2019 年第 9 期 第 14 卷

动态心电图和动态血压监测在临床肾性高血压患者中的应用价值

Application value of dynamic electrocardiogram and ambulatory blood pressure monitoring in patients with renal hypertension

作者：张亚男许静姚丽娜牛文明韩卫卫林文静

英文作者：

单位：050000石家庄市第一医院功能科（张亚男、姚丽娜），肾内科（许静、牛文明），心内科（韩卫卫），老年病科（林文静）

英文单位：

关键词：肾性高血压；动态血压监测；动态心电图

英文关键词：

• 摘要：

• 【摘要】目的    探讨动态心电图和动态血压监测在临床肾性高血压患者中的应用价值。方法    选择2018年3—5月于石家庄市第一医院就诊的肾性高血压患者74例作为观察组，选择本院同期体检健康者75名作为对照组，2组研究对象入选后分别进行动态心电图及动态血压监测，比较2组动态血压水平和非杓型血压的发生率以及动态心电图监测ST-T改变和心律失常的发生率。结果    观察组患者白昼与夜间的收缩压和舒张压水平均显著高于对照组［白昼收缩压：（158±12）mmHg(1 mmHg=0.133 kPa)比（126±6）mmHg，白昼舒张压：（95±7）mmHg比（76±5）mmHg，夜间收缩压：（154±12）mmHg比（112±4）mmHg，夜间舒张压：（93±7）mmHg比（68±3）mmHg］，对照组夜间收缩压和舒张压水平均低于白昼，差异均有统计学意义（均P<0.001），但观察组患者夜间收缩压和舒张压水平与白昼比较差异均无统计学意义（均P>0.05）。观察组患者非杓型血压的发生率显著高于对照组［71.6%(53/74)比9.3%（7/75）］（P<0.001）。观察组患者动态心电图监测显示ST-T改变及心律失常的发生率均显著高于对照组［16.2%(12/74)比0,74.3%（55/74）比8.0%（6/75）］（均P<0.001）。结论    动态血压监测能够获得肾性高血压患者全天血压变化规律，同步监测动态心电图能尽早发现心肌缺血和心律失常等不良情况。

• 【Abstract】Objective    To explore the application value of dynamic electrocardiogram and ambulatory blood pressure monitoring in patients with clinical renal hypertension. Methods    From March to May 2018, 74 patients with renal hypertension who were admitted to Shijiazhuang First Hospital were enrolled as observation group, 75 healthy people were enrolled as control group. All patients had dynamic electrocardiogram and blood pressure monitoring. Ambulatory blood pressure, non-dipping blood pressure, ST-T change in electrocardiogram and arrhythmia were analyzed. Results    Daytime and nocturnal systolic/diastolic blood pressure in observation group were significantly higher than those in control group［daytime systolic pressure:（158±12）mmHg vs （126±6）mmHg, daytime diastolic pressure:（95±7）mmHg vs （76±5）mmHg, nocturnal systolic pressure:（154±12）mmHg vs （112±4）mmHg, nocturnal diastolic pressure:（93±7）mmHg vs （68±3）mmHg］; nocturnal systolic/diastolic blood pressure in control group were significantly lower than daytime blood pressure（all P<0.001）; there were no significant differences between nocturnal and daytime blood pressure in observation group（all P>0.05）. Incidence of non-dipping blood pressure in observation group was significantly higher than that in control group［71.6%(53/74) vs 9.3%（7/75）］（P<0.001）. Incidences of ST-T change and arrhythmia in observation group were significantly higher than those in control group［16.2%(12/74) vs 0, 74.3%（55/74） vs 8.0%（6/75）］（both P<0.001）. Conclusions    Ambulatory blood pressure monitoring can reflect the changes of blood pressure throughout the day in patients with renal hypertension. Simultaneous dynamic electrocardiogram monitoring can identify adverse events such as myocardial ischemia and arrhythmia.