血壓晨峰與原發(fā)性高血壓患者心律失常及心肌缺血的關(guān)系

楊蓮 翁一文

【摘要】目的 深入分析及研究血壓晨峰與原發(fā)性高血壓患者心律失常及心肌缺血之間是否存在一定的關(guān)聯(lián)性。方法 選取本院2017年6月～2018年6月的80名原發(fā)性高血壓患者作為此次研究對(duì)象，依照每位患者的動(dòng)態(tài)血壓結(jié)果隨機(jī)分為兩組，對(duì)照小組與觀察小組。血壓晨峰值大于23.6 mmHg柱的患者歸類到對(duì)照小組，血壓晨峰值小于23.6 mmHg的患者歸類到觀察小組，各40名。對(duì)全部患者實(shí)施全天性動(dòng)態(tài)心電圖與動(dòng)態(tài)血壓監(jiān)測(cè)，同時(shí)對(duì)比兩組心律失常和心肌缺血引發(fā)狀況。結(jié)果 兩組病人的一般臨床狀況存在一定的可比性，相較于觀察組，對(duì)照組高血壓患者出現(xiàn)頻發(fā)房性早搏、房速、室性早搏與室速等心律失常癥狀幾率較大，兩組相比差異有統(tǒng)計(jì)學(xué)意義。對(duì)照組患者出現(xiàn)心律失常人數(shù)要比觀察組多，同時(shí)易發(fā)生ST段改變，ST-T改變與T波改變均無(wú)明顯差異。對(duì)照組患者出現(xiàn)心肌缺血概率要比觀察組高。結(jié)論 如果血壓晨峰與原發(fā)性高血壓患者心律失常及心肌缺血概率上漲，特別是房性早搏發(fā)生率，由此血壓晨峰與原發(fā)性高血壓患者心律失常及心肌缺血之間的聯(lián)系非常緊密，可在臨床上進(jìn)行推廣。

【關(guān)鍵詞】血壓晨峰;原發(fā)性高血壓;心律失常;心肌缺血

【中圖分類號(hào)】R544.1 【文獻(xiàn)標(biāo)識(shí)碼】A 【文章編號(hào)】ISSN.2095.6681.2020.6..02

【Abstract】Objective ? To analyze and study whether there is a certain correlation between blood pressure morning peak and arrhythmia and myocardial ischemia in patients with essential hypertension.METHODS ? Eighty patients with essential hypertension from June 2017 to June 1818 were enrolled in this study.The dynamic blood pressure results of each patient were randomly divided into two groups，the control group and the observation group.Patients with a peak blood pressure greater than 23.6 mm Hg were classified in the control group， and patients with a peak blood pressure of less than 23.6 mm mm Hg were classified in the observation group，with 40 in each group.All-day dynamic electrocardiogram and ambulatory blood pressure monitoring were performed in all patients，and the arrhythmia and myocardial ischemia were compared between the two groups.RESULTS ? There was a certain degree of comparability in the general clinical status between the two groups.Compared with the observation group，the hypertensive patients in the control group had a high incidence of atrial arrhythmia，atrial tachycardia， ventricular premature beats and ventricular tachycardia.The difference between the two groups was statistically significant.In the control group， there were more arrhythmia than the observation group，and ST segment changes were easy to occur.There was no significant difference between ST-T changes and T wave changes.The probability of myocardial ischemia in the control group was higher than that in the observation group.Conclusion ? If the blood pressure morning peak and essential hypertension patients have arrhythmia and myocardial ischemia probability，especially the incidence of atrial premature beats，thus the relationship between blood pressure morning peak and arrhythmia and myocardial ischemia in patients with essential hypertension The link is very close and can be promoted clinically.

【Key words】Morning blood pressure peak;Essential hypertension;Arrhythmia;Myocardial ischemia

誘發(fā)心血管疾病的關(guān)鍵因素是高血壓，病人血壓浮動(dòng)較大、晝夜變異情況嚴(yán)重、血壓升高都對(duì)病人預(yù)后造成影響。利用全天動(dòng)態(tài)血壓監(jiān)測(cè)可以清楚的掌握血壓浮動(dòng)頻率與變化狀態(tài)，而清晨是體現(xiàn)血壓變化的重要階段。相較于這一環(huán)節(jié)而言，人們漸漸從睡眠狀態(tài)蘇醒，這時(shí)血壓會(huì)不斷上漲，這種情況就叫做血壓晨峰。近幾年，隨著各類臨床實(shí)驗(yàn)及病例研究結(jié)果證明，血壓晨峰與原發(fā)性高血壓患者的心腦血管發(fā)病率有著直接聯(lián)系。病人早上血壓高峰和心腦血管發(fā)病率的時(shí)間相符，因此作為研究重點(diǎn)。

