| 高血压患者不同血压昼夜节律对心脏结构和功能的影响 |
| Alternative Title | Influence of Different Blood Pressure Circadian Rhythm on Cardiac Structure and Function in Patients with Hypertension
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| 史平平 |
| Thesis Advisor | 乔成栋
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| 2014-05-24
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| Degree Grantor | 兰州大学
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| Place of Conferral | 兰州
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| Degree Name | 硕士
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| Keyword | 高血压病
血压昼夜节律
心功能
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| Abstract | 目的：研究高血压病患者不同血压昼夜节律对心脏结构和功能的影响。
方法：选择日间血压控制良好的高血压患者180例，根据血压昼夜节律不同划分为杓型组30例、非杓型组99例和反杓型组51例，测定心脏结构和功能相关参数，分析心脏结构或功能的改变与血压昼夜节律及临床相关指标间的关系。
结果：
1．脉冲多普勒二尖瓣E峰与组织多普勒二尖瓣环E'峰之比值（E/E'）从杓型组到非杓型组及反杓型组依次升高，有显著性差异（8.1± 2.4，8.6± 2.5，9.6± 3.2，P＜0.05），反杓型组高于杓型组及非杓型组（P＜0.05）。
2．左心房大小：左房容积指数（LAVi）反杓型组和非杓型组大于杓型组（43.8± 11.8 ml/m2，40.7± 9.8 ml/m2，36.6± 8.5 ml/m2，P＜0.05或P＜0.01）。
3． E/E'与夜间收缩压、年龄正相关而与夜间血压下降率负相关，其中与年龄及夜间血压下降率独立相关； LAVi与夜间血压下降率、脉压、高血压病程独立相关。
结论：
1．血压昼夜节律异常与高血压患者的心脏损害有关，以舒张功能损害为主。
2．从非杓型组到反杓型组心功能损害逐渐加重。
3．临床医师不但要关注日间高血压的控制，同时也要加强对夜间血压的调节，力争血压昼夜节律趋于正常，使患者最大可能受益。 |
| Other Abstract | Objective: To investigate the affect of different blood pressure circadian rhythm on cardiac structure and function in hypertensive patients.
Method: One hundred and eighty hypertensive patients whose blood pressure reached the target value were divided into dipper group (n=30), non-dipper group (n=99), and reverse dipper group (n=51) according to the blood pressure circadian rhythm. Clinical data, 24-hour ambulatory blood pressure monitoring, and heart structure and function examination were obtained from the three groups and the relationship between them was analyzed as well.
Result:
1. Tissue doppler and its derivative parameters: From dipper to non-dipper and reverse-dipper group, the ratio of peak mitral E wave to peak mitral annulus E' wave (E/E') increased in order (8.1 ± 2.4, 8.6 ± 2.5, 9.6 ± 3.2, P＜0.05),and it was higher in reverse-dipper group than that in dipper and non-dipper groups (P<0.05).
2. Left atrial size: Left atrial volume index (LAVi) in reverse-dipper group and non-dipper group was greater than that in dipper group (43.8±11.8 ml/m2, 40.7±9.8 ml/m2, 36.6±8.5 ml/m2, P＜0.05 or P＜0.01).
3.Heart function influence factors analysis: E/E' was correlated with nighttime systolic blood pressure and age positively while with nocturnal blood pressure decline rate negatively, of which BPR was the independent predictor of E/E'; Pulse pressure, hypertension course and nocturnal blood pressure decline rate were independently correlated with LAVi.
Conclusion:
1.Abnormal blood pressure circadian rhythm adds damage to the heart function of hypertensive patients, with diastolic dysfunction as the key impairment.
2. Reverse-dipper than non-dipper blood pressure pattern deteriorated diastolic function more severely.
3. Clinicians should not only focus on control of daytime blood pressure, but also to strengthen the regulation of blood pressure at night, strive to blood pressure circadian rhythms tend to be normal, benefit the patients as possible. |
| URL | 查看原文
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| Language | 中文
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| Document Type | 学位论文
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| Identifier | https://ir.lzu.edu.cn/handle/262010/223450
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| Collection | 学院待认领
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| Affiliation | 临床医学院
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Recommended Citation
GB/T 7714 |
史平平. 高血压患者不同血压昼夜节律对心脏结构和功能的影响[D]. 兰州. 兰州大学,2014.
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