中老年高血压病患者血流动力学变化的临床研究
|
摘要
目的:高血压治疗是心血管领域内重要的课题,也是当今的社会问题,其中以中老年人群为主体。虽然美国指南、欧洲指南相继出台,新的抗高血压药物不断研发,但是高血压的控制率仍较低。可能的原因之一为:即使是同一血压水平,血流动力学状态也可能不同。也即单纯依靠血压水平进行降压治疗并不能达到优化降压治疗的目的。因此本研究拟探索中老年高血压患者的血流动力学特点,从而有助于实现真正的个体化治疗。另外心搏量/脉压(SV/PP)作为评价血管弹性的指标已被提出数十年,但应用并不广泛,也没有太多的证据来证明其有效性,但是由无创血流动力学检测系统检测SV/PP操作简单,重复性强,本论文另外一个目的是评价无创血流动力学检测系统测得的SV/PP与另一血管弹性指标脉搏波速度(PWV)的相关性。
方法:收集2008年4月至2008年10月到山东大学齐鲁医院健康查体中心健康查体的中老年人群462名(男303名,女159名),根据美国预防、检测、评价和治疗高血压全国联合委员会第七次报告(U.S.prevention,detection,evaluation and treatment of hypertension seventh reportof the National Joint Committee,JNC-7)分为3组,高血压组(288例)、高血压前期组(89例)和正常对照组(85例)。高血压组包括正在治疗的高血压患者(血压控制达标或不达标)以及未接受治疗的患者(收缩压≥140 mm Hg(1 mm Hg=01133 kPa)和(或)舒张压≥90 mm Hg)。高血压前期组为血压120～130/80～89mmHg。所有经检查证实的继发性高血压均剔除。三组患者均接受SVR、SVRI、MAP、CO、CI、SV、SI、PEP、LVET、VI、STR和ACI等血流动力学指标检测(LIFEGARDⅡ型无创血流动力学监护系统,CAS,USA)以及脉搏波速度检测(Complior动脉脉搏波速度测定仪,Artech,France)。
结果:1.受检者的一般临床资料:三组患者之间的年龄、体重指数和心率无统计学差异。
2.三组间的血流动力学指标比较:SBP、PP、MAP、SRV和SRVI等指标三组之间两两比较均有统计学差异(P＜0.05),DBP、SV、ACI、LCWI、VI和LVET等指标在高血压组与高血压前期组之间无统计学差异,而高血压组与正常对照组、高血压前期组与正常对照组均有显著的统计学差异(P＜0.05)。TFC、PEP和STR等指标在三组之间无统计学差异。
3.SV/PP与颈-股PWV相关性分析,相关系数=-0.424(P＜0.001)。SV/PP与颈-桡PWV相关性分析,相关系数=-0.012(P=0.791)。SV/PP与颈-足背PWV相关性分析,相关系数=-0.251(P＜0.001)
结论:1.中老年高血压患者的血流动力学变化,主要表现为外周血管阻力的升高,心肌收缩力功能受到损害,心肌做功增多。敏感指标包括SVRI、SVR、ACI、LCWI、VI和LVET。应用胸阻抗法检测血流动力学经济、有效及实用,并能早期发现高血压前期患者的心功能损伤。
2.SV/PP可考虑作为一种评价动脉弹性尤其是是大动脉弹性的临床指标。
Objective
Treatment of Essential hypertension is one of the most important subjects in Cardiology,which is also an important society problem.Middle-aged and elderly people make the main body of EH patients.Though new EH guidelines of ACA and ESC were pubulished and new anti-EH drugs were developed,the control rate of EH is still not satisfying.The different dynamics states in different patients,even with same level of EH,may be one of the causes,which make the satisfying control of EH can not be available by controlo of EH only. So we conducted our study on the dynamics states in middle-aged and elderly patients.
SV/PP was developed decades ago to evaluate vessel Elasticity.But its use is very limited.And not much prove is available to show its efficacy.But it has the advantages of convenience and reproducibility.So we also coduct our study to study the correlation between SV/PP and PWV,another index to evaluate vessel elasticity.
Method
Four hundred and sixty two subjects were enrolled in healthy check-up clinic of Qilu Hospital of Shandong University from August 2008 to October 2008.Means age is 63 years(40～87years),Three groups were included:288 patients in essential hypertension group(EH group);89 subjects in high-normal blood pressure group(HNBP group) and 85 subjects in healthy control group (HC group).Each subject undertook SVR、SVRI、MAP、CO、CI、SV、SI、PEP、LVET、VI、STR and ACI hemodynamic examination and pulse wave velocity(PWV)test.Pearson Correlation Analysis was used to study the correlations with SPSS 11.5 Software.
