Adrenomedullin in cirrhotic and non-cirrhotic portal hypertension

AIM:Adrenomedullin (ADM) is a potent vasodilator peptide.ADM and nitric oxide (NO) are produced in vascular endothelial cells. Increased ADM level has been linked to hyperdynamic circulation and arterial vasodilatation in cirrhotic portal hypertension (CPH). The role of ADM in non-cirrhotic portal hypertension (NCPH) is unknown, plasma ADM levels were studied in patients with NCPH, compensated and decompensated cirrhosis in order to determine its contribution to portal hypertension (PH) in these groups.METHODS: There were 4 groups of subjects. Group 1consisted of 27 patients (F/M: 12/15) with NCPH due to portal and/or splenic vein thrombosis (mean age: 41±12years), group 2 consisted of 14 patients (F/M: 6/8) with compensated (Child-Pugh A) cirrhosis (mean age: 46±4),group 3 consisted of 16 patients (F/M: 6/10) with decompensated (Child-Pugh C) cirrhosis (mean age: 47±12).Fourteen healthy subjects (F/M: 6/8) (mean age: 44±8) were used as controls in Group 4. ADM level was measured by ELISA. NO was determined as nitrite/nitrate level by chemoluminescence.RESULTS: Adl level in Group 11 (236±61.4 pg/mL) was significantly higher than that in group 2 (108.4±28.3 pg/mL)and group 4 (84.1±31.5 pg/mL) (both P＜0.0001) but was lower than that in Group3 (324±93.7 pg/mL) (P=0.002). NO level in group 1 (27±1.4 μmol/L) was significantly higher than that in group 2 (19.8±2.8 μmol/L) and group 4 (16.9±1.6μmol/L) but was lower than that in Group 3 (39±3.6 μmol/L)(for all three P＜0.0001). A strong correlation was observed between ADM and NO levels (r=0.827, P＜0.0001).CONCLUSION: Adrenomedullin and NO levels were high in both non-cirrhotic and cirrhotic portal hypertension and were closely correlated, Adrenomedullin and NO levels increased proportionally with the severity of cirrhosis, and were significantly higher than those in patients with NCPH.Portal hypertension plays an important role in the increase of ADM and NO. Parenchymal damage in cirrhosis may contribute to the increase in these parameters.

Effects of Magnetic Needle Acupuncture on Blood Pressure and Plasma ET-1 Level in the Patient of Hypertension

Endothelin-1 (ET-1) is ever known as a bio-peptidewith the strongest vasoconstrictive action and withwide biological effects.

Fathal pulmonary hypertension after distal splenorenal shunt in schistosomal portal hypertension

Mansonic schistosomiasis is the main cause of portal hypertension in Brazil. Hepatosplenic (HS) form is manifested by hepatomegaly mainly on the left hepatic lobe associated with large splenomegaly and bleeding due to esophageal varices with high mortality rates.

A Clinical Study on Haunglian Fire-Purging Mixture In Treatment of 46 Cases of Primary Hypertension

In order to observe the therapeutic effects of Huanglian Fire-Purging Mixture (黄连清降合剂) on primary hypertension, 46 cases of primary hypertension in the treatment group were treated with Huanglian Fire-Purging Mixture to clear away heat from the liver, relieve mental stress, purge fire and remove toxin;and the other 26 cases of primary hypertension in the control group were treated with Niuhuang Bolus for Lowering Blood Pressure (牛黄降压丸). The effect in the treatment group was obviously superior to that in the control group (P＜0.05). The Huanglian Fire-Purging Mixture shows noticeable effects 3-6 hours after medication. The mixture can improve the clinical symptoms, the left ventricular diastolic function and myocardial ischemia, correct dyslipoproteinemia and dysglycemia, and reduce blood viscosity. And it is safe and with no obvious adverse reactions.

