餐后低血压对高龄老年人远期预后的影响  

Effect of postprandial hypotension on long-term outcome in very old people

作　　者：卢水焕 朱中权 向桢 刘学员 林仁生 唐慧明 Lu Shuihuan;Zhu Zhongquan;Xiang Zhen;Liu Xueyuan;Lin Rensheng;Tang Huiming(Department of Geriatrics,Chinese PLA No.924 Hospital,Guilin 541002,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]解放军联勤保障部队第九二四医院干部病房,桂林541002 [2]解放军联勤保障部队第九二四医院心脏科,桂林541002 [3]解放军联勤保障部队第九二四医院健康管理中心,桂林541002

出　　处：《中华老年心脑血管病杂志》2020年第9期929-933,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：军队保健专项科研课题(12BJZ14)。

摘　　要：目的研究餐后低血压(postprandial hypotension,PPH)对高龄老年人远期预后的影响。方法连续入选2011年5月1日~2012年10月30日解放军联勤保障部队第九二四医院干部病房住院的高龄PPH患者78例(PPH组),随机抽取高龄非PPH患者78例(对照组)。收集2组一般资料、颈动脉粥样硬化及斑块、心脏结构及功能等,进行7年随访,主要研究终点包括全因病死率、影响预后的心脑血管事件(包括急性心肌梗死、脑梗死和心源性猝死)发生率。采用Kaplan-Meier法、log-rank检验及Cox回归模型进行预后危险因素分析。结果 PPH组全因死亡、急性脑梗死比例明显高于对照组(51.3%vs 32.1%,P=0.015;35.9%vs 21.8%,P=0.017)。以全因死亡为结局,PPH组第1、3、5、7年累积生存率分别为96.2%、82.1%、62.8%、48.7%,对照组第1、3、5、7年累积生存率分别为100%、88.5%、74.4%、67.9%,2组生存时间比较,差异有统计学意义(P<0.05)。以终点事件为结局,2组生存时间比较,差异无统计学意义(P>0.05)。多因素Cox回归分析显示,升主动脉内径、室间隔厚度、LVEF以及早餐△收缩压是全因死亡的独立危险因素(RR=0.898,95%CI:0.828~0.974,P=0.010;RR=1.424,95%CI:1.109~1.829,P=0.006;RR=0.940,95%CI:0.905~0.977,P=0.002;RR=1.800,95%CI:1.306~2.482,P=0.000)。结论高龄PPH患者远期预后较非PPH患者差,全因病死率随着早餐后收缩压下降幅度的增加而增加。Objective To study the effect of postprandial hypotention(PPH) on long-term outcome in very old people.Methods Seventy-eight very old PPH patients admitted to our hospital from 2011-05-01 to 2012-10-30 served as a PPH group and 78 very old PPH-free people served as a control group.Their general data,carotid atherosclerosis and plaques,cardiac structure and function were recorded.The patients were followed up for 7 years,during which the all-cause mortality,cardiocerebrovascular events(acute myocardial infarction,cerebral infarction and sudden cardiac death) affecting their outcome were recorded.The risk factors for their outcome were analyzed by Kaplan-Meier analysis,log-rank test and Cox regression model analysis respectively.Results The all-cause mortality and incidence of acute cerebral infarction were significantly higher in PPH group than in control group(51.3% vs 32.1%,P=0.015;35.9% vs 21.8%,P=0.017).The cumulative survival rate of 1,3,5,7 years was 96.2%,82.1%,62.8%,48.7% respectively in PPH group and 100%,88.5%,74.4%,67.9% respectively in control group(P<0.05) when the all-cause mortality was used as an end point.However,no significant difference was detected in cumulative survival rate between the two groups(P>0.05) when the cardio-and cerebrovascular events were used as an end point.Multivariate Cox regression model analysis showed that the inner diameter of ascending aorta,septal thickness,LVEF and post-breakfast SBP were independent risk factors for all-cause mortality in very old people(RR=0.898,95%CI:0.828-0.974,P=0.010;RR=1.424,95%CI:1.109-1.829,P=0.006;RR=0.940,95%CI:0.905-0.977,P=0.002;RR=1.800,95%CI:1.306-2.482,P=0.000).Conclusion The long-term outcome is poorer in very old PPH patients than in PPH-free people.The all-cause mortality increases with the decreasing post-breakfast SBP.

关 键 词：饭后期间 低血压 心肌梗死 脑梗死 猝死 心脏 预后 

分 类 号：R544.2[医药卫生—心血管疾病]