严重创伤对远期血压值及高血压发生率的影响

Influence of Trauma on Long-term Blood Pressure and the Prevalence of Hypertension

目的探讨创伤对远期血压值及高血压发生率的影响。方法采用回顾性队列研究方法,选择1997-01-1998-06在唐山6家医院重症病房住院的创伤患者497例(创伤组)及同期无创伤史的体检人员762例(对照组),对创伤组和对照组的基线资料、10年后高血压发生率进行分析。将创伤组按急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)评分值分为15～24分(n=283)、25～34分(n=162)及≥35分亚组(n=52),分析不同亚组受试者的血压值及高血压发生率。结果与对照组比较,创伤组收缩压、舒张压均增高[(135.1±23.0)/(86.7±14.1)比(118.4±16.1)/(77.6±9.5)mm Hg,均P<0.01]。创伤组高血压发生率也明显高于对照组(42.7%比20.6%,P<0.01)。随着APACHEⅡ评分值增加,收缩压、舒张压、高血压发生率均增高。Logistic回归分析显示,创伤是高血压的独立危险因素(RR=2.60,95%CI:1.99～3.40,P<0.01)。结论创伤是高血压的独立危险因素。创伤作为应激刺激增加患者远期血压值和高血压发生率。

Objective To investigate the influence of trauma on long-term blood pressure and the prevalence of hypertension.Methods A retrospective cohort study was carried out in Tangshan City.Baseline clinical indexes and the prevalence of hypertension 10 years after trauma collected from both the healthy people（n=762）and the trauma patients（n=497）selected from 6 hospitals in Tangshan City during January 1997 to June 1998 were analyzed with the logistic regression test.The trauma patients were devided into three groups according to acute physiology and chronic health evaluation（APACHE） Ⅱ scores [15-24（n=283）,25-34（n=162） and ≥35（n=52）]and then blood pressure and prevalence of hypertension were evaluated in each group.Results Compared to the patients in control group,the patients in trauma group had higher systolic blood pressure（SBP） and diastolic blood pressure（DBP） [（135.1±23.0）/（86.7±14.1） vs（118.4±16.1）/（77.6±9.5） mm Hg,P0.01].The prevalence of hypertension were higher in the trauma group than that in the control group（42.7% vs 20.6%,P0.01）.SBP and DBP were increased with the increase in APACHE Ⅱ scores.The logistic regression test showed that trauma is an independent risk factor of hypertension（RR=2.60,95% CI： 1.99-3.40,P0.01）.Conclusion Trauma is an independent risk factor of hypertension.Trauma as a stress increases blood pressure and the morbidity of hypertension.