Exploring the type of social support available to aged male hypertensive clients in Ghana

Objective: To explores the social support available to aged hypertensive male clients in a municipality in Ghana.Methods: The inclusion criteria were as follows: age ≥60 years and are known hypertensive patients. Data were collected from 186 selected aged male hypertensive patients for 3 months. The questionnaire was self-developed and open-ended. The data were processed and analyzed using SPSS version 23. Some of the variables were subjected to statistical tests and ranks in the order of impor tance to respondents. The enrolled respondents were allowed to par ticipate in the study after their informed consent was obtained. It was evident that respondents do not obtain much support or help in taking care of their condition.Results: The result revealed that the repondents has no support to help take care of their condition as evident by the responses in the study. The scores on average mean for some variables are(AM = 2.25, SD = 0.381) more than the test value of 2.50. Some of these supports were on feeding support(M = 3.97, SD = 0.278, n = 186), health support(M = 2.87, SD = 0.167, n = 186), and cleaning support(M = 2.59, SD = 0.868, n = 186). Supports such as clothing, socialization, medication, washing, transportation, and financial support were lacking.Conclusions: Based on the finding that certain forms of support were lacking, the study concludes that steps undertaken by the government, community, religious bodies, and family toward improving these supports can be of immense help for aged male hypertensive patients living in the Ejura-Sekyedumase municipality.

The Principle and Technique of Using Chinese Drugs in the Treatment of Hypertension

There are three principles which need to be grasped in the clinical use of Chinese drugs in the treatment of hypertension: Combination of syndrome differentiation in TCM with disease-differentiation in western medicine; combination of the theory of TCM with the results of modern pharmacological researches; and combination of symptom improving, blood-pressure reducing with complications preventing measures. Use of Chinese Drugs Based on the Western Medical Stages of Hypertension Patients should be classified for clinical stages of hypertension according to western medical criteria before TCM treatment program is made. For instance, in hypertension patients, apart from high blood pressure, there may also be other symptoms such as headache, dizziness, distending sensation in the head, stiff sensation in the neck, dim eyesight, tinnitus, poor memory, inability to concentrate the mind, insomnia, disphoria, general weakness, numbness of the four limbs, and palpitation. In some patients, these symptoms may not always be directly related to hypertension. In these cases, treatment for reducing blood pressure may not be taken into consideration, and the treatment based on general differentiation of the symptoms may serve the purpose. Only after the differential use of Chinese drugs shows no obvious improvement of the symptoms and high blood pressure, the treatment will be aimed at hypertension per se. When Chinese drugs alone can not reduce blood pressure, western medicine is often used in combination to reduce blood pressure, blood lipids and uric acid, correct water-electrolyte metabolism, and improve blood rheology. The combined Chinese and western medical treatment can make up each other's deficiencies so as to give better therapeutic effects.

基于土滞金藏理论从痰论治阻塞性睡眠呼吸暂停综合征相关性高血压

阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea-hypopnea Syndrome,OSAHS)相关性高血压患病率在高血压病患病人群中日益增高,常规西医降压药难以达到良好的降压效果,而近几年研究表明OSAHS是诱发高血压病的危险因素。中医认为,OSAHS相关性高血压的致病因素包括痰湿和气阻两方面,其中痰湿为根本病理因素。OSAHS患者好食肥甘厚味,导致脾失健运、水液输布不均,痰湿内生,损伤血管内皮及发生炎症反应,使血压升高;痰湿存肺,上行沿上呼吸道至咽喉,壅扼咽喉,阻塞呼吸运动,清气无法纳入,浊气无法吐出,加之脾失健运导致的水谷精微不足,宗气不足,无法正常完成主司呼吸运动,推动血脉运行的功能活动失常,血脉瘀滞,导致血压升高。本研究认为,痰湿生成与加重基于土滞金藏理论,脾主津液失常、肺主气机失利,土不运化则滞,金不畅散则藏,津液运行输布失常及气机失调与肺、脾、肾三脏相关。本研究结合OSAHS诱发高血压病的西医机制,分析中医角度下OSAHS从津液运化受阻、气的生成与运行失调等方面促成高血压病的病因病机,相类比西医治疗时患者依从性差、预后不良等缺点,临床治疗OSAHS相关性高血压可基于“土滞金藏”这一理论基础,围绕痰湿这一病理因素,以疏土、顺金、补充元阳为治疗法则,畅通患者气道,改善鼾眠症状,为控制OSAHS相关性高血压病患者血压提供新型中医诊疗思路。

