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目的通过在倾斜床和 Valsalva 试验(VM)中连续监测双侧大脑中动脉(MCA)的平均血流速度、平均动脉血压、潮气末 CO_2等多种指标,分析帕金森病(Parkinson’s disease,PD)的静态和动态脑自动调节功能的临床特征。方法同时连续监测17例 PD 患者和8名年龄、性别相匹配的健康对照者两侧 MCA 平均血流速度、平均动脉血压、校正到脑 Willis 环水平的脑平均动脉压、心率、潮气末 CO_2。首先进行倾斜床试验(基线平卧位,向上倾斜10°、30°、70°和恢复平卧位),然后进行 VM。计算所有相位动脉血压和左、右 MCA 的搏动指数(PI_(BP)、PI_L、PI_R)以及 PI_L/PI_(BP),PI_R/PI_(BP)。在倾斜床试验过程中计算脑血管阻力和静态脑自动调节指数,VM 则计算系列脑自动调节指数和相关指标的相位及波幅变化。结果倾斜床试验显示向上倾斜70°时,对照和 PD 组仅脑平均动脉压(mm Hg,1 mm Hg=0.133kPa)在明显比基线状态降低(59.9±10.2、77.1±12.3,P=0.03;61.8±15.1、79.2±11.8,P=0.02),但两组间差异无统计学意义(P>0.05),PD 组平均血流速度(cm/s)在所有相位[(34.1±7.5)～(44.1±13.8)]均明显低于对照组(61.4±15.9～65.4±19.2,p<0.05),而脑血管阻力(mm Hg·s~(-1)·cm~(-1))均明显高于对照组[(2.0±1.1)～(2.3±1.0),(1.0±0.2)～(1.2±0.4);P<0.05]。PD 组左、右静态脑自动调节指数(15.0%,6.8%)明显低于对照组(73.4%,75.7%;P<0.01)。VM 时,PD 组平均血流速度在所有相位[(35.7±12.7)～(54.2±16.1)]均明显低于对照组[(47.1±11.3)～(80.2±25.5),P<0.05],但在相位Ⅱa和Ⅱb差异无统计学意义(P>0.05);PI_(BP)在相位Ⅰ～Ⅲ[(0.6±0.1)～(0.5±0.2)]明显低于基线值[(0.7±0.1),P<0.05],但 PI_L/PI_(BP)和 PI_R/PI_(BP)从相位Ⅱa～Ⅲ[(2.1±1.0)～(2.9±1.5)]明显高于基线[(1.5±0.5),P<0.05]。结论 PD 患者处于高脑血管阻力和低平均血流速度的基础状态,倾斜床试验提示他们因脑远端阻力血管的舒张功能障碍,而显示一种特殊类型的静态脑自动调节障碍。VM 过程中动态脑自动调节反应显示特征性的时相延迟,PD 可使时相进一步延迟,而且脑自动调节反应的临床阈值升高,强度明显减弱,PI_L/PI_(BP)和 PI_R/PI_(BP)是反映 PD 动态脑自动调节功能的较好指标。
Objective To analyze Parkinson’s disease (PD) by continuously monitoring the average blood flow velocity, mean arterial pressure and end-tidal CO 2 in bilateral oblique middle cerebral artery (MCA) in tilt-bed and Valsalva test (VM) The clinical features of static and dynamic brain autoregulation. Methods Mean arterial blood pressure, mean arterial blood pressure, cerebral mean arterial pressure, heart rate and end-tidal CO 2 corrected for MCA in 17 patients with PD and 8 age-matched healthy controls at the same time were consecutively monitored. The tilt bed test (baseline supine position, tilting up 10 °, 30 °, 70 °, and rest supine position) was performed first, followed by VM. The pulsatility index (PI_ (BP), PI_L, PI_R) and PI_L / PI_ (BP) and PI_R / PI_ (BP) were calculated for all phases of arterial pressure and left and right MCA. Cerebral vascular resistance and static cerebral autoregulation index were calculated during the tilt-bed test, and the VM calculated the phase and amplitude changes of the series of autoregulation indices and related indicators. Results The tilted bed test showed that only the mean arterial pressure (mm Hg, 1 mm Hg = 0.133 kPa) in the control and PD groups was significantly lower than that at baseline (59.9 ± 10.2, 77.1 ± 12.3, P = 0.03; 61.8 ± 15.1,79.2 ± 11.8, P = 0.02), but there was no significant difference between the two groups (P> 0.05). The average blood flow velocity (cm / 44.1 ± 13.8)] were significantly lower than those in the control group (61.4 ± 15.9-65.4 ± 19.2, p <0.05), while the values of cerebrovascular resistance (mm Hg · s -1 · cm -1) were significantly higher In the control group [(2.0 ± 1.1) ~ (2.3 ± 1.0), (1.0 ± 0.2) ~ (1.2 ± 0.4); P <0.05]. Left and right static cerebral autoregulation index (15.0%, 6.8%) in PD group was significantly lower than that in control group (73.4%, 75.7%; P <0.01). VM, the average blood flow velocity in PD group was significantly lower than that in control group ([47.1 ± 11.3] ~ (80.2 ± 25.5), P <0.05] in all phases [(35.7 ± 12.7) ~ (54.2 ± 16.1) There was no significant difference in phase Ⅱa and Ⅱb between the two groups (P> 0.05); PI (PI) was significantly lower than baseline (0.7 ± 0.1) in phase Ⅰ ~ Ⅲ [(0.6 ± 0.1) ~ (0.5 ± 0.2) P <0.05]. However, PI_L / PI BP and PI PI / PI BP were significantly higher than baseline (1.5 ± 0.5) from phase Ⅱa ~ Ⅲ [(2.1 ± 1.0) ~ 2.9 ± 1.5), P < 0.05]. Conclusions PD patients are at a basal state of high cerebrovascular resistance and low mean blood flow velocity. Tilting bed tests suggest that they exhibit a special type of static cerebral autoregulation disorder due to diastolic dysfunction of the distal cerebral vascular resistance. Dynamic brain response during VM showed a characteristic time delay, PD delayed the time phase further, and the clinical threshold of brain autoregulation increased and the intensity was significantly weakened. PI-PI / PI and PI-R / PI_ BP) is a good indicator of PD dynamic brain autoregulation.