原发性高血压合并急性脑卒中患者心电图的改变临床分析
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摘要
目的分析原发性高血压合并急性脑卒中患者心电图改变的临床特点。方法搜集2015-03—2016-02原发性高血压患者156例,依据其是否合并急性脑卒中分为脑卒中组80例和对照组76例,2组患者均进行心电图检查,分析心电图异常检出率情况。结果脑卒中组心电图异常率(81.3%)高于对照组(52.6%),且不同心电图异常类型高于对照组(P<0.05)。80例高血压合并脑卒中患者中,不同类型、不同部位、不同预后脑卒中患者,其异常心电图检出率差异有统计学意义(P<0.05)。结论原发性高血压并发急性脑卒中患者中具有较高的心电图异常率,心电图异常率与脑卒中的类型及部位有关,且能够预测患者的预后。
Objective To analyze the clinical features of ECG changes in patients with essential hypertension and acute stroke.Methods A total of 156 patients with essential hypertension from March 2015 to February 2016 were enrolled.According to whether they had acute stroke,80 patients were divided into stroke group and 76 patients in control group.Both groups underwent electrocardiogram examination and analyzed abnormal electrocardiogram.Results The abnormal rate of electrocardiogram in the stroke group(81.3%) was higher than that in the control group(52.6%),and the abnormal type of ECG was higher than that in the control group(P<0.05).Among the 80 patients with hypertension and stroke,the abnormal electrocardiogram detection rate of patients with different types,different parts and different prognosis strokes was statistically significant(P<0.05).Conclusion There is a high rate of abnormal ECG in patients with acute hypertension complicated with acute stroke.The abnormal rate of ECG is related to the type and location of stroke,and can predict the prognosis of patients.
Objective To analyze the clinical features of ECG changes in patients with essential hypertension and acute stroke.Methods A total of 156 patients with essential hypertension from March 2015 to February 2016 were enrolled.According to whether they had acute stroke,80 patients were divided into stroke group and 76 patients in control group.Both groups underwent electrocardiogram examination and analyzed abnormal electrocardiogram.Results The abnormal rate of electrocardiogram in the stroke group(81.3%) was higher than that in the control group(52.6%),and the abnormal type of ECG was higher than that in the control group(P<0.05).Among the 80 patients with hypertension and stroke,the abnormal electrocardiogram detection rate of patients with different types,different parts and different prognosis strokes was statistically significant(P<0.05).Conclusion There is a high rate of abnormal ECG in patients with acute hypertension complicated with acute stroke.The abnormal rate of ECG is related to the type and location of stroke,and can predict the prognosis of patients.
引文
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[3] 胡华琴,张梅,杨倩.心电图 Cornell 电压对原发性高血压患者左室肥厚的评估价值及与心血管事件的相关性[J].海南医学院学报,2016,22(16):1 778-1 781.
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[14] 邓小勇.急性缺血性脑卒中与高血压颈动脉斑块的相关性[J].数理医药学杂志,2018,31(12):1 774-1 775.
[15] 陈孝红,周涛,马润,等.Lp-PLA2与H型高血压缺血性脑卒中的相关性研究[J].国际检验医学杂志,2018,39(13):1 615-1 618;1 621.
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[18] 许海华.原发性高血压并发缺血性脑卒中与颈动脉粥样硬化的关系分析[J].川北医学院学报,2017,32(5):785-787.
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[21] DOMIN H,PRZYKAZA ?,KOZNIEWSKA E,et al.Neuroprotective effect of the group III mGlu receptor agonist ACPT-I afterischemic stroke in rats with essential hypertension[J].Prog Neuropsychopharmacol Biol Psychiatry,2018,84(Pt A):93-101.
[22] UITERWIJK R,STAALS J,HUIJTS M,et al.Framingham Stroke Risk Profile is related to cerebral small vessel disease progression and lower cognitive performance in patients with hypertension[J].J Clin Hypertens (Greenwich),2018,20(2):240-245.