Results
1.There were no statistical differences in mean age,sex ratio,body mass index and heart rate between three groups.
2.There are significantly differences in SBP、PP、MAP、SRV and SRVI(P＜0.05) between EH group and HNBP group,EH group and HC group,HNBP group and HC group.There are significantly difference in DBP、SV、ACI、LCWI、VI and LVET between EH group and HC group(P＜0.01),HNBP group and HC group(P＜0.05).There are no significant differences in TFC,PEP,STR between EH group and HNBP group,EH group and HC group,HNBP group and HC group(P＞0.05).
3.Negative correlation were detected between SV-to-PP ratio and CFPWV(r=-0.450,P＜0.001),SV-to-PP ratio and CDPWV(r=-0.284,P＜0.001),SV-to-PP ratio and CRPWV(r=-0.047,P=0.791).
Conclusions
1.There are hemodynamics abnormities,especially increased peripheral vascular resistance and increased cardiac performance,in EH and HNBP patients.
2.SV-to-PP ratio can be used as a potential indicator to evaluate Arterial Elasticity.
方法:收集2008年4月至2008年10月到山东大学齐鲁医院健康查体中心健康查体的中老年人群462名(男303名,女159名),根据美国预防、检测、评价和治疗高血压全国联合委员会第七次报告(U.S.prevention,detection,evaluation and treatment of hypertension seventh reportof the National Joint Committee,JNC-7)分为3组,高血压组(288例)、高血压前期组(89例)和正常对照组(85例)。高血压组包括正在治疗的高血压患者(血压控制达标或不达标)以及未接受治疗的患者(收缩压≥140 mm Hg(1 mm Hg=01133 kPa)和(或)舒张压≥90 mm Hg)。高血压前期组为血压120～130/80～89mmHg。所有经检查证实的继发性高血压均剔除。三组患者均接受SVR、SVRI、MAP、CO、CI、SV、SI、PEP、LVET、VI、STR和ACI等血流动力学指标检测(LIFEGARDⅡ型无创血流动力学监护系统,CAS,USA)以及脉搏波速度检测(Complior动脉脉搏波速度测定仪,Artech,France)。
结果:1.受检者的一般临床资料:三组患者之间的年龄、体重指数和心率无统计学差异。
2.三组间的血流动力学指标比较:SBP、PP、MAP、SRV和SRVI等指标三组之间两两比较均有统计学差异(P＜0.05),DBP、SV、ACI、LCWI、VI和LVET等指标在高血压组与高血压前期组之间无统计学差异,而高血压组与正常对照组、高血压前期组与正常对照组均有显著的统计学差异(P＜0.05)。TFC、PEP和STR等指标在三组之间无统计学差异。
3.SV/PP与颈-股PWV相关性分析,相关系数=-0.424(P＜0.001)。SV/PP与颈-桡PWV相关性分析,相关系数=-0.012(P=0.791)。SV/PP与颈-足背PWV相关性分析,相关系数=-0.251(P＜0.001)
结论:1.中老年高血压患者的血流动力学变化,主要表现为外周血管阻力的升高,心肌收缩力功能受到损害,心肌做功增多。敏感指标包括SVRI、SVR、ACI、LCWI、VI和LVET。应用胸阻抗法检测血流动力学经济、有效及实用,并能早期发现高血压前期患者的心功能损伤。
2.SV/PP可考虑作为一种评价动脉弹性尤其是是大动脉弹性的临床指标。
Objective
Treatment of Essential hypertension is one of the most important subjects in Cardiology,which is also an important society problem.Middle-aged and elderly people make the main body of EH patients.Though new EH guidelines of ACA and ESC were pubulished and new anti-EH drugs were developed,the control rate of EH is still not satisfying.The different dynamics states in different patients,even with same level of EH,may be one of the causes,which make the satisfying control of EH can not be available by controlo of EH only. So we conducted our study on the dynamics states in middle-aged and elderly patients.
SV/PP was developed decades ago to evaluate vessel Elasticity.But its use is very limited.And not much prove is available to show its efficacy.But it has the advantages of convenience and reproducibility.So we also coduct our study to study the correlation between SV/PP and PWV,another index to evaluate vessel elasticity.
