中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2014年
1期
7-10
,共4页
刘学员%喻智%卢水焕%唐慧明%唐伟雄%黄心元%孙玺荣%周锦池%林仁生
劉學員%喻智%盧水煥%唐慧明%唐偉雄%黃心元%孫璽榮%週錦池%林仁生
류학원%유지%로수환%당혜명%당위웅%황심원%손새영%주금지%림인생
颈动脉疾病%颈动脉窦%动脉粥样硬化%血压测定
頸動脈疾病%頸動脈竇%動脈粥樣硬化%血壓測定
경동맥질병%경동맥두%동맥죽양경화%혈압측정
Carotid artery diseases%Carotid Sinus%Atherosclerosis%Blood pressure determination
目的 探讨颈动脉硬化(CA)对住院老年人餐后血压的影响. 方法 餐前15 min测1次血压,进第1口餐开始计时,20 min、40 min、60 min、90 min和120 min各测血压1次,以餐后血压变化最大值为餐后血压,使用彩色多普勒于颈总动脉分叉处10 mm内测量左右颈动脉各项指标,包括内径、最大流速、最小流速、阻力指数、内-中膜厚度(IMT)、有无颈总动脉体斑块、颈总动脉窦部斑块(以最大斑块为准),并将糖尿病、原发性高血压、冠状动脉粥样硬化性心脏病、慢性阻塞性肺疾病、心功能、卒中、肾脏疾病、下肢静脉曲张、营养不良、服用降压药、颈动脉有无斑块等因素对餐后血压变化情况进行偏相关分析.将138例患者分为:(1)餐后低血压组(PPH组,101例)与餐后无低血压组(对照组,37例),比较颈总动脉各项指标;(2)无CA组(IMT≤1.0 mm)与CA组(IMT＞ 1.0 mm);(3)单侧颈总动脉斑块组和双侧颈总动脉斑块组及双侧颈总动脉无斑块组;(4)单侧颈总动脉窦部斑块组和双侧颈总动脉窦部斑块组及双侧颈总动脉窦部无斑块组;比较各组餐后血压的变化. 结果 PPH组左右颈总动脉的血流速度均较对照组慢,血流阻力指数大,左右颈动脉窦部斑块面积均较对照组者明显(Z=-3.073、-2.303,P=0.002,0.021).偏相关分析:早餐后收缩压、舒张压变化最大值与颈动脉窦部斑块相关(r=0.195,P=0.022;r=-0.177,P=0.038),早餐后舒张压变化最大值与脑卒中相关(r=0.259,P=0.002),晚餐后收缩压变化最大值与糖尿病、冠心病相关(r=0.226,P=0.008;r=0.214,P=0.012);晚餐后舒张压变化最大值与冠心病相关(r=0.183,P=0.032).颈动脉IMT对餐后血压变化的影响无统计学意义;颈总动脉体斑块对早餐舒张压变化的影响有统计学意义(Z=-2.111,P=0.035).双侧颈动脉窦部斑块组与无斑块组比较,早餐收缩压、舒张压变化差异均有统计学意义(Z=-2.938、-2.735,P=0.003,0.006),单侧颈动脉窦部斑块组与无斑块组比较差异无统计学意义. 结论 颈动脉IMT与餐后血压变化不相关,颈总动脉斑块与早餐后舒张压变化、双侧颈动脉窦部斑块与早餐后收缩压、舒张压降低相关.
目的 探討頸動脈硬化(CA)對住院老年人餐後血壓的影響. 方法 餐前15 min測1次血壓,進第1口餐開始計時,20 min、40 min、60 min、90 min和120 min各測血壓1次,以餐後血壓變化最大值為餐後血壓,使用綵色多普勒于頸總動脈分扠處10 mm內測量左右頸動脈各項指標,包括內徑、最大流速、最小流速、阻力指數、內-中膜厚度(IMT)、有無頸總動脈體斑塊、頸總動脈竇部斑塊(以最大斑塊為準),併將糖尿病、原髮性高血壓、冠狀動脈粥樣硬化性心髒病、慢性阻塞性肺疾病、心功能、卒中、腎髒疾病、下肢靜脈麯張、營養不良、服用降壓藥、頸動脈有無斑塊等因素對餐後血壓變化情況進行偏相關分析.將138例患者分為:(1)餐後低血壓組(PPH組,101例)與餐後無低血壓組(對照組,37例),比較頸總動脈各項指標;(2)無CA組(IMT≤1.0 mm)與CA組(IMT＞ 1.0 mm);(3)單側頸總動脈斑塊組和雙側頸總動脈斑塊組及雙側頸總動脈無斑塊組;(4)單側頸總動脈竇部斑塊組和雙側頸總動脈竇部斑塊組及雙側頸總動脈竇部無斑塊組;比較各組餐後血壓的變化. 結果 PPH組左右頸總動脈的血流速度均較對照組慢,血流阻力指數大,左右頸動脈竇部斑塊麵積均較對照組者明顯(Z=-3.073、-2.303,P=0.002,0.021).偏相關分析:早餐後收縮壓、舒張壓變化最大值與頸動脈竇部斑塊相關(r=0.195,P=0.022;r=-0.177,P=0.038),早餐後舒張壓變化最大值與腦卒中相關(r=0.259,P=0.002),晚餐後收縮壓變化最大值與糖尿病、冠心病相關(r=0.226,P=0.008;r=0.214,P=0.012);晚餐後舒張壓變化最大值與冠心病相關(r=0.183,P=0.032).頸動脈IMT對餐後血壓變化的影響無統計學意義;頸總動脈體斑塊對早餐舒張壓變化的影響有統計學意義(Z=-2.111,P=0.035).雙側頸動脈竇部斑塊組與無斑塊組比較,早餐收縮壓、舒張壓變化差異均有統計學意義(Z=-2.938、-2.735,P=0.003,0.006),單側頸動脈竇部斑塊組與無斑塊組比較差異無統計學意義. 結論 頸動脈IMT與餐後血壓變化不相關,頸總動脈斑塊與早餐後舒張壓變化、雙側頸動脈竇部斑塊與早餐後收縮壓、舒張壓降低相關.
