發(fā)布時(shí)間：2018-05-28 00:15

  本文選題：H型高血壓 + 頸動(dòng)脈內(nèi)膜中層厚度�。� 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:根據(jù)目前指南,H型高血壓即為在原發(fā)性高血壓的基礎(chǔ)上血漿同型半胱氨酸(Hcy)水平超過10 μ mol/L,本研究觀察老年H型高血壓患者葉酸干預(yù)治療后血流動(dòng)力學(xué)各項(xiàng)指標(biāo)的變化特點(diǎn),以及治療前后血漿同型半胱氨酸含量變化、頸部血管彩超檢查結(jié)果,血漿葉酸含量來(lái)評(píng)估階段葉酸治療后,各項(xiàng)檢查指標(biāo)的變化及改善程度,為臨床葉酸治療老年人H型高血壓提供一定臨床指導(dǎo)。方法:選擇2016年4月～2017年1月就診于廣州軍區(qū)廣州總醫(yī)院門診及干部病房五科、心血管內(nèi)科的H型高血壓患者92例,納入標(biāo)準(zhǔn)血漿Hcy≥10 μmol/L,同時(shí)收縮壓≥140 mm Hg(1mm Hg = 0.133 kPa)和(或)舒張壓≥90 mm Hg,患者的平均年齡為(66.63±5.73)歲,其中男性患者82例,女性患者10例,隨機(jī)分為干預(yù)組和對(duì)照組,每組46例。有下列疾病的患者均排除在外:繼發(fā)性高血壓、心臟瓣膜病、慢性腎功能損害、慢性心功能不全(NYHA分級(jí)≥Ⅲ級(jí))、腦卒中、過去6個(gè)月發(fā)生過心肌梗死、認(rèn)知障礙、失語(yǔ)、精神和心理障礙、腫瘤、并且于入院之前未服用葉酸、B族維生素藥物。干預(yù)組與對(duì)照組同時(shí)給予相同降壓藥治療,干預(yù)組在降壓藥物治療基礎(chǔ)上,同時(shí)給予口服葉酸片0.8mg,qd,于觀察3個(gè)月、9個(gè)月時(shí)測(cè)量血清同型半胱氨酸、葉酸含量,并定期測(cè)量各項(xiàng)血流動(dòng)力學(xué)指標(biāo)、通過超聲測(cè)量頸動(dòng)脈內(nèi)膜中層厚度。并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:治療3個(gè)月后,對(duì)照組治療前后血漿同型半胱氨酸差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),干預(yù)組治療3個(gè)月后血漿同型半胱氨酸水平較前明顯降低(P0.05),且低于對(duì)照組水平(P0.05)。干預(yù)組治療后血清葉酸含量升高(P0.05),對(duì)照組治療后血清葉酸水平較治療前降低,干預(yù)組經(jīng)過治療后血流動(dòng)力學(xué)指標(biāo)改善情況比對(duì)照組改善更明顯,LVET、TFC、HR、PEP差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),C0、SV、ISI、SSVR、EPCI、SBP、DBP差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療9個(gè)月后,對(duì)照組血漿同型半胱氨酸水平較治療開始時(shí)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),干預(yù)組血漿同型半胱氨酸水平較治療開始時(shí)降低(P0.05),干預(yù)組血流動(dòng)力學(xué)指標(biāo)C0、SV、ISI、SSVR、EPCI、HR、SBP、DBP 差異有統(tǒng)計(jì)學(xué)意義(P0.05),LVET、TFC、PEP 差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。干預(yù)組左側(cè)、右側(cè)頸動(dòng)脈內(nèi)膜中層厚度治療前后差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組左側(cè)、右側(cè)頸動(dòng)脈內(nèi)膜中層厚度治療前后差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:無(wú)創(chuàng)血流動(dòng)力學(xué)監(jiān)測(cè)能夠較為方便而且全面的檢測(cè)血流動(dòng)力學(xué)參數(shù),又可以動(dòng)態(tài)地了解患者血流動(dòng)力的即時(shí)狀態(tài),具有監(jiān)測(cè)的持續(xù)性,通過這項(xiàng)檢查可以獲得多項(xiàng)血流動(dòng)力學(xué)參數(shù),為老年H型高血壓患者的治療提供臨床依據(jù),為早期H型高血壓的診斷和治療提供客觀依據(jù),葉酸干預(yù)老年H型高血壓治療后,血流動(dòng)力學(xué)參數(shù)好轉(zhuǎn),相比于對(duì)照組各項(xiàng)參數(shù),干預(yù)組與標(biāo)準(zhǔn)值的差距更小,干預(yù)組治療3個(gè)月、9個(gè)月后血清同型半胱氨酸水平下降,9個(gè)月時(shí)血清同型半胱氨酸水平較3個(gè)月時(shí)低,對(duì)照組治療3、9個(gè)月時(shí)血清同型半胱氨酸無(wú)明顯變化,而干預(yù)組治療第3、9個(gè)月血清葉酸濃度均較治療開始時(shí)升高,但第9個(gè)月時(shí)的葉酸濃度水平較第3個(gè)月時(shí)要稍低,對(duì)照組第3、9個(gè)月的葉酸濃度較治療開始時(shí)降低,第3、9個(gè)月的葉酸濃度水平變化不大。觀察9個(gè)月后,干預(yù)組左、右側(cè)頸動(dòng)脈內(nèi)膜中層厚度較治療初始時(shí)降低,而對(duì)照組左右側(cè)頸動(dòng)脈內(nèi)膜中層厚度總體趨勢(shì)則稍升高。
[Abstract]:Objective: according to the current guide, type H hypertension is the plasma homocysteine (Hcy) level exceeding 10 mol/L on the basis of essential hypertension. This study observed the changes in the changes in the hemodynamic indexes after the intervention of folic acid in the elderly patients with H type hypertension, and the change of plasma homocysteine content before and after treatment, and the blood of the neck before and after treatment. The results of Guan Caichao examination, the content of plasma folic acid to evaluate the changes and improvement of the examination indexes after the stage of folic acid treatment, provide certain clinical guidance for the clinical folic acid treatment for elderly patients with type H hypertension. Methods: from April 2016 to January 2017, five families in the outpatient and cadre ward of Genenral Hospital of PLA Guangzhou Military Area and the cardiovascular medicine department were selected. 