护理干预对原发性高血压患者动态血压参数及血压昼夜节律的影响

目的 探讨护理干预对原发性高血压患者动态血压参数及血压昼夜节律的影响.方法 选择住院治疗的原发性高血压患者247例,按随机数字表法随机分为干预组123例和对照组124例,干预组实施护理干预,对照组接受心内科常规护理;比较两组患者治疗前后动态血压参数及血压昼夜节律的变化.结果 干预前两组患者动态血压参数比较差异均无统计学意义（P＞0.05）;干预后干预组24 h SBP、24 h DBP分别为（121.6±9.7）,（82.7±7.9） mm Hg,均低于对照组的（124.7±10.1）,（84.3±8.1）mm Hg,差异有统计学意义（t值分别为2.301,1.968;P ＜0.05）;两组患者其他动态血压参数比较差异均有统计学意义（P＜0.05）;干预组患者治疗后勺型血压比例较前升高,血压晨峰发生率下降,与治疗前相比,差异有统计学意义（P＜0.05）;与对照组相比,差异有统计学意义（x2值分别为4.023,4.562;P ＜0.05）.对照组患者干预前后勺型血压、血压晨峰发生率比较差异有统计学意义（P＜0.05）.结论 护理干预能显著改善原发性高血压患者血压昼夜节律,具有显著的临床意义.     

综合干预在高血压患者护理管理中的应用效果及血压控制方面所产生的影响分析

目的 探讨综合护理干预模式在高血压患者中的应用效果。方法 选取 2022 年 1 月至 2022 年 12 月期间本院收治的 120 例高血压患者作为研究对象。采用随机数字表法将患者分为观察组和对照组，每组各 60 人。对照组以常规护理模式进行干预， 观察组以综合护理模式进行干预。分析对比两组的自我管理行为、血压水平以及护理满意度。结果 干预前，两组自我管理行 为各维度评分均无显著差异（P>0.05）。干预后，观察组的饮食管理、用药管理、运动管理、情绪管理、病情监测、工作和休 息管理评分均显著高于对照组（P<0.05）。干预前，观察组 SBP、DBP、血压控制达标率均无显著差异（P>0.05）。干预后，观 察组的SBP、DBP均显著低于对照组，血压控制达标率显著高于对照组（P<0.05）。观察组的护理满意度显著高于对照组（P<0.05）。 结论 通过综合护理干预，能改善高血压患者的血压控制效果，提升患者的自我管理能力和护理满意度。     

血压晨峰对老年原发性高血压患者靶器官损害的影响

目的：探讨血压晨峰（MBPS）对老年原发性高血压患者心、脑、肾靶器官损害的影响，为制定科学的护理方案提供依据。方法：利用动态血压监测仪对73例老年高血压患者进行血压分析，分为晨峰组37例与非晨峰组36例，依据超声心动图计算心肌左室质量指数（LVMI）、尿微量白蛋白及肌酐，并计算ACR；以颅脑磁共振或CT筛查脑梗死，并测定血清尿钠肽（BNP）、血糖、低密度脂蛋白胆固醇（LDL—C）、纤维蛋白原（Fib）及c一反应蛋白（CRP）。结果：晨峰组与非晨峰组BNP、LVMI及ACR比较均有显著性差异（P〈0．05），晨峰组脑梗死发生率较非晨峰组显著增高（P〈0．05）；晨峰组血糖、LDL、Fib及CRP均较非晨峰组显著增高（P〈0．05）。结论：老年高血压患者MBPS与心、脑、肾靶器官损害密切相关，应根据血压变化调整护理方案和服药时间，减少血压晨峰对靶器官的损害。     

