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目的研究不同程度降压对不同病理阶段老年高血压患者脑循环储备力(CCR)的影响及屏气试验对指导老年高血压个体化治疗的价值。方法选择老年原发性高血压(高血压组)及合并腔隙性脑梗死(腔梗组)患者各33例、健康老年志愿者(健康对照组)27例为观察对象,应用经颅多普勒技术测定不同血压水平下屏气试验后脑循环血流动力学参数及降压治疗后CCR下降>10%者所占比例。结果(1)高血压组及腔梗组降压前后平均峰流速(Vm)值(平静时)差异无显著性,屏气试验后屏气指数(BHI)及Vm上升率则较健康对照组明显下降(P<0.05,P<0.01)。小幅度降压(12.7%,12.8%)后BHI及Vm上升率两病例组均较降压治疗前有所提高,但差异无显著性;较大幅度降压(22.6%,22.4%)后BHI及Vm上升率两病例组均较治疗前显著提高(P<0.05,P<0.01);脉动指数(PI)下降率仅高血压组治疗前与健康对照组比较差异有显著性(P<0.05)。(2)高血压组及腔梗组降压治疗后CCR下降>10%者所占比例分别为12.1%和24.2%,差异无显著性(P>0.05)。结论合理降压治疗可部分提高不同病理阶段老年高血压患者脑血管对二氧化碳的反应性,改善其脑血管储备功能。
Objective To investigate the effects of different degrees of antihypertension on cerebral circulation reserve (CCR) in elderly hypertensive patients with different pathological stages and the value of breath-hold test on the individualized treatment of elderly hypertension. Methods Thirty-three elderly patients with essential hypertension (hypertension group) and 33 patients with lacunar infarction (infarction group) and 27 healthy volunteers (healthy control group) were enrolled in this study. Le technical determination of blood pressure levels at different levels of cerebral blood flow hemodynamic parameters and after antihypertensive treatment of CCR decreased> 10% of the proportion. Results (1) There was no significant difference in mean peak velocity (Vm) before and after depressurization between hypertension group and luminal infarction group (BHI) and Vm increase rate after the breath test (P < P <0.05, P <0.01). The incidence of BHI and Vm increased slightly after the small-scale decompression (12.7%, 12.8%) compared with that before the antihypertensive treatment, but there was no significant difference between the two groups (P> 0.05) (P <0.05, P <0.01). The decline rate of pulsatile index (PI) in hypertension group was significantly higher than that in healthy control group before treatment (P <0.05) . (2) There was no significant difference (P> 0.05) in the rate of CCR decline> 10% in hypertensive group and lumen group after treatment with antihypertensive therapy respectively 12.1% and 24.2%. Conclusions Rational antihypertensive treatment can partly improve the responsiveness of cerebrovascular to carbon dioxide in elderly hypertensive patients with different pathological stages and improve its cerebrovascular reserve function.