谈话对门诊患者诊室血压的影响

发布时间：2018-06-09 17:23

本文选题：谈话 + 血压　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:探讨谈话对门诊患者诊室血压的影响。方法:收集2016年6月至2016年9月南昌大学第二附属医院心血管内科门诊部就诊的患者。本研究共纳入200例(男性101人,女性99人;平均年龄58.1±13.4岁;SAS焦虑评分为32.7±5.6分)门诊患者,其中高血压患者122人,非高血压患者78人。所有合格入选者进入诊室后安静休息10分钟,然后使用示波法血压计测量3次患者静息状态的血压和心率,每次测量间隔为1分钟,测量值分别用Pre-1,Pre-2,Pre-3表示。然后采用同样的方法,在开始交谈后第1分钟、第3分钟、第5分钟测量患者血压和心率(During-1,During-3,During-5)。测量结束后停止交谈,在停止后的第1分钟、第3分钟、第5分钟测量血压及心率(Post-1,Post-3,Post-5)。比较谈话前,谈话时及谈话后血压及心率的变化情况。结果:谈话开始后During-1的收缩压较Pre-3明显升高(130.5±22.2mm Hg比123.5±18.9mm Hg,P0.01),升高幅度为7.0±9.3 mm Hg;同样,舒张压从Pre-3的71.1±12.5mm Hg升高至During-1的75.6±13.2mm Hg(P0.01),平均升高幅度为4.5±5.7mm Hg。在谈话期间,收缩压从During-1的130.5±22.2mm Hg缓慢升高到During-5的132.6±22.3mm Hg,因此整个谈话期间最大的收缩压升高幅度约为9.1mm Hg;舒张压未见谈话后逐渐升高的现象。谈话结束后收缩压从During-5的132.6±22.3mm Hg下降到Post-1的126.2±20.5mm Hg(P0.01),降低幅度为6.3±7.9 mm Hg;舒张压从75.4±13.3mm Hg下降到72.7±12.4mm Hg(P0.01),降低幅度为2.7±5.4mm Hg。Post-1及Post-3的收缩压仍高于Pre-3,Post-5的收缩压与Pre-3无统计学差异(123.7±19.4比123.5±18.9mm Hg,NS)。Post-1的舒张压高于Pre-3,Post-3舒张压与Pre-3无统计学差异(71.6±11.7比71.1±12.1mm Hg,NS)。这一现象表明,在谈话结束后收缩压需要大约5分钟恢复至静息状态水平,舒张压大约要3分钟降低到静息状态水平。心率从Pre-3的68.1±10.8次/分升至During-1的70.8±11.2次/分(P0.01),升高幅度为2.8±4.3次/分。采用SPSS 21.0软件建立数据库并作统计学分析。连续变量符合正态分布,以均数±标准差表示。连续变量使用独立样本t检验,配对资料使用配对t检验。采用Logistic多因素回归分析,P0.05为差异有统计学意义。结果发现,谈话前第3次收缩压水平(Pre-3SBP,P=0.023)是影响谈话血压升高幅度的独立影响因素,即安静状态下血压越高的人,谈话时血压的升高幅度也更大。结论:与医生在门诊持续约5分钟的谈话期间,患者收缩压最高升幅为9.1mm Hg,舒张压最高升幅为4.5mm Hg,并且收缩压需要大约5分钟才能恢复至静息状态水平,舒张压需要大约3分钟降低到静息状态水平。因此医生应在问诊开始前或者问诊结束后至少安静休息5分钟后测量诊室血压。
[Abstract]:Objective: to explore the effect of conversation on blood pressure in outpatient clinic. Methods: from June 2016 to September 2016, the outpatients of Department of Cardiovascular Medicine, second affiliated Hospital of Nanchang University were collected. A total of 200 outpatients (male 101, female 99; mean age 58.1 卤13.4 years old) were enrolled in this study, including 122 patients with hypertension and 78 patients with non-hypertension. After entering the clinic, all the eligible candidates took a quiet rest for 10 minutes, and then measured the blood pressure and heart rate of the patients three times by using the oscillographic sphygmomanometer. The interval of each measurement was 1 minute. The measured values were respectively expressed as Pre-1 Pre-2Pre-3. Then the same method was used to measure the patient's blood pressure and heart rate in the first minute, the third minute, and the fifth minute after the beginning of the conversation. Stop talking at the end of the measurement, measure blood pressure and heart rate at 1 minute, 3 minute and 5 minute after stopping, and measure Post-1 Post-3 Post-5. Compare changes in blood pressure and heart rate before, during and after conversation. Results: the systolic blood pressure (SBP) of During-1 was significantly higher than that of Pre-3 (130.5 卤22.2mm Hg vs 123.5 卤18.9mm HgG P 0.01g), and the diastolic blood pressure was increased from 71.1 卤12.5mm Hg of Pre-3 to 75.6 卤13.2mm 12.5mm Hg of During-1 with an average increase of 4.5 卤5.7mm Hg. Systolic blood pressure increased slowly from 130.5 卤22.2mm Hg of During-1 to 132.6 卤22.3mm Hg of During-5 during the conversation, so the maximal rise of systolic blood pressure during the whole conversation was 9.1mm Hg, but the diastolic blood pressure did not increase gradually after the conversation. After the conversation, systolic blood pressure decreased from 132.6 卤22.3mm Hg in During-5 to 126.2 卤20.5mm HgP0.01g in Post-1, and diastolic blood pressure decreased from 75.4 卤13.3mm Hg to 72.7 卤12.4mm Hg 0.01g, which was still higher than that of Pre-3Post-5 (123.7 卤19.4) than Pre-3Post-5 (123.7 卤19.4). There was no significant difference in diastolic blood pressure (DBP) between Pre-3 Post-3 and Pre-3 patients with 123.5 卤18.9mm HgG NSN. Post-1 (71.6 卤11.7 vs 71.1 卤12.1mm HgG). This phenomenon indicates that systolic blood pressure needs about 5 minutes to return to resting state and diastolic pressure to rest state level for about 3 minutes after the end of the conversation. The heart rate increased from 68.1 卤10.8 beats / min in Pre-3 to 70.8 卤11.2 beats / min / min in During-1 and increased by 2.8 卤4.3 beats / min. SPSS 21.0 software was used to establish the database and make statistical analysis. The continuous variables conform to the normal distribution, expressed as the mean 卤standard deviation. Independent sample t test was used for continuous variables and paired t test was used for paired data. Logistic multivariate regression analysis was used as a significant difference. The results showed that the third systolic blood pressure level (Pre-3SBP P0. 023) was an independent factor that affected the degree of elevated blood pressure in conversation, that is, the higher the blood pressure in the quiet state, the greater the increase in the blood pressure during the conversation. Conclusion: during a 5 minute conversation with a doctor, the highest increase in systolic blood pressure was 9.1mm Hg, and the highest increase in diastolic blood pressure was 4.5mm Hg, and it took about 5 minutes for systolic blood pressure to return to rest. Diastolic blood pressure takes about 3 minutes to drop to rest level. Doctors should therefore measure blood pressure at least five minutes before the start of the consultation or at least five minutes after the consultation.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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