有创通气下COPD合并高血压老年患者血压晨峰的观察及影响因素分析

目的：分析有创通气下COPD（Chronic Obstructive Pulmonary Disease,COPD）合并原发性高血压老年患者24 h动态血压情况,探讨血压晨峰的特点及晨峰高血压现象的影响因素。方法：选取天津市某三甲医院呼吸与危重症监护病房住院的有创通气治疗（均为SIMV通气模式,PEEP≤5 cmH2O）的COPD合并原发性高血压老年患者,采用心电监护仪（EKG）进行24 h动态血压监测并记录血压数据,采用APACHEⅡ评估患者入呼吸与危重症监护病房时的病情情况。结果：共纳入79例患者, 24 h收缩压（24 h SBP）均值为（151.20±5.69）mmHg（1 mmHg=0.133 kPa）,24 h DBP（24 h舒张压）均值为（76.39±6.42）mmHg,约72.2% 的患者具有晨峰高血压现象,血压晨峰均值为（38.82±8.78） mmHg;单因素分析显示,不同年龄、APACHEⅡ得分不同的患者间血压晨峰存在差异,是否具有晨峰高血压现象的患者间24 h SBP均值、d SBP均值存在统计学差异;Logistic回归分析显示 APACHEⅡ评分、24 h SBP均值、d SBP均值是晨峰高血压现象的影响因素,三者可解释血压变异的82.3% 。结论：有创通气下的COPD合并原发性高血压老年患者中晨峰高血压现象的比例较高;临床护理时应加强对具有晨峰高血压现象患者的鉴别,为降低晨峰高血压对靶器官损害的护理措施的实施提供依据。     

整体护理对妊娠期高血压产妇的影响研究

目的 探讨妊娠期高血压产妇在进行临床护理期间对其使用整体护理后对负性情绪、血压控制情况及护理满意度产生的 影响。方法 选取 2021.7-2023.4 期间本院收治的 83 例妊娠期高血压产妇作为研究对象。以随机分为对照组（行常规护理,n=41） 与观察组（行整体护理,n=42）。比较两组的负性情绪、血压控制效果与护理满意度。结果 观察组干预后的 SAS、SDS 评分均 显著低于对照组（P<0.05）。观察组干预后的 SBP、DBP 均显著低于对照组（P<0.05）。观察组的护理满意度高于对照组（P<0.05）。 结论 整体护理在妊娠期高血压产妇的血压控制护理较为良好,有效降低血压水平,缓解产妇的负性情绪,提高护理满意度。     

肾性高血压与原发性高血压患者动态血压观察

目的：观察肾性高血压与原发性高血压患动态血压情况及节律变化。方法;采用美国无创性便携式动态血压监测仪,测试时间8～9Am至次日8～9Am,测量间隔为30min。结果：两组患的24h SBP、24h DBP、d SBP、d DBP及血压负荷无明显差异(P>0.05),肾性高血压组n SBP、n DBP显高于原发性高血压组(P<0．001),原发性高血压组夜间n SBP、n DBP均低于白昼血压(P值均<0.01)．肾性高血压组的夜间n SBP、n DBP与白昼血压无明显差异(P>0．05)。肾性高血压组SBP、DBP夜间下降百分率<10％,明显高于原发性高血压组(分别为48％、60％及30％、22．5％．P<0.05)。结论：原发性高血压患的动态血压存在着昼夜节律．肾性高血压患节律性消失。     

临床护理路径在老年高血压患者中的应用效果分析

目的 探讨临床护理路径应用于老年高血压患者的方法及价值。方法 选取医院 2020 年 06 月至 2022 年 08 月收治的 78 例老年高血压患者作为研究对象。按照组间基线资料可比的原则分为对照组和研究组,各 39 例。对照组行常规护理,研究组 在对照组基础上应用临床护理路径。比较两组血压相关指标、依从性及护理满意度。结果 护理前两组 24 h SBP、24 h DBP 比 较,差异无统计学意义（P>0.05）。护理后两组 24 h SBP、24 h DBP 均较护理前有所下降,且研究组血压相关指标均优于对照 组（P<0.05）。研究组的依从性高于对照组（P<0.05）。研究组护理满意度高于对照组（P<0.05）。结论 应用临床护理路径有利 于老年高血压患者提升血压相关指标控制效果,提高依从性及护理满意度。     

