本文選題：老年 + 高血壓�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:收集老年高血壓患者24小時(shí)動(dòng)態(tài)血壓節(jié)律類型資料,觀察影響老年高血壓患者血壓節(jié)律的因素,有助于對(duì)老年高血壓患者進(jìn)行危險(xiǎn)分級(jí)以指導(dǎo)臨床用藥,使患者的血壓得到更好控制并盡可能恢復(fù)正常晝夜節(jié)律,從而降低心血管事件的發(fā)生率和病死率。方法:連續(xù)收集2014年9月——2017年3月在吉林大學(xué)中日聯(lián)誼醫(yī)院老年病科就診,明確診斷為原發(fā)性高血壓并行24小時(shí)動(dòng)態(tài)血壓監(jiān)測(cè)的老年患者202例(男性85例,女性117例,年齡60~98歲,平均年齡80.28±7.23歲),記錄24小時(shí)平均舒張壓(24-hour diastolic blood pressure,24h DBP),24小時(shí)平均收縮壓(24-hour systolic blood pressure,24h SBP),日間平均舒張壓(daytime diastolic blood pressure,d DBP),日間平均收縮壓(daytime systolic blood pressure,d SBP),夜間平均舒張壓(nighttime diastolic blood pressure,n DBP)以及夜間平均收縮壓(nighttime systolic blood pressure,n SBP),根據(jù)上述結(jié)果計(jì)算夜間血壓下降率,并據(jù)此將研究對(duì)象根據(jù)血壓節(jié)律分為杓型血壓組(57例)、非杓型血壓組(79例)、反杓型血壓組(65例)、超杓型血壓組(1例),記錄各組的臨床資料,分析影響老年高血壓患者血壓節(jié)律的危險(xiǎn)因素,探究老年高血壓患者血壓夜間下降率與紅細(xì)胞分布寬度(red cell distribution width,RDW)之間的相關(guān)性,同時(shí)計(jì)算RDW值診斷老年高血壓患者異常血壓節(jié)律的敏感性和特異性。采用SPSS 22.0統(tǒng)計(jì)軟件分析結(jié)果。結(jié)果:1、非杓型組和反杓型組年齡、吸煙人數(shù)顯著高于杓型組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05),三組間性別差異無統(tǒng)計(jì)學(xué)意義(p0.05)。2、老老年組血壓節(jié)律異常比例顯著高于老年組(77%vs 63.3%),差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。3、反杓型組和非杓型組合并糖尿病、血脂異常的比例及其RDW值、空腹血糖水平明顯高于杓型組,非杓型組血脂異常比例明顯高于反杓型組,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。4、單因素Logistic回歸分析結(jié)果顯示,年齡(OR=1.114,95%CI:1.063~1.167,p=0.000)、吸煙史(OR=3.126,95%CI:1.653~5.913,p=0.000)、糖尿病(OR=3.106,95%CI:1.412~6.833,p=0.005)、空腹血糖(OR=1.311,95%CI:1.117~1.539,p=0.001)、血脂異常(OR=4.283,95%CI:2.241~8.185,p=0.000)和RDW值(OR=1.810,95%CI:1.376~2.380,p=0.000)是引起老年高血壓患者血壓節(jié)律異常的危險(xiǎn)因素;多因素Logistic回歸分析中顯示,年齡(OR=1.077,95%CI1.009~1.150,p=0.025)、空腹血糖(OR=1.220,95%CI:1.008~1.477,p=0.041)、血脂異常(OR=2.613,95%CI:1.100~6.206,p=0.03)以及RDW值(OR=2.250,95%CI:1.580~3.206,p=0.000)是引起老年高血壓患者血壓節(jié)律異常的獨(dú)立危險(xiǎn)因素。5、RDW值與夜間血壓下降率呈負(fù)相關(guān)(r=-0.384,p=0.000)。6、RDW值預(yù)測(cè)診斷異常血壓節(jié)律的最佳臨界值為13.5,其敏感性為66.7%,特異性為71.9%。結(jié)論:1、非杓型組和反杓型組與杓型組相比,前兩者的年齡、吸煙者比例均高于杓型組,但性別無顯著差異。2、老老年組中異常血壓節(jié)律明顯高于老年組。3、非杓型組和反杓型組合并糖尿病、血脂異常的比例及RDW值和空腹血糖顯著高于杓型組。4、年齡、吸煙史、糖尿病、空腹血糖、血脂異常及RDW值是引起老年高血壓患者節(jié)律異常的危險(xiǎn)因素;年齡、空腹血糖、血脂異常、RDW值是引起老年高血壓患者節(jié)律異常的獨(dú)立危險(xiǎn)因素。5、RDW值與夜間血壓下降率呈負(fù)相關(guān),RDW值變化可作為早期推測(cè)高血壓節(jié)律異常的預(yù)測(cè)因素,RDW值預(yù)測(cè)診斷異常血壓節(jié)律的最佳臨界值為13.5,其敏感性為66.7%,特異性為71.9%。
[Abstract]:Objective: to collect the data of the 24 hour ambulatory blood pressure rhythm type in elderly hypertensive patients, to observe the factors affecting the rhythm of blood pressure in elderly hypertensive patients, to help the elderly patients with hypertension risk classification to guide clinical medication, to make the patient's blood pressure better control and to restore the normal circadian rhythm, thus reducing cardiovascular events. Methods: the incidence and fatality rate of the part were collected continuously from September 2014 to March 2017 at the Department of geriatrics in the Sino Japanese Friendship Hospital of Jilin University. 202 elderly patients (85 men, 117 women, aged 60~98 years, 80.28 + 7.23 years old) were diagnosed as primary hypertension and 24 hour ambulatory blood pressure monitoring. The records were recorded for 24 hours. Average diastolic pressure (24-hour diastolic blood pressure, 24h DBP), average systolic pressure (24-hour systolic blood pressure, 24h SBP), mean day diastolic pressure, mean day systolic pressure, and mean night diastolic pressure. N DBP) and the mean night systolic blood pressure (nighttime systolic blood pressure, n SBP). According to the above results, the rate of nocturnal blood pressure drop was calculated. According to this, the subjects were divided into dipper blood pressure group (57 cases), non dipper type blood pressure group (79 cases), anti dipper type blood pressure group (65 cases), and the super dipper type blood pressure group (1 cases), and recorded the clinical data of each group. The risk factors of blood pressure rhythm in elderly hypertensive patients were analyzed, and the correlation between the rate of nocturnal blood pressure drop and red cell distribution width (RDW) in elderly hypertensive patients was investigated, and the sensitivity and specificity of RDW value in the diagnosis of abnormal blood pressure rhythm in elderly hypertensive patients were calculated by SPSS 22. Results: 1, the age of the non dipper group and the anti dipper type group was significantly higher than the dipper group. The difference was statistically significant (P0.05). There was no statistical significance between the three groups (P0.05).2, the abnormal proportion of blood pressure rhythm in old age group was significantly higher than that of the old group (77%vs 63.3%), the difference was statistically significant (P0.05).3, and the anti dipper group was statistically significant. The proportion of diabetes, diabetes, diabetes, the ratio of blood lipid abnormality and its RDW value, the level of fasting blood glucose was significantly higher than that in the dipper group. The abnormal proportion of blood lipid in the non dipper group was significantly higher than that in the anti dipper group (P0.05).4. The results of single factor Logistic regression analysis showed that age (OR=1.114,95%CI:1.063~1.167, p=0.000), smoking history (OR=3.12) 6,95%CI:1.653~5.913, p=0.000), diabetes (OR=3.106,95%CI:1.412~6.833, p=0.005), fasting blood glucose (OR=1.311,95%CI:1.117~1.539, p=0.001), dyslipidemia (OR=4.283,95%CI:2.241~8.185, p=0.000) and RDW (OR=1.810,95%CI:1.376~2.380, p=0.000) are the risk factors for abnormal blood pressure rhythm in elderly patients with hypertension; multifactor Logistic Regression analysis showed that age (OR=1.077,95%CI1.009~1.150, p=0.025), fasting blood glucose (OR=1.220,95%CI:1.008~1.477, p=0.041), dyslipidemia (OR=2.613,95%CI:1.100~6.206, p=0.03), and RDW value (OR=2.250,95%CI:1.580~3.206, p=0.000) were independent risk factors for abnormal blood pressure rhythm in elderly hypertensive patients.5, RDW and nocturnal blood The rate of pressure descending was negative correlation (r=-0.384, p=0.000).6, and the best critical value for predicting abnormal blood pressure rhythm was 13.5, its sensitivity was 66.7%, the specificity was 71.9%. conclusion: 1, the age of the non dipper group and the dipper group and the dipper group were higher than that of the dipper group, the proportion of the smokers was higher than that in the dipper group, but there was no significant difference in sex.2 and in the old age group. The rhythm of normal blood pressure was significantly higher than that of.3 in the elderly group. The proportion of abnormal blood lipid and RDW value and fasting blood glucose were significantly higher than that of.4 in the dipper group. Age, smoking history, diabetes, fasting blood glucose, dyslipidemia and RDW were the risk factors for abnormal rhythm of the elderly hypertensive patients; age, fasting blood glucose, blood lipid were different. Often, the RDW value is an independent risk factor.5 for abnormal rhythm of the elderly hypertensive patients. The RDW value is negatively correlated with the rate of nocturnal blood pressure drop. The change of RDW value can be used as a predictor of early prediction of abnormal hypertension rhythm. The best critical value of the RDW value prediction for abnormal blood pressure rhythm is 13.5, its sensitivity is 66.7%, and the specificity is 71.9%..
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李寶琴,李勇;老年高血壓左心室肥厚與晝夜血壓節(jié)律改變的關(guān)系[J];前衛(wèi)醫(yī)藥雜志;2000年02期

