Stanford B型主动脉夹层血压节律异常的危险因素分析
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摘要
目的探讨Stanford B型主动脉夹层患者发生血压节律异常的危险因素。方法通过对2016年1月至2018年6月两年间在本院接受治疗的Stanford B型主动脉夹层的204例病例进行分析,根据住院期间患者血压节律的情况,将其分为正常血压节律组和异常血压节律组,其中正常血压节律组127例,异常血压节律组77例,对比两组患者一般资料、动态血压监测结果、合并内科疾病情况和使用药物情况的相关因素,并利用logistics多因素回归分析法对影响Stanford B型主动脉夹层患者血压节律的因素进行分析。结果两组研究对象在动态血压监测结果 {夜间平均收缩压[(112. 90±10. 00)mm Hg vs (128. 15±15. 20) mm Hg]、夜间平均舒张压[(66. 40±7. 91) mm Hg vs(76. 10±7. 97)mm Hg]}、合并内科疾病(高血脂、肾功能衰竭、呼吸睡眠暂停综合征)、是否吸烟及使用相关药物(镇痛药物、助眠药物及静脉泵入降压药物)等方面差异有统计学意义(P <0. 05);多因素logistic回归分析结果显示,合并呼吸睡眠暂停综合征和肾功能衰竭是Stanford B型主动脉夹层患者发生异常血压节律的独立危险因素,而使用镇痛药物、助眠药物、静脉泵入药物为保护因素。结论Stanford B型主动脉夹层患者发生血压节律异常的危险因素是合并肾功能衰竭和呼吸睡眠暂停综合征;保护因素是使用镇痛药物、助眠药物及静脉泵入降压药物。
Objective To investigate the risk factors of abnormal circadian rhythm of blood pressure in patients with Stanford type B aortic dissection. Methods Case information of 204 patients with Stanford type B aortic dissection admitted to vascular surgery department of the Second Xiangya hospital of Central South University from January 2016 to December 2018 were retrospectively analyzed. According to patients' blood pressure rhythm during hospitalization,patients were divided into normal blood pressure circadian rhythm group(127 cases) and abnormal blood pressure circadian rhythm group(77 cases). Demographic information,ambulatory blood pressure monitoring results,comorbilities and medication treatment of the two groups were compared by using multivariate logistics regression analysis. Results The difference of the ambulatory blood pressure monitoring results { average night systolic blood pressure [(112. 90 ± 10. 00)mm Hg vs(128. 15 ± 15. 20) mm Hg],average night diastolic blood pressure [(66. 40 ± 7. 91) mm Hg vs(76. 10 ± 7. 97) mm Hg]},comorbilities hyperlipidemia,renal failure,obstructive sleep apnea hypopnea syndrome,smoking and the medication treatment(analgesics,hypnotics and intravenous antihypertensive medicine) were statistically significant(P < 0. 05); multivariate logistic regression analysis showed that obstructive sleep apnea hypopnea syndrome and renal failure were independent risk factors of abnormal blood pressure rhythm in Stanford type B aortic dissection patients. While analgesics,hypnotics and intravenous antihypertensive medicine were protective factors. Conclusions The risk factors of abnormal circadian rhythm of blood pressure in patients with Stanford type B aortic dissection are renal failure and obstructive sleep apnea hypopnea syndrome. Protective factors were the usage of analgesics,hypnotics and intravenous antihypertensive medicine.
