头高位倾斜）期间监测心血管和脑血管振荡。评估交感神经（低频，LF）和呼吸（高频，HF）频段振荡的相关性及传导情况。
研究对象
13名健康志愿者、10名血管迷走性晕厥患者和12名非胰岛素依赖型糖尿病合并症患者。
主要观察指标
脑血流速度、动脉血压和心率的功率谱分析。相干分析用于研究每对振荡之间的相关性。相位分析显示心血管信号振荡相对于脑血管信号振荡的延迟。
结果
在对照组和血管迷走性晕厥患者中，头高位倾斜时所有振荡的交感神经（LF）成分功率均增加（p < 0.01），但糖尿病患者中未增加。大多数对照组和血管迷走性晕厥患者的脑血管和心血管振荡在LF频段存在显著相干性（> 0.5），但糖尿病患者中不存在（< 50%的患者）。在LF频段，所有组静息时脑血管振荡先于心血管振荡（p < 0.05）：健康和晕厥患者头高位倾斜时所有心血管信号的相移均减小（p < 0.05），但糖尿病患者仅心率相移减小。
结论
脑血管阻力血管受自主神经调节；脑血流速度的低频振荡先于其他心血管信号的相应波动。糖尿病患者的自主神经病变和微血管僵硬度降低了这种调节作用。
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