住院帕金森病患者24小时动态血压及心率变化的临床研究

Clinical study of twenty-four hour non-invasive ambulatory blood pressure and heart rate monitoring in hospitalized patients with Parkinson’s disease

目的调查住院帕金森病(PD)患者24h动态血压、心率、餐后血压变化特点及其可能的影响因素。方法采用无创性携带式动态血压监测仪进行24h动态血压及心率监测,评估受试者的动态血压变化节律及餐后血压变化特点,并进行住院PD患者相关量表评分,探讨病理性血压节律、餐后低血压的相关影响因素。结果(1)PD组血压节律倾向于反勺型血压,对照组血压节律倾向于非勺形血压(P<0.001)。(2)PD组夜间血压下降水平与年龄呈负相关(r=-0.454,P=0.005),与病程、统一PD评定量表第三部分(UPDRSⅢ)评分和Hoehn-Yahr(H-Y)分期、左旋多巴等效日剂量无相关性。(3)PD组早餐和晚餐后收缩压下降水平、低血压发生率较对照组均明显升高(均P<0.05)。(4)PD组早餐后收缩压下降水平与年龄呈正相关(r=0.361,P=0.028),与病程、UPDRSⅢ评分、H-Y分期、左旋多巴等效日剂量无相关性。结论住院PD患者广泛存在夜间高血压、餐后低血压。这些异常血压调节与年龄有关。

Objective To investigate the characteristics of 24 h non-invasive ambulatory blood pressure,heart rate,postprandial blood pressure and its possible influencing factors in hospitalized patients with Parkinson's disease ( PD).Methods A 24 h ambulatory blood pressure and heart rate monitoring were performed using a non-invasive ambulatory blood pressure monitor to assess the subject's ambulatory rhythm and postprandial blood pressure changes, hospitalized PD patient related scales were used to evaluate the related factors of pathological blood pressure rhythm and postprandial hypotension.Results ( 1) 24 h non-invasive ambulatory blood pressure monitoring showed a high prevalence of inverted dippers in PD group and non-dippers in control group( P < 0. 001).( 2) The nocturnal blood pressure dip of PD group was negatively correlated with the age( r =- 0. 454,P = 0. 005),which was not associated with disease duration,the Unified PD Rating Scale part Ⅲ( UPDRSⅢ) rating,Hoehn-Yahr( H-Y) staging and Ldopa equivalent daily dose.( 3) Compared with the control group,systolic blood pressure drop and incidence of hypotension after breakfast and after dinner were significantly higher in PD group( all P < 0. 05).( 4) The decline in systolic blood pressure after breakfast was positively correlated with age in PD group( r = 0. 361,P = 0. 028),which was not associated with disease duration,UPDRS Ⅲ rating,H-Y staging and L-dopa equivalent daily dose. Conclusions There are extensive nocturnal hypertension and postprandial hypotension in hospitalized PD patients. These abnormal blood pressure changes are related to age.