Method
Four hundred and sixty two subjects were enrolled in healthy check-up clinic of Qilu Hospital of Shandong University from August 2008 to October 2008.Means age is 63 years(40～87years),Three groups were included:288 patients in essential hypertension group(EH group);89 subjects in high-normal blood pressure group(HNBP group) and 85 subjects in healthy control group (HC group).Each subject undertook SVR、SVRI、MAP、CO、CI、SV、SI、PEP、LVET、VI、STR and ACI hemodynamic examination and pulse wave velocity(PWV)test.Pearson Correlation Analysis was used to study the correlations with SPSS 11.5 Software.
Results
1.There were no statistical differences in mean age,sex ratio,body mass index and heart rate between three groups.
2.There are significantly differences in SBP、PP、MAP、SRV and SRVI(P＜0.05) between EH group and HNBP group,EH group and HC group,HNBP group and HC group.There are significantly difference in DBP、SV、ACI、LCWI、VI and LVET between EH group and HC group(P＜0.01),HNBP group and HC group(P＜0.05).There are no significant differences in TFC,PEP,STR between EH group and HNBP group,EH group and HC group,HNBP group and HC group(P＞0.05).
3.Negative correlation were detected between SV-to-PP ratio and CFPWV(r=-0.450,P＜0.001),SV-to-PP ratio and CDPWV(r=-0.284,P＜0.001),SV-to-PP ratio and CRPWV(r=-0.047,P=0.791).
Conclusions
1.There are hemodynamics abnormities,especially increased peripheral vascular resistance and increased cardiac performance,in EH and HNBP patients.
2.SV-to-PP ratio can be used as a potential indicator to evaluate Arterial Elasticity.
引文
1. Nyboer J, Bango S, Barnett A, et al. Radiocardiograms: Electrical impedance changes of the heart in relation to electrocardiograms and heart sounds. J Clin Invest 1940;19:773.
2. Kubicek WG, Karnegis JN, Patterson RP, et al. Development and evaluation of an impedance cardiac output system. Aerosp Med 1966;37:1208-1212.
3. Patterson RP, Kubicek WG, Kinnen E, et al. Development of an electrical impedance plethysmography system to monitor cardiac output. Proc of the First Ann Rocky Mountain Bioengineering Symposium; 1964. p. 56-71.
4.Sramek BB, Rose DM, Miyamoto A. Stroke volume equation with a linear base impedance model and its accuracy, as compared to thermodilution and magnetic flowmeter techniques in humans and animals. Proceedings of Sixth International Conference on Electrical Bioimpedanee.1983,6:38-41.
5.Bernstein DP. A new stroke volume equation for thoracic electrical bioimpedance: theory and rationale. Crit Care Med 1986; 14:904-909.
6. Kubicek WG, Patterson RP, Lillehei RC. Impedance cardiography as a non-invasive method to monitor cardiac function and other parameters of the cardiovascular system. Ann NY Acad Sci 1970; 170:724-732.
7. Penney BC. Theory and cardiac applications of electrical impedance measurements. Crit Rev Biomed Eng 1986; 13:227-281.
8.IsnardRN,PannierBM,LaurentS,etal.Pulsatile diameter and elastic modulus of the aortic arch in essential hypertension:a noninvasive study.J Am Coil Cardiol.1989,13:399-405.
9.张维忠.动脉弹性功能检测的理论与实践.心脑血管病防治.2003,3:3-4.
10.Marie Lasater.Impedance Cardiography:A Method of noninvasive cardic output monitoring.AACN NEWS.2000,5:12-14.
11.任珍,孙德利.100例高血压病患者的无创心功能检测与分析.1998,7:71-73.
12.Lewington S,Clarke R,Qizilbash N,Peto R,Collins R;Prospective Studies Collaboration.Age-specific relevance of usual blood pressure to vascular mortality:a meta-analysis of individual data for one million adults in 61prospective studies.The Lancet,2002,360:1903-1913.
13.王靖,刘望彭,王宏宇.无创超声技术评估动脉弹性功能:现状与未来.中国民康医学.2005,17(11):689-693.
14.陆泽元,林怿吴,劭毫.非高血压人群血压与体脂和胰岛素抵抗相关.中华内分泌代谢杂志.2005,21:25-26.
15.Toikka JO,Laine H,Ahotupa M.Increased arterial intimamedia thickness and invivo LDL oxidation in young men with borderline.hypertension.2000,36:929.
16.Samer S.Najjar,Angelo Scuteri,Veena Shetty,Jeanette G.Wright,Denis C.Muller,Jerome L.Fleg,Harold P.Spurgeon,Luigi Ferrucci,Edward G.Lakatta.Pulse Wave Velocity Is an IndependentPredictor of the Longitudinal Increase in SystolicBlood Pressure and of Incident Hypertensionin the Baltimore Longitudinal Study of Aging.Jouraal of the American College of Cardiology.2008,51:1377-1383.
