本文選題：血壓晨峰　切入點(diǎn)：24h動(dòng)態(tài)血壓監(jiān)測(cè)　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：通過(guò)采集血壓晨峰患者的相關(guān)數(shù)據(jù),探討血壓晨峰患者的中醫(yī)證型分布情況及其與年齡、血壓級(jí)別、病程、血脂、尿微量白蛋白、頸動(dòng)脈內(nèi)膜中層厚度情況、血尿酸等相關(guān)危險(xiǎn)因素的關(guān)系。方法：采納2015年7月至2016年5月入住廣東省中醫(yī)院心血管科并確診為高血壓病的患者,行24h動(dòng)態(tài)血壓監(jiān)測(cè)篩查出血壓晨峰患者并完善其余各項(xiàng)檢查,采集相關(guān)數(shù)據(jù)后利用SPSS統(tǒng)計(jì)軟件進(jìn)行分析,得出結(jié)果,探討血壓晨峰患者的中醫(yī)證型分布情況及其與年齡、血壓級(jí)別、病程、血脂、尿微量白蛋白、頸動(dòng)脈內(nèi)膜中層厚度情況、血尿酸等相關(guān)危險(xiǎn)因素的關(guān)系。結(jié)果：(1)課題共納入110例患者。按中醫(yī)證候分組,肝火亢盛證26例,占23.6%,平均MBPS值37.54±1.58mmHg；陰虛陽(yáng)亢證18例,占16.5%,平均MBPS值36.79±1.03mmHg；陰陽(yáng)兩虛證23例,占23.9%,平均MBPS值36.99±0.96mmHg。痰濕壅盛證43例,占39.1%,平均MBPS值38.88±2.64mmHg。經(jīng)單因素方差分析比較,P0.05,差異顯著。(2)按血壓級(jí)別分組,高血壓1級(jí)患者8例,占7.3%,平均MBPS值36.23±0.79mmHg；高血壓2級(jí)患者24例,占21.8%,平均MBPS值37.34±2.27mmHg；高血壓3級(jí)患者78例,占70.9%,平均MBPS值38.15±2.09mmHg,經(jīng)單因素方差分析顯示,P0.05,層級(jí)差異顯著。(3)按年齡分組,55歲及以下血壓晨峰患者18例,占16.4%,平均MBPS值37.17±1.31mmHg；56～65歲血壓晨峰患者36例,占32.7%,平均MBPS值37.59±2.30mmHg；66-75歲血壓晨峰患者22例,占20.0%,平均MBPS值38.16±2.93mmHg；76～85歲血壓晨峰患者34例,占30.9%,平均MBPS值38.17±1.35mmHg。經(jīng)方差分析比較,P0.05,無(wú)明顯統(tǒng)計(jì)學(xué)差異。(4)按高血壓病程分組,病程小于10年者61例,占55.5%,平均MBPS值37.37±1.88mmHg；病程介于10～20年者24例,占21.8%,平均MBPS值38.05±1.51mmHg；病程大于20年者25例,占22.7%,平均MBPS值 38.74±2.74mmHg。方差分析顯示,P0.05,差異顯著。(5)按IMT增厚情況分組,雙側(cè)IMT未增厚者20例,平均MBPS者36.96±2.34mmHg；單側(cè)IMT增厚者17例,平均MBPS36.92±1.22mmHg；雙側(cè)IMT均增厚者64例,平均MBPS值38.40±2.12mmHg。方差分析顯示,P0.05,差異顯著。(6)按24h節(jié)律分組,24h節(jié)律存在者18例,平均MBPS值37.58±2.45mmHg；24h節(jié)律消失或倒置者83例,平均MBPS值37.96±2.05mmHg；經(jīng)t檢驗(yàn),P0.05。(7)按AASI分組,AASI小于0.55者64例,平均MBPS值37.83±1.89mmHg；AASI大于等于0.55者39例,平均MBPS值37.92±2.49mmHg。經(jīng)比較,P0.05。(8)按TCD血流情況分組,TCD正常者30例,平均MBPS值36.95±1.46mmHg；TCD血流異常者65例,平均MBPS值38.24±2.12mmHg。經(jīng)比較,二組P0.05。(9)按尿微量白蛋白分組,尿微量白蛋白升高組19例,平均MBPS值39.48±3.02mmHg；正常組42例,平均MBPS值37.14±1.35mmHg。經(jīng)比較,P0.05。(10)按血尿酸分組,尿酸正常者59例,平均MBPS值37.33±1.10mmHg；尿酸升高者36例,平均MBPS值37.43±1.25mmHg,經(jīng)比較,P0.05。(11)血脂方面,TC正常者65例,平均MBPS值37.52±1.54mmHg,TC升高者36例,平均MBPS值38.084±2.86mHg,t檢驗(yàn)顯示P＜0.05.NOn-HDL-C正常者67例,平均MBPS值37.49±1.52mmHg,升高者34例,平均MBPS值38.60±2.90mmHg,t檢驗(yàn)顯示P〈0.05。其余血脂(包括TG.HDL-C、LDL-C)分別進(jìn)行分組比較,經(jīng)t檢驗(yàn),P0.05。結(jié)論：血壓晨峰與病程、血壓級(jí)別有關(guān),病程愈長(zhǎng)、血壓級(jí)別愈高者,其血壓晨峰值愈大；血壓晨峰與血脂異常有一定關(guān)系,TC或non-HDL-C異常者,其血壓晨峰值愈大；血壓晨峰愈大,患者愈容易出現(xiàn)尿微量白蛋白增高；血壓晨峰值愈大,患者TCD血流情況、IMT愈容易出現(xiàn)異常；痰濕壅盛證患者血壓晨峰值較其余證型高。
