家庭自测血压在白大衣高血压患者转归中的作用

发布时间：2018-03-19 17:44

本文选题：家庭自测血压　切入点：白大衣高血压　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：实验目的:近年来随着国家对高血压防治工作的不断重视,专家学者们对白大衣高血压(WCH)的防治问题的讨论也越来越多。本研究探讨了家庭自测血压(HBPM)对WCH患者的诊断、治疗、促进生活方式改善的作用,为今后WCH的诊断、治疗提供科学依据。实验方法:选出2015年10月至2016年2月至青岛大学医学院附属医院心内科门诊就诊的高血压患者252例,通过24小时动态血压监测(ABPM)及HBPM,诊断出其中WCH患者为63例。利用调查表,对WCH患者的一般情况,生活行为情况,家庭血压情况等方面进行调查,并统计出WCH在不同人群中的发生率。将63例WCH患者随机分为自测组(32例)和常规组(31例)。自测组患者行诊室血压测量(CBPM)、24ABPM及HBPM,常规组仅行CBPM和24ABPM,并要求两组患者改善生活方式。随访12周后,比较两组患者生活方式的改善情况及诊室血压的达标情况,并比较自测组患者的HBPM与24h ABPM血压监测结果是否一致。实验结果:252例高血压患者中有63例诊断为WCH,WCH的检出率为25%;女性WCH的发生率为27.69%,男性WCH的发生率为22.13%。年龄在18-44岁之间的高血压患者中,WCH的发生率为9.10%;45-59岁之间的高血压患者中,WCH的发生率为24.75%;"g60岁的高血压患者中WCH的发生率为27.91%,差异有统计学意义(2c=20.57,p0.05)。1级高血压的患者中WCH的发生率最高为33.56%,2级高血压患者中WCH的发生率为15.66%,3级高血压患者中WCH发生率最低为4.34%。经过12周随访调查发现,自测组患者在食盐摄入量、运动量及BMI等方面,较常规组改善显著;12周后通过比较两组患者的诊室血压值发现,自测组患者诊室血压的血压达标率为31.25%,明显高于常规组9.68%,差异有显著性(2c=4.47,P0.05);自测组收缩压降低较常规组明显,差异有显著性(t=3.78,P0.001)。收集自测组患者12周的血压记录表,与两次24ABPM结果比较发现,自测组患者多次HBPM的收缩压与舒张压的平均值与24ABPM白昼平均收缩压及舒张压差异无显著性(P0.05),因此可以将HBPM作为WCH筛查的重要方法。实验结论:WCH在临床中较为常见,一旦发现,就需要长期监测、管理,防止和延迟其发展成持续性高血压。HBPM在WCH诊断方面具有与24ABPM相似的作用,其操作简单,可重复性较强,可以提高WCH的检出率,并可长期监测WCH患者血压的转归情况,而且HBPM对WCH患者的治疗和促进生活方式改善方面具有重要的指导作用,并能有效防止WCH患者的过度治疗问题。因此医生应积极推广并指导、鼓励患者自行监测血压。
[Abstract]:Objective: in recent years, with the increasing attention paid to the prevention and treatment of hypertension, experts and scholars have been discussing the prevention and treatment of white coat hypertension more and more. To promote the improvement of life style and provide scientific basis for the diagnosis and treatment of WCH in the future. Methods: from October 2015 to February 2016, 252 patients with hypertension were selected from the outpatient department of cardiology, affiliated Hospital of Qingdao University Medical College. A total of 63 patients with WCH were diagnosed by 24-hour ambulatory blood pressure monitoring (ABPM) and HBPM.Using questionnaire, we investigated the general condition, living behavior, family blood pressure of patients with WCH. 63 cases of WCH were randomly divided into self-test group (n = 32) and routine group (n = 31). Good lifestyle. After 12 weeks of follow-up, To compare the improvement of life style and the achievement of blood pressure in the diagnosis room between the two groups. The blood pressure monitoring results of HBPM and 24 h ABPM in the self-test group were compared. The results showed that 63 out of 252 hypertension patients were diagnosed as WCHG, the incidence of WCH in females was 27.69, and the incidence of WCH in males was 22.13. The age of the patients was as follows: (1) the incidence of WCHG was 25%; the rate of WCH in female was 27.69%; the incidence of WCH in male was 22.13%. The incidence of WCH in hypertensive patients aged between 18 and 44 years was 9.10% and 24.75% in hypertensive patients aged 45-59 years. "the incidence of WCH in hypertensive patients aged 60 years is 27.91%, the difference is statistically significant in the incidence of WCH in patients with hypertension of 20. 57% and 0. 05%. The highest rate of birth was 33.56. the incidence of WCH in the patients with grade 2 hypertension was 15.660.The incidence of WCH was the lowest in the patients with grade 3 hypertension, and the lowest rate was 4.34. after 12 weeks of follow-up investigation, it was found that, After 12 weeks of improvement in salt intake, exercise volume and BMI, the patients in the self-measured group were found to have better blood pressure than those in the conventional group, and the results showed that the blood pressure of the two groups was higher than that of the control group. The blood pressure of the self-measured group was 31.25, which was significantly higher than that of the routine group (9.68, P 0.05), the systolic blood pressure in the self-measured group was significantly lower than that in the conventional group, and the difference was significant. The blood pressure records of the self-measured group were collected for 12 weeks. Compared with two 24ABPM results, There was no significant difference in systolic blood pressure and diastolic blood pressure between multiple HBPM and 24 ABPM patients in self-test group (P 0.05). Therefore, HBPM can be used as an important method for WCH screening. It needs long-term monitoring, management, prevention and delay to develop into persistent hypertension. HBPM has the similar effect as 24ABPM in the diagnosis of WCH, and its operation is simple and reproducible, which can improve the detection rate of WCH. It can be used to monitor the outcome of blood pressure in patients with WCH for a long time. Moreover, HBPM plays an important role in guiding the treatment of WCH patients and promoting the improvement of their lifestyle. Therefore, doctors should actively promote and guide to encourage patients to monitor their blood pressure.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

【参考文献】