【作者】 王茜；

【导师】 高海青；

【作者基本信息】 山东大学 ， 内科学， 2009， 硕士

【摘要】 目的:高血压治疗是心血管领域内重要的课题,也是当今的社会问题,其中以中老年人群为主体。虽然美国指南、欧洲指南相继出台,新的抗高血压药物不断研发,但是高血压的控制率仍较低。可能的原因之一为:即使是同一血压水平,血流动力学状态也可能不同。也即单纯依靠血压水平进行降压治疗并不能达到优化降压治疗的目的。因此本研究拟探索中老年高血压患者的血流动力学特点,从而有助于实现真正的个体化治疗。另外心搏量/脉压(SV/PP)作为评价血管弹性的指标已被提出数十年,但应用并不广泛,也没有太多的证据来证明其有效性,但是由无创血流动力学检测系统检测SV/PP操作简单,重复性强,本论文另外一个目的是评价无创血流动力学检测系统测得的SV/PP与另一血管弹性指标脉搏波速度(PWV)的相关性。方法:收集2008年4月至2008年10月到山东大学齐鲁医院健康查体中心健康查体的中老年人群462名(男303名,女159名),根据美国预防、检测、评价和治疗高血压全国联合委员会第七次报告(U.S.prevention,detection,evaluation and treatment of hypertension seventh reportof the National Joint Committee,JNC-7)分为3组,高血压组(288例)、高血压前期组(89例)和正常对照组(85例)。高血压组包括正在治疗的高血压患者(血压控制达标或不达标)以及未接受治疗的患者(收缩压≥140 mm Hg(1 mm Hg=01133 kPa)和(或)舒张压≥90 mm Hg)。高血压前期组为血压120～130/80～89mmHg。所有经检查证实的继发性高血压均剔除。三组患者均接受SVR、SVRI、MAP、CO、CI、SV、SI、PEP、LVET、VI、STR和ACI等血流动力学指标检测(LIFEGARDⅡ型无创血流动力学监护系统,CAS,USA)以及脉搏波速度检测(Complior动脉脉搏波速度测定仪,Artech,France)。结果:1.受检者的一般临床资料:三组患者之间的年龄、体重指数和心率无统计学差异。2.三组间的血流动力学指标比较:SBP、PP、MAP、SRV和SRVI等指标三组之间两两比较均有统计学差异(P＜0.05),DBP、SV、ACI、LCWI、VI和LVET等指标在高血压组与高血压前期组之间无统计学差异,而高血压组与正常对照组、高血压前期组与正常对照组均有显著的统计学差异(P＜0.05)。TFC、PEP和STR等指标在三组之间无统计学差异。3.SV/PP与颈-股PWV相关性分析,相关系数=-0.424(P＜0.001)。SV/PP与颈-桡PWV相关性分析,相关系数=-0.012(P=0.791)。SV/PP与颈-足背PWV相关性分析,相关系数=-0.251(P＜0.001)结论:1.中老年高血压患者的血流动力学变化,主要表现为外周血管阻力的升高,心肌收缩力功能受到损害,心肌做功增多。敏感指标包括SVRI、SVR、ACI、LCWI、VI和LVET。应用胸阻抗法检测血流动力学经济、有效及实用,并能早期发现高血压前期患者的心功能损伤。2.SV/PP可考虑作为一种评价动脉弹性尤其是是大动脉弹性的临床指标。更多还原

【Abstract】 ObjectiveTreatment of Essential hypertension is one of the most important subjects in Cardiology,which is also an important society problem.Middle-aged and elderly people make the main body of EH patients.Though new EH guidelines of ACA and ESC were pubulished and new anti-EH drugs were developed,the control rate of EH is still not satisfying.The different dynamics states in different patients,even with same level of EH,may be one of the causes,which make the satisfying control of EH can not be available by controlo of EH only. So we conducted our study on the dynamics states in middle-aged and elderly patients.SV/PP was developed decades ago to evaluate vessel Elasticity.But its use is very limited.And not much prove is available to show its efficacy.But it has the advantages of convenience and reproducibility.So we also coduct our study to study the correlation between SV/PP and PWV,another index to evaluate vessel elasticity.MethodFour hundred and sixty two subjects were enrolled in healthy check-up clinic of Qilu Hospital of Shandong University from August 2008 to October 2008.Means age is 63 years(40～87years),Three groups were included:288 patients in essential hypertension group(EH group);89 subjects in high-normal blood pressure group(HNBP group) and 85 subjects in healthy control group (HC group).Each subject undertook SVR、SVRI、MAP、CO、CI、SV、SI、PEP、LVET、VI、STR and ACI hemodynamic examination and pulse wave velocity(PWV)test.Pearson Correlation Analysis was used to study the correlations with SPSS 11.5 Software.Results1.There were no statistical differences in mean age,sex ratio,body mass index and heart rate between three groups.2.There are significantly differences in SBP、PP、MAP、SRV and SRVI(P＜0.05) between EH group and HNBP group,EH group and HC group,HNBP group and HC group.There are significantly difference in DBP、SV、ACI、LCWI、VI and LVET between EH group and HC group(P＜0.01),HNBP group and HC group(P＜0.05).There are no significant differences in TFC,PEP,STR between EH group and HNBP group,EH group and HC group,HNBP group and HC group(P＞0.05). 3.Negative correlation were detected between SV-to-PP ratio and CFPWV(r=-0.450,P＜0.001),SV-to-PP ratio and CDPWV(r=-0.284,P＜0.001),SV-to-PP ratio and CRPWV(r=-0.047,P=0.791).Conclusions1.There are hemodynamics abnormities,especially increased peripheral vascular resistance and increased cardiac performance,in EH and HNBP patients.2.SV-to-PP ratio can be used as a potential indicator to evaluate Arterial Elasticity.更多还原