高血压患者血压晨峰与冠状动脉病变相关性研究

目的探讨原发性高血压患者血压晨峰（morning blood pressure surge,MBPS）与冠状动脉病变的相关性。方法203例原发性高血压患者行冠状动脉造影术（coronary angiography,CAG）和24h动态血压（ambulatory blood pressure monitoring,ABPM）监测,根据ABPM有无MBPS现象分为晨峰组71例和非晨峰组132例,比较2组冠状动脉病变支数、病变Gensini总积分,分析冠状动脉病变的影响因素。结果晨峰组24h、白昼及夜间平均收缩压、冠状动脉病变发生率、3支病变发生率以及Gensini总积分均高于非晨峰组（P〈0.01）,而单支病变发生率低于非晨峰组（P〈0.01）;冠状动脉病变程度多元线性回归分析结果显示,年龄、24h收缩压及MBPS为冠状动脉病变的独立影响因素。结论 MBPS与冠状动脉病变程度有关,有效控制高血压患者的晨峰血压对减少靶器官损害有重要意义。     

血压晨峰现象的识别和护理观察

目的 通过观测老年原发性高血压患者血压晨峰(morning blood pressure surge,MBPS)对心脑肾靶器官的影响,制定科学的护理方案.方法 对73例老年高血压患者利用动态血压监测仪进行血压分析,分为晨峰组(37例)与非晨峰组(36例),依据超声心动图计算心肌左室质量指数(LVMI),尿微量白蛋白及肌酐并计算2者比值(ACR),以颅脑磁共振或CT筛查脑梗塞.结果 晨峰组与非晨峰组的LVMI以及ACR均有显著差异(P<0.05),脑梗死发生率,晨峰组较非晨峰组也显著增高(P<0.05).结论 老年高血压患者MBPS与心脑肾靶器官损伤密切相关,因此应根据血压变化调整护理方案和服药时间,减少血压晨峰对靶器官的损害.     

八段锦运动对老年1级高血压患者血管内皮功能的影响

摘要 目的：从血管内皮功能探讨八段锦运动对老年1级原发性高血压（EH)患者降压效果的机制。 方法：将60例l级EH患者按随机数据表法随机分组,试验组30例,行常规药物治疗,护理及八段锦运动干预;对照组30例,行常规药物治疗及护理。收集两组干预前后血压、血清一氧化氮（NO）浓度和血浆内皮素-1（ET-1）浓度的变化情况。 结果：干预后试验组患者收缩压（SBP)下降程度显著优于对照组（P＜0.01）,而舒张压（DBP）与对照组相比,差异无显著性意义（P＞0.05）;试验组患者的平均SBP和平均DBP的下降幅度均大于对照组。血清NO浓度明显升高,与对照组比较,差异有显著性意义（P＜0.05）;血浆ET-1浓度显著降低,与对照组比较,差异有显著性意义（P＜0.05）。 结论：长期进行八段锦运动能够有效降低老年1级高血压患者的血压,其降压机制与血清NO浓度增加和血浆ET-1浓度降低所引起的血管内皮功能的改善有密切关系。     

Genetic polymorphism of cytochrome P450 1A1 (Cyp1A1) and glutathione transferases (M1, T1 and P1) among Africans.

The co-ordinate expression and regulation of the drug metabolising enzymes, cytochrome P4501A1 (CYPlAl) and glutathione transferases (GSTM1, GSTT1 and GSTP1), and their metabolic balance in the cells of target organs may determine whether exposure to carcinogens results in cancer. Besides showing variability in activity due to induction and inhibition, these enzymes also exhibit genetic polymorphism that alter enzyme levels and activity. We determined frequencies of common allelic variants of CYP1A1 and glutathione (M1, T1 and P1) among Tanzanians, South African Venda and Zimbabweans using PCR/restriction fragment length polymorphism techniques. The CYP1A1 Val462 mutant variant was found at a frequency of 1.3% among 114 subjects. The GSTM1*0 genotype was found at a frequency of 29% and 33% among Tanzanian psychiatric patients and healthy volunteers, respectively. Similarly, the GSTT1*0 polymorphism was present with a frequency of 25% in both the psychiatric patients and healthy controls. The frequency of GSTP1 Val105 variant was 16%, 12% and 21% among Tanzanians, South African Venda and Zimbabweans, respectively. We conclude here that CYP1A1 Val462 polymorphism is very rare among Africans. This is the first report of the GSTP1 Val105 variant frequency in African populations. We show here that there are no differences in frequencies of the variant alleles for CYP1A1, GSTM1, GSTT1 and GSTP1 in the three African populations.     

