【作者】 李翠云；

【导师】 林松波； 周国英；

【作者基本信息】 福建中医学院 ， 中医内科， 2000， 硕士

【摘要】 目的：研究原发性低血压（Essential Hypotension）患者的发病因素，通过24小时动态血压监测技术（Ambulatory blood pressuremonitoring，ABPM）观察患者的血压平均水平及变化规律，探索原发性低血压的诊断标准。通过检测患者的彩色超声心动图了解其心功能（Cardiac function）指标的变化，探讨原发性低血压的发病机制。观察原发性低血压患者气虚证、阴虚证型在心功能指标上的变化，探讨其各自的关系，提出这两种证型各自的病理改变基础。 结果： 1．50例患者中女性39例、占78％，男性11例、占22％，8例有家族史、占16％。体重低于标准体重者占48％，工作紧张度中等以上者占67％。饮食上未见明显偏好及习惯。性格较内向者占60.1％。症状上诉头晕48例（占96.4％）、头痛13例（占26％）、疲乏无力48例（占96.4％）、健忘41例（占82％）、心悸21例（占42％）、胸闷6例（占12％）、食欲不振5例（占10％）。偶测血压平均值为88.5±6.5/56.4±6.7mmHg。 2．50例动态血压监测显示：24小时平均血压值为100.9/62.1mmHg，白天血压平均值为102.8/63.7mmHg，夜间血压平 均值为95乃6．gmmHg，昼夜血压差别平均为7。8伯．7删Ilg。患者出 现低血压多在凌晨0点至清晨5点及下午3点左右，并以舒张压降低 为主。 3。C功能检测结果显示：①原发性低血压患者的室间隔厚度 （Interventrlcular sevtal thickness，IVST）、左星重量（left ventrlcular Inass，LVM）、左呈重量指数（left ventrlctlla．r lllass index，LVMI）及平均舒张期星壁厚度（。ean wall thickness at d柏叭1巳M们”D）均较正常组明显减少，左室收缩末内径（1听 yen上r。cUlar lute。nal diameter。t end－systole，LVDS）、左呈舒 张末内径（left ventricula。Internal diameter at end－ diastole，LVDD）较正常组明显增力，P＜0．of。①｛血压组的左室身 血分数（left ventricular ej6ction fraction，EF）、左呈短轴缩 短率（short。en frequency of ventrlcular short－axis，l。S）、左 室收缩末室壁应力（end－systolic stress on the left ventrlcular wall，ESS）及心 肌收 缩性（cardiac contractility）均较正常组明 显降低，其中EF值仍处正常值范围。③低血压组的舒张早期减速度 （early－dlastollc deceleration，DC）较正常组明显减低，P（．of。 其余舒张功能指标均未见明显统计学差异。 4．原发性低血压患者气虚证组与阴虚证组的心功能指标显示： ①心脏结构指标：气虚证组的IVST、IVSTS、左室后壁舒张末 及收缩末厚度uWT、PWT S）、LVM、MWTD及l。VMI均较正常组明显减 少，K0．OI及W0．05，而u“、u皿均较正常组明显增加，K0．O仁 阴虚证组的MM、LVMI均较正常组明显减少，P＜0．01，6 LVDS较正 常组明显增加；气虚证组与阴虚证组比较，气虚证组的IVSI’、IVS”rs、 PWT、PWTS、MWTD均明显减少，P＜0．01，而 LVDD明显增加，P＜0，01。 4 ①心脏收缩功能显示：气虚证组及阴虚证组的Er、ESS、。C几 收缩性均较正常组明显减少，且气虚证组的FS较正常组明显减少， 处于正常值低限，但其旺值仍属正常；气虚证组与阴虚证组比较， 气虚证组勺＊、ESS均明显减少，P＜0．01。 ③心脏舒张功能显示：气虚证组的二尖瓣口舒张期血流频谱E 峰与A峰t匕值u从）、DC较正常组明显减少，P州．01；阴虚证组的 DC较正常组减少，Pm．05；气虚证组与阴虚证组比较，气虚证组的 E／A明显减少，P＜0．05。 结论：原发性低血压患者多见于中青年女性，发病与体质因素、 遗传因素及生活工作压力有关。原发性低血压病是一个时域性的概 念，血压低于正常仅在一天的某些时段，且以舒张压降低为主。原 发性低血压患者的。C脏舒缩功能较正常组有相对减弱的趋势，表现 在患者的吓、FS、ESS、。G肌收缩性、DC明显降低；本病气虚证较 阴虚证在。。功能上改变明显，其左心室壁相对较薄，FS、ESS、E八 均较阴虚者明显降低。因此在治疗上采用增强。C肌收缩力的药物， 并配合使用中药补中益气、养心健脾将会取得良好的疗效。更多还原