17. Fagard RH.The pulse pressure-to-stroke index ratio predicts cardiovascular events and death in uncomplicated hypertension Journal of the American College of Cardiology. 2001,38: 227-231.
18. De Simone G, Roman MJ, Koren MJ, Mensah GA, Ganau A, Devereux RB. Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension.Hypertension. 1999 ,33(3):800-805.
19.Messerli FH, Garavaglia GE, Schmieder RE, et al. Disparate cardiovascular findings in men and women with essential hypertension. Ann Intern Med 1987,107:158-161.
20. Spinale FG, Smith AC, Crawford FA. Relationship of bioimpedance to thermodilution and echocardiographic measurements of cardiac function. Crit Care Med. 1990; 18:414-418.
21.Sheps DS, Petrovick ML, Kizakevich PN, Wolfe C, Craige E. Continuous noninvasive monitoring of left ventricular function during exercise by thoracic impedance cardiography-automated derivation of systolic time intervals. Am Heart J 1982;103:519-24.
22. Salandin V, Zussa C, Risica G, et al. Comparison of cardiac output estimation by thoracic electrica bioimpedance, thermodilution, and Fick methods.Crit Care Med.1988,16:1157-1158..
23.Belardinelli R,Ciampani N,Costantini C,et al.Comparison of impedance cardiogra with thermodilution and direct tick methods for noninvasive measurement of stroke volume and cardiac output during incremental exercise in patients with ischemic cardiomyopathy.The American Journal of Cardiology.1996,77:1293-1301.
24.Moore FA,Haenel JB,Moore EE.Alternatives to swan ganz cardiac output monitoring.[J]Surg Clin North Am.1991,71:699-721.
25.周建生,蔡琴,郭瑄,等.无创血流动力学监测可用于对老年慢性心力衰竭患者心功能的评价.心脏杂志.2008,20:83-86.
26.Karpawich PP,Mital S.Comparative left ventricular function following atrial,septal,and apical single chamber heart pacing in the young.Pacing Clin Electrophysiol,1997,20:1983-1988.
27.Lewis JF,Kuo LC,Nelson JG.Pulsed doppler echocardiographic determi -nation of stroke volume and cardiac output:clinical validation of two new methods using the apical window.Circulation.1984;70:425-431.
28.Dubin J,Wallerson DC,Cody RJ,et al.Comparative accuracy of doppler echocardiographic methods for clinical stroke volume determination.[J]Am Heart J.1990;120:116-123.
29.Kapuku GK,Seto S,Mori H,et al.Impaired left ventricular filling in borderline hypertensive patients without cardiac structural changes.Am Hart J.1993;125(6):1710-1716.
30.Bernstein DP,Shoemaker WC,Ayres S,Grenvik A,Holbrook PR,ThompsOn WL.Noninvasive cardiac output measurement.Textbook of critical care medicine.Toronto:Saunders,1989,4:159-185.
31.Sherwood A,Allen MT,Fahrenberg J,Kelsey RM,Lovallo WR,van Doornen LJ.Methodological guidelines for impedance cardiography.Psychophysiology.1990,27(1):1-23.
32.Shoemaker WC,Ayres S,Grenvik A,Holbrook PR,ThompsOn WL,.Noninvasive cardiac output measurement.Textbook of critical care medicine.Toronto:Saunders,1989,7:159-85.
33.M Packer,WT Abraham,MR Mehra,CW Yancy.Utility of Impedance Cardiography for the Identification of Short-TermRisk of Clinical Decompensation in Stable Patients With Chronic Heart Failure.Journal of the American College of Cardiology.2006,47:2245-2252.
34.苏爱梅,张洪,章海燕,龚海燕,杨帆.无创血流动力学监测对老年隐性心衰的临床意义.实用老年医学.2008,2:159-160.
35.Robert G.Turcott,Ronald M.Witteles,Paul J.Wang,Randal H.Vagelos,Michael B.Fowler,Euan A.Ashley.Impedance Cardiography Is Superior to Echocardiographic Methods for Pacing Interval Optimization.Journal of Cardiac Failure.2008,14:S65-S65.
36.J.McFetridge-Durdle,F.Routledge,M.Parry,C.Dean,B.Tucker. Ambulatory impedance cardiography in hypertension: A validation study. European Journal of Cardiovascular Nursing. 2008,7:204-213.
37.Nollert G, Reichart B. Registration of thoracic electrical bioimpedance for early diagnosis of rejection after heart transplantation. J Heart Lung Transplant. 1993,12:832-836.
