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目的应用 TCD 和倾斜试验评价脑血管病患者的脑血流自身调节。方法脑血管狭窄患者32例(A 组),无血管狭窄的脑梗死患者28例(B 组),健康对照26名。通过呼吸试验计算呼吸抑制指数(BHI)及血管运动反应性(VMR)评价脑小血管 CO_2反应性;头高位70°倾斜试验改变体位,记录卧立位脑血流速度(CBFV)及血压、心率,评价脑小血管的血压-自动调节。结果与对照组比较,A 组、B 组 VMR(分别为0.18±0.02和0.26±0.04,对照组为0.43±0.06)、BHI(分别为0.76±0.15和1.05±0.15,对照组为1.52±0.19)显著降低(P<0.05)。A 组患侧与对侧 VMR(分别为0.10±0.01、0.22±0.02)及 BHI(分别为0.51±0.14、0.94±0.16),差异有统计学意义(P<0.05)。A 组患侧 BHI 值小于0.69(P<0.05)。Logistic 回归分析显示 BHI 下降与脑梗死相关(B=2.234,P=0.016)。直立位时血压、心率增加,CBFV 下降。3例直立性低血压患者直立位血压和 CBFV 均显著下降,二者之间相关(r=0.430,P=0.004)。结论脑梗死及脑血管狭窄患者脑小血管 CO_2反应性受损。自身调节能力受损,卒中风险可能增加。直立位时,机体通过提高周围血压和心率,参与颅内自动调节。
Objective To evaluate the cerebral blood flow self-regulation in patients with cerebrovascular disease by TCD and tilt test. Methods 32 patients with cerebrovascular stenosis (group A), 28 patients without vascular stenosis (group B) and 26 healthy controls. The respiratory responsiveness (BHI) and vasomotor reactivity (VMR) were calculated by breath test to evaluate the responsiveness of CO 2 in cerebral blood vessels. The head position 70 ° tilt test was performed to change the position and the horizontal position was recorded. The CBFV, blood pressure, heart rate , Evaluate the blood pressure of brain blood vessels - automatically adjust. Results Compared with the control group, VMR (0.18 ± 0.02 and 0.26 ± 0.04, respectively, in control group and 0.43 ± 0.06 in control group), BHI (0.76 ± 0.15 and 1.05 ± 0.15 respectively in control group and 1.52 ± 0.19 in control group) Significantly lower (P <0.05). The VMR (0.10 ± 0.01, 0.22 ± 0.02) and BHI (0.51 ± 0.14, 0.94 ± 0.16, respectively) in the affected and contralateral sides in group A were significantly different (P <0.05). The BHI in group A was less than 0.69 (P <0.05). Logistic regression analysis showed that the decrease of BHI correlated with cerebral infarction (B = 2.234, P = 0.016). Upright position when blood pressure, heart rate increased, CBFV decreased. Blood pressure and CBFV in orthostatic hypotension were significantly decreased in 3 patients with orthostatic hypotension (r = 0.430, P = 0.004). Conclusion Cerebral vascular and cerebral vascular stenosis are impaired in patients with cerebral infarction and cerebrovascular stenosis. Impairment of self-regulation may increase the risk of stroke. Upright position, the body by increasing peripheral blood pressure and heart rate, involved in the regulation of intracranial autonomy.