个体化运动有效治疗高血压的研究及逐搏血压监测在临床中的应用

发布时间：2018-02-26 16:34

本文关键词： 高血压心肺运动试验个体化适度强度运动整体治疗方案有效治疗连续无创逐搏血压心肺运动试验运动试验停止指征　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:运用心肺运动试验(cardiopulmonary exercise testing,CPET)对患者进行客观定量整体功能评估,精准制定个体化适度强度运动整体治疗方案,以有效治疗高血压。方法:选择5例应用药物治疗稳定的高血压患者进行症状限制性CPET检查,以CPET结果为依据进行计算分析,进而精准地制定介于无氧阂和峰值功率之间的个体化适度强度负荷功率的运动处方,配合多种辅助运动、精神心理方面、劳逸结合、睡眠管理、禁烟限酒、健康饮食生活习惯及优化药物等形成整体方案。坚持每天强化运动一次、每周5天,共计12周,每天测定患者运动前、后的血压,运动中连续监测血压、心电图、心率和氧饱和度,期间根据血压稳定程度调整药物。将运动前、后和第1、12周血压的变化进行自身对照统计分析。结果:高血压患者运动治疗前均服用至少一种降压药物,运动治疗2～6周后全部停用降压药物。患者运动后收缩压(systolicblood pressure,SBP)[运动前(125±11)mmHg与运动后(116±10)mm Hg]、舒张压(diastolic blood pressure,DBP)[运动前(74±8)mm Hg与运动后(71±7)mmHg]均较运动前显著降低(P0.05)。虽然第12周时已经减、停用抗高血压药物6周以上,运动前静息SBP仍较第1周(使用药物时)显著降低[第1周(127±8)m Hg与第12周(121±9)m Hg](P0.05);第1周与第12周运动后静息SBP、运动前后静息DBP比较均无统计学差异(P0.05)。结论:本研究运用CPET客观定量评估指导的精准制订个体化适度强度运动为核心的整体方案,可以使高血压病患者获得惊人的降压效果,并且停药后仍然能够维持血压稳定。值得进一步扩大病例深入研究。目的:通过无创方法监测心肺运动试验(cardiopulmonary exercise testing,CPET)过程中的逐搏血压,同时与传统的袖带间断测压相比较,重点观察心肺运动试验过程中的最高血压值,以探讨定量的血压值是否能够作为终止心肺运动试验指征。方法:选择2016年8-10月份在阜外医院进行CPET的健康志愿者6例,在常规的心肺运动试验中佩戴连续无创逐搏血压监测仪器。对不同阶段的袖带间断测压与连续逐搏血压值进行统计学分析。结果:在心肺运动试验过程中6位志愿者中有两位的最高血压超过了 250mmHg,而袖带间断测压检测到的最高血压仅为187mmHg。收缩压在热身期以及恢复期5分钟有统计学差异(p0.05),其他时期无统计学差异;舒张压在恢复期2分钟及恢复期5分钟有统计学差异(pp0.05),其他时期无统计学差异。结论:连续逐搏血压可更好的反映CPET中的血压连续状态以及极限值。在症状限制性的CPET中,并不能完全以某一特定的最高血压值作为参考作为终止心肺运动试验的指标。
[Abstract]:Objective: to evaluate the overall function of patients with cardiopulmonary exercise test by using cardiopulmonary exercise test (CPET), and to formulate the individual moderate intensity exercise therapy accurately. Methods: five patients with stable hypertension who were treated with drugs were selected for symptomatic restricted CPET examination. The results of CPET were calculated and analyzed. And then make the exercise prescription of the individualized moderate intensity load power between the anaerobic barrier and the peak power accurately, and cooperate with various auxiliary sports, mental and psychological aspects, the combination of labor and rest, sleep management, no smoking and limiting alcohol, Health eating habits and optimizing medicine were the overall plan. The patients' blood pressure before and after exercise, monitoring blood pressure and electrocardiogram (ECG) were measured every day, 5 days a week, 5 days a week for a total of 12 weeks, the patients' blood pressure was measured before and after exercise, and the blood pressure and electrocardiogram were continuously monitored during exercise. Heart rate and oxygen saturation were adjusted according to the degree of blood pressure stability. The changes of blood pressure before, after and at 1th week were compared and analyzed. Results: patients with hypertension took at least one antihypertensive drug before exercise treatment. Systolic blood pressure pressure (SBP) [125 卤11mm Hg before exercise and 116 卤10mm Hg after exercise], diastolic blood pressure pressure (DBP) [74 卤8mm Hg before exercise and 71 卤7mm Hg after exercise] were significantly lower than those before exercise (125 卤11mm Hg and 116 卤10mm Hg after exercise) [74 卤8mm Hg before exercise and 71 卤7mm Hg after exercise]. Stop antihypertensive drugs for more than 6 weeks. Resting SBP before exercise was still significantly lower than that at week 1 (drug use) [1 week (127 卤8 mm Hg) and 12 week (121 卤9 mm Hg)] P 0.05A, and after 1 week and 12 weeks of exercise, there was no significant difference in resting DBP before and after exercise (P 0.05). Conclusion: this study shows that there is no significant difference in resting DBP before and after exercise. Conclusion: this study shows that there is no significant difference between the rest DBP before and after exercise. Conclusion: this study shows that there is no significant difference between the rest DBP before and after exercise. Using CPET objective quantitative evaluation to guide the accurate formulation of individual moderate intensity exercise as the core of the overall plan, Can make the hypertension patient obtain the astonishing effect of lowering blood pressure, And it can still maintain blood pressure stability after withdrawal, which is worthy of further study. Objective: to monitor the stroke blood pressure during cardiopulmonary exercise testing in cardiopulmonary exercise test (cardiopulmonary exercise testing) by non-invasive method, and to compare it with the traditional cuff intermittent blood pressure measurement. The maximum blood pressure during cardiopulmonary exercise test was observed in order to find out whether the quantitative blood pressure could be used as the indication of termination of cardiopulmonary exercise test. Methods: six healthy volunteers who underwent CPET in Fuwei Hospital from 2016 to October were selected. In the routine cardiopulmonary exercise test, a continuous noninvasive blood pressure monitoring instrument was worn. The values of intermittent cuff blood pressure and continuous stroke blood pressure in different stages were analyzed statistically. Results: during the cardiopulmonary exercise test, 6 records were performed. Two of the patients had the highest hypertension over 250 mmHg, while the most hypertension detected by cuff intermittent manometry was 187mm Hg.There was a significant difference in systolic blood pressure between warm up period and 5 minute recovery period (p 0.05), but there was no statistical difference in other periods. Diastolic blood pressure (DBP) was significantly different in 2 minutes of recovery period and 5 minutes of recovery period, but there was no statistical difference in other periods. Conclusion: continuous stroke blood pressure can better reflect the continuous state and limit value of blood pressure in CPET. No specific maximum blood pressure can be used as a reference for termination of cardiopulmonary exercise test.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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