Objective To investigate the risk factors of abnormal circadian rhythm of blood pressure in patients with Stanford type B aortic dissection. Methods Case information of 204 patients with Stanford type B aortic dissection admitted to vascular surgery department of the Second Xiangya hospital of Central South University from January 2016 to December 2018 were retrospectively analyzed. According to patients' blood pressure rhythm during hospitalization,patients were divided into normal blood pressure circadian rhythm group(127 cases) and abnormal blood pressure circadian rhythm group(77 cases). Demographic information,ambulatory blood pressure monitoring results,comorbilities and medication treatment of the two groups were compared by using multivariate logistics regression analysis. Results The difference of the ambulatory blood pressure monitoring results { average night systolic blood pressure [(112. 90 ± 10. 00)mm Hg vs(128. 15 ± 15. 20) mm Hg],average night diastolic blood pressure [(66. 40 ± 7. 91) mm Hg vs(76. 10 ± 7. 97) mm Hg]},comorbilities hyperlipidemia,renal failure,obstructive sleep apnea hypopnea syndrome,smoking and the medication treatment(analgesics,hypnotics and intravenous antihypertensive medicine) were statistically significant(P < 0. 05); multivariate logistic regression analysis showed that obstructive sleep apnea hypopnea syndrome and renal failure were independent risk factors of abnormal blood pressure rhythm in Stanford type B aortic dissection patients. While analgesics,hypnotics and intravenous antihypertensive medicine were protective factors. Conclusions The risk factors of abnormal circadian rhythm of blood pressure in patients with Stanford type B aortic dissection are renal failure and obstructive sleep apnea hypopnea syndrome. Protective factors were the usage of analgesics,hypnotics and intravenous antihypertensive medicine.
引文
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[12]曾利,史忠,邓国兰,等.阻塞性睡眠呼吸暂停低通气综合征对原发性高血压患者心率变异和血压节律的影响[J].中华高血压杂志,2010,18(2):124-128.
[13]张倩,张丙芳.阻塞性睡眠呼吸暂停低通气综合征与高血压的相关分析[J].心脏杂志,2015,27(4):486-489.DOI:10.3191/j.chj.2015.0136.
[14]孟亚星,张小玲,严激.原发性高血压伴血脂异常患者的动态血压特点[J].中国临床保健杂志,2018,21(3):323-327.DOI:10.3969/J.issn.1672-6790.2018.03.010.
[15]郝鹏,朱玮玮,罗鸿宇,等.原发性高血压患者血脂水平与血压变异性的相关研究[J].四川医学,2015,36(5):628-631.DOI:10.16252/j.cnki.issn1004-0501-2015.05.013.
[16]王硕.血脂控制对原发性高血压患者血压变异性及冠脉事件的影响[J].湖南师范大学学报:医学版,2017,14(5):70-72.DOI:10.3969/j.issn.1673-016X.2017.05.021.
[17]Jian P,Jian-Guo X,Lei-Lei Y.Effect of intravenous analgesia with ketamine on stress response in patients with severe burn in acute stage[J].J Clin Anesth,2010,26(1):24-26.
[18]杨永鑫,任明.血压变异性及昼夜节律与肾素-血管紧张素-醛固酮系统[J].中国临床研究,2014,27(12):1553-1555.DOI:10.13429/j.cnki.cjcr.2014.12.044.
[19]MonosíkováJ,HerichováI,Mravec B,et al.Effect of upregulated renin-angiotensin system on per2 and bmal1 gene expression in brain structures involved in blood pressure control in TGR(mREN-2)27 rats[J].Brain Res,2007,1180:29-38.DOI:10.1016/j.brainres.2007.08.061.
[20]Sugawara M,Higashiuesato Y,Yamane N.Influence of sleep habit and nocturnal lifestyle on circadian rhythm of blood pressure among workers in Okinawa[J].Rinsho Byori,2012,60(11):1058-1064.
[21]舒畅,张文波.主动脉夹层的降压药物治疗[J].中国实用外科杂志,2011,31(12):1098-1099.
[2]Trimarchi S,Tolenaar JL,Tsai TT,et al.Influence of clinical presentation on the outcome of acute B aortic dissection:evidences from IRAD[J].J Cardiovasc Surg(Torino),2012,53(2):161-168.
[3]赵雪敏,李骊华.高血压导致主动脉夹层发病机制的研究进展[J].心血管病学进展,2018,39(6):937-940.DOI:10.16806/j.cnki.issn.1004-3934.2018.06.017.
[4]郭瑞珍.高血压患者昼夜节律变化规律与心脑血管事件的相关性[J].中国社区医师,2017,33(31):94,96.DOI:10.3969/j.issn.1007-614x.2017.31.58.