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[25] O'COLLINS V E,DONNAN G A,MACLEOD M R,et al.Hypertension and experimental stroke therapies[J].J Cereb Blood Flow Metab,2013,33(8):1 141-1 147.DOI:10.1038/jcbfm.2013.88.
[26] 虞晓武,易兴阳,颜志钦,等.高血压伴脑梗死急性期患者的动态血压与动态心电图同步监测及临床意义[J].中国现代医生,2012,50(25):47-49.
[27] JI L D,HU S P,LI J Y,et al.Shared genetic etiology of hypertension and stroke:evidence from bioinformatics analysis of genome-wide association studies[J].J Hum Hypertens,2017,32(1):34-39.
[28] 王纯,梁雨露.高血压患者颈动脉斑块和急性缺血性脑卒中的相关性[J].贵阳医学院学报,2014,39(1):80-83.
[29] 孙辉平.急性脑出血患者心电图分析[J].当代医学,2011,17(11):107-108.
[30] 张昆,于倩.不同部位急性脑梗死患者的心电图异常及其与病情分型的关系[J].临床和实验医学杂志,2016,15(7):645-647.
[31] 张茜.急性脑梗死患者不同脑梗死部位对心电图检测结果的影响[J].中国卫生产业,2014,29(28):140-141.
[32] 高伟,吴翔.老年原发性高血压合并缺血性卒中临床分析[J].现代医药卫生,2015(17):2 634-2 635.
[33] KOJIMA S,KOJIMA S,HIFUMI A,et al.Therapeutic strategy for efficient reduction of serum uric acid levels with allopurinol versus benzbromarone in hyperuri-cemic patients with essential hypertension - A randomized crossover study (terao study)[J].Int J Cardiol,2016,224:437-439.
[34] LI T,ZHU J,FANG Q,et al.Association of H-Type Hypertension with Stroke Severity and Prognosis[J].Biomed Res Int,2018:8 725 908.DOI:10.1155/2018/8725908.
[35] APPIAH K O,MINHAS J S,ROBINSON T G.Managing high blood pressure during acute ischemic stroke and intracerebral hemorrhage[J].Curr Opin Neurol,2018,31(1):8-13.DOI:10.1097/WCO.0000000000000508.
[36] MA?ER B,GORY B,TAYLOR G,et al.Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy:A Collaborative Pooled Analysis[J].J Am Heart Assoc,2017,6(10).pii:e006484.DOI:10.1161/JAHA.117.006484.
[37] HAN T S,WANG H H,WEI L,et al.Impacts of undetected and inadequately treated hypertension on incident stroke in China[J].BMJ Open,2017,7(10):e016581.DOI:10.1136/bmjopen-2017-016581.
[38] B?SEL J.Blood pressure control for acute severe ischemic and hemorrhagic stroke[J].Curr Opin Crit Care,2017,23(2):81-86.DOI:10.1097/MCC.0000000000000394.
[39] OLIVEIRA G M M,MENDES M,MALACHIAS M V B,et al.2017 Guidelines for the management of arterial hypertension in primary health care in Portuguese-speaking countries[J].Rev Port Cardiol,2017,36(11):789-798.
[40] CHI X,LI M,ZHAN X,et al.Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients[J].Comput Biol Med,2018,92:73-77.
[41] KANAR B,OZBEN B,KANAR H S,et al.Left atrial volume changes are an early marker of end-organ damage in essential hypertension:A multidisciplinary approach to an old problem[J].Echocardiography,2017,34(12):1 895-1 902.
[42] TSOI B,AKIOYAMEN LE,BONNER A,et al.Comparative Efficacy of Angiotensin II Antagonists in Essential Hypertension:Systematic Review and Network Meta-Analysis of Randomised Controlled Trials[J].Heart Lung Circ,2018,27(6):666-682.
[43] LAI C L,XING J P,LIU X H,et al.Relationships of Inflammatory Factors and Risk Factors with Different Target Organ Damage in Essential Hypertension Patients[J].Chin Med J (Engl),2017,130(11):1 296-1 302.
