Traon Anne Pavy-Le, Costes-Salon Marie-Claude, Galinier Michel, Fourcade Joelle, Larrue Vincent
Neurology Department, Rangueil Hospital, 1 Av. J. Poulhes, 31054 cedex, Toulouse, France.
J Neurol Sci. 2002 Mar 30;195(2):139-44. doi: 10.1016/s0022-510x(02)00010-2.
In hypertensive patients, the upper and lower limits of cerebral autoregulation are shifted to higher levels. However, the dynamics of cerebral autoregulation in hypertensive patients are less well known. We compared the dynamics of cerebral autoregulation in 21 treated hypertensive patients (13 men and 8 women; mean age: 48.9+/-13.6 years) and in 21 normotensive subjects (13 men and 8 women; mean age: 51+/-14.5 years) by transcranial Doppler (TCD) of the middle cerebral artery (MCA) during the acute decrease in blood pressure induced by standing up after 2 min in squatting position. MCA maximal outline blood flow velocity (FV), blood pressure (Finapres) and end-tidal PCO2 were continuously monitored and computerised. A cerebral vascular resistance index (CR) was calculated as follows: mean arterial BP/MCA mean FV with normalised changes in CR per second during the blood pressure decrease (CR slope). The CR slope reflecting the rate of cerebral autoregulation did not differ between the two groups and within the hypertensive patients [well controlled (8 patients) and not controlled (13 patients)]. The time to maximum decrease of CR (T1) and the time to full recovery of CR after the initial drop (T2) were also similar in the two groups (controls T1: 11.3+/-3.1 s, T2: 12+/-5.9 s; hypertensive T1: 11.7+/-2.5 s, T2: 10.7+/-4.5 s) and within hypertensive patients. These findings suggest that the dynamics of cerebral autoregulation are well preserved in hypertensive patients, with no difference according to the efficiency of treatment of hypertension.
在高血压患者中，脑自动调节的上限和下限都向更高水平偏移。然而，高血压患者脑自动调节的动态变化尚不太清楚。我们通过经颅多普勒（TCD）检测大脑中动脉（MCA），比较了21例接受治疗的高血压患者（13名男性和8名女性；平均年龄：48.9±13.6岁）和21名血压正常的受试者（13名男性和8名女性；平均年龄：51±14.5岁）在蹲位2分钟后站立引起血压急性下降期间脑自动调节的动态变化。持续监测并计算机化MCA最大轮廓血流速度（FV）、血压（Finapres）和呼气末PCO2。计算脑血管阻力指数（CR）如下：平均动脉血压/MCA平均FV，并计算血压下降期间每秒CR的标准化变化（CR斜率）。反映脑自动调节速率的CR斜率在两组之间以及高血压患者内部[血压控制良好（8例患者）和未控制（13例患者）]没有差异。两组（对照组T1：11.3±3.1秒，T2：12±5.9秒；高血压组T1：11.7±2.5秒，T2：10.7±4.5秒）以及高血压患者内部，CR最大下降时间（T1）和CR在初始下降后完全恢复的时间（T2）也相似。这些发现表明，高血压患者脑自动调节的动态变化保存良好，与高血压治疗效果无关。
