80岁及以上患者餐后低血压与肠系膜上动脉血流量的关系

Relationship between postprandial hypotension and superior mesenteric artery blood flow in elderly patients aged 80 years and over

目的 探讨年龄80岁及以上患者餐后血压下降与肠系膜上动脉（SMA）血流分布的关系. 方法 选取年龄80岁及以上餐后低血压（PPH）患者25例（PPH组）和非餐后低血压者27例（对照组）.监测两组空腹和餐后2h血压、SMA血流动力学指标,分析两组间各指标的差异. 结果 PPH组糖代谢异常（包括糖尿病和糖耐量降低）的患病率高于对照组[92.0％（23例）比40.7％（11例）,P＜0.05].两组餐后各时段的收缩压和舒张压均较空腹下降,PPH组餐后收缩压和舒张压的最大降幅较对照组增加[分别为（31.3±14.8） mmHg（1 mmHg=0.133 kPa）比（6.9±16.5）mmHg,（13.1±6.6）mmHg比（9.0±3.9） mmHg,P＜0.05].PPH组和对照组餐后各时段的SMA血流量均较空腹增加,但PPH组餐后SMA血流量的最大增幅较对照组升高[（550.5±149.5）ml/min比（312.8±241.4）ml/min,P＜0.05].餐后收缩压最大下降幅度与餐后SMA血流量最大增加幅度呈正相关（r=0.352,P=0.025）. 结论 餐后血压的下降与肠系膜上动脉血流量的增加有关,餐后内脏血流灌注异常增多是餐后低血压形成的机制之一.

Objective To explore the relationship between the fall of postprandial blood pressure and superior mesenteric artery （SMA） blood flow in elderly patients aged 80 years and over.Methods The study included 25 inpatients aged 80 years and over with postprandial hypotension （PPH group） and 27 age matched cases without PPH （control group）.The changes in blood pressure and the hemodynamics of SMA at fasting stage and 2 hour after meal were observed.The differences between the two groups were compared.Results The incidence of abnormal glucose metabolism （including diabetes and impaired glucose tolerance） was significantly higher in PPH group than in control group [[92.0% （23 cases） vs.40.7% （11 cases）, P〈0.05].There were no significant differences in other clinical data between the two groups （all P〉0.05）.The blood pressure in two groups at different time points was decreased after meal significantly as compared with that at fasting stage （all P〉0.05）.The maximal fall of postprandial systolic blood pressure and diastolic blood pressure was significantly increased in PPH group as compared with in control group [（31.3± 14.8）mmHg（1 mmHg=0.133 kPa） vs.（6.9±16.5） mmHg, （13.1±6.6） mmHg vs.（9.0±3.9）mmHg, both P〈0.05].The postprandial SMA blood flow at different time points was significantly increased after meal as compared with that at fasting stage in two groups （all P〉0.05）.The maximal increase of postprandial SMA blood flow was larger in PPH group than in control group [（550.5±149.5） ml/min vs.（312.8±241.4） ml/min, P〈0.05].The maximal fall of postprandial systolic blood pressure was positively associated with the maximal increase of postprandial SMA blood flow （r=0.352, P=0.025）.Conclusions The fall of postprandial blood pressure is associated with the increase of the SMA blood flow.Postprandial increase in splanchnic perfusion is one of the mechanisms for the formation of PPH.