用野百合碱诱导的肺动脉高压雄性大鼠的右心室结构与功能变化

目的观测用野百合碱(monocrotaline,MCT)诱导的肺动脉高压(pulmonary arterial hypertension,PAH)雄性大鼠的右心室(right ventricle,RV)结构与功能变化情况,以进一步验证其诱发肺动脉高压的机制。方法将SD雄性大鼠随机分为对照组、模型组,每组12只。模型组大鼠接受单次40 mg·kg-1的MCT皮下注射。注射MCT第0周、2周、3周、4周末时检测超声心动图,评价右心室功能和右心室-肺动脉(RV-PA)耦合情况。注射MCT第4周时采用右心导管术检测大鼠平均肺动脉压(mPAP),取脏器并称重,计算脏器系数及右心室肥厚指数(RVHI);采用HE染色法观察肺小动脉病理形态学变化,计算管腔面积占血管总面积的百分比(WA%)、管壁厚度占血管外半径的百分比(WT%);采用HE、Masson染色法观察右心室心肌细胞的肥大程度和纤维化程度。结果与0周相比,2周时,模型组大鼠右心室游离壁厚度(RVFW)增加、平均肺动脉压(mPAP)升高(P<0.05),三尖瓣环平面收缩期位移(TAPSE),肺动脉加速时间(PA-AT)和右心室流出道速度时间积分(RVOT-VTI)及PAT/PET、TAPSE/mPAP降低(P<0.05);3周时,右心室内径(RVID)增加、TAPSE/PAT升高(P<0.05)。与对照组比,模型组大鼠mPAP、RVHI升高(P<0.05)。模型组大鼠肺小动脉管壁增厚,中膜平滑肌细胞增生,管腔狭窄,WA%、WT%升高(P<0.05);RV心肌细胞肥大,心肌纤维化(P<0.05)。模型组大鼠心、肺增大(P<0.05)。结论用MCT诱导的PAH雄性大鼠的右心室结构与功能均发生变化,导致肺动脉高压。

Hyperammonemia,brain edema and blood-brain barrier alterations in prehepatic portal hypertensive rats and paracetamol intoxication

AIM: To study the blood-brain barrier integrity, brain edema,animal behavior and ammonia plasma levels in prehepatic portal hypertensive rats with and without acute liver intoxication.METHODS: Adults male Wistar rats were divided into four groups. Group I: sham operation; II: Prehepatic portal hypertension, produced by partial portal vein ligation; III:Acetaminophen intoxication and IV: Prehepatic portal hypertension plus acetaminophen. Acetaminophen was administered to produce acute hepatic injury. Portal pressure, liver serum enzymes and ammonia plasma levels were determined. Brain cortex water content was registered and trypan blue was utilized to study blood brain barrier integrity. Reflexes and behavioral tests were recorded.RESULTS: Portal hypertension was significantly elevated in groups II and IV. Liver enzymes and ammonia plasma levels were increased in groups II, III and IV. Prehepatic portal hypertension (group II), acetaminophen intoxication (group III) and both (group IV) had changes in the blood brain-barrier integrity (trypan blue) and hyperammonemia. Cortical edema was present in rats with acute hepatic injury in groups III and IV. Behavioral test (rota rod) was altered in group IV.CONCLUSION: These results suggest the possibility of another pathway for cortical edema production because blood brain barrier was altered (vasogenic) and hyperammonemia was registered (cytotoxic). Group IV, with behavioral altered test, can be considered as a model for study at an early stage of portal-systemic encephalopathy.