38.Julius S, Krause L, Schork NJ, Mejia AD, Jones KA, van de Ven C, Johnson EH, Sekkarie MA, Kjeldsen SE, Petrin J. Hyperkinetic borderline hypertension in Tecumseh, Michigan. J Hypertens.1991,9:77-84.
39. Harold H. Woltjer.rediction of pulmonary capillary wedge pressure and assessment of stroke volume by noninvasive impedance cardiography. American Heart Journal. 1997, 134:450-455.
40. de Divitiis O, Di Somma S, Liguori V, Petitto M, Magnotta C, Ausiello M, Natale N, Brignoli M, Galderisi M.Effort blood pressure control in the course of antihypertensive treatment. Am J Med.l989,87:(Suppl 3C)46S-56S.
41.Hinderliter A, Blumenthal J, Waugh R, Chilukuri M, Sherwood A.Ethnic differences in left ventricular structure: relations to hemodynamics and diurnal blood pressure variation. Am J Hypertens.2004,17:43-49.
42.Kjeldsen SE,Farsang C,Seigh P,et al.1999 WHO/ISH hypertension guidelines -highlights and ESH update.[J] .Hypertens,2001,19( 12):2285-2288.
43. Linb G, Eisenberg BM.Noninvasive techniques for evaluation of heart function and hemodynamics in arterial hypertension. Acta Cardiol. 1990,45:133-139.
44. Adelhamed AI, Levy P, Smith KS, Wilkins J, Smith R, Ferrario CM.Value of non-invasive hemodynamic measurements in hypertensive patients.Am J Hypertens.2002,15:A89.
45. Eliot RS.The dynamics of hypertension-an overview: present practices, new possibilities, and new approaches. Am Heart J.1988,116:583-589.
46. Taler SJ, Augustine J, Burnett JC, Textor SC. Hemodynamic and volume changes during intensive treatment (Rx) for resistant hypertension (ResHTN) (Abstract). Am J Hypertens .2000;13:61A-62A.
47. Vuurmans T, Boper P, Koomans H.Effects of endothelin-1 and endothelin-1 receptor blockade on cardiac output, aortic pressure, and pule wave velocity in humans. Hypertension. 2003,41:1253-1258.
48.Taler SJ, Textor SC, Augustine JE.Resistant hypertension: comparing hemodynamic management to specialist care.Hypertension. 2002,39:982- 988.
49.Sharman DL, Gomes CP, Rutherford JP.Improvement in blood pressure control with impedance cardiograph-guided pharmacologic decision making. Congest Heart Fail. 2004,10:54-58.
50.Sramek BB, Tichy JA, Hojerova M, Cervenka V.Normohemodynamic goal-oriented antihypertensive therapy improves the outcome.Am J Hypertens. 1996,9:141A.
51. Smith RD, Levy P, Ferrario CM.Consideration of Noninvasive Hemodynamic Monitoring to Target Reduction of Blood Pressure Levels Study Group Value of noninvasive hemodynamics to achieve blood pressure control in hypertensive subjects. Hypertension. 2006 ,47:771-777.
52. Henriksen JH, Fuglsang S, Bendtsen F, Christensen E, M(?)ller S. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index.Am J Physiol Gastrointest Liver Physiol.2001, 280(4): G584-94.
53. de Simone G, Roman MJ, Koren MJ, Mensah GA, Ganau A, Devereux RB. Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension.Hypertension.l999,33(3):800-805.
54.Yung GL, Fedullo PF, Kinninger K, et al. Comparison of impedance cardiography to direct Fick and thermodilution cardiac output determination in pulmonary arterial hypertension. Congest Heart Fail.2004,10:7-10.
55.Drazner MH, Thompson B, Rosenberg PB, et al. Comparison of impedance cardiography with invasivehemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy.Am J Cardiol. 2002,89:993-995.
56. JM Van De Water, TW Miller, RL Vogel, BE, et al. Impedance cardiography: the next vital sign technology? Chest.2003,123:2028-2033.
57. Clancy TV, Norman K, Reynolds R, Covington D,Maxwell JG. Cardiac output measurement in critical care patients: Thoracic electrical bioimpedance versus thermodilution. J Trauma. 1991,31:1116-1119.
58. Ferrario CM, Smith RD.CONTROL Trial Investigators Cost-effectiveness of impedance cardiography testing in uncontrolled hypertension. Am Heart Hosp J. 2006, 4(4):279-289.
