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研究生:黃映茹
研究生(外文):Ying-Ju Huang
論文名稱:人類後大腦循環與前大腦循環之血流動力學的比較
論文名稱(外文):Comparison of Cerebral Hemodynamics Between Posterior and Anterior Cerebral Circulation in Normal People
指導教授:胡漢華胡漢華引用關係黃映茹
指導教授(外文):Han-Hwa HuYing-Ju Huang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:腦科學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:36
中文關鍵詞:大腦循環血流動力學暈厥傾斜床測試穿顱杜卜勒超音波
外文關鍵詞:Cerebral CirculationHemodynamicsSyncopeHead-up tilt-table testTranscranial doppler ultrasonography
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暈厥為後大腦腦血液循環障礙症狀之一,臨床上,針對起立性暈厥的病人,會應用傾斜床測試(Head-up tilt-table test, HUT)結果協助臨床確診,但目前有很多的研究是以觀察前大腦腦血液循環的變化為主,而非針對後大腦腦血液循環,我們假設當人在瞬間改變姿勢時,後大腦腦血液循環的變化會比前大腦腦血液循環明顯。
所以我們針對健康受試者研究姿勢變化對後大腦動脈血流與中大腦動脈血流的影響。我們徵求健康自願受試者接受傾斜床測試,應用穿顱杜卜勒超音波(transcranial Doppler ultrasonography, TCD)觀察後大腦動脈(posterior cerebral artery, PCA)與中大腦動脈(middle cerebral arteries, MCA)的血流動力變化。
研究結果發現,傾斜床瞬間立起3分鐘時,正常人平均腦血流在後大腦動脈下降22.23±9.42 %顯著低於中大腦動脈的18.61±7.27 %,而腦血管阻力在後大腦動脈則上升25.88±15.16 %顯著高於中大腦動脈的20.14±1.97 %。顯示後大腦動脈的血流變化對瞬間的姿勢改變遠較中大腦動脈的變化顯著且有意義,然此結果是否與臨床上起立性暈厥(orthostatic syncope)病人的暈厥機制有關,仍需進一步的研究。
Syncope is one of symptoms of posterior circulation insufficiency. Current Head-up tilt-table test (HUT) studies for syncope monitor the anterior circulation, but not posterior. We tested the hypothesis that hemodynamic changes of posterior circulation changes are greater than those of anterior circulation during posture changes. Subsequently, we investigated posterior cerebral arteries (PCA) and middle cerebral artery (MCA) flow in health people. We recruited thirty nine healthy volunteers to receive HUT test. Middle cerebral artery and posterior cerebral arteries were monitored with transcranial doppler simultaneously.
The results showed that cerebral blood flow of posterior cerebral artery decreased more than cerebral blood flow of middle cerebral artery. cerebrovascular resistance (CVR) of posterior cerebral artery increased more than cerebrovascular resistance of middle cerebral artery.
These documented our hypothesis that hemodynamic changes of the posterior circulation are greater in normal people when they changed their postures. We suggest that monitory of the hemodynamic changes in posterior circulation is more relevant than monitory the anterior circulation in the study of syncope.
前  言
暈厥 ------------------------------------------------------------------------------- 1
姿勢變化與腦血流的關係 ---------------------------------------------------- 2
研究目的 ------------------------------------------------------------------------- 5
材料與方法
受試者 --------------------------------------------------------------------------- 7
傾斜床測試檢查程序 --------------------------------------------------------- 8
穿顱杜卜勒超音波 ------------------------------------------------------------ 9
腦血管參數計算 -------------------------------------------------------------- 10
統計分析 ----------------------------------------------------------------------- 10
結  果
傾斜床測試時大腦血流的變化 -------------------------------------------- 11
傾斜床測試時大腦血管阻力的變化 -------------------------------------- 12
傾斜床測試時大腦血管阻力變化的差異 -------------------------------- 13
傾斜床測試時血壓的變化 -------------------------------------------------- 13
討  論 ----------------------------------------------------------------------- 15
總  結 ----------------------------------------------------------------------- 20
參考資料 ----------------------------------------------------------------------- 32


表目錄

表一、比較斜床測試前後大腦動脈的血流變化 ------------------------- 21
表二、比較傾斜床測試前後大腦動脈的腦血管阻力 ------------------- 22
表三、比較傾斜床測試前後大腦動脈的腦血管阻力變化 ------------ 23
表四、比較傾斜床測試前後的血壓變化 ---------------------------------- 24
表五、斜床測試前後男性大腦動脈的血流變化 ------------------------ 25
表六、斜床測試前後女性大腦動脈的血流變化 ------------------------ 26
表七、平躺與傾斜床立起後十分鐘腦血流最低時,男性大腦動脈的平均腦血流 --------------------------------------------------------------- 27
表八、平躺與傾斜床立起後十分鐘腦血流最低時,女性大腦動脈的平均腦血流 --------------------------------------------------------------- 28
表九、平躺與傾斜床立起後三分鐘腦血流最低時,男性大腦動脈的平均腦血流 --------------------------------------------------------------- 29
表十、平躺與傾斜床立起後三分鐘腦血流最低時,男性大腦動脈的平均腦血流 --------------------------------------------------------------- 30

圖目錄

圖一、比較傾斜床測試前後腦血管阻力的變化 ------------------------ 31
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