听诊法血压重复测量在儿童青少年高血压调查中的应用

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目的研究听诊法进行儿童青少年血压调查时测量次数对高血压的筛查及诊断的影响和作用。方法利用2010年北京市儿童青少年血压调查数据,根据调查时连续3次血压测量结果,分析血压测量次数对测量2次间的差值、不同程度和不同类型高血压检出率的影响。研究中采用台式水银血压计测量坐位右上臂血压,依据中国儿童青少年血压参照标准进行高血压诊断。结果总计6694名3~17岁儿童青少年参加了调查,无论收缩压或舒张压,第1次测量结果高于第2及第3次(P<0.05),第2和第3次测量结果趋于接近(P>0.05);75.9%的收缩压以及77.3%的舒张压测量2次间最大变化幅度发生于第1和第3次之间。对收缩压和舒张压,第1次与第2次测量差值均数分别为4.0和4.4mm Hg,第2次和第3次间为1.8和1.6mm Hg。从第1、2及3次血压测量中男生高血压的检出率分别为19.9%,18.5%和17.0%,女生分别为18.3%,17.5%和16.4%;测量3次中,男生重度高血压检出率依次为20.2%,8.9%和8.1%,女生依次为20.0%,7.6%和7.0%;测量3次中,单纯收缩期高血压检出率,男生依次为13.4%,8.9%和8.2%,女生依次为12.8%,7.8%和7.1%,均呈逐渐下降趋势(趋势P值<0.05)。与首次血压诊断结果相比,采用后2次血压测量值检出的血压分级不变组主要由正常血压(88.1%)和正常高值血压(9.8%)儿童构成,血压分级升高组主要由正常血压(82.3%)和正常高值血压(17.7%)儿童构成,血压分级降低组主要由正常高值血压(89.3%)和高血压(10.7%)儿童构成。结论儿童高血压筛查中连续3次测量是必要的,第2与第3次血压测量值趋于接近,以后2次测量的均值作为血压的测量值有其合理性。 Objective To study the influence and effect of the number of measurements on screening and diagnosis of hypertension in auscultation of children and adolescents by auscultation method. Methods Based on the 2010 Beijing children and adolescents blood pressure survey data, according to the results of 3 consecutive blood pressure surveys, the influence of the number of blood pressure measurements on the difference between the 2 measurements, the degree of hypertension and the detection rate of different types of hypertension was analyzed. In the study, a tabletop mercury sphygmomanometer was used to measure blood pressure in the upper right arm of a sitting seat. Hypertension was diagnosed according to the blood pressure reference standard of Chinese children and adolescents. RESULTS: A total of 6,694 adolescents aged 3 to 17 years participated in the survey. No matter systolic or diastolic blood pressure, the first measurement was higher than the second and third (P <0.05), and the second and third measurements tended to (P> 0.05). The maximum change of 75.9% of systolic blood pressure and 77.3% of diastolic blood pressure between two times occurred between the first and the third. For systolic and diastolic blood pressure, the mean difference between the first and second measurements was 4.0 and 4.4 mm Hg respectively, with 1.8 and 1.6 mm Hg between the second and third interventions. The detection rate of male hypertension was 19.9%, 18.5% and 17.0% respectively from the first, second and third blood pressure measurement, while the female students were 18.3%, 17.5% and 16.4% respectively; The detection rates were 20.2%, 8.9% and 8.1% in turn, followed by 20.0%, 7.6% and 7.0% in girls. The detection rate of isolated systolic hypertension was 13.4%, 8.9% and 8.2% %, Followed by girls 12.8%, 7.8% and 7.1%, all showed a gradual downward trend (trend P value <0.05). Compared with the results of the first blood pressure diagnosis, the blood pressure grading group detected by the last two blood pressure measurements consisted mainly of children with normal blood pressure (88.1%) and normal high blood pressure (9.8%). The blood pressure grading group mainly consisted of Normal blood pressure (82.3%) and normal high blood pressure (17.7%) children constituted, blood pressure classification decreased group is mainly composed of normal high blood pressure (89.3%) and hypertension (10.7%). Conclusions Three consecutive measurements of hypertension in children are necessary. The second and third measurements of blood pressure tend to be close to each other, and the average of the second measurement as a measure of blood pressure is reasonable.
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