92 patients with type H hypertension were included in the standard plasma Hcy > 10 mol/L, and the systolic pressure was more than 140 mm Hg (1mm Hg = 0.133 kPa) and (or) diastolic pressure more than 90 mm Hg. The average age of the patients was (66.63 + 5.73) years, among which 82 men and 10 women were randomly divided into the intervention group and the control group, 46 cases in each group. The patients with the following diseases were all discharged. In addition to secondary hypertension, valvular heart disease, chronic renal dysfunction, chronic cardiac insufficiency (NYHA grade more than grade III), cerebral apoplexy, myocardial infarction, cognitive impairment, aphasia, mental and psychological disorders, and tumor, and B vitamin drugs before admission. The intervention group was given simultaneously with the control group in the past 6 months. On the basis of antihypertensive drugs, the intervention group gave oral Folic Acid Tablets 0.8mg and QD on the basis of antihypertensive drugs, and measured serum homocysteine and folic acid content for 3 months and 9 months, and measured the hemodynamic indexes regularly, measured the thickness of the middle layer of the carotid artery by ultrasound and carried out statistical analysis. Results: 3 cases were treated. After month, there was no significant difference in plasma homocysteine before and after treatment in the control group (P0.05). The level of plasma homocysteine in the intervention group was significantly lower after 3 months of treatment (P0.05) and lower than that of the control group (P0.05). The serum folic acid content in the intervention group was higher (P0.05) after treatment. The serum folic acid level in the control group was lower than that of the control group before treatment. After treatment, the improvement of hemodynamic indexes in the intervention group was more obvious than that of the control group. There was no significant difference in LVET, TFC, HR, PEP (P0.05), C0, SV, ISI, SSVR, EPCI, SBP, and DBP differences were statistically significant. After 9 months of treatment, there was no significant difference in plasma homocysteine levels in the control group compared with the beginning of treatment. The plasma homocysteine level in the intervention group was lower than that at the beginning of treatment (P0.05). The hemodynamic indexes of the intervention group were C0, SV, ISI, SSVR, EPCI, HR, SBP, DBP, there was no statistical significance (P0.05), LVET, TFC, and there was statistical significance in the left side of the intervention group before and after the treatment of the intima thickness of the carotid artery. .05) there was no significant difference between the left side of the control group and the right carotid artery intima media thickness before and after treatment (P0.05). Conclusion: noninvasive hemodynamic monitoring can be more convenient and comprehensive to detect the hemodynamic parameters, and can dynamically understand the time state of the patient's hemodynamic, with monitoring continuity, through this examination can In order to obtain a number of hemodynamic parameters, it provides clinical basis for the treatment of elderly patients with type H hypertension and provides an objective basis for the diagnosis and treatment of early H type hypertension. After the intervention of folic acid in old H type hypertension, the hemodynamic parameters are improved. Compared with the parameters of the control group, the gap between the intervention group and the standard value is smaller and the intervention group is smaller. The level of serum homocysteine decreased after 3 months and 9 months after treatment. The serum homocysteine level was lower at 9 months than that at 3 months. The serum homocysteine in the control group was not significantly changed at 3,9 months, while the concentration of serum folic acid in the intervention group was higher than that at the beginning of the treatment for the 3,9 month, but the level of folic acid at ninth months was at the level of folic acid at ninth months. When compared with third months, the concentration of folic acid in the control group decreased at the beginning of the 3,9 month and the level of folic acid at the first 3,9 month changed little. After 9 months, the intervention group was lower than the treatment in the left and right carotid artery intima media, while the overall trend of the intima intima thickness of the left and right carotid artery intima intima was slightly higher.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1
，

本文編號(hào)：1944405