探讨高血压患者血压变化与心律失常和心肌缺血的关系

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　　DOI：10.16662/j.cnki.1674-0742.2019.35.037
　　[摘要] 目的 探讨高血压患者血压变化与心律失常和心肌缺血的关系。方法 方便选择该院2017年10月—2019年1月收治的高血压患者参与该次研究，一共120例，根据患者晨峰血压差值进行分组，划分为晨峰血压组、非晨峰血压組。在监测前3天停止一切药物，佩戴动态血压仪、心电图仪器对患者的血压水平、心肌缺血程度进行持续24 h监测。比较两组患者平均动态血压和血糖、血脂。然后测定两组患者清晨血压、心率、左心房内径（LAD）、左心室质量指数（LVMI）、左心室肥厚检出率，对比两组患者的上述指标。最后比较两组患者心律失常和ST段压低的检出率。结果 两组患者的平均动态血压、血糖、血脂，差异无统计学意义（t=0.003、0.773、0.041、1.095、0.716、0.172、0.348，P>0.05）。和非晨峰组对比，晨峰组清晨血压[收缩压（153.91±10.90）mmHg、舒张压（84.55±9.20）mmHg]、心率（71.00±19.00）次/min、左心房内径（46.32±10.99）mm、左心室质量指数（119.00±20.88）9/m2明显更高，差异有统计学意义（t=4.589、2.668、2.624、4.357、9.523，P<0.05）。和非晨峰组对比，晨峰组心律失常（房性早搏91.67%，房性心动过速50.00%，阵发性心房颤动25.00%，室性早搏80.00%，室性心动过速16.67%）、ST段压低检出率50.00%、左心室肥厚检出率38.33%明显更高，差异有统计学意义（P<0.05）。ST段压低的血压晨峰升高值和相应时段的ST段压低值呈正相关关系（χ2=6.000、11.868、17.143、5.714、5.926、15.000、7.064，P<0.05）。ST段压低的血压晨峰升高值和相应时段的ST段压低值呈正相关关系，差异有统计学意义（P<0.05）。结论 高血压患者的血压波动和心律失常、心肌缺血之间存在正相关关系，通过动态血压监测和动态心电图联合监测可以及时发现高血压患者的血压波动，从而及时阻断血压波动对靶器官的损害和心血管事件的形成。
　　[关键词] 高血压;血压变化;心律失常;心肌缺血
　　[中图分类号] R5          [文献标识码] A          [文章编号] 1674-0742（2019）12（b）-0037-04
　　To Explore the Relationship between Blood Pressure Changes and Arrhythmia and Myocardial Ischemia in Patients with Hypertension
　　CHEN Ni-na
　　Department of Cardiology， Haishu Hospital of Xiamen， Xiamen， Fujian Province， 361000， China
　　[Abstract] Objective To investigate the relationship between blood pressure changes and arrhythmia and myocardial ischemia in patients with hypertension. Methods 120patients with hypertension admitted to our hospital from 10th 2017 to 1st 2019 were convenient selected to participate in this study. They were divided into morning peak blood pressure group and non-morning peak blood pressure group according to the difference of morning peak blood pressure. All medicines were stopped three days before monitoring. Ambulatory blood pressure monitor and electrocardiogram were used to monitor the blood pressure and myocardial ischemia for 24 hours. The average ambulatory blood pressure， blood sugar and blood lipid were compared between the two groups. Then blood pressure， heart rate， left atrial diameter （LAD）， left ventricular mass index （LVMI） and left ventricular hypertrophy were measured in the morning of the two groups， and the above indexes were compared between the two groups. Finally， the detection rates of arrhythmia and ST segment depression were compared between the two groups. Results There was no significant difference in mean ambulatory blood pressure， blood glucose and blood lipid between the two groups， the difference was not statistically significant（t=0.003，0.773，0.041，1.095，0.716， 0.172，0.348， P>0.05）. Comparison with non-morning peaks， Early morning blood pressure in the morning peak group（systolic pressure （153.91±10.90）mmHg， diastolic pressure （84.55±9.20）mmHg]， heart rate（71.00±19.00）times/min， left atrium inner diameter（46.32±10.99）mm， left ventricle mass index（119.00±20.88）g/m2 was significantly higher， and the data difference was statistically significant （t=4.589，2.668，2.624， 4.357，9.523，P<0.05）. Compared with the non-morning peak group， the morning peak group arrhythmias（atrial premature beats 91.67%， atrial tachycardia 50.00%， paroxysmal atrial fibrillation 25.00%， ventricular premature beats 80.00 %， and ventricular cardiac tachycardia 16.67%）， ST segment depression rate 50.00%， left ventricular hypertrophy rate 38.33% was significantly higher， The difference in data is statistically significant（P<0.05）. As shown in table 3. The positive correlation between the morning peak of the low pressure of the ST segment and the low pressure of the ST segment at the corresponding period）.the difference was statistically significant （χ2=6.000，11.868，17.143，5.714，5.926，15.000，7.064，P<0.05）. The positive correlation between the morning peak of the low pressure of the ST segment and the low pressure of the ST segment at the corresponding period（P<0.05）. Conclusion There is a positive correlation between blood pressure fluctuation and arrhythmia and myocardial ischemia in patients with hypertension. The blood pressure fluctuation in patients with hypertension can be detected in time by combined monitoring of ambulatory blood pressure monitoring and ambulatory electrocardiogram， thus blocking the damage of blood pressure fluctuation to target organs and the formation of cardiovascular events in time.
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