本文選題：談話 + 血壓　； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:探討談話對(duì)門診患者診室血壓的影響。方法:收集2016年6月至2016年9月南昌大學(xué)第二附屬醫(yī)院心血管內(nèi)科門診部就診的患者。本研究共納入200例(男性101人,女性99人;平均年齡58.1±13.4歲;SAS焦慮評(píng)分為32.7±5.6分)門診患者,其中高血壓患者122人,非高血壓患者78人。所有合格入選者進(jìn)入診室后安靜休息10分鐘,然后使用示波法血壓計(jì)測(cè)量3次患者靜息狀態(tài)的血壓和心率,每次測(cè)量間隔為1分鐘,測(cè)量值分別用Pre-1,Pre-2,Pre-3表示。然后采用同樣的方法,在開始交談后第1分鐘、第3分鐘、第5分鐘測(cè)量患者血壓和心率(During-1,During-3,During-5)。測(cè)量結(jié)束后停止交談,在停止后的第1分鐘、第3分鐘、第5分鐘測(cè)量血壓及心率(Post-1,Post-3,Post-5)。比較談話前,談話時(shí)及談話后血壓及心率的變化情況。結(jié)果:談話開始后During-1的收縮壓較Pre-3明顯升高(130.5±22.2mm Hg比123.5±18.9mm Hg,P0.01),升高幅度為7.0±9.3 mm Hg;同樣,舒張壓從Pre-3的71.1±12.5mm Hg升高至During-1的75.6±13.2mm Hg(P0.01),平均升高幅度為4.5±5.7mm Hg。在談話期間,收縮壓從During-1的130.5±22.2mm Hg緩慢升高到During-5的132.6±22.3mm Hg,因此整個(gè)談話期間最大的收縮壓升高幅度約為9.1mm Hg;舒張壓未見談話后逐漸升高的現(xiàn)象。談話結(jié)束后收縮壓從During-5的132.6±22.3mm Hg下降到Post-1的126.2±20.5mm Hg(P0.01),降低幅度為6.3±7.9 mm Hg;舒張壓從75.4±13.3mm Hg下降到72.7±12.4mm Hg(P0.01),降低幅度為2.7±5.4mm Hg。Post-1及Post-3的收縮壓仍高于Pre-3,Post-5的收縮壓與Pre-3無統(tǒng)計(jì)學(xué)差異(123.7±19.4比123.5±18.9mm Hg,NS)。Post-1的舒張壓高于Pre-3,Post-3舒張壓與Pre-3無統(tǒng)計(jì)學(xué)差異(71.6±11.7比71.1±12.1mm Hg,NS)。這一現(xiàn)象表明,在談話結(jié)束后收縮壓需要大約5分鐘恢復(fù)至靜息狀態(tài)水平,舒張壓大約要3分鐘降低到靜息狀態(tài)水平。心率從Pre-3的68.1±10.8次/分升至During-1的70.8±11.2次/分(P0.01),升高幅度為2.8±4.3次/分。采用SPSS 21.0軟件建立數(shù)據(jù)庫并作統(tǒng)計(jì)學(xué)分析。連續(xù)變量符合正態(tài)分布,以均數(shù)±標(biāo)準(zhǔn)差表示。連續(xù)變量使用獨(dú)立樣本t檢驗(yàn),配對(duì)資料使用配對(duì)t檢驗(yàn)。采用Logistic多因素回歸分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果發(fā)現(xiàn),談話前第3次收縮壓水平(Pre-3SBP,P=0.023)是影響談話血壓升高幅度的獨(dú)立影響因素,即安靜狀態(tài)下血壓越高的人,談話時(shí)血壓的升高幅度也更大。結(jié)論:與醫(yī)生在門診持續(xù)約5分鐘的談話期間,患者收縮壓最高升幅為9.1mm Hg,舒張壓最高升幅為4.5mm Hg,并且收縮壓需要大約5分鐘才能恢復(fù)至靜息狀態(tài)水平,舒張壓需要大約3分鐘降低到靜息狀態(tài)水平。因此醫(yī)生應(yīng)在問診開始前或者問診結(jié)束后至少安靜休息5分鐘后測(cè)量診室血壓。
[Abstract]:Objective: to explore the effect of conversation on blood pressure in outpatient clinic. Methods: from June 2016 to September 2016, the outpatients of Department of Cardiovascular Medicine, second affiliated Hospital of Nanchang University were collected. A total of 200 outpatients (male 101, female 99; mean age 58.1 鹵13.4 years old) were enrolled in this study, including 122 patients with hypertension and 78 patients with non-hypertension. After entering the clinic, all the eligible candidates took a quiet rest for 10 minutes, and then measured the blood pressure and heart rate of the patients three times by using the oscillographic sphygmomanometer. The interval of each measurement was 1 minute. The measured values were respectively expressed as Pre-1 Pre-2Pre-3. Then the same method was used to measure the patient's blood pressure and heart rate in the first minute, the third minute, and the fifth minute after the beginning of the conversation. Stop talking at the end of the measurement, measure blood pressure and heart rate at 1 minute, 3 minute