【摘要】：研究目的:探討老年高血壓患者直立性低血壓(OH)與血壓晝夜節(jié)律、左心室結構及功能的相關性。方法:選擇2015年4月15日至2016年4月14日在我院門診及住院的原發(fā)性高血壓患者共256例,女性122例,男性134例,年齡60-80歲(平均:68.47±8.15)。對所有受試者進行臥—立位血壓測定、24h動態(tài)血壓監(jiān)測以及超聲心動圖測量心臟結構及功能。按照直立性低血壓的診斷標準,分為OH組和非OH組。采用SPSS16.0統(tǒng)計學軟件進行處理分析。結果:1)兩組受試者臨床資料比較256例受試者OH發(fā)生率為34.8%,OH組89例,非OH組167例。與非OH組比較,OH組的年齡、高血壓病程、臥位收縮壓、臥位舒張壓、LDL-C(低密度脂蛋白膽固醇)均顯著高于非OH組,差異有統(tǒng)計學意義(P0.05)。為OH組的性別、體重指數(shù)、TCH(總膽固醇)、TG(甘油三酯)、HDL-C(高密度脂蛋白膽固醇)、空腹血糖、血管緊張素轉換酶抑制劑、利尿劑、血管緊張素受體拮抗劑、β受體阻滯劑、鈣拮抗劑、a受體阻滯劑無明顯變化,差異無統(tǒng)計學意義(P0.05)。2)兩組受試者24hABPM參數(shù)比較與非OH組相比,OH組的24h平均收縮壓和夜間平均收縮壓明顯高于非OH組;夜間收縮壓下降率和夜間舒張壓下降率明顯低于非OH組,差異有統(tǒng)計學意義(P0.05)。兩組白晝平均收縮壓、夜間平均舒張壓、24 h平均舒張壓無明顯變化,差異無統(tǒng)計學意義(P0.05)。3)兩組受試者左心室結構參數(shù)的比較與非OH組相比,OH組的左心室舒張末內徑(LVEDD)、舒張期室間隔厚度(IVSD)、左心室收縮末內徑(LVESD)及左心室質量指數(shù)(LVMI)較非OH組升高,差異有統(tǒng)計學意義(P0.05)。2組受試者舒張期左心室后壁厚度無明顯變化,差異無統(tǒng)計學意義(P0.05)。4)兩組受試者左心室功能參數(shù)的比較與非OH組相比,OH組的左室射血分數(shù)(LVEF)、每搏輸出量(SV)、E/A比值較非OH組明顯降低,差異有統(tǒng)計學意義(P0.05)。兩組受試者左心室短軸縮短率(FS)、心輸出量(CO)比較,無明顯變化,差異無統(tǒng)計學意義(P0.05)。結論:1)老年高血壓患者直立性低血壓與血壓晝夜節(jié)律改變密切相關。2)老年高血壓患者直立性低血壓影響左心室結構,對左心室舒張末內徑、收縮末內徑、舒張期室間隔厚度有明顯影響。3)老年高血壓患者直立性低血壓易影響左心室功能,對左心室射血分數(shù)、每搏輸出量、E/A比值有明顯影響。
[Abstract]:Objective: to investigate the relationship between (OH) and circadian rhythm of blood pressure, left ventricular structure and function in elderly patients with hypertension. Methods: from April 15, 2015 to April 14, 2016, there were 256 out-patient and inpatients with essential hypertension in our hospital, including 122females and 134males, aged 60-80 years (mean: 68.47 鹵8.15). All subjects were measured by lying-standing blood pressure, 24-hour ambulatory blood pressure monitoring and echocardiographic measurement of cardiac structure and function. According to the diagnostic criteria of orthostatic hypotension, they were divided into OH group and non-OH group. SPSS16.0 statistical software was used for processing and analysis. Results: 1) the incidence of OH was 34.8% in the two groups, 89 cases in OH group and 167 cases in non-OH group. Compared with non-OH group, the age, duration of hypertension, supine systolic blood pressure, supine diastolic blood pressure and LDL-C (low density lipoprotein cholesterol) in OH group were significantly higher than those in non-OH group (P0.05). Sex, body mass index (, TCH (), total cholesterol (), TG (), triglyceride (), TG (), high density lipoprotein cholesterol (HDL-C), fasting blood glucose, angiotensin converting enzyme inhibitors, diuretics, angiotensin receptor antagonists (angiotensin receptor antagonists) in the OH group. There was no significant difference in 尾-blocker, calcium antagonist and a-receptor blocker between the two groups (P0.05). 2) compared with the non-OH group, the 24hABPM parameters in the two groups were significantly higher than those in the non-OH group. The 24-hour mean systolic blood pressure and nighttime mean systolic blood pressure in OH group were significantly higher than those in non-OH group. The nocturnal systolic blood pressure drop rate and nocturnal diastolic blood pressure drop rate were significantly lower than those in non-OH group (P0.05). There was no significant difference in mean daytime systolic blood pressure, nocturnal mean diastolic blood pressure and 24-hour mean diastolic blood pressure between the two groups (P0.05). 3) the left ventricular structural parameters in the two groups were compared with those in the non-OH group, and there was no significant difference between the two groups (P0.05). Left ventricular end-diastolic diameter (LVEDD), diastolic septal thickness (IVSD), left ventricular end-systolic diameter (LVESD) and left ventricular mass index (LVMI) in OH group were higher than those in non-OH group. There was no significant difference in the left ventricular posterior wall thickness between the two groups (P0.05). 4) the left ventricular function parameters in the two groups were compared with those in the non-OH group, and there was no significant difference in the left ventricular posterior wall thickness between the two groups (P0.05), but there was no significant difference between the two groups (P0.05). Left ventricular ejection fraction (LVEF) in OH group was significantly lower than that in non-OH group (P 0.05). (SV), / E / A ratio of LVEF was significantly lower in LVEF group than that in non-OH group (P0.05). There was no significant difference in left ventricular shortening rate (FS),) and cardiac output (CO) between the two groups (P0.05). Conclusion: 1) there is a close relationship between orthostatic hypotension and circadian rhythm of blood pressure in elderly patients with hypertension. 2) erectile hypotension affects left ventricular structure, end-diastolic diameter and end-systolic diameter of left ventricle in elderly patients with hypertension. (3) the left ventricular function was easily affected by orthostatic hypotension, and the left ventricular ejection fraction (LVEF), stroke volume and E / A ratio were significantly affected in elderly patients with hypertension. 3) the left ventricular ejection fraction (LVEF), stroke volume and E / A ratio were significantly affected by orthostatic hypotension.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1

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