叶酸干预老年H型高血压患者血流动动力学变化临床观察

发布时间：2018-05-28 00:15

  本文选题：H型高血压 + 颈动脉内膜中层厚度　； 参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:根据目前指南,H型高血压即为在原发性高血压的基础上血浆同型半胱氨酸(Hcy)水平超过10 μ mol/L,本研究观察老年H型高血压患者叶酸干预治疗后血流动力学各项指标的变化特点,以及治疗前后血浆同型半胱氨酸含量变化、颈部血管彩超检查结果,血浆叶酸含量来评估阶段叶酸治疗后,各项检查指标的变化及改善程度,为临床叶酸治疗老年人H型高血压提供一定临床指导。方法:选择2016年4月～2017年1月就诊于广州军区广州总医院门诊及干部病房五科、心血管内科的H型高血压患者92例,纳入标准血浆Hcy≥10 μmol/L,同时收缩压≥140 mm Hg(1mm Hg = 0.133 kPa)和(或)舒张压≥90 mm Hg,患者的平均年龄为(66.63±5.73)岁,其中男性患者82例,女性患者10例,随机分为干预组和对照组,每组46例。有下列疾病的患者均排除在外:继发性高血压、心脏瓣膜病、慢性肾功能损害、慢性心功能不全(NYHA分级≥Ⅲ级)、脑卒中、过去6个月发生过心肌梗死、认知障碍、失语、精神和心理障碍、肿瘤、并且于入院之前未服用叶酸、B族维生素药物。干预组与对照组同时给予相同降压药治疗,干预组在降压药物治疗基础上,同时给予口服叶酸片0.8mg,qd,于观察3个月、9个月时测量血清同型半胱氨酸、叶酸含量,并定期测量各项血流动力学指标、通过超声测量颈动脉内膜中层厚度。并进行统计学分析。结果:治疗3个月后,对照组治疗前后血浆同型半胱氨酸差异无统计学意义(P0.05),干预组治疗3个月后血浆同型半胱氨酸水平较前明显降低(P0.05),且低于对照组水平(P0.05)。干预组治疗后血清叶酸含量升高(P0.05),对照组治疗后血清叶酸水平较治疗前降低,干预组经过治疗后血流动力学指标改善情况比对照组改善更明显,LVET、TFC、HR、PEP差异无统计学意义(P0.05),C0、SV、ISI、SSVR、EPCI、SBP、DBP差异有统计学意义(P0.05)。治疗9个月后,对照组血浆同型半胱氨酸水平较治疗开始时差异无统计学意义(P0.05),干预组血浆同型半胱氨酸水平较治疗开始时降低(P0.05),干预组血流动力学指标C0、SV、ISI、SSVR、EPCI、HR、SBP、DBP 差异有统计学意义(P0.05),LVET、TFC、PEP 差异无统计学意义(P0.05)。干预组左侧、右侧颈动脉内膜中层厚度治疗前后差异有统计学意义(P0.05),对照组左侧、右侧颈动脉内膜中层厚度治疗前后差异无统计学意义(P0.05)。结论:无创血流动力学监测能够较为方便而且全面的检测血流动力学参数,又可以动态地了解患者血流动力的即时状态,具有监测的持续性,通过这项检查可以获得多项血流动力学参数,为老年H型高血压患者的治疗提供临床依据,为早期H型高血压的诊断和治疗提供客观依据,叶酸干预老年H型高血压治疗后,血流动力学参数好转,相比于对照组各项参数,干预组与标准值的差距更小,干预组治疗3个月、9个月后血清同型半胱氨酸水平下降,9个月时血清同型半胱氨酸水平较3个月时低,对照组治疗3、9个月时血清同型半胱氨酸无明显变化,而干预组治疗第3、9个月血清叶酸浓度均较治疗开始时升高,但第9个月时的叶酸浓度水平较第3个月时要稍低,对照组第3、9个月的叶酸浓度较治疗开始时降低,第3、9个月的叶酸浓度水平变化不大。观察9个月后,干预组左、右侧颈动脉内膜中层厚度较治疗初始时降低,而对照组左右侧颈动脉内膜中层厚度总体趋势则稍升高。
[Abstract]:Objective: according to the current guide, type H hypertension is the plasma homocysteine (Hcy) level exceeding 10 mol/L on the basis of essential hypertension. This study observed the changes in the changes in the hemodynamic indexes after the intervention of folic acid in the elderly patients with H type hypertension, and the change of plasma homocysteine content before and after treatment, and the blood of the neck before and after treatment. The results of Guan Caichao examination, the content of plasma folic acid to evaluate the changes and improvement of the examination indexes after the stage of folic acid treatment, provide certain clinical guidance for the clinical folic acid treatment for elderly patients with type H hypertension. Methods: from April 2016 to January 2017, five families in the outpatient and cadre ward of Genenral Hospital of PLA Guangzhou Military Area and the cardiovascular medicine department were selected. 92 patients with type H hypertension were included in the standard plasma Hcy > 10 mol/L, and the systolic pressure was more than 140 mm Hg (1mm Hg = 0.133 kPa) and (or) diastolic pressure more than 90 mm Hg. The average age of the patients was (66.63 + 5.73) years, among which 82 men and 10 women were randomly divided into the intervention group and the control group, 46 cases in each group. The patients with the following diseases were all discharged. In addition to secondary hypertension, valvular heart disease, chronic renal dysfunction, chronic cardiac insufficiency (NYHA grade more than grade III), cerebral apoplexy, myocardial infarction, cognitive impairment, aphasia, mental and psychological disorders, and tumor, and B vitamin drugs before admission. The intervention group was given simultaneously with the control group in the past 6 months. On the basis of antihypertensive drugs, the intervention group gave oral Folic Acid Tablets 0.8mg and QD on the basis of antihypertensive drugs, and measured serum homocysteine and