听诊法血压重复测量在儿童青少年高血压调查中的应用

Consecutive measurements by auscultation are necessary in epidemiological survey on hypertension in children and adolescents

目的 研究听诊法进行儿童青少年血压调查时测量次数对高血压的筛查及诊断的影响和作用。方法 利用2010年北京市儿童青少年血压调查数据,根据调查时连续3次血压测量结果,分析血压测量次数对测量2次间的差值、不同程度和不同类型高血压检出率的影响。研究中采用台式水银血压计测量坐位右上臂血压,依据中国儿童青少年血压参照标准进行高血压诊断。结果 总计6694名3~17岁儿童青少年参加了调查,无论收缩压或舒张压,第1次测量结果高于第2及第3次（P〈0.05）,第2和第3次测量结果趋于接近（P〉0.05）;75.9%的收缩压以及77.3%的舒张压测量2次间最大变化幅度发生于第1和第3次之间。对收缩压和舒张压,第1次与第2次测量差值均数分别为4.0和4.4mm Hg,第2次和第3次间为1.8和1.6mm Hg。从第1、2及3次血压测量中男生高血压的检出率分别为19.9%,18.5%和17.0%,女生分别为18.3%,17.5%和16.4%;测量3次中,男生重度高血压检出率依次为20.2%,8.9%和8.1%,女生依次为20.0%,7.6%和7.0%;测量3次中,单纯收缩期高血压检出率,男生依次为13.4%,8.9%和8.2%,女生依次为12.8%,7.8%和7.1%,均呈逐渐下降趋势（趋势P值〈0.05）。与首次血压诊断结果相比,采用后2次血压测量值检出的血压分级不变组主要由正常血压（88.1%）和正常高值血压（9.8%）儿童构成,血压分级升高组主要由正常血压（82.3%）和正常高值血压（17.7%）儿童构成,血压分级降低组主要由正常高值血压（89.3%）和高血压（10.7%）儿童构成。结论 儿童高血压筛查中连续3次测量是必要的,第2与第3次血压测量值趋于接近,以后2次测量的均值作为血压的测量值有其合理性。

Objective To explore the effects of repeated blood pressure measurements in epidemiological survey on hypertension diagnosis in children. Methods The data was collected from a blood pressure survey conducted in children in Beijing in 2010. Based on the three consecutive blood pressure measurements, the effect of blood pres- sure measurement times on differences between two measurements and its respective detection rate of different types and degrees of hypertension were analyzed. Blood pressure was measured on the right upper arm with a mercury sphygmomanometer in sitting position and the diagnosis was based on blood pressure standard reference for Chinese children and adolescents. Results A total of 6694 children, aged 3--17 years old, were enrolled. Both the sys- tolic and diastolic blood pressure decreased from the first to third measurement. The first measurement was signifi- cantly higher than latter two （P〈0.05） which were close to each other （P〉0.05）. The largest fluctuation of the systolic blood pressure and diastolic blood pressure values happened between the first and third measurement, which happened in 75.9% and 77.3% children respectively. The differences of systolic blood pressure and diastolic blood pressure values between the first and second measurements were 4.0 and 4.4 mm Hg and the difference between the latter two was 1.8 and 1.6 mm Hg, respectively. Based on each measurement, the prevalence of hypertension was respectively 19.9%, 18.5%, 17.0% in boys, and 18.3%, 17.5%, 16.4% in girls, and the prevalence of severe hypertension was respectively 20.2%, 8.9%, 8.1% in boys; 20.0%, 7.6%, 7.0% in girls. The prevalence of isolated systolic hypertension determined by each measurement was 13.4%, 8.9% and 8.2% in boys, and 12.8%,7.8 % and 7. 1%in girls, all with a trend of declining （Ptrend〈0.05）. Compared with determined by the first meas- urement, when determined by the latter two measurements, the distribution of blood pressure classification in each group was examined. Among children and adolescents for whom blood pressure didn＇t change classification,88.1 were classified as normotensive and 9.8% were classified as prehypertensive. Among children and adolescents for whom blood pressure classification went up, 82.3% were classified as normotensive and 17.7% were classified as prehypertensive. Among children and adolescents for whom blood pressure classification went down, 89.3% were classified as prehypertensive and 10.7% were classified as hypertensive. Conclusion Three consecutive measure ments of blood pressure was necessary in hypertension screenings in children. The blood pressure measurements became steady at the second and third measurement; it would be reliable to use the mean value of the latter two measurements to reveal the blood pressure in children.