老年男性阻塞性睡眠呼吸暂停综合征相关高血压的影响因素分析及风险预测积分评定系统构建

目的探讨老年男性阻塞性睡眠呼吸暂停综合征(OSAS)相关高血压的影响因素,构建预测OSAS专病人群高血压风险的积分评定系统。方法选取2015年1月至2017年10月于6家三甲医院(北京、甘肃及山东等地)诊断为OSAS的798例老年男性患者为研究对象。根据是否存在高血压分为高血压组538例及非高血压组260例。收集患者的一般资料及生化指标等。采用SPSS 25.0统计软件进行数据分析。采用Spearman相关分析评估各指标与高血压分级的相关性。采用logistic回归分析影响高血压的因素,并构建老年男性OSAS专病人群发生高血压的风险预测模型。采用受试者工作特征(ROC)曲线对风险预测模型进行评价。结果高血压组患者体质量指数(BMI)、氧减指数(ODI)、脉搏血氧饱和度(SpO 2)<90%持续时间、SpO 2<90%时间占总睡眠时长百分比(T90)、肌酐、空腹血糖、饮酒史比例以及糖尿病、冠心病、颈动脉粥样硬化和高脂血症患病率均显著高于非高血压组,差异均有统计学意义(均P<0.05)。相关性分析提示,年龄、BMI、呼吸暂停低通气指数(AHI)、ODI、SpO 2<90%持续时间、T90、低密度脂蛋白胆固醇、空腹血糖及肌酐水平与高血压分级呈显著正相关(r=0.107,0.160,0.072,0.079,0.089,0.087,0.080,0.112,0.154;均P<0.05),最低氧饱和度及高密度脂蛋白胆固醇与高血压分级呈显著负相关(r=-0.082,-0.087;均P<0.05)。多因素logistic回归分析显示,BMI(OR=1.098,95%CI 1.053~1.145)、空腹血糖(OR=1.144,95%CI 1.028~1.274)、肌酐(OR=1.008,95%CI 1.002~1.014)和高脂血症(OR=1.543,95%CI 1.070~2.224)是老年男性OSAS患者高血压的危险因素,应用持续气道正压通气(CPAP)治疗是老年男性OSAS患者高血压的保护因素(OR=0.612,95%CI 0.387~0.967)。风险预测模型公式为logit(P)=-3.263+0.093×BMI+0.135×空腹血糖+0.008×肌酐+0.434×高脂血症-0.491×CPAP。风险预测模型的ROC曲线下面积为0.654(95%CI 0.614~0.694),灵敏度为0.701,特异度为0.542。对模型中各因素进行赋值后,理论上被评估患者个体的积分取值范围为-2~11分。根据公式计算其相应的高血压患病概率:P=1/[1+exp(0.2277-0.217S)],其中S代表对应的积分值。结论BMI、空腹血糖、肌酐、高脂血症和CPAP是老年男性OSAS患者高血压的影响因素。本研究建立的风险预测模型对老年男性OSAS患者高血压有一定的区分能力,设计的积分评定系统可简单直观地预测高血压风险。

高血压病现患率调查及相关因素的研究

目的了解高血压病分布规律和易患因素。方法运用整群抽样方法，共抽查城乡居民1796人，年龄20～75岁，按照WHO高血压委员会1978年规定的高血压病诊断标准进行诊断，由调查员对研究对象易患因素的暴露情况进行调查。填写调查表，对结果进行统计学多元回归分析。结果高血压病的患病率为11．41％，如包括临界高血压患病率达32．29％。分布特征表现为城市高于农村，女性高于男性，有随年龄增大而增高的趋势。结果还表明打鼾、肥胖、吸烟、饮酒等为高血压病的易患因素。结论结果提示高血压病是城乡居民中的一种常见病，特别对城市居民的健康威胁更大。