[Abstract]:Objective: through the relevant data collection of morning blood pressure surge of patients, to explore the distribution of TCM syndromes in patients with morning blood pressure surge and blood pressure levels, age, duration, blood lipid, urinary albumin, carotid intima-media thickness, the relationship between blood uric acid and related risk factors. Methods: from July 2015 to May 2016 in Guangdong Province Traditional Chinese Medical Hospital adopted in cardiovascular department and diagnosed in patients with hypertension, 24h ambulatory blood pressure monitoring in patients with morning blood pressure peak and improve the rest of the inspection, after collecting relevant data were analyzed by SPSS statistical software, the results of the distribution of TCM syndromes in patients with morning blood pressure surge and blood pressure levels, age, duration, blood lipid, urine trace albumin, carotid intima-media thickness, the relationship between blood uric acid and related risk factors. Results: (1) study included 110 patients grouped according to TCM syndrome, Anger hyperactivity syndrome 26 cases, accounting for 23.6%, the average MBPS value of 37.54 + 1.58mmHg; Yin deficiency and yang hyperactivity syndrome 18 cases, accounting for 16.5%, the average value of MBPS 36.79 + 1.03mmHg two; deficiency of yin and Yang 23 cases, accounting for 23.9%, the average value of MBPS 36.99 + 0.96mmHg. phlegm dampness syndrome in 43 cases, accounting for 39.1%, 38.88 + 2.64mmHg. the single factor variance analysis, P0.05, significant difference between the average MBPS value. (2) groups according to the blood pressure level, grade 1 hypertension patients in 8 cases, accounting for 7.3%, the average MBPS value of 36.23 + 0.79mmHg; grade 2 hypertension patients in 24 cases, accounting for 21.8%, the average MBPS value of 37.34 + 2.27mmHg; grade 3 hypertension patients in 78 cases, accounting for 70.9%, the average MBPS value of 38.15 + 2.09mmHg, the single factor variance analysis showed that the level of P0.05, the difference was significant. (3) according to the age, under the age of 55 and the morning blood pressure surge in patients with 18 cases, accounting for 16.4%, the average MBPS value of 37.17 + 1.31mmHg; 56~65 Mbps in patients with 36 cases, accounting for 32.7%, average MBPS a value of 37.59 + 2.30mmHg; 66-75 year old blood pressure Morning peak in 22 cases, accounting for 20%, the average MBPS value of 38.16 + 2.93mmHg; 76~85 Mbps in patients with 34 cases, accounting for 30.9%, 38.17 + 1.35mmHg. by variance analysis, the average P0.05 value of MBPS, no significant difference. (4) groups according to the duration of hypertension, duration of less than 10 years in 61 cases, accounting for 55.5% MBPS, the average value of 37.37 + 1.88mmHg; duration ranged from 10~20 years in 24 cases, accounting for 21.8%, the average MBPS value of 38.05 + 1.51mmHg; the course of more than 20 years in 25 cases, accounting for 22.7%, 38.74 + 2.74mmHg. variance analysis showed