24小时动态血压监测对高血压合并脑梗死复发的预测

Studies on the prediction of recurrent cerebral infarction by 24 h ambulatory blood pressure monitoring

【目的】分析原发性高血压合并脑梗死患者24 h动态血压变化特点,探讨血压异常与脑梗死复发的关系。【方法】对40例高血压合并脑梗死患者(复发组)和94例高血压合并脑梗死患者(无复发组)进行3年前24 h动态血压监测分析,对两组患者的24 h、日间、夜间血压平均值,血压负荷值,血压变异性和血压昼夜节律性进行统计检验。【结果】高血压合并脑梗死患者(复发组)24 h、日间、夜间收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)及SBP和DBP负荷值均明显高于高血压合并脑梗死患者(无复发组),24 hSBP和日间SBP及负荷值差异有统计学意义(P<0.05)。高血压合并脑梗死患者(复发组)日间SBP变异性高于高血压合并脑梗死患者(无复发组)[(16.44±3.19)mmHg(1 mmHg=0.1333 kPa)比(15.20±4.45)mmHg],SBP和DBP夜间下降率低于高血压合并脑梗死患者(无复发组)[(5±3)%比(7±2)%,(4±2)%比(6±4)%],差异有统计学意义(P<0.05)。【结论】血压平均值和血压负荷值增高对脑血管病的发生具有影响,血压变异性及昼夜节律性消失与脑梗死复发相关。

[Objective]To explore the relationship between abnormal blood pressure and recurrence of cerebral infarction by analyzing the characterics of 24 h ambulatory blood pressure of essential hypertension patients. [ Methods] 40 patients with hypertension and recurrent cerebral infarction（recurrent group） and 94 patients with hypertension but without recurrent cerebral infarction（relapse-free group） were entrolled in this study. Data of 24 h ambulatory blood pressure monitoring collected 3 years age including daytime and nighttime blood pressure, average blood pressure load values, blood pressure variability and circadian rhythm of blood pressure were analyzed. [ Result] In recurrent group the 24 h daytime and nighttime systolic blood pressure （SBP） and diastolic blood pressure （DBP） and SBP and DBP load values were significantly higher than that of relapse-free group. 24 h SBP, daytime SBP and load value difference were statistically different（P 〈 0.05）. In recurrent group the daytime SBP variability was higher than relapse-free group[（16.44 ＋ 3.19） mmHg （1 mmHg = 0.133 kPa） than （15.20 ＋ 4.45） mmHg）. SBP and DBP night falling rates of recurrent group were lower than that of the relapse-free group [（5 ＋ 3） % than （7 ＋ 2） %, （4 ＋ 2） than （6 -＋ 4） %]. The difference was statistically significant （P 〈 0.05）. [ Conclusion ] Higher average blood pressure and blood pressure load values has influence on the onset of cerebrovascular disease, and the variability of blood pressure and disappearence of circadian rhythm are associated with recurrent cerebral infarction.