无创中心动脉压的研究进展及应用

本文将就无创中心动脉压做出详细的描述，包括其影响因素、测量方法、其临床意义。同时我们将中心动脉压与周围的动脉压进行对比，探讨中心动脉压、高血压与脉搏波传导速度(PWV)、颈动脉硬化、冠脉病变的相关性，更明显的将中心动脉压的作用以及价值列举出来，最后我们将明确的列出降压药的使用对于中心动脉压的影响。     

平均动脉压的无创自动测定

在危重病人和外科监护中,血压测量是一个重要的组成部份。在正常循环状态时血压在正常范围内,听诊法测量收缩压(S.P)和舒张压(d.p)当无困难,然而在异常血压范围.特别是在休克时,听诊法就不能准确的测量。此时超声法虽可以间接测量,但这种技术也有某些缺点。已经知道振动描记法(Oscillometric Method)可以用来测量收缩压,并且具有相当的准确性。动物实验还发现振动描记技术也可以用来测量平均动脉压,研究表明在最低的袖套压力给出最大的振动时,该袖套压接近平均动脉压。应该指出平均动脉压不是收缩压和舒张压的算术平均,而是整个动脉压波形对于时间的平均,在肱动脉可以近似     

孕中期超声监测子宫动脉血流动力学参数及平均动脉压对妊娠期高血压的预测价值探讨

目的:探究孕中期超声监测子宫动脉血流动力学参数及平均动脉压对妊娠期高血压的预测价值.方法:选取我科2019年2月至2021年5月期间收治的75例妊娠期高血压疾病孕妇为观察组,同期75例正常孕妇作为对照组,均于孕中期(孕28～32 w)应用多普勒超声监测子宫动脉参数及平均动脉压,对比两组子宫动脉血流动力学参数、平均动脉压(Mean arterial pressure,MAP)、胎儿脐动脉血流动力学参数、母婴结局.采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析MAP、子宫动脉血流动力学参数及胎儿脐动脉血流动力学参数对妊娠期高血压孕妇的相关性,及对母婴结局的影响.结果:观察组子宫动脉搏动指数(Pulsatility index,PI)、阻力指数(Resistive index,RI)、收缩压最大血流速度与舒张末期最大血流速度比值(Maximum systolic blood flow velocity/Maximal end-diastolic flow velocity,S/D)、MAP、胎儿脐动脉PI、RI、S/D、早产率、新生儿窒息发生率均高于对照组,新生儿体质量、Apgar评分低于对照组(P＜0.05).经ROC分析得知,子宫动脉PI、RI、S/D和MAP诊断妊娠期高血压疾病的AUC分别为0.984、0.956、0.820、0.929,脐动脉PI、RI、S/D诊断妊娠期高血压疾病的AUC分别为0.989、0.824、0.820,均具有较高的特异度和敏感度.结论:孕中期超声监测子宫动脉、胎儿脐动脉血流动力学参数联合MAP利于对筛查妊娠期高血压.     

直接连续的动态血压监测对原发性高血压患者冠状血管和脑血管疾病的发病率和死亡率的预测

本研究目的为评价动态血压与相应临床血压测量两种方法对预后的价值和动态收缩压和舒张压水平相关的心血管危险性．研究对象是６８８个年龄５１±１１岁病人，有临床高血压基础，进行２４小时动脉内动态血压监测．在 ９．２±４．１年的随访期，总共有 １５７人发生第 １次心血管事件．进行回归分析的因素包括年龄、性别、种族、体重指数、吸烟、糖尿病、空腹胆固醇水平和原有心血管病史，加上动态收缩或舒张压参数或脉搏压．认为最好的预测模型包括动态收缩压参数．其中２４小时动态收缩压、年龄、男性、南亚人种、糖尿病、原先的心血管事…     

无创中心动脉压测量的现状与展望

心血管系统疾病是威胁居民健康的重要因素之一，居各种死因首位。因此，对人体心血管健康状况的监测和诊断尤为重要。相较于传统的外周动脉压，中心动脉压（central arterial pressure, CAP）与许多心血管事件发生有更高的相关性，通过测量CAP可以更加准确地反映人体血压的真实情况，并为诊断和疾病的预防提供重要依据。因此，实现高精度、高泛化能力、低成本的CAP无创测量方法一直是该领域的研究重点。结合国内外的相关文献，总结CAP测量现状，从参数测量与波形测量两个方面介绍相关的研究进展，并探讨现有方法的特点以及未来的发展方向。     