Influenza A (H1N1) vs non-H1N1 ARDS: Analysis of clinical course

Purpose

The purpose of the study is to compare H1N1-induced acute respiratory distress syndrome (ARDS) with ARDS due to other causes of severe community-acquired pneumonia focusing on pulmonary function.

Materials and methods

This is a retrospective data analysis of adult ARDS patients between January 2009 and December 2010 in an ARDS referral center. Patient characteristics, severity of illness scores, modalities, and duration of extracorporeal lung support were evaluated as well as intensive care unit stay and survival. Parameters of mechanical ventilation and pulmonary function were analyzed on day of admission and over the consecutive 10 days using a nonparametric analysis of longitudinal data in a 2-factorial design. In a logistic regression analysis, risk factors for extracorporeal lung support were investigated.

Results

Twenty-one patients with H1N1-ARDS and 41 with non-H1N1-ARDS were identified. Gas exchange was more severely impaired in patients with H1N1-ARDS over course of time. Extracorporeal membrane oxygenation was more frequently needed in H1N1-ARDS. Despite significantly prolonged weaning off extracorporeal lung support and intensive care unit stay in H1N1 patients, the proportion of survivors did not differ significantly. Only Sepsis-Related Organ Failure Assessment score could be identified as an independent predictor of extracorporeal lung support.

Conclusions

Clinical course of H1N1-ARDS is substantially different from non-H1N1-ARDS. Affected patients may require extensive therapy including extracorporeal lung support in ARDS referral centers.     

Effect of OATP1B1 (SLCO1B1) variant alleles on the pharmacokinetics of pitavastatin in healthy volunteers

BACKGROUND: Pitavastatin is a potent, newly developed 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor for the treatment of hyperlipidemia. We characterized the effects of organic anion transporting polypeptide 1 B 1 (OATP 1 B 1) alleles *1a, *1b, and *15 on the pharmacokinetics of pitavastatin. METHODS: Twenty-four healthy Korean volunteers who had previously participated in a pharmacokinetic study of pitavastatin (single oral dose, 1--8 mg) were further investigated. Subjects were grouped according to OATP 1 B 1 genotype. Dose-normalized area under the plasma concentration-time curve (AUC) and peak plasma concentration (C(max)) values were analyzed, because different dosages were administered to subjects, whereas the pharmacokinetics showed linear characteristics. RESULTS: Dose-normalized pitavastatin AUCs for *1b/*1b (group 1), *1a/*1a or *1a/*1b (group 2), and *1a/*15 or *1b/*15 (group 3) were 38.8+/-13.3, 54.4 +/-12.4, and 68.1+/-6.3 ng.h.mL(-1).mg(-1) (mean+/-SD), respectively, with significant differences between all 3 groups (P=.008) and between subjects carrying and those not carrying the *15 allele (P = .004). Dose-normalized pitavastatin C(max) values were 13.2+/- 3.3, 18.2+/-5.7, and 29.4+/- 9.6 ng.mL(-1).mg(-1) in groups 1, 2, and 3, respectively, and also showed significant differences (P=.003) in a manner similar to that shown by AUC. No significant differences were found between the genotype groups in terms of dose-normalized AUC or C(max) values of pitavastatin lactone. CONCLUSION: OATP 1 B 1 variant haplotypes were found to have a significant effect on the pharmacokinetics of pitavastatin. These results suggest that the *15 allele is associated with decreased pitavastatin uptake from blood into hepatocytes and that OATP 1 B 1 genetic polymorphisms have no effect on the pharmacokinetics of pitavastatin lactone.