本文選題：家庭自測血壓　切入點：白大衣高血壓　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：實驗?zāi)康?近年來隨著國家對高血壓防治工作的不斷重視,專家學者們對白大衣高血壓(WCH)的防治問題的討論也越來越多。本研究探討了家庭自測血壓(HBPM)對WCH患者的診斷、治療、促進生活方式改善的作用,為今后WCH的診斷、治療提供科學依據(jù)。實驗方法:選出2015年10月至2016年2月至青島大學醫(yī)學院附屬醫(yī)院心內(nèi)科門診就診的高血壓患者252例,通過24小時動態(tài)血壓監(jiān)測(ABPM)及HBPM,診斷出其中WCH患者為63例。利用調(diào)查表,對WCH患者的一般情況,生活行為情況,家庭血壓情況等方面進行調(diào)查,并統(tǒng)計出WCH在不同人群中的發(fā)生率。將63例WCH患者隨機分為自測組(32例)和常規(guī)組(31例)。自測組患者行診室血壓測量(CBPM)、24ABPM及HBPM,常規(guī)組僅行CBPM和24ABPM,并要求兩組患者改善生活方式。隨訪12周后,比較兩組患者生活方式的改善情況及診室血壓的達標情況,并比較自測組患者的HBPM與24h ABPM血壓監(jiān)測結(jié)果是否一致。實驗結(jié)果:252例高血壓患者中有63例診斷為WCH,WCH的檢出率為25%;女性WCH的發(fā)生率為27.69%,男性WCH的發(fā)生率為22.13%。年齡在18-44歲之間的高血壓患者中,WCH的發(fā)生率為9.10%;45-59歲之間的高血壓患者中,WCH的發(fā)生率為24.75%;"g60歲的高血壓患者中WCH的發(fā)生率為27.91%,差異有統(tǒng)計學意義(2c=20.57,p0.05)。1級高血壓的患者中WCH的發(fā)生率最高為33.56%,2級高血壓患者中WCH的發(fā)生率為15.66%,3級高血壓患者中WCH發(fā)生率最低為4.34%。經(jīng)過12周隨訪調(diào)查發(fā)現(xiàn),自測組患者在食鹽攝入量、運動量及BMI等方面,較常規(guī)組改善顯著;12周后通過比較兩組患者的診室血壓值發(fā)現(xiàn),自測組患者診室血壓的血壓達標率為31.25%,明顯高于常規(guī)組9.68%,差異有顯著性(2c=4.47,P0.05);自測組收縮壓降低較常規(guī)組明顯,差異有顯著性(t=3.78,P0.001)。收集自測組患者12周的血壓記錄表,與兩次24ABPM結(jié)果比較發(fā)現(xiàn),自測組患者多次HBPM的收縮壓與舒張壓的平均值與24ABPM白晝平均收縮壓及舒張壓差異無顯著性(P0.05),因此可以將HBPM作為WCH篩查的重要方法。實驗結(jié)論:WCH在臨床中較為常見,一旦發(fā)現(xiàn),就需要長期監(jiān)測、管理,防止和延遲其發(fā)展成持續(xù)性高血壓。HBPM在WCH診斷方面具有與24ABPM相似的作用,其操作簡單,可重復性較強,可以提高WCH的檢出率,并可長期監(jiān)測WCH患者血壓的轉(zhuǎn)歸情況,而且HBPM對WCH患者的治療和促進生活方式改善方面具有重要的指導作用,并能有效防止WCH患者的過度治療問題。因此醫(yī)生應(yīng)積極推廣并指導、鼓勵患者自行監(jiān)測血壓。
[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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1

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