合并高血压的老年缓慢型心律失常患者起搏器置入前后血压特点分析  

Analysis of blood pressure characteristics before and after pacemaker implantation in elderly patients with hypertension associated with slow arrhythmia

作　　者：孔祥赟 李红[1] 蒲连美[1] 金泽宁[1] KONG Xiangyun;LI Hong;PU Lianmei;JIN Zening(Department of Emergency Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beifing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所急诊危重症中心,100029

出　　处：《心肺血管病杂志》2018年第9期818-822,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：心血管疾病精准医学北京实验室(PXM2017_014226_000037)

摘　　要：目的:探讨合并高血压的病态窦房结综合征、高度房室传导阻滞的老年患者在未改变降压药物治疗的基础上,安置心脏永久起搏器后血压的变化特点。方法:回顾性分析北京安贞医院,2014年至2016年,因缓慢型心律失常行永久起搏器置入的患者,其中包括病态窦房结综合征(SSS)患者192例;Ⅲ度房室传导阻滞(Ⅲ°-AVB)患者155例;Ⅱ°Ⅱ型房室传导阻滞患者59例,记录临床资料,比较三组患者起搏器置入前后SBP、DBP、脉压特点以及变化。结果:(1)组内比较:SSS术前术后血压变化:[SBP(136.0±17.2)vs.(135.6±14.4)mmHg;DBP(71.7±11.3)vs.(71.1±7.7)mmHg;脉压(64.6±17.0)vs.(64.5±13.7)mmHg,P均>0.05)]。Ⅱ°-Ⅱ型AVB术前术后血压变化:[SBP(141.0±19.7)vs.(140.1±19.7)mmHg;DBP(69.8±10.5)vs.(73.0±8.0)mmHg;脉压(71.7±20.6)vs.(67.1±13.7)mmHg,P均>0.05]。Ⅲ°-AVB术前术后血压变化:[SBP(142.4±19.8)vs.(139.6±15.4)mmHg;DBP(69.4±11.3)vs.(71.9±8.3)mmHg,P均>0.05];脉压[(73.0±21.4)vs.(67.7±13.9)mmHg,P<0.05],差异有统计学意义。(2)组间比较:SSS与Ⅲ°-AVB术前SBP、脉压,术后DBP、脉压相比,差异有统计意义(P均<0.05),其余两组间血压比较可见有一定差异,但差异无统计学意义。结论:虽然起搏器置入术对SSS、Ⅱ°-Ⅱ型AVB患者的血压有一定影响,并可见变化趋势;而起搏器置入术对Ⅲ°AVB患者的脉压有明显影响,且对脉压的影响可能通过降低SBP和升高DBP两方面起作用。因此,Ⅲ°AVB患者术前DBP低而SBP过高可能是一种代偿机制,可不予积极降压,以免DBP进一步下降而增加脑卒中风险,而起搏器置入术可能有降低其SBP的作用,故术后应密切监测患者血压,并适当予降压药物调整。Objective： To investigate the blood pressure changes in sinoatrial node syndrome as well as high degree atrioventricular block of elderly patients who also have the disease of hypertension on condition that they are not have changed antihypertensive drugs in hospital. Methods： This is a retrospective study,analysis is collected from Beijing An Zhen Hospital during 2014 to 2016,patients are selected on the condition that having slow arrhythmia,further more,having permanent pacemaker implantation,including sick sinus syndrome（ SSS）patients in 192 cases; 155 cases with three degree atrioventricular block（ AVB） patients; 59 cases of Mobitz ⅡAVB,collected their clinical characteristics. Then,compare blood pressure include systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） and pulse pressure difference of three groups before and after pacemaker implantation. Results： Intragroup Comparison：（ preoperative to postoperative changes） SSS： SBP（ 136. 0 ±17. 2） vs.（ 135. 6 ± 14. 4） mmH g; DBP（ 71. 7 ± 11. 3） vs.（ 71. 1 ± 7. 7） mmH g; pulse pressure（ 64. 6 ± 17. 0）vs.（ 64. 5 ± 13. 7） mmH g; P〈0. 05（ all of the blood pressure change） Mobitz ⅡAVB： SBP（ 141. 0 ± 19. 7） vs.（ 140. 1 ± 19. 7） mmH g; DBP（ 69. 8 ± 10. 5） vs.（ 73. 0 ± 8. 0） mmH g; pulse pressure（ 71. 7 ± 20. 6） vs.（ 67. 1± 13. 7） mmH g（ P〈0. 05）. Third-degree AVB： SBP（ 142. 4 ± 19. 8） vs.（ 139. 6 ± 15. 4） mmH g（ P〈0. 05）;DBP（ 69. 4 ± 11. 3） vs.（ 71. 9 ± 8. 3） mmH g（ P〈0. 05）; Pulse pressure（ 73. 0 ± 21. 4） vs.（ 67. 7 ± 13. 9）mmH g（ P〈0. 05）. Comparison Between The Groups： There were significantly different between SSS and Thirddegree AVB in SBP、pulse pressure before operation as well as DBP、pulse pressure after operation（ P〈0. 05）.Although there were some differences in blood pressure between the other two groups,the difference was not statistically significant. Conclusion： After intra-group

关 键 词：高血压起搏器置入术 老年 病态窦房结综合征 房室传导阻滞 

分 类 号：R54[医药卫生—心血管疾病]