[44] DIXON K B,DAVIES S S,KIRABO A.Dendritic cells and isolevuglandins in immunity,inflammation,and hypertension[J].Am J Physiol Heart Circ Physiol,2017 ,312(3):H368-H374.
[45] 张艺,张霞,周建千.超声心动图对原发性高血压心脏病的诊断价值研究[J].影像研究与医学应用,2018,2(4):67-68.
[46] GUZIK A,BUSHNELL C.Stroke Epidemiology and Risk Factor Management[J].Continuum (Minneap Minn),2017,23(1,Cerebrovascular Disease):15-39.DOI:10.1212/CON.0000000000000416.
[47] CRUICKSHANK J M.The Role of Beta-Blockers in the Treatment of Hypertension[J].Adv Exp Med Biol,2017,956:149-166.
[48] HAMRAHIAN S M,FALKNER B.Hypertension in Chronic Kidney Disease[J].Adv Exp Med Bio,2017,956:307-325.
[49] KUPFERMAN J C,ZAFEIRIOU D I,LANDE M B,et al.Stroke and Hypertension in Children and Adolescents[J].J Child Neurol,2017,32(4):408-417.DOI:10.1177/0883073816685240.
[50] ERGUL A,HAFEZ S,FOUDA A,et al.Impact of Comorbidities on Acute Injury and Recovery in Preclinical Stroke Research:Focus on Hypertension and Diabetes[J].Transl Stroke Res,2016,7(4):248-260.DOI:10.1007/s12975-016-0464-8.
[51] WILLEY J Z,BOEHME A K,CASTAGNA F,et al.Hypertension and Stroke in Patients with Left Ventricular Assist Devices (LVADs)[J].Curr Hypertens Rep,2016,18(2):12.DOI:10.1007/s11906-015-0618-1.
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[2] 陈松涛.蒙古族人群原发性高血压晨峰现象与脑卒中筛查的研究分析[J].西部中医药,2013,26(7):56-57.
[3] 胡华琴,张梅,杨倩.心电图 Cornell 电压对原发性高血压患者左室肥厚的评估价值及与心血管事件的相关性[J].海南医学院学报,2016,22(16):1 778-1 781.
[4] 闫福堂,于建平,袁军,等.血清同型半胱氨酸与原发性高血压的关系研究[J].现代检验医学杂志,2013,28(5):50-52.
[5] PAN Y,WANG T,LI Y,et al.Association of ACE2 polymorphisms with susceptibility to essential hypertension and dyslipidemia in Xinjiang,China[J].Lipids Health Dis,2018,17(1):241.
[6] BOLIN L P,HORNE C E,CRANE P B,et al.Low-salt diet adherence in African Americans with hypertension[J].J Clin Nurs,2018,27(19/20):3 750-3 757.
[7] ZHANG J,LIU L,SUN H,et al.Cerebral Microbleeds Are Associated With Mild Cognitive Impairment in Patients With Hypertension[J].J Am Heart Assoc,2018,7(11).pii:e008453.
[8] TSARTSALIS D,DRAGIOTI E,KONTOANGELOS K,et al.The impact of depression and cardiophobia on quality of life in patients with essential hypertension[J].Psychiatriki,2016,27(3):192-203.
[9] PAULOSE-RAM R,GU Q,KIT B.Characteristics of U.S.Adults With Hypertension Who Are Unaware of Their Hypertension,2011-2014[J].NCHS Data Brief,2017(278):1-8.
[10] KULCHAITANAROAJ P,BROOKS J M,CHAIYAKUNAPRUK N,et al.Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with usual care[J].J Hypertens,2017,35(1):178-187.
[11] APOSTOLOVA M H,SEAMAN C D,COMER D M,et al.Prevalence and Risk Factors Associated With Hypertension in von Wille brand Disease[J].Clin Appl Thromb Hemost,2018,24(1):93-99.