【Abstract】 Research on the Relationship between the EssentialHypotension Patients’ Ambulatory Blood PressureCardiac Function and Their TCM-SyndromeMajor: Clinic of the Traditional Chinese Medicine Postgraduate: Li Cuiyun Tutor: Prof. Lin SongboVice Prof. Zhou GuoyingABSTRACTObjectives: To observe the essential hypotension patients’ average blood pressure and their regulation by the technology of Ambulatory Blood Pressure Monitoring(ABPM), To research the pathogenesis of essential hypotension , especially the cardiac function by the echocardiograra, To research the difference between Qi-deficiency TCM-syndrome and Yin-deficiency TCM-syndrome in cardiac function.Results:1. 50 patients were observed, 39 female cases > 11 male cases, 8 patients have family history of Essential Hypotension, 48 percent patients’ body weight 10 percent lower than the standard weight. 67 percent have emotional stress in work. There is no obviously habit in diet. 60 percent have introversion temperament. In complaint: 48 cases dizzy , 13 cases headache , 48 cases fatigued and weak , 41 cases forgetful , 21 cases palpitation -. 6 cases have oppressive sensation in the chest , 5 cases have poor appetite. The average blood pressure were 88. 5?. 5/56. 4?. 7mmHg.2. The ABPM indicated that: the average blood pressure in 24 hours x daytime and night were 100.9 /62. 1 mmHg > 102.8 /63.7mmHg and 95 756.9 mmHg. Most" oT TTIe blood pressure decreased during early dawn or at 3 O’clock in the afternoon. The diastolic pressure decreased more obviously than the systolic blood pressure.3. The result of cardiac function by echocardiogram showed that: ㏕he patients’ Interventricular Septal Thickness(IVST) , Left Ventricular Mass (LVM) , Left Ventricular Mass Index (LVMI) and Mean Wall Thickness at Diastole(MWTD) decreased significantly, while the left ventricular internal diameter at end-systole(LVDs) and the left ventricular internal diameter at end-diastole (LVDd) decreased, p<0. 01. (2) The patients’ left ventricular ejection fraction(EF) , FS, end-systolic stress on the left ventricular wall (ESS) and the cardiac contractility descended obviously, but the EF was still in the normal field. (3) The patients’ early-diastolic deceleration(DC) descended significantly, p<0.01. There was no difference in statistics of the cardiac diastolic function.4. The indexes of the cardiac function of Qi-deficiency TCM-syndrome and Yin-deficiency TCM-syndrome in Essential Hypotension showed that: The indexes of IVST , left ventricular posterior wall thickness(PWT) , LVM and MWTD in the Qi-deficiency TCM-syndrome decreased more significantly than that in the Yin-deficiency TCM-syndrome, so did the FS, ESS and E/A.Conclusion: The Essential Hypotension is commonest in the young female. The disease is associated with constitution and genetic factor, as well as emotional stress in work. The blood pressure of Essential Hypotension always below normal level in some period of one day, especially the diastolic blood pressure. The patients’ cardiac function descended relatively, especially the systolic cardiac function of Qi-deficiency TCM-syndrome changed more significantly than that of Yin-deficiency TCM-syndrome. So if take medicine increasing the cardiac contractility .meanwhile with the Chinese herbal invigorating Qi, strengthening the spleen and reinforcing the heart, will get good curative effect.更多还原