动态血压监测在心力衰竭患者病情评估中的价值  

Value of ambulatory blood pressure monitoring in severity evaluation of patients with congestive heart failure

作　　者：邰胜[1] 刘志华[2] 

机构地区：[1]苏州大学附属第一医院老年医学科,江苏苏州215006 [2]苏州大学附属第一医院心内科,江苏苏州215006

出　　处：《临床荟萃》2013年第3期266-269,共4页Clinical Focus

摘　　要：目的研究动态血压监测在心力衰竭患者病情评估中的价值。方法 92例心力衰竭患者,均行动态血压监测(ABPM),并准确记录监测时的心功能分级。分别按基础心脏病病因和纽约心脏病协会(NYHA)心功能分级分组。选取同时期门诊及住院的72例有基础心脏病但无心力衰竭的患者作为对照组。观察动态血压参数与心功能分级关系。结果与对照组比较,心力衰竭组的白昼平均收缩压(DSBP)、白昼平均舒张压(DDBP)、24小时平均压(24hMBP)、白昼平均压(DMBP)、白昼舒张压变异(DDBPV)水平明显低于对照组,DSBP(116.2±17.8)mmHg vs(123.9±14.5)mmHg,DDBP(69.5±10.2)mmHg vs(75.9±9.7)mmHg,24hMBP(89.4±12.5)mmHg vs(95.9±11.4)mmHg,DMBP(90.4±13.5)mmHg vs(100.2±11.5)mmHg,DDBPV(8.5±2.4)mmHg vs(10.4±2.4)mmHg(P<0.01)。心力衰竭Ⅳ级组24小时平均收缩压(24hSBP)、DSBP、夜间平均收缩压(NSBP)、DDBP、24hMBP、DMBP、夜间平均压(NMBP)、24小时平均脉压(24hPP)、白昼平均脉压(DPP)、夜间平均脉压(NPP)均明显低于Ⅱ级组和(或)Ⅲ级组(P<0.01)。相关分析表明,24hSBP、24hDBP、24hMBP、24hPP、24小时收缩压变异(24hSBPV)与NYHA分级呈负相关(P<0.05或<0.01)。结论心力衰竭患者DSBP、DDBP、24hMBP、DMBP、DDBPV较对照组明显降低,且随着心力衰竭程度加重,血压均值有下降趋势,心功能Ⅳ级患者24hSBP、DSBP、NSBP、DDBP、24hMBP、DMBP、NMBP、24hPP、DPP、NPP均低于Ⅱ级和Ⅲ级患者。Objective To research the value of ambulatory blood pressure monitoring （ABPM） for severity evaluation of patients with congestive heart failure（CHF）. Methods A total of 92 inpatients with CHF were enrolled into study,all experienced 24 h ambulatory blood pressure monitoring and were divided into different groups by New York Heart Association（NYHA） functional class. Selected 72 inpatients and outpatients with the basic heart disease but no CHF during the same period served as control group. The relationship between the parameters of ABPM and the NYHA class of CHF was explored. Results The day systolic blood pressure （DSBP）, day diastolic blood pressure （DDBP） ,24-hour mean blood pressure （24hMBP）, day mean blood pressure（DMBP）, day diastolic blood pressure variability（DDBPV） of CHF were significantly lower than those of control group（ P〈0.01）;DSBP（116.2±17.8） mmHg vs （123.9±14.5） mmHg,DDBP（69. 5±10. 2） mmHg vs （75.9±9.7） mmHg,24hMBP（89.4±12. 5） mmHg vs （95.9±11.4） mmHg,DMBP（90. 4±13.5） mmHg vs （100.2±11.5） mmHg,DDBPV（8. 5±2. 4） mmHg vs （10.4± 2.4） mm Hg, and 24 h systolic blood pressure（ 24 hSBP）, DSBP, night systolic blood pressure （NSBP）, DDBP, 24 hMBP, DMBP,night mean blood pressure （NMBP）, 24 h pulse pressure （24hPP）, day pulse pressure （DPP）, night pulse pressure（NPP） of NYHA Ⅳ were significantly lower than those of NYHA Ⅱ and（or） Ⅲ （P 〈0.01）. 24hSBP, 24hDBP,24hMBP, 24hPP, 24 h systolic blood pressure variability and NYHA class presented obviously negative correlation（ P 〈0.05 or 〈0.01）. Conclusion DSBP,DDBP,24hMBP,DMBP,and DDBPV in CHF were significantly lower than those in control group. Blood pressure decreased with the severity of CHF. 24hSBP, DSBP, NSBP, DDBP, 24hMBP, DMBP, NMBP, 24hPP, DPP, NPP of NYHA Ⅳ were lower than those of NYHA Ⅱ and Ⅲ.

关 键 词：心力衰竭 充血性 血压 血压监测 便携式 

分 类 号：R541.61[医药卫生—心血管疾病]