and 5 minute after stopping, and measure Post-1 Post-3 Post-5. Compare changes in blood pressure and heart rate before, during and after conversation. Results: the systolic blood pressure (SBP) of During-1 was significantly higher than that of Pre-3 (130.5 鹵22.2mm Hg vs 123.5 鹵18.9mm HgG P 0.01g), and the diastolic blood pressure was increased from 71.1 鹵12.5mm Hg of Pre-3 to 75.6 鹵13.2mm 12.5mm Hg of During-1 with an average increase of 4.5 鹵5.7mm Hg. Systolic blood pressure increased slowly from 130.5 鹵22.2mm Hg of During-1 to 132.6 鹵22.3mm Hg of During-5 during the conversation, so the maximal rise of systolic blood pressure during the whole conversation was 9.1mm Hg, but the diastolic blood pressure did not increase gradually after the conversation. After the conversation, systolic blood pressure decreased from 132.6 鹵22.3mm Hg in During-5 to 126.2 鹵20.5mm HgP0.01g in Post-1, and diastolic blood pressure decreased from 75.4 鹵13.3mm Hg to 72.7 鹵12.4mm Hg 0.01g, which was still higher than that of Pre-3Post-5 (123.7 鹵19.4) than Pre-3Post-5 (123.7 鹵19.4). There was no significant difference in diastolic blood pressure (DBP) between Pre-3 Post-3 and Pre-3 patients with 123.5 鹵18.9mm HgG NSN. Post-1 (71.6 鹵11.7 vs 71.1 鹵12.1mm HgG). This phenomenon indicates that systolic blood pressure needs about 5 minutes to return to resting state and diastolic pressure to rest state level for about 3 minutes after the end of the conversation. The heart rate increased from 68.1 鹵10.8 beats / min in Pre-3 to 70.8 鹵11.2 beats / min / min in During-1 and increased by 2.8 鹵4.3 beats / min. SPSS 21.0 software was used to establish the database and make statistical analysis. The continuous variables conform to the normal distribution, expressed as the mean 鹵standard deviation. Independent sample t test was used for continuous variables and paired t test was used for paired data. Logistic multivariate regression analysis was used as a significant difference. The results showed that the third systolic blood pressure level (Pre-3SBP P0. 023) was an independent factor that affected the degree of elevated blood pressure in conversation, that is, the higher the blood pressure in the quiet state, the greater the increase in the blood pressure during the conversation. Conclusion: during a 5 minute conversation with a doctor, the highest increase in systolic blood pressure was 9.1mm Hg, and the highest increase in diastolic blood pressure was 4.5mm Hg, and it took about 5 minutes for systolic blood pressure to return to rest. Diastolic blood pressure takes about 3 minutes to drop to rest level. Doctors should therefore measure blood pressure at least five minutes before the start of the consultation or at least five minutes after the consultation.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1

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