Ficzere A, Valikovics A, Fülesdi B, Juhász A, Czuriga I, Csiba L
Department of Neurology and Psychiatry, University of Debrecen Medical School, Hungary.
J Clin Ultrasound. 1997 Sep;25(7):383-9. doi: 10.1002/(sici)1097-0096(199709)25:7<383::aid-jcu6>3.0.co;2-6.
We studied the usefulness of transcranial Doppler sonography for assessing changes in vasoreactivity in patients with hypertension and the hemodynamic consequences of hypertension.
The study group comprised 25 patients with chronic severe hypertension and 25 age- and sex-matched healthy subjects. Cerebrovascular reserve capacity was assessed by transcranial Doppler recording of the blood flow velocity in both middle cerebral arteries before and 5, 10, 15, and 20 minutes after intravenous injection of 1 g of acetazolamide (Diamox). Blood pressure, blood gases, and other blood parameters were also measured before and after acetazolamide injection. The sizes of the left atrium, left ventricle, and aortic root were measured by echocardiography and correlated with the vasoreactivity after acetazolamide injection.
After acetazolamide injection, no significant changes in blood pressure were observed in either group. The mean blood flow velocity in the middle cerebral arteries of hypertensive patients (60.8 +/- 2.6 cm/sec) was not significantly different from that of controls (58.8 +/- 1.9 cm/sec) before acetazolamide injection. Ten minutes after acetazolamide injection, the percentage change in blood flow velocity was significantly lower in the hypertensive group (36.2 +/- 4.5%) than in the controls (52.6 +/- 3.7%). A significant negative correlation (p < 0.05) between decreased vasoreactivity and increased size of the left atrium and aortic root was observed.
Vasoreactivity decreases in hypertensive patients without neurologic deficits or computed tomography abnormalities. Enlargement of the left atrium correlates well with the severity of the impairment in vasoreactivity. Transcranial Doppler sonography can be a sensitive tool in the investigation of vascular impairment caused by hypertension and in the follow-up of hypertensive patients.
我们研究了经颅多普勒超声检查在评估高血压患者血管反应性变化及高血压血流动力学后果方面的实用性。
研究组包括25例慢性重度高血压患者和25例年龄及性别匹配的健康受试者。通过经颅多普勒记录静脉注射1克乙酰唑胺（醋氮酰胺）前以及注射后5、10、15和20分钟时双侧大脑中动脉的血流速度，评估脑血管储备能力。在注射乙酰唑胺前后还测量了血压、血气及其他血液参数。通过超声心动图测量左心房、左心室和主动脉根部的大小，并将其与注射乙酰唑胺后的血管反应性相关联。
注射乙酰唑胺后，两组血压均未观察到显著变化。注射乙酰唑胺前，高血压患者大脑中动脉的平均血流速度（60.8±2.6厘米/秒）与对照组（58.8±1.9厘米/秒）无显著差异。注射乙酰唑胺10分钟后，高血压组血流速度的百分比变化（36.2±4.5%）显著低于对照组（52.6±3.7%）。观察到血管反应性降低与左心房和主动脉根部增大之间存在显著负相关（p<0.05）。
无神经功能缺损或计算机断层扫描异常的高血压患者血管反应性降低。左心房增大与血管反应性损害的严重程度密切相关。经颅多普勒超声检查可成为研究高血压所致血管损害及高血压患者随访的敏感工具。