1 資料與方法

1.1 ?一般資料

選取本院2017年6月～2018年6月的80名原發(fā)性高血壓患者作為此次研究對(duì)象，全部患者都依據(jù)相關(guān)診斷標(biāo)準(zhǔn)執(zhí)行。原發(fā)性心肌梗塞或梗死、心力衰竭、繼發(fā)性高血壓的患者排除，長(zhǎng)期服用過抗心律、抗高血壓患病人嚴(yán)禁參加實(shí)驗(yàn)，所挑選的病人在參加實(shí)驗(yàn)前必須停藥兩周。

1.2 ?儀器與方法

利用全天動(dòng)態(tài)心電圖與動(dòng)態(tài)血壓監(jiān)測(cè)來觀察兩組病人情況，掌握心律失常與心肌缺血次數(shù)。動(dòng)態(tài)血壓監(jiān)測(cè)運(yùn)用中健科儀動(dòng)態(tài)血壓儀完成測(cè)量，測(cè)量時(shí)間為前一天晚上十點(diǎn)到第二天早上六點(diǎn)，視為夜間血壓。早上六點(diǎn)至晚上十點(diǎn)每30分鐘完整一次測(cè)量，視為白天血壓。結(jié)合動(dòng)態(tài)血壓結(jié)果，血壓晨峰值大于23.6 mmHg的患者歸類到對(duì)照小組，血壓晨峰值小于23.6 mmHg的患者歸類到觀察小組，各40名。動(dòng)態(tài)心電圖使用12.3導(dǎo)動(dòng)態(tài)心電圖分析系統(tǒng)，檢查前期不在服用抗心律失常藥物，連接導(dǎo)聯(lián)接線以后，將開關(guān)記錄打開，對(duì)病人房性、室性心律、心臟傳導(dǎo)阻滯、ST波段予以觀察。

1.3 ?統(tǒng)計(jì)學(xué)方法

采用SPSS 18.0統(tǒng)計(jì)學(xué)軟件來分析和整理相關(guān)數(shù)據(jù)，計(jì)量資料用“x±s”代替，T表示兩組資料差異性對(duì)比;計(jì)數(shù)資料用%代替。

2 結(jié) 果

2.1 ?比較對(duì)照組和觀察組高血壓患者心律失常

相較于觀察組而言，對(duì)照組高血壓患者出現(xiàn)頻發(fā)房性早搏、房速、室性早搏與室速等心律失常癥狀幾率較大，心律失常人數(shù)要比觀察組多。如表1所示。

2.2 ?比較照組和觀察組高血壓患者心肌缺血

相較于觀察組而言，易發(fā)生ST段改變，ST-T改變與T波改變均無(wú)明顯差異。對(duì)照組患者出現(xiàn)心肌缺血概率要比觀察組高，證明血壓晨峰可直接影響心肌缺血癥狀，需提高警惕。如表2所示。

3 討 論

針對(duì)原發(fā)性高血壓病人來說，他們的心血管系統(tǒng)始終都在高負(fù)荷狀態(tài)下運(yùn)行，以此出現(xiàn)了機(jī)體代償性事件，如擴(kuò)充心室壁張力、肥胖、心肌等。在心房顫動(dòng)疾病中高血壓是最危險(xiǎn)的因素

血壓晨峰與原發(fā)性高血壓患者心律失常及心肌缺血之間存在某種緊密聯(lián)系，血壓晨峰是導(dǎo)致心律失常及心肌缺血的主要危險(xiǎn)因素。在監(jiān)測(cè)過程中一般會(huì)用到的器具為同期動(dòng)態(tài)心電圖與動(dòng)態(tài)血壓，能夠快速探索到血壓晨峰，正確引導(dǎo)病人服藥，避免高血壓心血管事件的發(fā)生。

參考文獻(xiàn)

[1] 曹迎笑，胡杰鋒，高春香.動(dòng)態(tài)心電圖、常規(guī)心電圖對(duì)原發(fā)性高血壓患者心肌缺血及心律失常的診斷價(jià)值[J].現(xiàn)代電生理學(xué)雜志，2018，25（04）：15-18.

[2] 羅銘華，鄭淑萍，何燕峰，等.高血壓患者動(dòng)態(tài)血壓變化與心電圖同步監(jiān)測(cè)的相關(guān)分析[J].上海醫(yī)藥，2018（2）：18-20.