临床研究——危重病人动态血压监测的临床意义  

Clinical Significant of Ambulatory Blood Pressure Monitoring for Critical Patients

作　　者：寿松涛[1] 柴艳芬[1] 崔书章[1] 刘洪斌[1] 温前宽[1] 

机构地区：[1]天津医科大学总医院急救中心,天津市300052

出　　处：《中国全科医学》2008年第7期599-601,共3页Chinese General Practice

摘　　要：目的了解危重病人动态血压变化规律及其与病人预后关系。方法监测147例住院危重病人动态血压,计算:(1)24h平均收缩压(24hSBP)、舒张压(24hDBP)、动脉压(24hMAP)和脉压(24hPP);(2)日间平均收缩压(dSBP)、舒张压(dDBP)、动脉压(dMAP)和脉压(dPP);(3)夜间平均收缩压(nSBP)、舒张压(nDBP)、动脉压(nMAP)和脉压(nPP);(4)收缩压和舒张压夜间下降率(SBPF,DBPF);(5)血压变异性,包括24h收缩压和舒张压变异、日间收缩压和舒张压变异、夜间收缩压和舒张压变异。根据APACHEⅡ评分分为两组:APACHEⅡ>20分组和APACHEⅡ≤20分组,比较两组病人的动态血压监测各指标变化;再根据24hPP分为两组:PP>40mmHg组和PP≤40mmHg组,观察两组病人的临床特点。结果APACHEⅡ>20分组24hSBP、24hDBP、24hPP及非勺型率均高于APACHEⅡ≤20分组,差别有统计学意义(P<0.01);APACHEⅡ>20分组和APACHEⅡ≤20分组病人的24h收张压变异、舒张压变异及昼间收缩压变异、舒张压变异间差别均有统计学意义(P<0.01)。PP>40mmHg组病人年龄、女性比例、心率(HR)、SBP、MAP、血糖、APACHEⅡ评分、总病死率均高于PP≤40mmHg组,差别有统计学意义(P<0.05)。Logistic回归分析发现:24hPP、APACHEⅡ评分、24hSBP和昼间收缩压变异是影响病人预后的危险因素。结论监测危重病人动态血压可以更准确、更全面地了解病人血压情况,对血压风险评估更有价值;24hPP也是危重病人预后的独立危险因素。Objective To study the circadian rhythms of blood pressure and its relation with prognosis for critical patients. Methods The blood pressure in 147 critical inpatients was monitored, then the following were calculated ： （ 1 ） 24 - hour average systolic blood pressure （24hSBP）, 24- hour average diastolic blood pressure （24hDBP）, 24- hour mean artery pressure （24hMAP）, and 24 -hour average pulse pressure （24hPP） ; （2） average daytime SBP （dSBP）, average daytime DBP （dDBP）, average daytime MBP （dMAP）, and average daytime PP （dPP） ; （3） average nocturnal SBP （nSBP）, average nocturnal DBP （nDBP） , average nocturnal MBP （nMAP） and average nocturnal PP （nPP） ; （4） nocturnal systolic and diastolic blood pressure falling rate （ SBPF and DBPF） ; （5） blood pressure variability （BPV） , including 24 - hour systolic and diastolic variability, daytime systolic and diastolic variability, and nocturnal systolic and diastolic variability. The patients were divided into two groups according to the acute physiology, and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score ： APACHE Ⅱ 〉 20 and APACHE Ⅱ≤20, to compare the changes of various indexes in ambulatory blood pressure monitoring. Then the patients were again divided into two groups according to 24hPP： PP 〉40 mm Hg and PP≤〈40 mm Hg, to observe the clinical features of the patients in the two groups. Results There were differences between APACHE I1 〉 20 group and APACHE Ⅱ≤20 group in 24hSBP, 24hDBP, PP and the incidence of non - dippers （ P 〈 0. 01 ）. There were differences between APACHE Ⅱ 〉 20 group and APACHE Ⅱ≤20 group in 24 -hour systolic and diastolic variability, daytime systolic and diastolic variability （ P 〈 0. 01 ）. The age, the percentage of women, heart rate, SBP, MAP, blood glucose, APACHE Ⅱ score and total mortality were significantly higher in patients with PP 〉 40 mm Hg （ P 〈 0. 05 ）. Logistic regression showed that 24hBP, APACHE

关 键 词：动态血压 脉压 APACHEⅡ评分 预后 

分 类 号：R505.97[医药卫生—内科学]