목적 탐토경동맥경화(CA)대주원노년인찬후혈압적영향. 방법 찬전15 min측1차혈압,진제1구찬개시계시,20 min、40 min、60 min、90 min화120 min각측혈압1차,이찬후혈압변화최대치위찬후혈압,사용채색다보륵우경총동맥분차처10 mm내측량좌우경동맥각항지표,포괄내경、최대류속、최소류속、조력지수、내-중막후도(IMT)、유무경총동맥체반괴、경총동맥두부반괴(이최대반괴위준),병장당뇨병、원발성고혈압、관상동맥죽양경화성심장병、만성조새성폐질병、심공능、졸중、신장질병、하지정맥곡장、영양불량、복용강압약、경동맥유무반괴등인소대찬후혈압변화정황진행편상관분석.장138례환자분위:(1)찬후저혈압조(PPH조,101례)여찬후무저혈압조(대조조,37례),비교경총동맥각항지표;(2)무CA조(IMT≤1.0 mm)여CA조(IMT＞ 1.0 mm);(3)단측경총동맥반괴조화쌍측경총동맥반괴조급쌍측경총동맥무반괴조;(4)단측경총동맥두부반괴조화쌍측경총동맥두부반괴조급쌍측경총동맥두부무반괴조;비교각조찬후혈압적변화. 결과 PPH조좌우경총동맥적혈류속도균교대조조만,혈류조력지수대,좌우경동맥두부반괴면적균교대조조자명현(Z=-3.073、-2.303,P=0.002,0.021).편상관분석:조찬후수축압、서장압변화최대치여경동맥두부반괴상관(r=0.195,P=0.022;r=-0.177,P=0.038),조찬후서장압변화최대치여뇌졸중상관(r=0.259,P=0.002),만찬후수축압변화최대치여당뇨병、관심병상관(r=0.226,P=0.008;r=0.214,P=0.012);만찬후서장압변화최대치여관심병상관(r=0.183,P=0.032).경동맥IMT대찬후혈압변화적영향무통계학의의;경총동맥체반괴대조찬서장압변화적영향유통계학의의(Z=-2.111,P=0.035).쌍측경동맥두부반괴조여무반괴조비교,조찬수축압、서장압변화차이균유통계학의의(Z=-2.938、-2.735,P=0.003,0.006),단측경동맥두부반괴조여무반괴조비교차이무통계학의의. 결론 경동맥IMT여찬후혈압변화불상관,경총동맥반괴여조찬후서장압변화、쌍측경동맥두부반괴여조찬후수축압、서장압강저상관.
Objective To investigate the effect of carotid atherosclerosis (CA) on postprandial blood pressure in hospitalized elderly patients.Methods Blood pressures were measured at 15 minutes before meals and defined as preprandial blood pressures.Then blood pressures were measured at 20,40,90,120 min after the first chewing respectively.And blood pressures with maximal changes after meals were defined as postprandial blood pressures.Color Doppler (Philips IU22) was used to measure the indicators of left and right carotid artery inside the proximal 10 mm of the common carotid artery bifurcation,including inside diameter,maximum flow rate,minimum flow rate,resistance index,intima-media thickness (IMT),the presence or absence of carotid artery plaques,carotid artery sinus plaque (with maximum plaque).The impacts of diabetes mellitus,primary hypertension,coronary atherosclerotic heart disease,chronic obstructive pulmonary disease,heart function,stroke,kidney disease,varicose vein of lower extremity,malnutrition,taking antihypertensive drugs and carotid sinus with or without plaques on postprandial blood pressure were analyzed by partial correlation analysis.Results The blood flow velocity in left and right common carotid arteries was slower,blood flow resistance was higher and plaque areas of left and right carotid artery sinus were more obvious in postprand hypotension group than in control group (Z=-3.073,-2.303,P＜0.01 or 0.05).Partial correlation analysis showed that the maximal changes in systolic and diastolic blood pressures after breakfast were associated with the presence of plaques in carotid sinus or not (r=0.195,-0.177,both P＜ 0.05),the maximal changes in systolic blood pressure after breakfast were correlated with stroke (r=0.259,P＜0.01),the maximal changes in systolic blood pressure after dinner were correlated with diabetes mellitus and coronary heart disease (r =0.226,0.214,P ＜ 0.01 or 0.05),the maximal changes in diastolic blood pressure after dinner were correlated with coronary heart disease (r=0.183,P＜0.05).Carotid artery intima-media thickness had no significant impact on postprandial blood pressure.Carotid plaques had significant impact on diastolic pressure after breakfast (Z =-2.111,P ＜ 0.05).There were statistically significant differences in the changes of systolic and diastolic blood pressures after breakfast between patients with and without bilateral plaques in carotid sinus (Z=-2.938,-2.735,P＜0.01).There were no statistically significant differences in changes of systolic and diastolic blood pressures between patients with unilateral plaques and patients without plaques in carotid sinus.Conclusions The carotid artery intima-media thickness has no association with the changes of postprandial blood pressure.The carotid plaques are associated with the reduction of diastolic blood pressure after breakfast.The bilateral plaques in carotid sinus are associated with the reduction of systolic and diastolic blood pressures after breakfast.