男性打鼾与高血压的关系

目的调查男性职工打鼾与高血压的关系。方法采用整群抽样方法,抽取马鞍山钢铁企业不同车间不同工种的当班作业工人1172人,采用自填问卷法,调查打鼾、吸烟、饮酒情况,同时测量血压、血脂、身高、体重以及常规内科检查(包括心电图、胸透)。结果钢铁企业男性职工习惯性打鼾的流行率为14.6%,偶尔打鼾的流行率为55.3%;习惯性打鼾随年龄的增长,流行率增加,随着体质指数的升高,打鼾率升高,与吸烟20支以上和曾经饮酒有关;随打鼾频率增加,高血压患病率增加,从不打鼾者高血压患病率为13.6%,偶尔打鼾为16.4%,习惯性打鼾为30.4%(O R=1.651,95%可信区间为1.307～2.085),但在校正年龄、肥胖、高血压家族史、吸烟、饮酒、血脂等因素后,打鼾与高血压联系不强(O R=1.373,95%可信区间0.906～2.080)。结论打鼾可能与高血压无关。

鼾症老年人睡眠呼吸暂停症与心血管疾病的相关性

目的 观察鼾症老年人中睡眠呼吸暂停症 (SAS)与部分心血管异常改变的相关性及经鼻持续气道正压通气(nCPAP)对SAS的有关疗效。方法 采用多导睡眠仪将 6 7例 6 0岁以上老年鼾症者分为SAS组和非SAS组 ,同时通过Holter心电及血压检测仪就两组间血压昼夜节律、高血压、心率变异性、部分心律失常、冠心病的状况作出比较。在SAS组中将接受nCPAP治疗 5～ 7d后的以上有关心血管状况与治疗前加以比较。结果 鼾症老人中SAS的发病率较高 (47.8% ) ;在SAS组中 ,高血压、血压昼夜节律消失、冠心病心绞痛对扩冠药疗效不佳、睡眠期心率变异性降低、心律失常及动脉血氧饱和度 (SaO2 )降低的发生率均明显高于非SAS组。经nCPAP治疗后睡眠期不仅鼾声消除、SaO2 明显增高和呼吸暂停 /低通气指数明显降低 ;而且心率变异性 (HRV)和血压昼夜节律恢复。结论 SAS在老年心血管疾病的发生和发展上有着不可忽视的相关性 ,应用nCPAP不仅对SAS有较满意的疗效 ,而且对改善其并存的心血管病变也有重要的作用。

福州市20岁以上人群鼾症流行情况及其与高血压的相关性研究

目的了解福州市20岁以上人群鼾症的流行情况及其与高血压的关系。方法对2005年5月—2008年2月在福州市区收集的20岁以上常住居民4286人鼾症及阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的流行病学调查资料进行分析,估算人群鼾症发生率;多因素分析鼾症发生的危险因素,并进行鼾症与高血压之间的关系探讨。结果调查人群鼾症发生率为14.1%;男性、女性鼾症发生率分别为20.2%、7.9%(P<0.01),在各年龄组中男性鼾症发生率均高于同年龄组女性(P<0.01);鼾症发生率随年龄增加而升高,以≥60岁组最高(P<0.01),但在男性人群40～59岁和≥60岁组之间比较差异无统计学意义(P>0.05);有打鼾家族史者鼾症发生率(26.2%)明显高于无打鼾家族史者(9.4%)(P<0.01)。多元Logistic逐步回归分析发现鼾症的主要危险因素是高龄、肥胖、打鼾家族史、饮酒、男性(OR值分别为4.693、3.920、3.839、2.632、2.070,P均<0.01)。鼾症患者高血压发生率26.6%,高血压患者鼾症发生率39.7%;去除其他因素影响,鼻鼾症患者发生高血压的风险是无鼾症者的2.691倍。结论福州市人群鼾症发生率较低,应根据其在福州市区的流行特点制定相应防治策略,减少鼾症发生中可变因素的作用以降低鼾症发生率及危害。鼾症与高血压关系密切,需注意二者并存的可能。