[12] HAO C,KANG C,XUE J,et al.Effects of blood pressure and sex on heart-vessel coupling in essential hypertension[J].Turk J Med Sci,2016,46(3):680-685.
[13] 何桂霞.临床护理路径在急性脑卒中患者康复护理中的应用[J].中国实用神经疾病杂志,2013,16(11):105-106.
[14] 邓小勇.急性缺血性脑卒中与高血压颈动脉斑块的相关性[J].数理医药学杂志,2018,31(12):1 774-1 775.
[15] 陈孝红,周涛,马润,等.Lp-PLA2与H型高血压缺血性脑卒中的相关性研究[J].国际检验医学杂志,2018,39(13):1 615-1 618;1 621.
[16] 靳彤.原发性高血压病因、危险因素与治疗研究进展[J].继续医学教育,2017,31(10):105-107.
[17] 易月婵,李勤,徐宁,等.原发性高血压并发缺血性脑卒中与颈动脉粥样硬化的关系研究[J].中国实用神经疾病杂志,2016,19(2):43-44.
[18] 许海华.原发性高血压并发缺血性脑卒中与颈动脉粥样硬化的关系分析[J].川北医学院学报,2017,32(5):785-787.
[19] 阮萍,蔡丽芹.高血压并发急性脑卒中患者心电图的变化临床分析[J].中国实用神经疾病杂志,2015,18(19):40-41.
[20] BANJANIN N,BELOJEVIC G.Changes of Blood Pressure and Hemodynamic Parameters after Oral Magnesium Supplementation in Patients with Essential Hypertension-An Intervention Study[J].Nutrients,2018,10(5).pii:E581.
[21] DOMIN H,PRZYKAZA ?,KOZNIEWSKA E,et al.Neuroprotective effect of the group III mGlu receptor agonist ACPT-I afterischemic stroke in rats with essential hypertension[J].Prog Neuropsychopharmacol Biol Psychiatry,2018,84(Pt A):93-101.
[22] UITERWIJK R,STAALS J,HUIJTS M,et al.Framingham Stroke Risk Profile is related to cerebral small vessel disease progression and lower cognitive performance in patients with hypertension[J].J Clin Hypertens (Greenwich),2018,20(2):240-245.
[23] DI RAIMONDO D.Editorial:Management of Elevated Heart Rate in Essential Hypertension:Pathophysiol-ogical Insights and Therapeutic Approach[J].Curr Pharm Des,2017 23(31):4 571-4 572.
[24] FARACO G,IADECOLA C.Hypertension:a harbinger of stroke and dementia[J].Hypertension,2013,62(5):810-817.DOI:10.1161/HYPERTENSIONAHA.113.01063.
[25] O'COLLINS V E,DONNAN G A,MACLEOD M R,et al.Hypertension and experimental stroke therapies[J].J Cereb Blood Flow Metab,2013,33(8):1 141-1 147.DOI:10.1038/jcbfm.2013.88.
[26] 虞晓武,易兴阳,颜志钦,等.高血压伴脑梗死急性期患者的动态血压与动态心电图同步监测及临床意义[J].中国现代医生,2012,50(25):47-49.
[27] JI L D,HU S P,LI J Y,et al.Shared genetic etiology of hypertension and stroke:evidence from bioinformatics analysis of genome-wide association studies[J].J Hum Hypertens,2017,32(1):34-39.
[28] 王纯,梁雨露.高血压患者颈动脉斑块和急性缺血性脑卒中的相关性[J].贵阳医学院学报,2014,39(1):80-83.
[29] 孙辉平.急性脑出血患者心电图分析[J].当代医学,2011,17(11):107-108.
[30] 张昆,于倩.不同部位急性脑梗死患者的心电图异常及其与病情分型的关系[J].临床和实验医学杂志,2016,15(7):645-647.
[31] 张茜.急性脑梗死患者不同脑梗死部位对心电图检测结果的影响[J].中国卫生产业,2014,29(28):140-141.