59. M. Packer, W. Abraham, M. Mehra, C. Yancy, C. Lawless, J. Mitchell, F. Smart, R. Bijou, C. O'Connor, B. Massie.Utility of impedance cardiography for the identification of short-term risk of clinical decompensation in stable patients with chronic heart failure.J Am Coll Cardiol.2006,47:2245-2252.
60. W.H. Wilson Tang. Measuring impedance in congestive heart failure:Current options and clinical applications.Am Heart J 2009;0:1-10.
61. G. Parrinello, S. Paterna, P. Di Pasquale, D. Torres, A. Fatta, M. Mezzero, R. Scaglione, G. Licata .The Usefulness of Bioelectrical Impedance Analysis in Differentiating Dyspnea Due to Decompensated Heart Failure Journal of Cardiac Failure.2008,14: 676-686.
2. Kubicek WG, Karnegis JN, Patterson RP, et al. Development and evaluation of an impedance cardiac output system. Aerosp Med 1966;37:1208-1212.
3. Patterson RP, Kubicek WG, Kinnen E, et al. Development of an electrical impedance plethysmography system to monitor cardiac output. Proc of the First Ann Rocky Mountain Bioengineering Symposium; 1964. p. 56-71.
4.Sramek BB, Rose DM, Miyamoto A. Stroke volume equation with a linear base impedance model and its accuracy, as compared to thermodilution and magnetic flowmeter techniques in humans and animals. Proceedings of Sixth International Conference on Electrical Bioimpedanee.1983,6:38-41.
5.Bernstein DP. A new stroke volume equation for thoracic electrical bioimpedance: theory and rationale. Crit Care Med 1986; 14:904-909.
6. Kubicek WG, Patterson RP, Lillehei RC. Impedance cardiography as a non-invasive method to monitor cardiac function and other parameters of the cardiovascular system. Ann NY Acad Sci 1970; 170:724-732.
7. Penney BC. Theory and cardiac applications of electrical impedance measurements. Crit Rev Biomed Eng 1986; 13:227-281.
8.IsnardRN,PannierBM,LaurentS,etal.Pulsatile diameter and elastic modulus of the aortic arch in essential hypertension:a noninvasive study.J Am Coil Cardiol.1989,13:399-405.
9.张维忠.动脉弹性功能检测的理论与实践.心脑血管病防治.2003,3:3-4.
10.Marie Lasater.Impedance Cardiography:A Method of noninvasive cardic output monitoring.AACN NEWS.2000,5:12-14.
11.任珍,孙德利.100例高血压病患者的无创心功能检测与分析.1998,7:71-73.
12.Lewington S,Clarke R,Qizilbash N,Peto R,Collins R;Prospective Studies Collaboration.Age-specific relevance of usual blood pressure to vascular mortality:a meta-analysis of individual data for one million adults in 61prospective studies.The Lancet,2002,360:1903-1913.
13.王靖,刘望彭,王宏宇.无创超声技术评估动脉弹性功能:现状与未来.中国民康医学.2005,17(11):689-693.
14.陆泽元,林怿吴,劭毫.非高血压人群血压与体脂和胰岛素抵抗相关.中华内分泌代谢杂志.2005,21:25-26.
15.Toikka JO,Laine H,Ahotupa M.Increased arterial intimamedia thickness and invivo LDL oxidation in young men with borderline.hypertension.2000,36:929.
16.Samer S.Najjar,Angelo Scuteri,Veena Shetty,Jeanette G.Wright,Denis C.Muller,Jerome L.Fleg,Harold P.Spurgeon,Luigi Ferrucci,Edward G.Lakatta.Pulse Wave Velocity Is an IndependentPredictor of the Longitudinal Increase in SystolicBlood Pressure and of Incident Hypertensionin the Baltimore Longitudinal Study of Aging.Jouraal of the American College of Cardiology.2008,51:1377-1383.
17. Fagard RH.The pulse pressure-to-stroke index ratio predicts cardiovascular events and death in uncomplicated hypertension Journal of the American College of Cardiology. 2001,38: 227-231.
18. De Simone G, Roman MJ, Koren MJ, Mensah GA, Ganau A, Devereux RB. Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension.Hypertension. 1999 ,33(3):800-805.
19.Messerli FH, Garavaglia GE, Schmieder RE, et al. Disparate cardiovascular findings in men and women with essential hypertension. Ann Intern Med 1987,107:158-161.
20. Spinale FG, Smith AC, Crawford FA. Relationship of bioimpedance to thermodilution and echocardiographic measurements of cardiac function. Crit Care Med. 1990; 18:414-418.
