颈动脉硬化对老年人餐后血压的影响  

Clinical studies of impact of carotid atherosclerosison postprandial blood pressure in the elderly

作　　者：刘学员[1] 喻智[1] 卢水焕[1] 唐慧明[1] 唐伟雄[1] 黄心元[1] 孙玺荣[1] 周锦池[1] 林仁生[1] 

机构地区：[1]解放军第181医院干部病房,广西桂林541002

出　　处：《中华老年医学杂志》2014年第1期7-10,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨颈动脉硬化（CA）对住院老年人餐后血压的影响。方法餐前15min测1次血压，进第1口餐开始计时，20min、40min、60min、90min和120min各测血压1次，以餐后血压变化最大值为餐后血压，使用彩色多普勒于颈总动脉分叉处10mm内测量左右颈动脉各项指标，包括内径、最大流速、最小流速、阻力指数、内一中膜厚度（IMT）、有无颈总动脉体斑块、颈总动脉窦部斑块（以最大斑块为准），并将糖尿病、原发性高血压、冠状动脉粥样硬化性心脏病、慢性阻塞性肺疾病、心功能、卒中、肾脏疾病、下肢静脉曲张、营养不良、服用降压药、颈动脉有无斑块等因素对餐后血压变化情况进行偏相关分析。将138例患者分为：（1）餐后低血压组（PPH组，101例）与餐后无低血压组（对照组，37例），比较颈总动脉各项指标；（2）无CA组（IMT≤1．0mm）与CA组（IMT〉1．0ram）；（3）单侧颈总动脉斑块组和双侧颈总动脉斑块组及双侧颈总动脉无斑块组；（4）单侧颈总动脉窦部斑块组和双侧颈总动脉窦部斑块组及双侧颈总动脉窦部无斑块组；比较各组餐后血压的变化。结果PPH组左右颈总动脉的血流速度均较对照组慢，血流阻力指数大，左右颈动脉窦部斑块面积均较对照组者明显（Z=-3．073、-2．303，P=0．002，0．021）。偏相关分析：早餐后收缩压、舒张压变化最大值与颈动脉窦部斑块相关（r=0．195，P=0．022；r=-0．177，P=0．038），早餐后舒张压变化最大值与脑卒中相关（r=0．259，P=0．002），晚餐后收缩压变化最大值与糖尿病、冠心病相关（r=0．226，P=0．008；r=0．214，P=0．012）；晚餐后舒张压变化最大值与冠心病相关（r=0．183，P=0．032）。颈动脉IMT对餐后血压变化的影响无统计学意义；颈总动脉体斑块对早餐舒张压变化的影响有统计学意义（Z=-2．111，P=0．035）。双Objective To investigate the effect of carotid atherosclerosis （CA） on postprandial blood pressure in hospitalized elderly patients. Methods Blood pressures were measured at 15 minutes before meals and defined as preprandial blood pressures. Then blood pressures were measured at 20, 40, 90, 120 min after the first chewing respectively. And blood pressures with maximal changes after meals were defined as postprandial blood pressures. Color Doppler （ Philips IU22 ） was used to measure the indicators of left and right carotid artery inside the proximal 10 mm of the common carotid artery bifurcation, including inside diameter, maximum flow rate, minimum flow rate, resistance index, intima-media thickness （IMT）, the presence or absence of carotid artery plaques, carotid artery sinus plaque （with maximum plaque ）. The impacts of diabetes mellitus, primary hypertension, coronary atherosclerotic heart disease, chronic obstructive pulmonary disease, heart function, stroke, kidney disease, varicose vein of lower extremity, malnutrition, taking antihypertensive drugs and carotid sinus with or without plaques on postprandial blood pressure were analyzed by partial correlation analysis. Results The blood flow velocity in left and right common carotid arteries was slower, blood flow resistance was higher and plaque areas of left and right carotid artery sinus were more obvious in postprand hypotension group than in control group （Z=- 3. 073,-- 2. 303, P〈0.01 or 0.05）. Partial correlation analysis showed that the maximal changes in systolic and diastolic blood pressures after breakfast were associated with the presence of plaques in carotid sinus or not （r = 0. 195, - 0. 177, both P % 0.05）, the maximal changes in systolic blood pressure after breakfast were correlated with stroke （r=0. 259, P%0.01）, the maximal changes in systolic blood pressure after dinner were correlated with diabetes mellitus and coronary heart disease （r = 0. 226, 0. 214, P % 0.01 or 0.05）, the maximal changes in diastoli

关 键 词：颈动脉疾病 颈动脉窦 动脉粥样硬化 血压测定 

分 类 号：R543.4[医药卫生—心血管疾病]