摘要:目的:研究老年患者动脉弹性功能与围术期血压变化的关系。方法:随机选择68例ASA分级Ⅰ－Ⅱ级行全麻手术的老年患者,根据检查所得动脉弹性的结果分为四组,分别是A组(C1、C2均正常),B组(C1异常,C2正常),C组(C1正常,C2异常),D组(C1、C2均异常)。测量其术前血压及全麻诱导8分钟后的血压水平。结果:〓动脉弹性功能不良的患者其术前MAP较高,且全麻诱导以后血压波动的比例较大。结论:高血压病的老年患者动脉弹性功能普遍降低;动脉弹性下降的老年病人全麻诱导后血压波动较大。Abstract: Objective:To investigate the relationship between the function of arterial elasticity and BP changes during perioperation in senile patients.Methods: 68 senile patients ASA class Ⅰor Ⅱ undergoing elective surgery under general anesthestia, were divided into four groups by evaluation of arterial elasticity (C1 was for large arterial elastic index and C2 for small. C1 and C2 were normal in group A, only C2 normal in group B, only C1 normal in group C, neither was normal in group D). Arterial blood pressure (BP) before operation and 8 min after induction were monitored and recorded. Results: Patients with dysfunction of arterial elasticity presented higher MAP during preoperation and significant BP changes after induction. Conclusion: Hypertension plays a key role in arterial elasticity.Arterial Blood Pressure of the senile patients with decreased arterial elasticity changes significantly after general anesthesia induction.
ObjectiveTo systematically review the effectiveness and safety of intensive blood pressure lowering in intracerebral hemorrhage (ICH). MethodsRandomised controlled trials (RCTs) and quasi-RCTs about ICH patients receiving intensive blood pressure lowering were searched from PubMed, EMbase, SCIE, The Cochrane Library (Issue 2, 2013), CBM, CNKI, VIP and WanFang Data until March, 2014. Literature was screened according to the exclusion and inclusion criteria by two reviewers independently and meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. ResultsA total of 24 studies were included involving 6 299 patients, of which 10 were RCTs and 14 were quasi-RCTs. The results of meta-analysis showed that intensive blood pressure lowering was superior to guideline-recommended intervention in reducing 24-h hematoma expansion rates (OR=0.36, 95%CI 0.28 to 0.46, P < 0.05), 24-h hematoma expansion volume (MD=-3.71, 95%CI-4.15 to-3.28, P < 0.05) and perihematomal edema volume (MD=-1.09, 95%CI-1.92 to-0.22, P < 0.05). Meanwhile, intensive blood pressure lowering improved 21-d NIHSS score (MD=-3.44, 95%CI-5.02 to-1.87, P < 0.05). But there was no significant difference in mortality and adverse reaction between the two groups. ConclusionCurrent evidence shows that intensive blood pressure lowering could reduce hematoma expansion volume and perihematomal edema volume, which is beneficial to recovery of neurological function, but ICH patients' long-term prognosis needs to be further studied. Due to the limited quantity and quality of the included studies, high quality studies are needed to verify the above conclusion.
ObjectiveTo compare home blood pressure monitoring (HBPM) versus ambulatory blood pressure monitoring (ABPM) versus office blood pressure monitoring (OBPM) in diagnosis and management of hypertension, and to find the optimal blood pressure measurement and management.MethodsThe following were compared among three BP monitoring, such as cost-effectiveness, prognostic value of target organ damage (TOD), predictive value of the progress in chronic kidney disease (CKD) and blood pressure variety (BPV). ResultsCompared to OBPM, ABPM was the most cost-effective method in the primary diagnosis of hypertension, but HBPM was the optimal method in long-term and self-management in hypertension. In hypertensives, compared to OBPM, HBPM and ABPM, especially HBPM, had a stronger predictive value for cardiovascular events, stroke, end-stage renal dysfunction (ESRD) and all-cause mortality. In hypertensives with renal dysfunction, controlling HBPM and ABPM, especially controlling ABPM, was an effective way to slow the progress in renal dysfunction, to decrease cardiovascular events, and to decrease the need of dialysis. All BPV derived from OBPM, ABPM and HBPM had a predictive significance of cardiovascular events, and HBPM BPV performed the best.ConclusionCompared to OBPM, ABPM is the best method in primary diagnosis of hypertension and BP control in CKD patients, while HBPM is the best method in predicting and in evaluating BPV, as well as in long-term and self-management in hypertension.