that the average value of MBPS P0.05, the difference was significant. (5) grouped by IMT thickening, 20 cases of bilateral IMT thickening of MBPS, average 36.96 + 2.34mmHg; 17 cases of unilateral IMT thickening, the average MBPS36.92 + 1.22mmHg; 64 cases of bilateral IMT were thickened, 38.40 + 2.12mmHg. variance analysis showed that the average value of MBPS P0.05, the difference was significant. (6) grouped according to the 24h 24h rhythm rhythm, there were 18 cases, an average of MBPS a value of 37.58. 2.45mmHg; 83 cases of 24h rhythm disappeared or inverted, the average MBPS value of 37.96 + 2.05mmHg; by t test, P0.05. (7) group by AASI, AASI is less than 64 in 0.55 cases, the average MBPS value of 37.83 + 1.89mmHg; AASI is greater than or equal to 0.55 in 39 cases, the average MBPS value of 37.92 + 2.49mmHg. by comparison, P0.05. (8 TCD) groups according to the blood flow, 30 cases with normal TCD, the average value of MBPS 36.95 + 1.46mmHg TCD; 65 cases of abnormal blood flow, the average MBPS value of 38.24 + 2.12mmHg. by comparison, two groups of P0.05. (9) groups according to urinary albumin, 19 cases of microalbuminuria group increased, the average MBPS value of 39.48 + 3.02mmHg; normal group of 42 cases, the average MBPS value of 37.14 + 1.35mmHg. by comparison, P0.05. (10) groups according to the serum uric acid, uric acid in 59 cases of normal subjects, the average MBPS value of 37.33 + 1.10mmHg; uric acid increased in 36 cases, the average MBPS value of 37.43 + 1.25mmHg, by comparison, P0.05. (11) blood, 65 cases with normal TC. The average value of MBPS 37.52 + 1.54mmHg, T 36 cases of C increased, the average MBPS value of 38.084 + 2.86mHg, P < T test showed 67 cases of normal 0.05.NOn-HDL-C, the average MBPS value of 37.49 + 1.52mmHg, 34 cases were increased, the average MBPS value of 38.60 + 2.90mmHg, t P "0.05. test showed that the blood lipid (TG.HDL-C, LDL-C) were divided into groups by t test, P0.05. conclusion: morning blood pressure surge and the course of disease, blood pressure level, longer duration, higher blood pressure levels, the peak morning blood pressure is bigger; there is a certain relationship between morning blood pressure surge and dyslipidemia, TC or non-HDL-C are abnormal, the morning blood pressure peak morning blood pressure peak is bigger; larger, more patients prone to urinary albumin increased; morning blood pressure peak more blood flow in patients with TCD, IMT is more prone to abnormalities; phlegm dampness syndrome of morning blood pressure peak than the other syndromes.

【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】：2016
【分類(lèi)號(hào)】：R259

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