糖尿病心脏自主神经病变患者蹲立位试验中血压和心率变化的研究

Alteration in blood pressure and heart rate during standing-squatting-restanding test in patients with diabetic cardiovascular autonomic neuropathy

目的探讨糖尿病心脏自主神经病变(DCAN)对糖尿病患者体位变化时心率和血压变化的影响。方法选取2003年1~6月于我院内分泌科住院治疗的糖尿病患者54例,根据有无DCAN分为糖尿病组(DM)31例和DCAN组23例,另选取体检正常的成人22名为健康对照(NC)组。采用指动脉血压监测系统,连续测定静止站立位、蹲位、起立位过程中的动脉血压和心率,观察各组不同时间点及体位的血压和心率变化的差异。结果与NC组比较,DCAN组的下蹲位DBP、起立位SBP和DBP变化幅度均增加[(17.9±9.5)vs(24.1±18.1)mmHg,P<0.05],[(-49.4±20.4)vs(-73.5±21.3)mmHg,P<0.01],[(-32.2±7.1)vs(-43.1±15.8)mmHg,P<0.05或P<0.01],下蹲位和起立位心率变化幅度均降低[(-21.3±13.0)vs(-6.5±7.8)bpm,(34.6±10.8)vs(11.4±9.8)bpm,P<0.05或P<0.01],恢复过程延缓(P<0.05)。与DM组比较,DCAN组同样表现为体位改变时血压变化幅度增大,心率变化幅度减小,恢复过程延缓(P<0.05)。相关性分析显示,糖尿病患者血压与心率变化值无相关性。结论糖尿病尤其是DCAN患者在体位变化过程中血压和心率调节功能受损。

Objective To investigate the impact of diabetic cardiovascular autonomic neuropathy（DCAN）on heart rate and blood pressure during position change in patients with diabetes mellitus.Methods From January to June 2003,54 patients with diabetes mellitus were divided into diabetes mellitus group（n=31）and DCAN group（n=23）according to the presence or absence of DCAN.22 healthy adults were selected as control group（n=22）.The blood pressure and heart rate were measured continuously by digital arterial blood pressure monitoring system in the process of standing,squatting and standing up.The changes of blood pressure and heart rate were observed at different time points and posture. Results Compared to NC group,there were significant increased rangeability of changes in blood pressure[squatting diastolic pressure：（17.9±9.5）vs（24.1±18.1）,P〈0.05;standing systole pressure：（-49.4±20.4）vs（-73.5±21.3）mmHg,P〈0.01;standing diastolic pressure：（-32.2±7.1）vs（-43.1±15.8）mmHg,P〈0.05 or P〈0.01]and significant decreased rangeability of changes in heart rate[squatting（-21.3±13.0）vs（-6.5±7.8）bpm,P〈0.05 or P〈0.01;standing（34.6±10.8）vs（11.4±9.8）bpm,P〈0.05 or P〈0.01]and remarkable longer recovery time especially in DCAN group（P〈0.05 or P〈0.01）during standing-squatting-standing test.There was no significant correlation between rangeability of blood pressure changes and heart rate in patients with diabetes. Conclusion There is impaired regulation of blood pressure and heart rate during postural changes in patients with diabetes,especially DCAN.