Objective To analyze the influencing factors of prognosis of patients with traumatic brain injury (TBI), and explore the influence of hemoglobin (Hb) level combined with blood pressure variability (BPV) on the quality of prognosis of patients with TBI. Methods The data of 186 TBI patients who received systemic treatment in the Affiliated Zhangjiagang Hospital of Soochow University between January 2020 and December 2021 were retrospectively analyzed. According to the Glasgow Outcome Scale (GOS) 3 months after treatment, they were divided into group A (GOS 4-5, 159 cases) and group B (GOS 1-3, 27 cases). The general clinical data, BPV indexes and Hb levels of the two groups were analyzed by single factor analysis and multiple logistic regression analysis, and the predictive value of the logistic regression model was evaluated by receiver operating characteristic (ROC) curve, sensitivity, specificity and area under the curve (AUC). Results There was no statistical significance in gender, age, body mass index, blood urea nitrogen, prothrombin time, fasting blood glucose level, or smoking history (P>0.05); the patients’ Glasgow Coma Scale at admission in group A was higher than that in group B (P<0.05), and the constituent ratio with a history of hypertension of group A was significantly lower than that of group B (P<0.05). The between-group differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and Hb at admission, and SBP, DBP, and MAP 72 h after treatment were not statistically significant (P>0.05); the SBP-standard deviation (SD), DBP-SD, SPB-coefficient of variation (CV) and DBP-CV of group B 72 h after treatment were significantly higher than those of group A (P<0.05), and the level of Hb was significantly lower than that of group A (P<0.05). Hb [odds ratio (OR)=0.787, 95% confidence interval (CI) (0.633, 0.978), P=0.031], SBP-CV [OR=1.756, 95%CI (1.073, 2.880), P=0.023] and DBP-CV [OR=1.717, 95%CI (1.107, 2.665), P=0.016] were all independent prognostic factors of TBI patients. The ROC showed that the combined index of BPV and Hb was more valuable than that of single prediction, with an AUC of 0.896 [95%CI (0.825, 0.935), P<0.05]. Conclusions Both BPV and Hb are independent factors affecting the prognosis of TBI patients, and their combined application can more effectively predict the prognosis of TBI patients. Therefore, when treating and evaluating the prognosis of TBI patients, closely monitoring the changes in blood pressure and Hb levels can timely and effectively control the development of the disease, and provide scientific reference for subsequent treatment.
【Abstract】 Objective To study the effects of obstructive sleep apnea hypopnea syndrome ( OSAHS) on blood pressure variations, and explore the possible mechanism. Methods 84 adult patients ( mean age 50. 1 ±14. 8 years, male /female 67 /17) were recruited for polysomnography ( PSG) and ambulatory blood pressure monitoring. Four groups were identified based on apnea hyponea index ( AHI) ,ie. non-OSAHS group ( n=9) ,mild group ( n=19) , moderate group ( n=23) , and severe group ( n =33) .The blood pressure levels were compared among the four groups. Correlations between PSG indexes,variations of systolic blood pressure ( SBP) and diastolic blood pressure ( DBP) were analyzed. Results Inter-group blood pressure comparison showed significant differences in SBP and DBP( P lt;0. 05) , except forthe mild and the moderate OSAHS patients. As compared with the non-OSAHS patients, SBP for those with severe OSAHS was about 15 mm Hg higher, and DBP 10 mm Hg higher. Observation on SBP non-dipping rate indicated that, except for the mild and the moderate OSAHS patients where no significant differences were found, SBP non-dipping rate increased with the severity of OSAHS( the rates were 78. 3%, 57. 1% ,54. 5%, and 32. 6% , respectively for the four groups) , whereas DBP non-dipping rate significantly increased in the severe OSAHS patients( 54. 3% ) ( P lt;0. 05) . For the mild OSAHS patients, blood pressure was found to be correlated positively with the body mass index ( correlation coefficient for day time SBP was 0. 26, and for DBP was 0. 22) , the arousal index ( correlation coefficient for day time SBP was 0. 25, and for DBP was 0. 17) , and heart rate variation ( correlation coefficient for night time SBP was 0. 18, and for DBP was 0. 17) . For the moderate OSAHS patients, a positive correlation was also found between blood pressure and AHI ( correlation coefficient for day time SBP was 0. 31, and for DBP was 0. 22, correlation coefficient fornight time SBP was 0. 26) , and between blood pressure and the longest hypopnea time during sleep ( LH) ( correlation coefficient for night time DBP was 0. 2) . For the severe OSAHS patients, blood pressure was correlated positively with apnea index ( AI) ( correlation coefficient for day time SBP was 0. 61, and for DBP was 0. 5, correlation coefficient for night time SBP was 0. 57 and for night time DBP was 0. 48) . Conclusions OSAHS has ber impact on SBP than on DBP. DBP hypertension and SBP non-dipping are usually found in early OSAHS-affected patients. Factors affecting blood pressure differ with the severity of the OSAHS.
