阻抗微分心动图监测下老年H型高血压患者叶酸治疗疗效的临床观察

Role of impedance cardiography in monitoring the therapeutic effect of folic acid in elderly H-type hypertension patients

目的阻抗微分心动图监测法指导下观察口服叶酸治疗老年H型高血压的疗效。方法选择老年H型高血压患者50例,随机分为干预组25例和对照组25例。2组同时给予相同降压药物治疗,干预组在降压药物治疗基础上,同时给予叶酸口服0.8mg,1次/d,疗程3个月,采用无创血流动力监测系统检测治疗前后各项血流动力学参数以及血浆同型半胱氨酸(Hcy)和叶酸水平。结果干预组治疗后血浆Hcy水平较治疗前明显降低[(15.10±1.35)μmol/L vs(15.90±1.30)μmol/L,P<0.01],叶酸水平较治疗前明显升高[(21.66±10.21)μmol/L vs(19.98±10.20)μmol/L,P<0.01]。干预组治疗后血浆Hcy水平明显低于对照组(P<0.01)。干预组治疗后心输出量、每搏输出量、变力状态指数、左心室射血收缩指数较治疗前明显升高,每搏外周阻力、心率、收缩压、舒张压较治疗前明显降低(P<0.01)。对照组治疗后每搏输出量、变力状态指数较治疗前明显升高,每搏外周阻力、收缩压及舒张压较治疗前明显降低(P<0.01)。结论叶酸治疗的血流动力学参数改善状况并不独立于血压的控制,叶酸对H型高血压的治疗可以作为辅助手段。

Objective To study the role of impedance cardiography in monitoring the therapeutic effect of oral folic acid in elderly H-type hypertension patients. Methods Fifty elderly H-type hypertension patients were randomly divided into treatment group （n=25） and control group （n= 25） and treated with same antihypertensive drugs. The patients in treatment group were treated with antihypertensive drugs plus oral folic acid （0.8 rag,once a day） for 1 month. Their hemodynamic parameters and serum levels of homocysteine （Hcy） and folic acid were measured before and after treatment. Results The serum Hcy level was significantly lower while the serum folic acid level was significantly higher in treatment group after treatment than before treatment （15.10± 1.35 μmol/L vs 15.90±1.30 μmol/L,P〈0. 01;21. 66±10. 21 μmol/L vs 19.98±10.20 μmol/L, P〈0.01）. The serum Hcy level was significantly lower in treatment group than in control group after treatment （P〈0.01）. The CO,SV,ISI and LVEPCI were significantly higher while the SS- VR,HR,SBP and DBP were significantly lower in treatment group after treatment than before treatment. The SV and ISI were significantly higher while the SSVR, SBP and DBP were significantly lower in control group after treatment than before treatment （P〈0.01）. Conclusion Folic acid can improve the hemodynamic parameters, which is not independent of blood pressure control,and can thus be used as a supplementary mean in treatment of H-type hypertension patients.