[32] 高伟,吴翔.老年原发性高血压合并缺血性卒中临床分析[J].现代医药卫生,2015(17):2 634-2 635.
[33] KOJIMA S,KOJIMA S,HIFUMI A,et al.Therapeutic strategy for efficient reduction of serum uric acid levels with allopurinol versus benzbromarone in hyperuri-cemic patients with essential hypertension - A randomized crossover study (terao study)[J].Int J Cardiol,2016,224:437-439.
[34] LI T,ZHU J,FANG Q,et al.Association of H-Type Hypertension with Stroke Severity and Prognosis[J].Biomed Res Int,2018:8 725 908.DOI:10.1155/2018/8725908.
[35] APPIAH K O,MINHAS J S,ROBINSON T G.Managing high blood pressure during acute ischemic stroke and intracerebral hemorrhage[J].Curr Opin Neurol,2018,31(1):8-13.DOI:10.1097/WCO.0000000000000508.
[36] MA?ER B,GORY B,TAYLOR G,et al.Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy:A Collaborative Pooled Analysis[J].J Am Heart Assoc,2017,6(10).pii:e006484.DOI:10.1161/JAHA.117.006484.
[37] HAN T S,WANG H H,WEI L,et al.Impacts of undetected and inadequately treated hypertension on incident stroke in China[J].BMJ Open,2017,7(10):e016581.DOI:10.1136/bmjopen-2017-016581.
[38] B?SEL J.Blood pressure control for acute severe ischemic and hemorrhagic stroke[J].Curr Opin Crit Care,2017,23(2):81-86.DOI:10.1097/MCC.0000000000000394.
[39] OLIVEIRA G M M,MENDES M,MALACHIAS M V B,et al.2017 Guidelines for the management of arterial hypertension in primary health care in Portuguese-speaking countries[J].Rev Port Cardiol,2017,36(11):789-798.
[40] CHI X,LI M,ZHAN X,et al.Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients[J].Comput Biol Med,2018,92:73-77.
[41] KANAR B,OZBEN B,KANAR H S,et al.Left atrial volume changes are an early marker of end-organ damage in essential hypertension:A multidisciplinary approach to an old problem[J].Echocardiography,2017,34(12):1 895-1 902.
[42] TSOI B,AKIOYAMEN LE,BONNER A,et al.Comparative Efficacy of Angiotensin II Antagonists in Essential Hypertension:Systematic Review and Network Meta-Analysis of Randomised Controlled Trials[J].Heart Lung Circ,2018,27(6):666-682.
[43] LAI C L,XING J P,LIU X H,et al.Relationships of Inflammatory Factors and Risk Factors with Different Target Organ Damage in Essential Hypertension Patients[J].Chin Med J (Engl),2017,130(11):1 296-1 302.
[44] DIXON K B,DAVIES S S,KIRABO A.Dendritic cells and isolevuglandins in immunity,inflammation,and hypertension[J].Am J Physiol Heart Circ Physiol,2017 ,312(3):H368-H374.
[45] 张艺,张霞,周建千.超声心动图对原发性高血压心脏病的诊断价值研究[J].影像研究与医学应用,2018,2(4):67-68.
[46] GUZIK A,BUSHNELL C.Stroke Epidemiology and Risk Factor Management[J].Continuum (Minneap Minn),2017,23(1,Cerebrovascular Disease):15-39.DOI:10.1212/CON.0000000000000416.
[47] CRUICKSHANK J M.The Role of Beta-Blockers in the Treatment of Hypertension[J].Adv Exp Med Biol,2017,956:149-166.
[48] HAMRAHIAN S M,FALKNER B.Hypertension in Chronic Kidney Disease[J].Adv Exp Med Bio,2017,956:307-325.
[49] KUPFERMAN J C,ZAFEIRIOU D I,LANDE M B,et al.Stroke and Hypertension in Children and Adolescents[J].J Child Neurol,2017,32(4):408-417.DOI:10.1177/0883073816685240.
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