2 陳安;血壓節(jié)律調(diào)節(jié)及相關(guān)因素[J];國(guó)外醫(yī)學(xué).心血管疾病分冊(cè);2001年06期

3 周巧巧;湯鋒;;維持性血液透析患者血壓節(jié)律異常的機(jī)制及治療[J];中華臨床醫(yī)師雜志(電子版);2013年15期

4 蘇永峰;李子玲;董智慧;石福彥;;踝肱指數(shù)、血壓節(jié)律與頸動(dòng)脈內(nèi)-中膜厚度關(guān)系研究[J];疾病監(jiān)測(cè)與控制;2014年02期

5 喬延國(guó),張開,韓盈,王英;睡眠呼吸暫停對(duì)夜間血壓節(jié)律影響的臨床研究[J];武警醫(yī)學(xué);2005年01期

6 周巧巧;湯鋒;;維持性血液透析患者血壓節(jié)律的研究進(jìn)展[J];中國(guó)血液凈化;2013年07期

7 陳建華;唐秀敏;焦秀華;孔紅軍;張麗;;甲狀旁腺素與血壓及血壓節(jié)律的研究進(jìn)展[J];河北醫(yī)學(xué);2014年03期

8 王紅武;高血壓患者血壓節(jié)律紊亂與腦血管意外的關(guān)系[J];廣州醫(yī)藥;1997年04期

9 汪德嫻;趙瑋;孫燕淑;陳巖;田清平;;動(dòng)態(tài)血壓節(jié)律與靶器官損害的臨床研究[J];北京醫(yī)學(xué);2006年03期

10 馬慶春;;關(guān)注血壓節(jié)律,平穩(wěn)降壓,保護(hù)靶器官[J];中國(guó)心血管雜志;2008年03期

相關(guān)會(huì)議論文 前2條

1 馮李婷;;睡眠呼吸暫停低通氣綜合征對(duì)高血壓及血壓節(jié)律的影響[A];中華醫(yī)學(xué)會(huì)呼吸病學(xué)年會(huì)——2013第十四次全國(guó)呼吸病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2013年

2 馬慶春;孫寧玲;;高血壓患者血壓節(jié)律與動(dòng)脈彈性的研究[A];中華醫(yī)學(xué)會(huì)心血管病分會(huì)第八次全國(guó)心血管病學(xué)術(shù)會(huì)議匯編[C];2004年

相關(guān)重要報(bào)紙文章 前2條

1 哈爾濱市第一醫(yī)院心血管內(nèi)科 杜屏;睡前服藥或可改善晝夜血壓節(jié)律[N];健康報(bào);2014年

2 向君;雙高者更要多方調(diào)護(hù)[N];醫(yī)藥養(yǎng)生保健報(bào);2007年

相關(guān)博士學(xué)位論文 前2條

1 牟利軍;慢性腎臟病血壓節(jié)律紊亂及其影響因素的初步研究[D];北京協(xié)和醫(yī)學(xué)院;2011年

2 陽濤;中藥方擇時(shí)給藥對(duì)SHR血壓節(jié)律調(diào)節(jié)和靶器官保護(hù)機(jī)制研究[D];廣州中醫(yī)藥大學(xué);2013年

相關(guān)碩士學(xué)位論文 前7條

1 楊小霞;對(duì)老年高血壓患者血壓節(jié)律影響因素的分析[D];吉林大學(xué);2017年

2 林利容;IgA腎病患者血壓節(jié)律異常的意義及影響因素[D];第三軍醫(yī)大學(xué);2013年

3 朱娜;高血壓病合并OSAHS對(duì)血壓節(jié)律和左室結(jié)構(gòu)的影響[D];蚌埠醫(yī)學(xué)院;2012年

4 路超;血壓節(jié)律變化對(duì)血管性認(rèn)知功能障礙的影響[D];吉林大學(xué);2014年

5 燕竹青;調(diào)平康片對(duì)高血壓病患者血壓節(jié)律及臨床療效的影響[D];廣州中醫(yī)藥大學(xué);2008年

6 劉星;動(dòng)態(tài)血壓評(píng)價(jià)慢性腎臟病合并高血壓患者的血壓節(jié)律及降壓的時(shí)間治療學(xué)研究[D];中南大學(xué);2014年

7 趙星;原發(fā)性高血壓患者晝夜血壓節(jié)律變化對(duì)動(dòng)態(tài)動(dòng)脈硬化指數(shù)影響的臨床研究[D];中南大學(xué);2010年

，

本文編號(hào)：1920668