论文部分内容阅读
目的探讨高血压合并主动脉夹层患者脉搏波传导速度(PWV)的变化及其临床意义。方法经症状、CT血管造影(CTA)确诊的高血压合并急性主动脉夹层患者22人(主动脉夹层组),平均发病时间为9.6h,患者均有高血压史,入院平均血压为(180±16)/(97±9)mmHg,其中DebakeyⅠ型9例、Ⅱ型6例、Ⅲ型7例。入院后维持血压在140/80mmHg左右,于24h内血压控制稳定后分别测定上肢动脉段(C-R)、主动脉段(C-F)、下肢动脉段(F-A)的PWV。选择高血压患者22例作为对照组,同样测定上述动脉段的PWV。比较两组患者各动脉段PWV的变化和主动脉夹层患者不同类型之间各动脉段PWV的差别。结果主动脉夹层组患者的主动脉段PWV显著低于高血压对照组[夹层组RC-F(8.14±0.78)比高血压(9.64±1.79)m/s;夹层组LC-F(8.16±1.85)比高血压(9.38±1.56)m/s],左上肢颈桡动脉段PWV显著低于高血压对照组(夹层组LC-R(8.42±1.84)比高血压(9.01±2.13)m/s,P<0.05],其余动脉段两组之间无显著性差别。亚组分析表明,对主动脉段PWV来说,三亚型之间均有显著性差别,其中Ⅰ型主动脉夹层患者最低,Ⅱ型最高,Ⅲ型居中[RC-F,Ⅰ型:(8.04±1.89),Ⅱ型:(8.77±0.78),Ⅲ型:(8.36±1.86)m/s;LC-F,Ⅰ型:(8.10±1.56),Ⅱ型:(8.64±1.85),Ⅲ型:(8.38±1.86)m/s,P<0.05];左上肢动脉段PWVⅠ型主动脉夹层显著低于部Ⅱ、Ⅲ型[Ⅰ型:(8.11±1.15),Ⅱ型:(8.35±2.81),Ⅲ型:(8.64±1.86)m/s,P<0.05],而Ⅱ、Ⅲ型之间无显著性差别。结论主动脉夹层患者的主动脉PWV显著降低,累及的主动脉段越长,PWV越低。因此PWV检查有助于主动脉夹层的诊断和预后判断。
Objective To investigate the changes and clinical significance of pulse wave velocity (PWV) in patients with hypertension and aortic dissection. Methods Twenty-two patients (aortic dissection group) with hypertension diagnosed by CT angiography (CTA) with acute aortic dissection had an average onset time of 9.6 hours. All patients had a history of hypertension and the mean admission blood pressure was (180 ± 16) / (97 ± 9) mmHg, including 9 cases of Debakey type Ⅰ, 6 cases of type Ⅱ and 7 cases of type Ⅲ. After admission, the blood pressure was maintained at about 140 / 80mmHg. After stable blood pressure control within 24 hours, PWV of upper extremity arterial segment (C-R), aortic segment (C-F) and lower extremity arterial segment (F-A) were measured. Twenty-two patients with hypertension were selected as the control group, and the PWV of the above artery segment was also measured. The changes of PWV in different arterial segments in two groups were compared with those in different segments of aortic dissection. Results The PWV of the aortic segment in aortic dissection group was significantly lower than that in the control group [RC-F (8.14 ± 0.78) and hypertension (9.64 ± 1.79) m / s in the dissection group; LC-F (9.38 ± 1.56) m / s). The PWV of the radial artery of the left upper extremity was significantly lower than that of the hypertensive control group (LC-R (8.42 ± 1.84) and hypertension (9.01 ± 2.13) m / , P <0.05], there was no significant difference between the other arterial segments.The subgroup analysis showed that there was a significant difference between the three subtypes in the aortic segment PWV, among them, the type I aortic dissection was the lowest, Type Ⅱ: (8.77 ± 0.78), Type Ⅲ: (8.36 ± 1.86) m / s; Type LC: F (Type Ⅰ: 8.10 ± 1.56), Type Ⅱ (8.64 ± 1.85), Type Ⅲ (8.38 ± 1.86) m / s, P <0.05]. The PWV type Ⅰ aortic dissection in the left upper extremity was significantly lower than that in the type Ⅱ and Ⅲ [Ⅰ (8.11 ± 1.15), type Ⅱ (8.35 ± 2.81), type Ⅲ (8.64 ± 1.86) m / s, P <0.05], while there was no significant difference between type Ⅱ and type Ⅲ.Conclusion Aortic dissection Patients with aortic PWV significantly reduced, involving the longer the aortic segment, the lower the PWV.Therefore, PWV examination is helpful for aortic dissection diagnosis and prognosis.