Autonomic control of the cerebral circulation during normal and impaired peripheral circulatory control
Autonomic control of the cerebral circulation during normal and impaired peripheral circulatory control
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DOI：
10.1136/hrt.82.3.365
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发表时间：
1999-09-01
期刊：
影响因子：
5.7
通讯作者：
Bernardi, L
中科院分区：
文献类型：
--
作者：
Cencetti, S;Lagi, A;Bernardi, L
目的：探讨脑血管循环振荡是否与心血管振荡一样具有自主调节机制。设计-在休息和交感刺激（头向上倾斜）时监测心脑血管振荡。评估了交感（低频，LF）和呼吸（高频，HF）波段振荡的关联和传递。受试者：健康志愿者13例，血管迷走神经性晕厥患者10例，合并非胰岛素依赖型糖尿病患者12例。主要观察指标-脑血流速度、动脉血压和心率的功率谱分析。相干分析用于研究每对振荡之间的关联。相位分析表明，心血管信号的振荡相对于脑血管信号有延迟。结果：在正常对照组和血管迷走神经性晕厥患者中，头向上倾斜时交感神经（LF）各振荡分量的功率均增加（p < 0.01），而在糖尿病患者中无显著差异。在大多数对照组和血管迷走神经性晕厥患者中，LF波段的脑血管和心血管振荡之间存在显著的一致性（>.5），但在糖尿病患者中没有（< 50%的患者）。在LF波段，各组休息时脑血管振荡先于心血管振荡（p < 0.05）；健康人和晕厥受试者在抬头时所有心血管信号的相移均减少（p < 0.05），但只有糖尿病患者的心率相移减少。结论：脑血管阻力血管受自主调节；脑血流速度的低频振荡先于其他心血管信号的波动。糖尿病患者的自主神经病变和微血管僵硬降低了这种调节。
Objective-To determine whether oscillations in the cerebrovascular circulation undergo autonomic modulation in the same way as cardiovascular oscillations.Design-Cardiovascular and cerebrovascular oscillations were monitored at rest and during sympathetic stimulation (head up tilt). The association with and transmission of the oscillations in the sympathetic (low frequency, LF) and respiratory (high frequency, HF) bands was assessed.Subjects-13 healthy volunteers, 10 subjects with vasovagal syncope, and 12 patients with complicated non-insulin dependent diabetes mellitus.Main outcome measures-Power spectrum analysis of cerebral blood flow velocity, arterial blood pressure, and heart rate. Coherence analysis was used to study the association between each pair of oscillations. Phase analysis showed the delay of the oscillations in the cardiovascular signals with respect to the cerebrovascular signals.Results-The power in the sympathetic (LF) components in all the oscillations increased during head up tilt (p < 0.01) in the controls and in the subjects with vasovagal syncope, but not in patients with diabetes. Significant coherence (> 0.5) in the LF band was present between cerebrovascular and cardiovascular oscillations in most of the controls and in subjects with vasovagal syncope, but not in the diabetic patients (< 50% of the patients). In the LF band, cerebrovascular oscillations preceded the cardiovascular oscillations (p < 0.05) at rest in all groups: the phase shifts were reduced (p < 0.05) during head up tilt for all cardiovascular signals in healthy and syncopal subjects, but only for heart rate in diabetic patients.Conclusions-The cerebrovascular resistance vessels are subject to autonomic modulation; low frequency oscillations in cerebral blood flow velocity precede the resulting fluctuations in other cardiovascular signals. Autonomic neuropathy and microvascular stiffness in diabetic patients reduces this modulation.