高血压血流动力学脉图检测分型治疗的临床研究

Value of radial arterial electropulsography in the treatment of hypertension on cardiovascular hemodynamics

目的 :检验用脉图高血压血流动力学分型指导的临床应用价值。方法 :2 90例高血压病患者随机分成三组。脉图组 (RE组 ,n=10 0 ) ,根据脉图分型 : 型服用阿替洛尔或非洛地平 ; 型服用双氢克脲塞 ; 型服用苯那普利或非洛地平 ; 型混合使用上述药物。随测血压组 (CBP组 ,n=92 )和动态血压组 (ABP组 ,n=98)两组药物治疗采用阶梯治疗。治疗开始 ,第 1,2和 6个月随访 ,记录药物治疗后达到靶血压 (DBP=10 .7～ 11.9k Pa)时剂量及副作用 ,随访开始和结束时均查超声心动图、心电图。结果 :三种方法指导治疗前后血压均有明显降低 (P<0 .0 0 1) ,但 RE法组血压下降程度 >CBP>ABP组 ,用 RE法和 ABP法指导治疗可使 2 5 %左右患者血压稳定或低于靶血压范围暂停用药 ,而 CBP法仅有 7%达到靶血压。RE法仅有 2 5 .4%的患者需要多药联合治疗 ,而 ABP法为 2 3.6 % ,CBP法则高达 45 % ,三者差异显著 (P<0 .0 1) ;RE法和A BP法减轻左室质量较 CBP法明显 (P<0 .0 1) ,室间隔及左室后壁变薄明显 (P<0 .0 1) ,RE法比 ABP法、 CBP法节省药品费用分别为 19%和 44%。结论 :用脉图高血压血流动力学分型指导降压治疗 ,方法简便 ,降压效果好 。

Objective: It is to evaluate the reliability of radial electropulsography (RE) in the treatment of hypertension. Methods: 290 patients with hypertension were divided into 100 cases RE, 92 cases conventional blood pressure(CBP), 98 cases ambulatory blood pressure (ABP). The RE, ABP and CBP levels intensity of drug treatment electrocardiographic and echocardiography left ventricular mass and cost.Results: At the end of study more RE and ABP than CBP patients had stopped antihypertensive drug treatment (26%, 25% vs 7%, P <0.001) and fewer RE and ABP patients had progressed to sustained multiple-drug treatment (25.4%, 23.6 vs 45%, P <0.001), left treatment in the RE group were fewer.Conclusion: Adjustment of antihypertensive treatment based on RE is safe, effective and reduces the overall costs antihypertensive treatment.