高血压患者“因时制宜”的血压管理调查研究

发布时间：2018-02-26 19:24

本文关键词： 高血压节气血压管理中医时间医学　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：高血压病是一种常见、多发病,也是心脑血管疾病最重要的危险因素,其并发症严重威胁人民的健康。有效的控制血压有助于减少心脑肾等靶器官的损害,降低心脑血管事件的发病率和死亡率。随着经济的发展,社会的进步,人们生活水平的提高,我国高血压患病率呈上升趋势,如何有效控制血压成为目前医学工作的热点之一。目的:探讨高血压患者血压波动与节气、气象因素的关系以及不同节气(不同气象条件下)高血压患者心脑血管事件发生率。从中医学"因时制宜"的角度阐释血压波动与节气的关系,丰富中医"因时制宜"调整高血压患者血压管理策略的理论。方法:本研究采用流行病学调查方法,临床观察对象为2016年1月至12月在广东省中医院心血管专科门诊就诊的原发性高血压患者,要求观察对象于二十四节气当日测量血压并记录具体数值。血压达标标准:一般患者血压140/90mmHg。按此标准分别计算观察对象二十四节气日的血压达标率并如实统计患者血压波动情况。并选取广州市气象局发布的广州市于二十四节气日当日的地面气象资料进行统计。数据记录整理入库,采用SPSS17.0软件进行统计分析。收缩压、舒张压平均值与节气关系的分析,组内比较采用方差分析或多个独立样本的非参数检验(Kruskal-Wallis H检验),收缩压、舒张压平均值以及收缩压、舒张压达标人数与气象因素的关系,分别采用散点图直观展示,两变量关系采用Pearson积矩相关分析。结果:1.血压波动与节气的关系不同节气条件下,高血压患者收缩压和舒张压平均值显著不同(P0.05)。在小寒、大寒、冬至、大雪这四个节气高血压患者收缩压、舒张压平均值较高,其中,小寒时,患者血压最高;大暑、小暑、立秋、夏至这四个节气收缩压、舒张压平均值较低,其中,大暑时血压平均值最低。在清明、芒种,舒张压达标人数最多;而在小寒时,舒张压达标人数最少。在立夏、大暑、立秋,收缩压达标人数最多;从霜降-大寒,血压达标人数逐渐减少,其中,大寒时,收缩压达标人数最少。2.急诊就诊人次与节气的关系该研究统计了在24节气日当天,64例高血压患者因急性心脑血管事件急诊就诊的次数,结果发现在大寒、立春、处暑、秋分这三个节气,高血压患者因急性心脑血管事件急诊就诊次数较高,其中,大寒时最高。而在,白露、寒露、霜降这3个节气急诊就诊人数较少。3.血压波动与气象因素的关系日平均气温与收缩压平均值呈负相关(P0.01),r=-0.699;日平均气温与舒张压平均值呈负相关(P0.01),r=-0.676;日平均气温与收缩压达标人数呈正相关(P0.01),r=0.676;日平均气温与舒张压达标人数无线性关系(P0.05)。日平均大气压与收缩压平均值呈正相关(P0.05),r=0.468;日平均大气压与舒张压平均值呈正相关(P0.05),r=0.436;日平均大气压与收缩压达标人数呈负相关(P0.05),r=-0.414;日平均大气压与舒张压达标人数无线性关系(P0.05)。日降水量、日平均相对湿度、日平均风速与收缩压平均值、舒张压平均值、收缩压达标人数、舒张压达标人数无线性关系(P0.05)。结论:本研究发现原发性高血压患者的血压达标率、急诊就诊人次与节气、气温、大气压有一定的关联性。在不同的节气,原发性高血压患者收缩压、舒张压平均值,以及血压达标率、急诊就诊人次有所差异,高血压患者血压的波动容易受气温因素、气压因素的影响,结合气温的变化、大气压的情况调整降压药、降低高血压患者急诊就诊率及预防心脑血管事件的发生具有一定的意义。本研究的样本量小,所收集的数据有限,以后可引入高血压慢病管理的大数据,结合气象学资料可得出更有说服力更科学的结论。
[Abstract]:Hypertension is a common disease, is also the most important risk factor for cardiovascular disease, the complications of a serious threat to people's health. Effective control of blood pressure can help reduce cardiovascular and kidney and other target organ damage, reducing cardiovascular events and mortality. With the development of economy, the progress of the society. The improvement of people's living standard, the prevalence of hypertension in China is rising, how to effectively control the blood pressure has become one of the focus of medical work. Objective: To investigate the fluctuation of blood pressure in patients with hypertension and the solar term, the relationship between meteorological factors and the different solar term (different meteorological conditions) the incidence of cardiovascular events in patients with hypertension. From the relationship between the traditional Chinese medicine "since" the perspective of blood pressure fluctuation and solar term, the rich Chinese medicine "time" to adjust the blood pressure of patients with hypertension management strategy theory. Methods: This study used epidemiological Methods of investigation, clinical observation object from January 2016 to December in Guangdong Province Traditional Chinese Medical Hospital cardiovascular clinic of primary hypertension patients, on the twenty-four day solar term blood pressure measurement and recording specific numerical observation object requirements. Blood pressure standard: blood pressure 140/ 90mmHg. patients according to the standards were calculated on the twenty-four solar term observation standard rate of blood pressure of patients and truthfully statistics the fluctuation of blood pressure. And choose to publish the Guangzhou Municipal Meteorological Bureau of Guangzhou City Statistics on meteorological data of twenty-four solar term on the day of data recording. Organize storage, using SPSS17.0 software for statistical analysis. The systolic blood pressure, diastolic blood pressure and the relationship between the solar term mean value analysis were compared by analysis of variance, multiple independent sample non parametric test (Kruskal-Wallis H test), systolic pressure, diastolic pressure and mean systolic blood pressure, diastolic blood pressure standard number The relationship with the