摘要
目的分析老年高血压患者24 h昼夜血压节律(Blood pressure circadian rhythm,BPCR)变化对心脏舒张功能影响。方法选取2016年2月至2018年2月在中山大学附属中山医院接受治疗老年高血压患者120例,依据患者24 h动态血压状况将其分成两组,杓型组(夜间血压下降率≥10%)65例与非杓型组(夜间血压下降率<10%)55例;检测患者动态血压状况,超声心动图检测舒张末期左室后壁(posterior wall,PW)、室间隔(interventricular septum ,IVS)厚度状况及左室内径((left ventricular end-diastolic diameter,LVEDD),同时计算左室重量(left ventricular mass,LVM)与左室重量指数(left ventricular mass index,LVMI),计算左室短轴缩短率(fractional shortening,FS)、每搏量(stroke volume,SV)、心输出量(cardiac output,CO)及心脏指数(cardiac index,CI),检测心房收缩期内血流(A峰)流速积分(A peak flow time total integration,ATVI)、峰值流速(A peak flow rate ventricular,APFV);舒张前期血流(E峰)流速积分(E peak flow time ventricular integral,ETVI)、峰值流速( early peak flow velocity ,EPFV)及左心室射血分数(left ventricular ejection fraction,LVEF)。结果杓型组患者24 h舒张压(diastolic blood pressure,DBP)、24 h收缩压(systolic blood pressure,SBP)、夜间DBP、夜间SBP分别为(80.27±7.29)、(125.29±10.38)、(69.98±6.36)、(110.39±10.52)mmHg,低于非杓型组的(83.82±7.51)、(130.89±10.71)、(79.81±6.84)、(126.83±10.92) mmHg,差异均有统计学意义(t值分别为12.809、13.954、11.053、13.289,P值分别为0.042、0.021、0.014、0.006)。杓型组患者EPFV为(65.02±11.83) cm/s,高于非杓型组的(60.84±11.29) cm/s,杓型组患者A/E、ATVI、APFV分别为(1.03±0.58)、(5.59±1.72) cm、(63.74±11.06) cm/s,低于非杓型组的(1.14±0.54)、(6.11±1.68) cm、(68.82±11.17) cm/s,差异均有统计学意义(t值分别为10.895、11.643、12.339、10.854,P值分别为0.032、0.027、0.013、0.006)。直线相关因素显示患者左心室舒张功能和白昼DBP为负相关(r值分别为-0.195、-0.217、-0.174、-0.173,P均<0.05),和夜间SBP为正相关(r值分别为0.194、0.171、0.220、0.206,P均<0.05)。结论老年高血压患者中非杓型者其左心室舒张功能和左心室肥厚状况更严重,临床需加强对老年高血压患者夜间血压调控。
Objective To analyze the effects of 24-hour diurnal blood pressure rhythm (BPCR) changes on diastolic function in elderly hypertensive patients.Methods From February 2016 to February 2018, one hundred and twenty elderly patients with hypertension were divided into two groups according to their 24-hour ambulatory blood pressure status: dipper group with 65 cases (nocturnal blood pressure drop rate (>10%) and non-dipper group with 55 cases (nocturnal blood pressure drop rate<10%);ambulatory blood pressure and echocardiographic relaxation were detected.Posterior wall (PW), interventricular septum (IVS), left ventricular diameter (LVEDD), left ventricular mass index (LVM) and left ventricular mass index (LVMI) were examined.Fractional shortening (FS), stroke volume (SV), cardiac output (CO) and cardiac index (CI) were calculated, and peak flow time (A peak flow time total integration, ATVI) and peak flow velocity (A Pea) were measured.K flow rate ventricular (APFV);E peak flow time ventricular integral (ETVI), early Peak flow Velocity (EPFV) and left ventricular ejection fraction (LVEF) were detected.Results The 24 h DBP, 24 hSBP, nocturnal DBP, and nocturnal SBP in dipper group were (80.27±7.29) mmHg, (125.29±10.38) mmHg, (69.98±6.36) mmHg, (110.39±10.52) mmHg, which were lower than those of the noninvasive group ((83.82±7.51) mmHg, (130.89±10.71) mmHg, (79.81±6.84) mmHg, (126.83±10.92) mmHg), the differences were statistically significant (t=12.809, 13.954, 11.053, 13.289, P=0.042, 0.021, 0.014, 0.006). The EPFV in the dipper group was (65.02±11.83) cm/s, which was higher than that in the non-dipper group ((60.84±11.29) cm/s). The A/E, ATVI, and APFV in the dipper group were (1.03±0.58), (5.59±1.72) cm, (63.74±11.06) cm/s, respectively, lower than those in non-dipper group( (1.14±0.54), (6.11±1.68) cm, (68.82±11.17) cm/s), the differences were statistically significant (t=10.895, 11.643, 12.339, 10.854, P=0.032, 0.027, 0.013, 0.006). Left ventricular diastolic function was negatively correlated with daytime DBP (r=- 0.195, -0.217, -0.174, -0.173, P<0.05) and positively correlated with nighttime SBP(r=0.194, 0.171, 0.220, 0.206, P<0.05).Conclusion In elderly hypertensive patients, the left ventricular diastolic function and left ventricular hypertrophy are more serious in non-dipper patients, and it is necessary to strengthen the control of nocturnal blood pressure in elderly hypertensive patients.
作者
敖道畅
刘少中
Ao Daochang;Liu Shaozhong(Heart Center of Sun,Yat-sen University Affiliated Sun Yat-sen Hospital,Zhongshan 528403,China)
出处
《中国综合临床》
2019年第1期76-80,共5页
Clinical Medicine of China
基金
中山市科技计划项目(20113A085).
关键词
血压昼夜节律
高血压
老年
心脏舒张功能
Blood pressure circadian rhythm
hypertension
elderly
diastolic function
