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血液透析患者颈内动脉血流动力学参数和脑血流量的变化
Research on the variations in the hemodynamic parameters of internal carotid artery and cerebral blood flow in patients of hemodialysis
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DOI:
作者:
郭强,罗伟华, 陈道芳,徐 芳,史登刚,支芬燕,姚 宏
GUO Qiang, LUO Weihua, CHEN Daofang, XU Fang, SHI Denggang,ZHI Fenyan,YAO hong
作者单位:
上海市第六人民医院金山分院
Jinshan Branch of Shanghai No.6 People's Hospital
关键词:
血液透析;颈动脉;彩色多普勒超声;脑血流量
Hemodialysis; Carotid Artery; Color Doppler Flow Imaging; Cerebral blood flow
摘要:
【摘要】 目的 应用彩色多普勒超声观察长期行血液透析的患者颈内动脉血流动力学参数和脑血流量的变化,以期为临床早期治疗血液透析后脑血管并发症提供理论依据。方法 选取慢性肾衰竭行血液透析治疗的患者58例(颈动脉116根)为病例组,平均透析时间为(6.23±3.14)年;选取存在类似血管损伤风险因素的肾功能异常患者40例(颈动脉80根)为对照组。应用颈动脉彩色多普勒超声测量颈动脉内中膜厚度(IMT)、颈动脉斑块数量和厚度,以及颈内动脉血流各项血流参数[舒张末期流速(EDV)、收缩期峰值流速(PSV)、阻力指数(RI)、心率(HR)、速度时间积分(VTI)、管腔截面积(S),计算单侧前循环脑血流量。结果 病例组患者颈动脉IMT、颈动脉斑块数量和斑块厚度分别为(1.42±0.17) mm、(3.45±2.19)个和(1.98±0.38) mm,分别显著高于对照组的(1.21±0.18) mm、(2.32±1.98)个和(1.42±0.19) mm(P值均<0.05)。病例组的EDV和单侧前循环脑血流量分别为(18.79±8.83) cm/s和(498.89±62.48) mL/min,均显著低于对照组的(22.38±9.85) cm/s和(525.67±9.85) mL/min(P值均<0.05);RI为0.74±0.09,显著高于对照组的0.65±0.08(P<0.05);PSV为(78.61±18.69) cm/s,与对照组的(75.52±19.62) cm/s比较,差异无统计学意义(P>0.05)。单侧前循环脑血流量与血液透析时间呈负相关,(P<0.05),y=-18.838x+609.5,相关系数(R²)=0.7222。结论 行血液透析治疗的患者颈动脉更易发生内膜增厚、斑块形成和血流动力学改变,导致脑血流量减少。
【Abstract】 Objective To assess the variations in the hemodynamic parameters of internal carotid artery and cerebral blood flow in patients after long-term hemodialysis by Color Doppler Flow Imaging, further providing theoretical basis for guidance of treatment of clinical cerebrovascular complications after long-term hemodialysis. Methods we studied 58 patients (116 carotids) of chronic renal failure after long-term hemodialysis from the haemodialysis centre in our hospital during January 2013 to January 2014. Patients had been on dialysis for a mean of (6.23 ± 3.14) years. Forty patients (80 carotids) with abnormal renal function and similar risks of vascular injury factors were included as control group. Characteristics of carotid arteries were evaluated by Color Doppler Ultrasound in all of the patients and corresponding indexes were observed and measured including artery intima-media thickness (IMT), size and number of atherosclerotic plaques. Then we analyzed the blood flow parameters of internal carotid artery and calculated the cerebral blood flow of anterior circulation. Results A comparison between the case and control groups showed that the IMT, number and thickness of atherosclerotic plaques in case group were higher compared with the control group (P < 0.05). They were (1.42±0.17) mm, (3.45±2.19) and (1.98±0.38) mm, respectively. The peak systolic velocity (PSV), the End Diastolic velocity (EDV) and the resistive index (RI) in the case group were (78.61±18.69) cm/s, (18.79±8.83) cm/s and (0.74±0.09), respectively. There were statistical differences in EDV and RI between these groups except for the PSV index. The EDV in case group was lower and the RI was higher than that in control group (P<0.05). Moreover, the unilateral anterior circulation flow (Q) in the case group was (498.89±62.48) mL/min. It was negatively correlated with the time of hemodialysis (P<0.05, y=-18.838x+609.5, R²=0.7222). Conclusions Patients after long-term hemodialysis was prone to lesion of carotid artery with increased thicknesses of the carotid artery intima-media thickness (IMT) and the atherosclerotic plaques, and obvious changes in haemodynamics, leading to reduced blood flow of the anterior circulation of cerebrum after long-term hemodialysis.
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