高血压患者直立性低血压与血压昼夜节律、左心室结构及功能相关研究

发布时间：2019-04-03 15:33

【摘要】：研究目的:探讨老年高血压患者直立性低血压(OH)与血压昼夜节律、左心室结构及功能的相关性。方法:选择2015年4月15日至2016年4月14日在我院门诊及住院的原发性高血压患者共256例,女性122例,男性134例,年龄60-80岁(平均:68.47±8.15)。对所有受试者进行卧—立位血压测定、24h动态血压监测以及超声心动图测量心脏结构及功能。按照直立性低血压的诊断标准,分为OH组和非OH组。采用SPSS16.0统计学软件进行处理分析。结果:1)两组受试者临床资料比较256例受试者OH发生率为34.8%,OH组89例,非OH组167例。与非OH组比较,OH组的年龄、高血压病程、卧位收缩压、卧位舒张压、LDL-C(低密度脂蛋白胆固醇)均显著高于非OH组,差异有统计学意义(P0.05)。为OH组的性别、体重指数、TCH(总胆固醇)、TG(甘油三酯)、HDL-C(高密度脂蛋白胆固醇)、空腹血糖、血管紧张素转换酶抑制剂、利尿剂、血管紧张素受体拮抗剂、β受体阻滞剂、钙拮抗剂、a受体阻滞剂无明显变化,差异无统计学意义(P0.05)。2)两组受试者24hABPM参数比较与非OH组相比,OH组的24h平均收缩压和夜间平均收缩压明显高于非OH组;夜间收缩压下降率和夜间舒张压下降率明显低于非OH组,差异有统计学意义(P0.05)。两组白昼平均收缩压、夜间平均舒张压、24 h平均舒张压无明显变化,差异无统计学意义(P0.05)。3)两组受试者左心室结构参数的比较与非OH组相比,OH组的左心室舒张末内径(LVEDD)、舒张期室间隔厚度(IVSD)、左心室收缩末内径(LVESD)及左心室质量指数(LVMI)较非OH组升高,差异有统计学意义(P0.05)。2组受试者舒张期左心室后壁厚度无明显变化,差异无统计学意义(P0.05)。4)两组受试者左心室功能参数的比较与非OH组相比,OH组的左室射血分数(LVEF)、每搏输出量(SV)、E/A比值较非OH组明显降低,差异有统计学意义(P0.05)。两组受试者左心室短轴缩短率(FS)、心输出量(CO)比较,无明显变化,差异无统计学意义(P0.05)。结论:1)老年高血压患者直立性低血压与血压昼夜节律改变密切相关。2)老年高血压患者直立性低血压影响左心室结构,对左心室舒张末内径、收缩末内径、舒张期室间隔厚度有明显影响。3)老年高血压患者直立性低血压易影响左心室功能,对左心室射血分数、每搏输出量、E/A比值有明显影响。
[Abstract]:Objective: to investigate the relationship between (OH) and circadian rhythm of blood pressure, left ventricular structure and function in elderly patients with hypertension. Methods: from April 15, 2015 to April 14, 2016, there were 256 out-patient and inpatients with essential hypertension in our hospital, including 122females and 134males, aged 60-80 years (mean: 68.47 卤8.15). All subjects were measured by lying-standing blood pressure, 24-hour ambulatory blood pressure monitoring and echocardiographic measurement of cardiac structure and function. According to the diagnostic criteria of orthostatic hypotension, they were divided into OH group and non-OH group. SPSS16.0 statistical software was used for processing and analysis. Results: 1) the incidence of OH was 34.8% in the two groups, 89 cases in OH group and 167 cases in non-OH group. Compared with non-OH group, the age, duration of hypertension, supine systolic blood pressure, supine diastolic blood pressure and LDL-C (low density lipoprotein cholesterol) in OH group were significantly higher than those in non-OH group (P0.05). Sex, body mass index (, TCH (), total cholesterol (), TG (), triglyceride (), TG (), high density lipoprotein cholesterol (HDL-C), fasting blood glucose, angiotensin converting enzyme inhibitors, diuretics, angiotensin receptor antagonists (angiotensin receptor antagonists) in the OH group. There was no significant difference in 尾-blocker, calcium antagonist and a-receptor blocker between the two groups (P0.05). 2) compared with the non-OH group, the 24hABPM parameters in the two groups were significantly higher than those in the non-OH group. The 24-hour mean systolic blood pressure and nighttime mean systolic blood pressure in OH group were significantly higher than those in non-OH group. The nocturnal systolic blood pressure drop rate and nocturnal diastolic blood pressure drop rate were significantly lower than those in non-OH group (P0.05). There was no significant difference in mean daytime systolic blood pressure, nocturnal mean diastolic blood pressure and 24-hour mean diastolic blood pressure between the two groups (P0.05). 3) the left ventricular structural parameters in the two groups were compared with those in the non-OH group, and there was no significant difference between the two groups (P0.05). Left ventricular end-diastolic diameter (LVEDD), diastolic septal thickness (IVSD), left ventricular end-systolic diameter (LVESD) and left ventricular mass index (LVMI) in OH group were higher than those in non-OH group. There was no significant difference in the left ventricular posterior wall thickness between the two groups (P0.05). 4) the left ventricular function parameters in the two groups were compared with those in the non-OH group, and there was no significant difference in the left ventricular posterior wall thickness between the two groups (P0.05), but there was no significant difference between the two groups (P0.05). Left ventricular ejection fraction (LVEF) in OH group was significantly lower than that in non-OH group (P 0.05). (SV), / E / A ratio of LVEF was significantly lower in LVEF group than that in non-OH group (P0.05). There was no significant difference in left ventricular shortening rate (FS),) and cardiac output (CO) between the two groups (P0.05). Conclusion: 1) there is a close relationship between orthostatic hypotension and circadian rhythm of blood pressure in elderly patients with hypertension. 2) erectile hypotension affects left ventricular structure, end-diastolic diameter and end-systolic diameter of left ventricle in elderly patients with hypertension. (3) the left ventricular function was easily affected by orthostatic hypotension, and the left ventricular ejection fraction (LVEF), stroke volume and E / A ratio were significantly affected in elderly patients with hypertension. 3) the left ventricular ejection fraction (LVEF), stroke volume and E / A ratio were significantly affected by orthostatic hypotension.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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