meteorological factors, were used to plot visual display, two variables using Pearson product moment correlation analysis. Results: 1. blood pressure fluctuation and the different conditions of solar term solar term in patients with hypertension, systolic and diastolic blood pressure was significantly different (P0.05). In it, the winter solstice, but the contraction of patients with snow the four solar term high blood pressure, average blood pressure is higher, the cold, the blood pressure of patients with the highest; the great heat, slight heat, autumn, summer solstice of the four solar term systolic pressure, the diastolic blood pressure mean value is low, when the average value of blood pressure. The lowest heat in Qingming, grain in ear, diastolic blood pressure and in the largest number of standards; but when the diastolic blood pressure for at least the standard number. At the beginning of summer, autumn, great heat, the largest number of systolic blood pressure standard; from frost - chill, gradually reduce the number of blood pressure, the big chill, systolic blood pressure, the standard number of at least.2. emergency visits and solar term. The research department of statistics in the 24 solar term on the same day, 64 cases of patients with hypertension due to the number of acute cardiovascular events of emergency treatment, it was found at the beginning of spring, Chushu, autumnal equinox, the three solar term, due to acute cardiovascular events in patients with hypertension in the emergency department visits high, it was the highest. In the dew, cold dew, frost of the 3 solar term emergency fewer.3. blood pressure fluctuation and meteorological factors the relationship between daily mean temperature and mean systolic pressure was negatively correlated (P0.01, r=-0.699); the average daily temperature and average blood pressure was negatively correlated (P0.01, r=-0.676); the average daily temperature was positively correlated with systolic blood pressure (standard number P0.01, r=0.676); the average daily temperature and the standard number of no linear relationship between diastolic blood pressure (P0.05). The average pressure and the mean systolic pressure was positively correlated (P0.05), r=0.468; the average atmospheric pressure and average diastolic blood pressure values were positively correlated (P0.05), r= 0.436; average atmospheric pressure was negatively correlated with systolic blood pressure (P0.05), the standard number of r=-0.414; the average atmospheric pressure and diastolic blood pressure standard number no linear relationship (P0.05). Daily precipitation, daily average relative humidity, average wind speed and average systolic blood pressure, diastolic blood pressure average systolic blood pressure standard number. The standard number of no linear relationship between diastolic blood pressure (P0.05). Conclusion: This study found that the compliance rate of patients with primary hypertension and blood pressure, people in emergency department of air temperature, solar term, atmospheric pressure have certain relevance. In different solar term, essential hypertension patients with systolic blood pressure, diastolic blood pressure, average blood pressure rate of emergency visits vary, the blood pressure of hypertension patients easily affected by temperature fluctuation factors, pressure influence factors, combined with the change of temperature, pressure adjustment of antihypertensive drugs, reduce hypertension emergency treatment rate and prevention of cardiovascular and cerebrovascular events The occurrence of this disease has certain significance. The sample size of this study is small, and the data collected are limited. Later, big data of chronic disease management can be introduced. Combined with meteorology data, a more convincing and more scientific conclusion can be drawn.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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