鼾症患者高血压危险因素分析

目的:了解鼾症患者中高血压的发病情况及发生高血压的危险因素。方法:分析248例鼾症患者高血压的构成,分析单纯鼾症与阻塞性睡眠呼吸暂停综合征(OSAHS)患者高血压构成之间的差异以及发生高血压的危险因素。结果:本组患者中,患高血压者占54.03%;OSAHS患者中,患高血压者占57.34%;单纯鼾症患高血压者占35.14%。OSAHS患者与单纯鼾症比较,高血压的构成比明显增加(χ2=6.253,P=0.012);中、重度OSAHS患者与单纯鼾症比较,高血压的构成比明显增加(χ2=7.623,P=0.006);高血压的危险因素是年龄(Exp(B)=1.027,P=0.026)、呼吸暂停和低通气指数(Exp(B)=1.010,P=0.030)和体质量指数(Exp(B)=1.154,P=0.001)。结论:在鼾症患者中,特别是在OSAHS患者中并发高血压者明显增加,年龄、体质量指数以及呼吸暂停低通气指数是高血压的危险因素。

奥美沙坦酯对男性高血压患者性功能的影响

目的探讨奥美沙坦酯及苯磺酸氨氯地平对男性高血压患者性功能的影响。方法选取2012年1月—2014年6月在江阴市中医院门诊就诊的男性高血压患者160例（高血压分级为1-2级）,采用随机数字表法将患者分为奥美沙坦酯组和苯磺酸氨氯地平组,各80例。奥美沙坦酯组给予奥美沙坦酯20 mg/d口服,苯磺酸氨氯地平组给予苯磺酸氨氯地平5 mg/d口服,疗程均为24周。观察两组治疗前后性功能和血清睾酮、雌二醇水平的变化。性功能评定按照勃起功能国际问卷-5（IIEF-5）进行问卷调查,主要通过勃起功能、性交满意度、达到高潮能力、性欲、总体满意度分值评价男性性功能。结果奥美沙坦酯组和苯磺酸氨氯地平组各有5例患者因血压持续不达标而退出。两组患者治疗后收缩压、舒张压比较,差异均无统计学意义（t=0.802、0.811,P〉0.05）。治疗前两组勃起功能、性交满意度、达到高潮能力、性欲、总体满意度分值比较,差异均无统计学意义（P〉0.05）;治疗后两组性交满意度、达到高潮能力、总体满意度分值比较,差异均无统计学意义（P〉0.05）;奥美沙坦酯组勃起功能、性欲评分均高于苯磺酸氨氯地平组,差异有统计学意义（P〉0.05）;治疗后两组雌二醇水平比较,差异无统计学意义（P〉0.05）;奥美沙坦酯组睾酮水平高于苯磺酸氨氯地平组,差异有统计学意义（P〈0.05）。奥美沙坦酯组治疗后睾酮水平高于治疗前,差异有统计学意义（P〈0.05）。结论奥美沙坦酯能提高男性高血压患者睾酮水平,改善性功能。

雄激素及其受体和雌激素变化在老年男性高血压患者中的初步研究

目的探讨老年男性高血压患者的雄激素及其受体以及雌激素水平变化。方法选择172例老年男性高血压患者(高血压组)和104例同龄健康男性(健康组),检测所有入选者血清7种性激素,黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮(TT)和雌二醇(E2)采用化学发光法检测;游离睾酮(FT),硫酸脱氢表雄酮(DHEA-s),性激素结合球蛋白(SHBG)采用酶联免疫吸附法检测。使用流式细胞技术测定外周淋巴细胞的雄激素受体(AR)含量(AR平均荧光强度)。结果(1)与健康组比较,高血压组体重指数(BMI),腰围,腰臀比,空腹血糖和E2/TT明显增高,TT明显下降(P<0.01)(。2)控制BMI因素影响后,与收缩压相关的性激素有TT(P=0.047)和E2/TT(P=0.001);与舒张压相关的因素有E2,E2/TT和AR荧光强度(P<0.05)。结论男性高血压患者TT明显下降、E2/TT明显升高。E2/TT与收缩压和舒张压呈正相关,E2和AR荧光强度与舒张压呈正相关。