21.Sheps DS, Petrovick ML, Kizakevich PN, Wolfe C, Craige E. Continuous noninvasive monitoring of left ventricular function during exercise by thoracic impedance cardiography-automated derivation of systolic time intervals. Am Heart J 1982;103:519-24.
22. Salandin V, Zussa C, Risica G, et al. Comparison of cardiac output estimation by thoracic electrica bioimpedance, thermodilution, and Fick methods.Crit Care Med.1988,16:1157-1158..
23.Belardinelli R,Ciampani N,Costantini C,et al.Comparison of impedance cardiogra with thermodilution and direct tick methods for noninvasive measurement of stroke volume and cardiac output during incremental exercise in patients with ischemic cardiomyopathy.The American Journal of Cardiology.1996,77:1293-1301.
24.Moore FA,Haenel JB,Moore EE.Alternatives to swan ganz cardiac output monitoring.[J]Surg Clin North Am.1991,71:699-721.
25.周建生,蔡琴,郭瑄,等.无创血流动力学监测可用于对老年慢性心力衰竭患者心功能的评价.心脏杂志.2008,20:83-86.
26.Karpawich PP,Mital S.Comparative left ventricular function following atrial,septal,and apical single chamber heart pacing in the young.Pacing Clin Electrophysiol,1997,20:1983-1988.
27.Lewis JF,Kuo LC,Nelson JG.Pulsed doppler echocardiographic determi -nation of stroke volume and cardiac output:clinical validation of two new methods using the apical window.Circulation.1984;70:425-431.
28.Dubin J,Wallerson DC,Cody RJ,et al.Comparative accuracy of doppler echocardiographic methods for clinical stroke volume determination.[J]Am Heart J.1990;120:116-123.
29.Kapuku GK,Seto S,Mori H,et al.Impaired left ventricular filling in borderline hypertensive patients without cardiac structural changes.Am Hart J.1993;125(6):1710-1716.
30.Bernstein DP,Shoemaker WC,Ayres S,Grenvik A,Holbrook PR,ThompsOn WL.Noninvasive cardiac output measurement.Textbook of critical care medicine.Toronto:Saunders,1989,4:159-185.
31.Sherwood A,Allen MT,Fahrenberg J,Kelsey RM,Lovallo WR,van Doornen LJ.Methodological guidelines for impedance cardiography.Psychophysiology.1990,27(1):1-23.
32.Shoemaker WC,Ayres S,Grenvik A,Holbrook PR,ThompsOn WL,.Noninvasive cardiac output measurement.Textbook of critical care medicine.Toronto:Saunders,1989,7:159-85.
33.M Packer,WT Abraham,MR Mehra,CW Yancy.Utility of Impedance Cardiography for the Identification of Short-TermRisk of Clinical Decompensation in Stable Patients With Chronic Heart Failure.Journal of the American College of Cardiology.2006,47:2245-2252.
34.苏爱梅,张洪,章海燕,龚海燕,杨帆.无创血流动力学监测对老年隐性心衰的临床意义.实用老年医学.2008,2:159-160.
35.Robert G.Turcott,Ronald M.Witteles,Paul J.Wang,Randal H.Vagelos,Michael B.Fowler,Euan A.Ashley.Impedance Cardiography Is Superior to Echocardiographic Methods for Pacing Interval Optimization.Journal of Cardiac Failure.2008,14:S65-S65.
36.J.McFetridge-Durdle,F.Routledge,M.Parry,C.Dean,B.Tucker. Ambulatory impedance cardiography in hypertension: A validation study. European Journal of Cardiovascular Nursing. 2008,7:204-213.
37.Nollert G, Reichart B. Registration of thoracic electrical bioimpedance for early diagnosis of rejection after heart transplantation. J Heart Lung Transplant. 1993,12:832-836.
38.Julius S, Krause L, Schork NJ, Mejia AD, Jones KA, van de Ven C, Johnson EH, Sekkarie MA, Kjeldsen SE, Petrin J. Hyperkinetic borderline hypertension in Tecumseh, Michigan. J Hypertens.1991,9:77-84.
39. Harold H. Woltjer.rediction of pulmonary capillary wedge pressure and assessment of stroke volume by noninvasive impedance cardiography. American Heart Journal. 1997, 134:450-455.
40. de Divitiis O, Di Somma S, Liguori V, Petitto M, Magnotta C, Ausiello M, Natale N, Brignoli M, Galderisi M.Effort blood pressure control in the course of antihypertensive treatment. Am J Med.l989,87:(Suppl 3C)46S-56S.
41.Hinderliter A, Blumenthal J, Waugh R, Chilukuri M, Sherwood A.Ethnic differences in left ventricular structure: relations to hemodynamics and diurnal blood pressure variation. Am J Hypertens.2004,17:43-49.