folic acid content for 3 months and 9 months, and measured the hemodynamic indexes regularly, measured the thickness of the middle layer of the carotid artery by ultrasound and carried out statistical analysis. Results: 3 cases were treated. After month, there was no significant difference in plasma homocysteine before and after treatment in the control group (P0.05). The level of plasma homocysteine in the intervention group was significantly lower after 3 months of treatment (P0.05) and lower than that of the control group (P0.05). The serum folic acid content in the intervention group was higher (P0.05) after treatment. The serum folic acid level in the control group was lower than that of the control group before treatment. After treatment, the improvement of hemodynamic indexes in the intervention group was more obvious than that of the control group. There was no significant difference in LVET, TFC, HR, PEP (P0.05), C0, SV, ISI, SSVR, EPCI, SBP, and DBP differences were statistically significant. After 9 months of treatment, there was no significant difference in plasma homocysteine levels in the control group compared with the beginning of treatment. The plasma homocysteine level in the intervention group was lower than that at the beginning of treatment (P0.05). The hemodynamic indexes of the intervention group were C0, SV, ISI, SSVR, EPCI, HR, SBP, DBP, there was no statistical significance (P0.05), LVET, TFC, and there was statistical significance in the left side of the intervention group before and after the treatment of the intima thickness of the carotid artery. .05) there was no significant difference between the left side of the control group and the right carotid artery intima media thickness before and after treatment (P0.05). Conclusion: noninvasive hemodynamic monitoring can be more convenient and comprehensive to detect the hemodynamic parameters, and can dynamically understand the time state of the patient's hemodynamic, with monitoring continuity, through this examination can In order to obtain a number of hemodynamic parameters, it provides clinical basis for the treatment of elderly patients with type H hypertension and provides an objective basis for the diagnosis and treatment of early H type hypertension. After the intervention of folic acid in old H type hypertension, the hemodynamic parameters are improved. Compared with the parameters of the control group, the gap between the intervention group and the standard value is smaller and the intervention group is smaller. The level of serum homocysteine decreased after 3 months and 9 months after treatment. The serum homocysteine level was lower at 9 months than that at 3 months. The serum homocysteine in the control group was not significantly changed at 3,9 months, while the concentration of serum folic acid in the intervention group was higher than that at the beginning of the treatment for the 3,9 month, but the level of folic acid at ninth months was at the level of folic acid at ninth months. When compared with third months, the concentration of folic acid in the control group decreased at the beginning of the 3,9 month and the level of folic acid at the first 3,9 month changed little. After 9 months, the intervention group was lower than the treatment in the left and right carotid artery intima media, while the overall trend of the intima intima thickness of the left and right carotid artery intima intima was slightly higher.
【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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本文编号：1944405