摘要:目的：研究成都地区中老年人群体重指数(BMI)与高血压患病率及血压水平的关系。方法:按照随机抽样的方法抽取样本,对711人(平均年龄为63.28±6.25岁;男性占57.8%)进行了相关调查,调查内容中包括身高、体重、血压及脉搏等。结果:成都地区中老年人群的超重及肥胖所占比重较大(约45%),按BMI分组(lt;18.5 kg/m2,18.5~23.9 kg/m2,24~27.9 kg/m2,≥28.0 kg/m2)的高血压患病率分别是31.6%,54.8%,64.4%,82.8%,差异有统计学意义。采用logistic回归分析发现在调整年龄、性别、腰围及尿酸等后,BMI对高血压的患病率有独立影响。在整个人群及女性病人中,血压随着BMI的升高而有升高的趋势,差异有统计学意义。结论:成都地区中老年人群超重及肥胖所占比重较大。BMI可以影响高血压的患病率及影响女性病人的血压水平,是高血压的独立危险因素。Abstract: Objective: To investigate the effects of body mass index on prevalence of hypertension and blood pressure in the elderly. MethodsA survey, including height, weight, blood pressure and pulse, was carried out in a general population of Chengdu. A total of 711 subjects (average age: 63.28±6.25 years; male: 57.8%) were recruited by random sampling method. Results：The proportion of overweight and obesity was about 45%. The hypertension prevalence rate was significantly positively correlated with BMI (Plt;0.01), and that was also seen in the level of SBP and DBP for the female (Plt;0.05). In logistic regression analysis adjusting for age, gender, waist, uric acid, the standardized OR for higher BMI (≥28.0 kg/m2) as a risk factor of hypertension was 5.140. Conclusion：The proportion of overweight and obesity was great in Chengdu area. BMI can affect the prevalence rate of hypertension and the level of blood pressure.
Sleep apnea causes cardiac arrest, sleep rhythm disorders, nocturnal hypoxia and abnormal blood pressure fluctuations in patients, which eventually lead to nocturnal target organ damage in hypertensive patients. The incidence of obstructive sleep apnea hypopnea syndrome (OSAHS) is extremely high, which seriously affects the physical and mental health of patients. This study attempts to extract features associated with OSAHS from 24-hour ambulatory blood pressure data and identify OSAHS by machine learning models for the differential diagnosis of this disease. The study data were obtained from ambulatory blood pressure examination data of 339 patients collected in outpatient clinics of the Chinese PLA General Hospital from December 2018 to December 2019, including 115 patients with OSAHS diagnosed by polysomnography (PSG) and 224 patients with non-OSAHS. Based on the characteristics of clinical changes of blood pressure in OSAHS patients, feature extraction rules were defined and algorithms were developed to extract features, while logistic regression and lightGBM models were then used to classify and predict the disease. The results showed that the identification accuracy of the lightGBM model trained in this study was 80.0%, precision was 82.9%, recall was 72.5%, and the area under the working characteristic curve (AUC) of the subjects was 0.906. The defined ambulatory blood pressure features could be effectively used for identifying OSAHS. This study provides a new idea and method for OSAHS screening.
