老年高血压病患者植物神经功能与血压变化规律的探讨

Studying the Regularity of Vegetative Nerve Function and the Blood Press ure Variety for old Hypertensive Disease Patients

目的:了解老年高血压病患者植物神经功能及血压的变化规律,为临床治疗提供理论依据。方法:选择老年高血压病患者(观察组)及血压正常者(对照组)各60例,进行24h动态血压和动态心电图检查,对两组患者各参数进行对照分析。结果:①观察组以收缩压增高为主,动态脉压增大;夜间血压下降率减低(P<0.05～<0.01)。②观察组心率变异性(HRV)指标低于对照组(P<0.05),PNN50、HF等反映迷走神经功能的指标明显低于对照组(P<0.01)。两组HRV昼夜比较,观察组白天夜间无明显变化(P>0.05),SD甚至低于白天(P<0.05);对照组夜间SD、PNN50、HF、LF/HF均高于白天(P<0.05),符合正常人的变化规律。③观察组心律失常、心肌缺血发生率较对照组增高(P<0.05)。结论:①老年高血压病呈现收缩压增高,脉压增大的流行病学特点。②老年高血压病患者交感、迷走神经功能双重受损,表现为HRV减低和正常昼夜节律消失,最终导致血压的正常昼夜变化规律消失;并且构成了心律失常、心肌缺血的相关因素。提示临床应重视收缩压增高,脉压增大的老年高血压病患者。在治疗上除积极降压外,还应考虑植物神经功能的受损情况,给予相应的处理,才能收到较好的疗效。

Objective: Studying the regularity of vegetative nerve function and the blood pressure variety for old hypertensive disease patients, to provide the basis for clinical treatment. Method: 60 old hypertensive disease patients and 60 normal persons were performed 24h dynamic blood pressure and dynamic ECG. Compared the parameters to two groups. Results: For the old hypertensive disease group, the systolic pressure and dynamic pulse pressure were increased, the night descent rate of blood pressure was decreased, and the index such as HRV, PNN50, HF were all lower than control group. HRV of two groups hadn’t obviously change in day and night, and SD in night was even lower than in daytime. For the control group, SD PNN50, HF, LF/HF in night were higher than in daytime. The incidence rates of arrhythmia and myocardial ischemia were higher than control group. Conclusion: ①The epidemiological characteristic of old hypertensive disease was: the systolic pressure and pulse pressure increased. ② The damage manifestation of sympathetic nerve and vagus nerve function of old hypertensive disease patients was: HRV decreased and normal circadian rhythm disappeared, leaded to the normal circadian rhythm of blood pressure disappeared the final, and constructed arrhythmia and myocardial ischemia. The clinic must think highly of the old hypertensive disease patients with systolic pressure and pulse pressure increased, and must think highly of the damage degree of vegetative nerve function.