动态血压监测过程对老年高血压患者睡眠质量及血压监测结果的影响研究

The Effects of Ambulatory Blood Pressure Monitoring on the Quality of Sleep and the Monitoring Parameters in Aged Patients with Hypertension

目的观察动态血压监测(ABPM)过程中夜间频繁测量血压是否会对老年受查者睡眠产生影响,从而可能干扰夜间血压的真实变化,使血压昼夜节律曲线产生偏移等结果。方法选择解放军第210医院干部病房于2010年3月至2012年3月收治的原发性高血压患者50例,患者入院后行两次ABPM检查:第一次行ABPM检查夜眠前不予药物干预睡眠(干预前组),第二次行ABPM检查于睡眠前给予阿普唑仑0.8 mg口服(干预后组)以模拟不受夜间ABPM干扰的睡眠情况。记录干预前后两次睡眠时间及觉醒次数,干预前后血压昼夜形态(杓型、非杓型、反杓型、深杓型),夜间收缩压下降率(NSBPRR),夜间舒张压下降率(NDBPRR),晨峰血压(MBPS),起床后2 h内收缩压平均值,夜间收缩压标准差(nSBP-SD),夜间舒张压标准差(nDBP-SD),夜间收缩压负荷值(nSBPL),舒张压负荷值(nDBPL)。结果患者两次行ABPM检查,干预前组与干预后组在睡眠时间及觉醒次数上比较差异有统计学意义(P<0.05);干预前后两组NSBPRR、NDBPRR、晨间收缩压均值、nSBP-SD、nSBPL、nDBPL的差异有统计学意义(P<0.05)。结论 ABPM检查过程可影响老年高血压患者夜间睡眠质量,从而造成患者夜间血压下降率减少、昼夜血压形态出现偏差、夜间收缩压变异性增大、夜间血压负荷值比例增高。

Objective To observe frequent blood pressure measuring at night during the ambulatory blood pressure monitoring（ABPM） effect on sleeping quality in the elderly patients ,which may interfere with the real changes in blood pressure and shift the diurnal rhythm curve. Methods Fifty essential hypertensive patients admitted by Dalian PLA 210th Hospital during Mar. 2010 and Mar. 2012 were included. The same patient had twice ABPM during five days. The first test did not receive any drugs intervention（ before intervention group）. While during the second test the patients were given tablets of Alpraolamum to simulate the sleeping without ABPM interference （after intervention group）. Record data：sleep time and awake times at night in different con- ditions before and after interference by Alpraolamum during ABPM;four blood pressure diurnal rhythms （dipper,non- dipper,anti-dipper, dark dipper）, nighttime systolic and diastolic blood pressure reduction rates （NSBPRR, NDBPRR） ; morning blood pressure surge （MBPS）, average systolic blood pressure in two hours after getting up, nighttime systolic and diastolic blood pressure standard deviation （ nSBP-SD, nDBP-SD ）, nighttime systolic and diastolic blood pressure load （ nSBPL, nDBPL）. Results Significant differences in the sleep time and awake times during night between the two groups were observed （P 〈 0.05 ） ;NSBPRR, NDBPRR, morning mean systolic blood pressure, nSBP-SD, nSBPL, nDBPL were significantly different between two groups （ P 〈 0.05 ）. Conclusion ABPM examination may influence the sleeping quality of aged patients with hypertension,which may result in NSBPRR and NDBPRR shrink and shifted diurnal rhythm curve, increased nSBPV and nBPL.