“健步行”运动对社区老年男性高血压人群健康促进效果的研究

目的·分析"健步行"运动处方对上海社区老年男性高血压人群的血压、体质量指数(BMI)、自主神经活动等的干预效果。方法·在上海浦东新区社区医院630名自愿参与"健步行"运动(>10 000步/d)的老年男性中,选取坚持完成12周训练者210名,根据是否患有高血压分为高血压干预组(干预组,n=110)和正常干预对照组(对照组1,n=100)。再选取200名高血压老年男性患者,进行常规治疗,不进行运动干预(对照组2)。比较各组训练前后血压、BMI、心率和自主神经活动的变化。结果·干预组经12周训练后收缩压(SBP)、舒张压(DBP)和交感神经活动较训练前均显著降低(均P<0.05),SBP显著低于对照组2(P<0.05),而心率、BMI、副交感神经活动和压力感受器反射敏感性训练前后差异均无统计学意义(均P>0.05)。结论·对高血压老年男性患者实施12周的"健步行"运动处方,可以降低血压和交感神经活动,值得在社区中普及推广。

习惯性鼾症患者动态血压监测及其临床意义

对42例习惯性鼾症伴高血压患者进行动态血压监测和晨晚间血浆血管紧张素Ⅰ（AngⅠ）、血管紧张素Ⅱ（Ang Ⅱ）测定。结果显示鼾症组夜间血压较白昼无明显降低,昼夜节律消失。晨间Ang Ⅰ和Ang Ⅱ比晚间增高（P<0.01）。与对照组比较动态血压多项参数和血浆Ang Ⅰ、Ang Ⅱ均有非常显著性差异（P<0.01）。提示鼾症可因低氧血症激活肾素-血管紧张素系统和儿茶酚胺分泌增加等因素引起夜间血压升高,并加重对靶器官损害,使心脑血管并发症增多。

妊娠期睡眠呼吸障碍的发生及其高危因素

目的:分析不同孕期妇女睡眠呼吸障碍(SDB)的发生情况,探讨SDB高危因素及其与妊娠结局的关系。方法:选取90例妊娠中期及139例妊娠晚期孕妇,进行流行病学的问卷调查。问卷内容包括一般资料、家族史、个人史、吸烟史、饮酒史、孕期睡眠情况,身高、体重、颈围;并记录孕妇的产检及分娩情况,包括妊娠结局、合并症及新生儿出生体重、Apgar评分等。将结果进行统计学分析。结果:妊娠期SDB的发生率较高,妊娠晚期的SDB发生率为38.13%,高于妊娠中期(24.44%),差异有统计学意义(P<0.05)。妊娠期睡眠障碍的相关症状发生率也随着孕周增加而增加,其中以夜间憋醒(P<0.05)、用口呼吸(P<0.05)、夜间多尿(P<0.01)、睡眠时多汗(P<0.01)明显。较粗的颈围(OR=1.309,P<0.01)及打鼾家族史(OR=2.885,P<0.01)为打鼾的危险因素。且当颈围≥36cm时,打鼾的发生风险明显增大(P<0.01)。打鼾可增加妊娠期发生高血压疾病的风险(12.0%vs 3.9%,P<0.05)。打鼾组的分娩前体重指数(BMI)、打鼾家族史及被动吸烟者均高于非打鼾组,差异有统计学意义(P<0.05)。结论:妊娠期SDB的发生率较高,随着孕周增加而增加,且与妊娠高血压疾病的发生相关;妊娠期可通过孕前BMI、颈围、被动吸烟等因素筛查SDB的高危孕妇,并尽早对其进行睡眠呼吸监测,以早期发现、早期干预。