中心动脉压与血管功能

(mmH g)
24 years old
Nichols WW et al. 1993
Estimated aortic blood pressure
16 0 14 0 12 0 10 0 8 0 6 0 4 0 2 0 0
(mmH g)
Age and central blood BP was matched as 150 mmHg in all age pressure Radial groups
Systolic BP
Augmentati on Index
Diastolic BP Arrival of reflection wave
反射波机制对中心动脉压的影响
脉搏波传导速度(PWV) --反射波速度 阻力微、小动脉—反射位点 动脉弹性--反射波幅度 心率--反射波在收缩期叠加的幅度
Reflection component Incident component
Aortic diastolic BP
31
31
49
32
49
5059
Kohara K et al. J Am Geriatr Soc, 1999
Ag
6069
70 -
Arterial stiffness augmentation by reflection pressure wave Reduced compliance Impaired Windkessel function
Event ↑Risk ↑↑↑Risk
The Strong Heart Study
Central Blood Pressure Better predicts Cardiovascular Events than Does Peripheral Blood Pressure 2662 patients, 63yrs, follow-up 3.4y

进一步校正颈动脉粥样硬化病变，主动脉 PP仍然与CVD显著独立相关。
Reflection of pressure wave as risk factor
ESRD patients
Even free rate for cardiovascular accidents
1.0 1.0 PWV<9.4m/s 9.4≦PWV≦12.0m/s
心肌缺血
内皮损伤和功能紊乱，动脉硬化性疾病
进展
AI and coronary heart disease Association between aortic AI and coronary arteriogram
1 2 1 1 1 0 9
Augmented pressure
mmHg
8
7 6
60 %
Decreased aortic compliance
Systol e
50 % 50 %
Diastol e
50 %
London and Guerin. Am Heart J 1999;138:220-224
主动脉顺应性下降
• 大动脉顺应性降低，弹性降低，收缩压力在
动脉内不能得到缓冲，使收缩压升高。
5
4
NO lesions
Two One vessel vessels
Three vessels
Circulation 2004;109:184189
Roman MJ, et al. AHA Sept. 2005
The Strong Heart Study: ox regression analyses

(校正年龄、性别、体重指数、吸烟、LDL-C、DM)
主动脉SBP和PP与CVD发生率独立相关， RR/10mmHg分别为1.07与1.10, p分别为 0.043与0.009。
• 舒张期大血管弹性回缩减低，使舒张压降低。
结果：脉压增大
Augmentation and reflection wave
Incident wave
Reflection wave
McDonald’s fourth edit
Arterial pressure waveform and reflection wave
中心动脉压与血管功能
动脉压相关因素
心搏量
末梢阻力 血管壁硬度 反射波
中心动脉压
主动脉顺应性（大血管硬度）
反射波 时间 幅度
Aortic compliance and pulse pressure Windkessel Normal function
Systol e
60 %
40 %
Diastol e
0
0
0
35
70
105
140
0
35
70
105
140
Time (month)
Time (month)
Blacher et al. Circulation, 1999
London GM et al. Hypertension, 2001
中心动脉压和脉压升高对 心血管系统影响
左室后负荷增加，左室重构
冠状动脉灌注下降，储备功能下降，
Central hypertension Systolic hypertension Wide pulse pressure
The Great Hemodynamic Divide
Mean Pressure
Pulse Pressure
Anatomy Heart, small arteries Aorta Physiology ↑ Cardiac output ↑ Stiffiness ↑ Peripheral resistance BP ↑ SBP ,↑ DBP ↑ SBP ↓ DBP
AI与主动脉压、脉压的测量
Attenuation of peripheral augmentation effect by arterial stiffness Peripheral BP and central BP
15 0 10 0 5 0
(mmH g)
68 years old
15 0 10 0 5 0
Augmentation index 1 群 Augmentation index 2 群
Survival rate for cardiovascular death
0.75
0.75
0.50
12.0m/s <PWV
0.50
Augmentation index 3 群
0.25
0.25
Augmentation index 4 群