42.Kjeldsen SE,Farsang C,Seigh P,et al.1999 WHO/ISH hypertension guidelines -highlights and ESH update.[J] .Hypertens,2001,19( 12):2285-2288.
43. Linb G, Eisenberg BM.Noninvasive techniques for evaluation of heart function and hemodynamics in arterial hypertension. Acta Cardiol. 1990,45:133-139.
44. Adelhamed AI, Levy P, Smith KS, Wilkins J, Smith R, Ferrario CM.Value of non-invasive hemodynamic measurements in hypertensive patients.Am J Hypertens.2002,15:A89.
45. Eliot RS.The dynamics of hypertension-an overview: present practices, new possibilities, and new approaches. Am Heart J.1988,116:583-589.
46. Taler SJ, Augustine J, Burnett JC, Textor SC. Hemodynamic and volume changes during intensive treatment (Rx) for resistant hypertension (ResHTN) (Abstract). Am J Hypertens .2000;13:61A-62A.
47. Vuurmans T, Boper P, Koomans H.Effects of endothelin-1 and endothelin-1 receptor blockade on cardiac output, aortic pressure, and pule wave velocity in humans. Hypertension. 2003,41:1253-1258.
48.Taler SJ, Textor SC, Augustine JE.Resistant hypertension: comparing hemodynamic management to specialist care.Hypertension. 2002,39:982- 988.
49.Sharman DL, Gomes CP, Rutherford JP.Improvement in blood pressure control with impedance cardiograph-guided pharmacologic decision making. Congest Heart Fail. 2004,10:54-58.
50.Sramek BB, Tichy JA, Hojerova M, Cervenka V.Normohemodynamic goal-oriented antihypertensive therapy improves the outcome.Am J Hypertens. 1996,9:141A.
51. Smith RD, Levy P, Ferrario CM.Consideration of Noninvasive Hemodynamic Monitoring to Target Reduction of Blood Pressure Levels Study Group Value of noninvasive hemodynamics to achieve blood pressure control in hypertensive subjects. Hypertension. 2006 ,47:771-777.
52. Henriksen JH, Fuglsang S, Bendtsen F, Christensen E, M(?)ller S. Arterial compliance in patients with cirrhosis: stroke volume-pulse pressure ratio as simplified index.Am J Physiol Gastrointest Liver Physiol.2001, 280(4): G584-94.
53. de Simone G, Roman MJ, Koren MJ, Mensah GA, Ganau A, Devereux RB. Stroke volume/pulse pressure ratio and cardiovascular risk in arterial hypertension.Hypertension.l999,33(3):800-805.
54.Yung GL, Fedullo PF, Kinninger K, et al. Comparison of impedance cardiography to direct Fick and thermodilution cardiac output determination in pulmonary arterial hypertension. Congest Heart Fail.2004,10:7-10.
55.Drazner MH, Thompson B, Rosenberg PB, et al. Comparison of impedance cardiography with invasivehemodynamic measurements in patients with heart failure secondary to ischemic or nonischemic cardiomyopathy.Am J Cardiol. 2002,89:993-995.
56. JM Van De Water, TW Miller, RL Vogel, BE, et al. Impedance cardiography: the next vital sign technology? Chest.2003,123:2028-2033.
57. Clancy TV, Norman K, Reynolds R, Covington D,Maxwell JG. Cardiac output measurement in critical care patients: Thoracic electrical bioimpedance versus thermodilution. J Trauma. 1991,31:1116-1119.
58. Ferrario CM, Smith RD.CONTROL Trial Investigators Cost-effectiveness of impedance cardiography testing in uncontrolled hypertension. Am Heart Hosp J. 2006, 4(4):279-289.
59. M. Packer, W. Abraham, M. Mehra, C. Yancy, C. Lawless, J. Mitchell, F. Smart, R. Bijou, C. O'Connor, B. Massie.Utility of impedance cardiography for the identification of short-term risk of clinical decompensation in stable patients with chronic heart failure.J Am Coll Cardiol.2006,47:2245-2252.
60. W.H. Wilson Tang. Measuring impedance in congestive heart failure:Current options and clinical applications.Am Heart J 2009;0:1-10.
61. G. Parrinello, S. Paterna, P. Di Pasquale, D. Torres, A. Fatta, M. Mezzero, R. Scaglione, G. Licata .The Usefulness of Bioelectrical Impedance Analysis in Differentiating Dyspnea Due to Decompensated Heart Failure Journal of Cardiac Failure.2008,14: 676-686.