[5]Masera G,Fagard R,Narkiewicz K,et al.2013 ESH/ESC Guidelines for the management of arterial hypertension[J].Eur Heart J,2013,34(2):2159-2219.
[6]江金锋,邹文博,蔡文钦,等.正常血压者血压变异性与血压节律的相关性[J].中华高血压杂志,2017,25(10):950-955.
[7]Kordzadeh A,Askari A,Panayiotopoulos Y.Atmospheric pressure and infra-renal abdominal aortic aneurysm rupture:a single observational study and a comprehensive review of literature[J].Int JSurg,2013,11(6):458-462.DOI:10.1016/j.ijsu.2013.04.008.
[8]Raghavan ML,Vorp DA,Federle MP,et al.Wall stress distribution on three-dimensionally reconstructed models of human abdominal aortic aneurysm[J].J Vasc Surg,2000,31(4):760-769.DOI:10.1067/mva.2000.103971.
[9]Hermida RC,Ayala DE,Smolensky MH,et al.Chronotherapy improves blood pressure control and reduces vascular risk in CKD[J].Nat Rev Nephrol,2013,9(6):358-368.DOI:10.1038/nrneph.2013.79.
[10]Fukuda M,Mizuno M,Yamanaka T,et al.Patients with renal dysfunction require a longer duration until blood pressure dips during the night[J].Hypertension,2008,52(6):1155-1160.DOI:10.1161/HYPERTENSIONAHA.108.115329.
[11]王希,卢利菊,黄春春.高龄老年高血压患者血压昼夜节律及其影响因素分析[J].内科,2018,13(4):669-671,647.DOI:10.16121/j.cnki.cn45-1347/r.2018.04.42.
[12]曾利,史忠,邓国兰,等.阻塞性睡眠呼吸暂停低通气综合征对原发性高血压患者心率变异和血压节律的影响[J].中华高血压杂志,2010,18(2):124-128.
[13]张倩,张丙芳.阻塞性睡眠呼吸暂停低通气综合征与高血压的相关分析[J].心脏杂志,2015,27(4):486-489.DOI:10.3191/j.chj.2015.0136.
[14]孟亚星,张小玲,严激.原发性高血压伴血脂异常患者的动态血压特点[J].中国临床保健杂志,2018,21(3):323-327.DOI:10.3969/J.issn.1672-6790.2018.03.010.
[15]郝鹏,朱玮玮,罗鸿宇,等.原发性高血压患者血脂水平与血压变异性的相关研究[J].四川医学,2015,36(5):628-631.DOI:10.16252/j.cnki.issn1004-0501-2015.05.013.
[16]王硕.血脂控制对原发性高血压患者血压变异性及冠脉事件的影响[J].湖南师范大学学报:医学版,2017,14(5):70-72.DOI:10.3969/j.issn.1673-016X.2017.05.021.
[17]Jian P,Jian-Guo X,Lei-Lei Y.Effect of intravenous analgesia with ketamine on stress response in patients with severe burn in acute stage[J].J Clin Anesth,2010,26(1):24-26.
[18]杨永鑫,任明.血压变异性及昼夜节律与肾素-血管紧张素-醛固酮系统[J].中国临床研究,2014,27(12):1553-1555.DOI:10.13429/j.cnki.cjcr.2014.12.044.
[19]MonosíkováJ,HerichováI,Mravec B,et al.Effect of upregulated renin-angiotensin system on per2 and bmal1 gene expression in brain structures involved in blood pressure control in TGR(mREN-2)27 rats[J].Brain Res,2007,1180:29-38.DOI:10.1016/j.brainres.2007.08.061.
[20]Sugawara M,Higashiuesato Y,Yamane N.Influence of sleep habit and nocturnal lifestyle on circadian rhythm of blood pressure among workers in Okinawa[J].Rinsho Byori,2012,60(11):1058-1064.
[21]舒畅,张文波.主动脉夹层的降压药物治疗[J].中国实用外科杂志,2011,31(12):1098-1099.