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目的探讨高龄老年高血压病患者血压昼夜节律异常对左室结构及功能变化的相关性。方法应用24h动态血压检测仪检测123例年龄≥80岁的高血压病患者的血压水平,根据血压下降率将患者分为非杓型组,杓型组和反勺型组;分别测量3组患者室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室舒张末期内径(LVEDD),计算左室质量指数(LVMI)、左室射血分数(LVEF)及E/A,进行对比分析。结果①24h动态血压结果表明高龄老年高血压患者,杓型血压类型占5%(6例),非杓型血压类型占58%(71例),反杓型血压类型占37%(46例)。②心脏功能和结构指标观察,杓型组、非构型组与反杓型组间比较:主动脉根部内径(mm)(22.4±2.45,26.5±4.49,31.3±5.16)、室间隔厚度(mm)(9.4±1.10,10.6±1.13,11.2±2.50,)、左室后壁厚(mm)(9.0±0.91,9.3±1.02,9.7±1.41)、每搏量(ml)(61.1±16.24,55.2±13.21,45.1±17.36)射血分数(%)(58.21±10.13,52.33±9.81,46.26±12.66)、左室质量(g)(182.7±61.02,202.1±44.51,224.5±43.32,)、左室质量指数(g/m2)(101.3±32.62,110.4±25.71,124.1±22.54)各组间具有统计学差异(P<0.05)。结论高龄老年高血压患者,反杓型血压较杓型及非杓型血压使心脏功能和结构受损更为显著;而非杓型血压较杓型血压使心脏功能和结构受损明显。
Objective To investigate the correlation between abnormal circadian rhythm of blood pressure and changes of left ventricular structure and function in senile hypertensive patients. Methods The blood pressure of 123 patients with hypertension ≥ 80 years old was detected by 24h ambulatory blood pressure monitor. According to the rate of decline of blood pressure, the patients were divided into non-dipper group, dipper group and anti-dipper group. (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic dimension (LVEDD), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and E / . Results ①24h ambulatory blood pressure results showed that the type of dipper blood pressure accounted for 5% (6 cases), non-dipper type accounted for 58% (71 cases) and anti-dipper type accounted for 37% (46 cases) in elderly patients with senile hypertension. Cardiac function and structural indexes were compared between dipper group, non-conformer group and anti-dipper group: the diameters of the aortic root (mm) (22.4 ± 2.45,26.5 ± 4.49,31.3 ± 5.16), the thickness of the interventricular septum (9.4 ± 1.10, 10.6 ± 1.13, 11.2 ± 2.50, respectively), LV posterior wall thickness (9.0 ± 0.91,9.3 ± 1.02,9.7 ± 1.41), stroke volume (ml) (61.1 ± 16.24,55.2) (13.21,45.1 ± 17.36), ejection fraction (%) (58.21 ± 10.13,52.33 ± 9.81,46.26 ± 12.66), left ventricular mass (g) (182.7 ± 61.02,202.1 ± 44.51,224.5 ± 43.32) The quality index (g / m2) (101.3 ± 32.62,110.4 ± 25.71,124.1 ± 22.54) was statistically significant among the groups (P <0.05). CONCLUSIONS: Compared with dipper and non-dipper blood pressure, anti-dipper blood pressure has more significant impairment of cardiac function and structure in senile hypertensive patients. However, non-dipper blood pressure significantly impaired cardiac function and structure compared with dipper blood pressure.