体位性低血压与持续性心房颤动的关系

Relationship between orthostatic hypotension and persistent atrial fibrillation

目的:通过对持续性心房颤动动及非心房颤动人群卧立位血压的测量,研究体位性低血压与持续性心房颤动的关系。方法:研究共入组患者366例,其中心房颤动患者入选我院诊断为"持续性心房颤动"为行射频消融术住院者共181例,非心房颤动患者入选于社区中医科门诊为中医保健就诊的患者共185例。使被测者安静状态下平卧位休息至少5min,使用欧姆龙电子血压计测量患者平卧位上臂血压及脉率,后使被测者主动转换为站立位,测量被测者直立后0.5、1、2、及3min的血压。体位性低血压定义为从卧位转为立位3min内,出现收缩压下降≥20mm Hg(mm Hg=0.133Pka)和(或)舒张压下降≥10mm Hg,对于伴有卧位高血压患者,以收缩压下降≥30mm Hg为诊断标准。结果:心房颤动患者体位性低血压的患病率为21.6%,非心房颤动患者为13.0%,其患病率差异有统计学意义(P=0.021)。Logistic分析调整多个变量后发现,持续性心房颤动(OR=2.525,95%CI:1.256~5.076,P=0.009)、年龄>60周岁(OR=2.125,95%CI:1.163~3.880,P=0.014)及高血压未控制(OR=2.416,95%CI:1.276~4.575,P=0.007)是体位性低血压的独立危险因素,BMI≥24kg/m^2(OR=0.505,95%CI:0.273~0.932,P=0.029)与存在体位性低血压负相关。结论:持续性心房颤动是体位性低血压的独立危险因素,对于年龄≥60周岁及高血压未控制的患者,伴有体位性低血压概率更高。

Objective： Through the blood pressure measurement of persistent atrial fibrillation patients and control population,to figure out the relationship between orthostatic hypotension and persistent atrial fibrillation. Methods： The total number of patients enrolled in the research are 366. The 181 patients with persistent atrial fibrillation are diagnosed with＂persistent atrial fibrillation＂in our hospital,and admitted for radiofrequency ablation. Control group are 185 patients who attend community hospital traditional Chinese medicine clinic for health care. All subjects are asked to rest at horizontal position for at least 5 minutes,then tested their blood pressure while horizontal position and 0. 5 min,1 min,2 min,3 min after standing with an Omron electronic sphygmomanometer. Orthostatic hypotension is defined as a supine-standing drop in SBP by 20 mm Hg or DBP by10 mm Hg,for patients with supine hypertension,use a SBP drop of 30 mm Hg as diagnostic criteria. Results：The morbidity of orthostatic hypotension in persistent atrial fibrillation patients is 21. 6%,in control population is 13. 0%（ P = 0. 021）. After using Logistic regression adjusted multiple variables,persistent atrial fibrillation（ OR = 2. 525,95% CI： 1. 256-5. 076,P = 0. 009）,Older than 60-years-old（ OR = 2. 125,95% CI ： 1. 163-3. 880,P = 0. 014） and with uncontrolled hypertension（ OR = 2. 416,95% CI： 1. 276-4. 575,P = 0. 007） has a positive correlation with orthostatic hypotension,and BMI over 24 kg/m^2（ OR = 0. 505,95% CI： 0. 273-0. 932,P = 0. 029） has a negative correlation with orthostatic hypotension. Conclusion： Persistent atrial fibrillation is an independent risk factor of orthostatic hypotension,for patients older than 60-years-old,with uncontrolled hypertension,there is a higher probability of orthostatic hypertension. BMI 24 kg/m2 is a protective factor ofrthostatic hypertension.