高血压合并急性冠脉综合征病人经皮冠状动脉介入治疗术后昼夜血压节律变化与预后的关系  

Relationship Between Diurnal Blood Pressure Rhythm and Prognosis after Percutaneous Coronary Intervention for Hypertension Complicated with Acute Coronary Syndrome

作　　者：金新[1] 牛静[1] 刘平原 王俊侠 刘淑华[1] JIN Xin;NIU Jing;LIU Pingyuan;WANG Junxia;LIU Shuhua(The First Hospital of Qinhuangdao,Qinhuangdao 066500,Hebei,China)

机构地区：[1]秦皇岛市第一医院,河北秦皇岛066500

出　　处：《中西医结合心脑血管病杂志》2024年第24期4512-4517,共6页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的:探讨高血压合并急性冠脉综合征经皮冠状动脉介入治疗(PCI)术后病人昼夜血压节律变化与预后的关系。方法:回顾性选取2018年9月—2019年8月收治于我院的高血压合并急性冠脉综合征病人110例,根据术后不良心血管事件发生情况将其分为预后不良组(30例)和预后良好组(80例),比较两组PCI术后动态血压指标;分析影响病人术后不良心血管事件发生的危险因素;应用卡方自动交互检测(CHAID)分类树算法构建病人术后不良心血管事件发生的风险预测模型,收益图和索引图评价模型的临床应用价值。结果:预后不良组夜间收缩压(SBP)、舒张压(DBP)均明显高于预后良好组,夜间SBP和DBP的降低率均低于预后良好组,差异均有统计学意义(P<0.05);吸烟、非杓型血压、冠状动脉病变多支、支架植入≥3个是影响术后不良心血管事件发生的独立危险因素(P<0.05);分类树模型结果显示,吸烟、高血压类型、冠状动脉病变支数和支架植入个数4个解释变量中,高血压类型对术后发生不良心血管事件的影响最大。增益图和索引图均显示该模型对不良心血管事件的预测效果良好。结论:高血压合并急性冠脉综合征PCI术后昼夜血压节律消失,表现为夜间血压升高,夜间血压下降率降低;昼夜血压节律消失容易引起病人术后不良心血管事件的发生,不利于预后。Objective:To investigate the relationship between circadian rhythm of blood pressure and prognosis after percutaneous coronary intervention(PCI)in patients with hypertension complicated by acute coronary syndrome.Methods:Patients with hypertension combined with acute coronary syndrome admitted to our hospital from September 2018 to August 2019 were retrospectively selected and divided into poor prognosis group(30 cases)and good prognosis group(80 cases)according to the occurrence of postoperative adverse cardiovascular events.Dynamic blood pressure indexes of patients after PCI were compared between the two groups.Univariate and multivariate analysis of risk factors affecting the occurrence of postoperative adverse cardiovascular events.Chi-square automatic Interactive detection(CHAID)classification tree algorithm was used to construct the risk prediction model of postoperative adverse cardiovascular events,and the benefit chart and index chart were used to evaluate the clinical application value of the model.Results:Night systolic blood pressure(SBP)and diastolic blood pressure(DBP)in poor prognosis group were significantly higher than those in good prognosis group,and the reduction rates of night SBP and DBP were significantly lower than those in good prognosis group,the difference was statistically significant(P<0.05).Smoking,non-dipping blood pressure,multiple coronary artery lesions,and≥3 stents implantation were independent risk factors for postoperative adverse cardiovascular events(P<0.05).The results of classification tree model showed that among the four explanatory variables of smoking,type of hypertension,number of coronary artery lesions,and number of stent implantation,type of hypertension had the greatest influence on postoperative adverse cardiovascular events.Both gain plots and index plots showed that the model was effective in predicting adverse cardiovascular events.Conclusion:The diurnal blood pressure rhythm disappeared after PCI in patients with hypertension and acute coronary syndrome,wh

关 键 词：急性冠脉综合征 经皮冠状动脉介入治疗 高血压 预后 

分 类 号：R544.1[医药卫生—心血管疾病] R541.4[医药卫生—内科学]