ObjectiveTo investigate the significance of using the term "high-normal blood pressure" and its intervention in the early stage. MethodsIn 1992 and 2007, we performed two similar investigations focusing on cardiovascular risk factors in 711 people in Chengdu city. Since 114 individuals were diagnosed with hypertension, 597 people without hypertension were eligible and divided into two groups:the normal-pressure[<120/80 mm Hg (1 mm Hg=0.133 kPa)] group and the high-normal blood pressure (systolic blood pressure 120-139 mm Hg and/or diastolic blood pressure 80-89 mm Hg) group. Data in the two investigations were compared to explore the relationship among high-normal blood pressure, cardiovascular disease (CVD) and hypertension. ResultsThe high-normal blood pressure group had a higher level of CVD risk factors both in 1992 and 2007, and the 15-year cumulative incidence of hypertension in the high-normal blood pressure group was higher than that of normal-pressure group (91.2% vs. 22.2%, P<0.001). After adjusting for serum lipid, body weight and other CVD risk factors, high-normal blood pressure could predict the progression into hypertension[HR=5.354, 95% CI (4.094, 7.002), P=0.001]. There was no statistics difference in CVD prevalence in the two groups in 1992, but in 2007 the prevalence of CVD tended to be higher in the high-normal blood pressure group (6.6% vs. 3.1%, P=0.052). ConclusionHigh-normal blood pressure is a special stage of blood pressure with high level of CVD risk factors and high potential to progress into hypertension. The term should be emphasized and intervention should be done in the early stage for high-normal blood pressure people to prevent from hypertension and CVD.
To investigate the effect of stepwise paced breathing (PB) on pulse transit time (PTT), we collected physiological signals of electrocardiogram (ECG), respiration and arterial pulse wave during a procedure of stepwise PB, which consists of 6 different breathing rates changing in a protocol of 14.0-12.5-11.0-9.5-8.0-7.0 breath per minute (BPM), with each breathing rate lasting 3 minutes. Twenty two healthy adults involved in this experiment and the change of PTT was analyzed during the stepwise PB procedure. In our study, the PTT was measured by calculating the time interval from the R-spike of the ECG to the peaks of the second derivative of the arterial pulse wave. Ensemble empirical mode decomposition (EEMD) was applied to PTT to decompose the signal into different intrinsic mode function, and respiratory oscillation and trend component (baseline) in PTT were further extracted. It was found that the respiratory oscillations in the PTT increased with decreasing of the PB rate, and many of the subjects (14 out of 22) showed the phenomena of PTT baseline increasing during the stepwise PB procedure. The results indicated that the stepwise PB procedure induced a high level of cardiovascular oscillation and produced an accumulative effect of PTT baseline increase. As PTT is capable of predicting changes in BP over a short period of time, increase of PTT baseline indicates the decrease of blood pressure. The experiments showed that the stepwise PB procedure could reduce blood pressure for most subjects. For future work, it is necessary to develop certain indices differentiating the effectiveness of the stepwise PB procedure on the PTT baseline change, and to test the effectiveness of this stepwise PB procedure on blood pressure reduction for patients with essential hypertension.
摘要:目的: 观察腰硬联合麻醉在前列腺电切术患者中的临床应用效果。 方法 : 76例经尿道前列腺电切术患者(78±7岁)随机均分为腰硬联合麻醉组(C组)及硬膜外组(E组)。C组以腰硬联合穿刺针于L34穿刺至蛛网膜下腔后,注入05%布比卡因2 mL,通过硬膜外穿刺针置入硬膜外导管;E组行L34间隙硬膜外穿刺置管。记录麻醉起效时间、麻醉效果、麻醉前及麻醉后5、15、30分钟时血压、心率。 结果 : 所有患者均穿刺顺利,麻醉起效时间C组为36±13 min, E组68±15 min;C组麻醉效果完善率为100%,E组为95%;麻醉后两组血压均下降(〖WTBX〗P lt;005),但降幅均未超过基础值的20%;两组麻醉前及麻醉后血压、心率均无显著性差异。 结论 :腰硬联合麻醉用于前列腺电切术具有起效快、麻醉效果佳的优点。Abstract: Objective: To investigate and compare the clinical efficacy and safety of combined spinalepidural(CSEA) and epidural(EA) anesthesia on elderly patients undergoing transurethral resection of the prostate(TURP). Methods : 76 patients(78±7 years) suffering TURP were divided into two group: group CSEA(38cases) and groupEA(38 cases). The dose of bupivacaine in spinal anesthesia is 10 mg. Blood pressure(BP), heart rate(HR) and anesthesia efficacy were observed before anesthesia, 5, 15 and 30min after anesthesia. Results : BP decreased after anesthesia in two groups than before anesthesia(〖WTBX〗P lt;005). The decreases of BP were less than 20% of basises. There were no significant differents of BP and HR between two groups before and after anesthesia. Conclusion :CSEA with bupivacaine 10 mg is safe and efficient in elderly undergoing TURP.