脉搏波速度在高血压病早期干预中的临床意义

目的探讨脉搏波传导速度（PWV）与高血压病早期干预的相关性及其相关因素。方法应用脉搏波速度自动测量系统对104例健康人和397例高血压病患者进行肱动脉-踝动脉脉搏波传导速度（baPWV）检测。结果高血压患者的脉搏波传导速度显著高于健康人（P〈0.01）。年龄是影响健康人大动脉弹性功能最主要的因素,年龄、收缩压和脉压与高血压患者的大动脉弹性功能密切相关。结论脉搏波传导速度是敏感反映高血压大动脉弹性的重要指标,年龄、收缩压和脉压是影响baPWV值的主要因素,可作为心血管疾病的一个危险信号,以指导早期预防干预。     

狗桡动脉全压力范围内血压常数K的测定

一、前言在临床实践中,收缩压、舒张压和平均压三种动脉压,在心血管动力学评价方面是很重要的。收缩压是最大值,舒张压是最小值。平均血压是血液流经动脉的平均压力。因为血压脉搏波相对于时间轴不是均匀的,所以平均血压不是收缩压和舒张压的平均值(图1)。     

骨形态发生蛋白-7基因变异与新疆维吾尔族老年人原发性高血压相关

 目的 探讨骨形态发生蛋白-7（BMP7）基因变异与新疆维吾尔族人高血压的关系。 方法 测序筛查BMP7基因功能区变异位点,选取代表性变异应用TaqMan-PCR技术在1446例维吾尔族人中进行基因型鉴定并开展病例-对照关联研究。 结果 在BMP7基因功能区共发现5个新的和8个已知的变异位点。BMP7基因rs60254222、rs17480735变异符合Hardy-Weinberg平衡。在高血压及对照组中rs17480735变异的GG、GA和AA基因型频率分布有差异（P<0.05）。年龄≥50岁人群中携带rs17480735变异GG型人群收缩压、舒张压、平均动脉压水平均低于GA+AA基因型组（P<0.05）。应用Logistic 回归分析校正性别、年龄、体重指数、吸烟及饮酒等影响因素后显示,在年龄≥50岁人群中rs17480735变异与高血压相关（P<0.05）。结论 BMP7基因变异位点rs17480735可能与新疆维吾尔族年龄≥50岁人群高血压相关。     

冠心病患者的循环阻力

对有高血压病史的１００例冠心病人进行了血压、指动脉压、毛细血管压、甲襞微循环检查，并对其中２０例心肌梗塞患者进行正中静脉压测定。结果表明：舒张期血压、正中静脉压与正常组对比有显著性差异，毛细血管压有极显著性差异。收缩期血压、指动脉压差异不显著。微循环见血流速度减慢、红细胞聚集、血色变暗，垂危者出现白色血栓。提示冠心病时循环阻力增大，与病情严重程度呈正相关。降低循环阻力可作为探索治疗冠心病的新路。     

四川省成年健康人1989名脉压差及相关因素调查

背景:调查研究发现,无论高血压人群还是正常血压人群,脉压差增大都是动脉硬化和心血管疾病危险度增大的标志之一。目的:通过对四川省1989名成年健康人群脉压差及其相关因素分析,探讨预防脉压差过大、降低心血管疾病发病率以及提高人群生活质量等问题。方法:采取分层、整群抽样,对1989名健康成年人进行问卷调查,并进行体质检查和血液生物化学血糖、肾功能以及血脂4项等检测,分析脉压差与各观察指标间的关系。结果与结论:男性、女性脉压差随年龄增加而增加,其中50岁以上人群,脉压差随年龄呈线性增加,空腹血糖、尿酸、血尿素氮、总胆固醇、三酰甘油、收缩压、舒张压随脉压差增大而增大,且年龄、BMI、腰臀比、三酰甘油与脉压差呈线性依存关系,脉压差与体育锻炼呈显著负相关。脉压差随着年龄、BMI、腰臀比、三酰甘油增加而增加,随着脉压差的增大,肾功能和血糖调节能力相对下降。提示,中老年人群需要通过合理饮食、运动控制向心性肥胖,从而控制脉压差,减小脉压差增大对肾脏功能损害,降低心血管疾病发病率。     

Cardiovascular risks related to increased diastolic, systolic and pulse pressure. An epidemiologist's point of view.

Since the introduction of the sphygmomanometer at the beginning to the 20th century, the significance of diastolic (DBP), Systolic (DBP) and pulse pressure (PP) as hypertensive cardiovascular risk factors has been controversial. These historical controversies are reviewed. Initially, DBP was thought to be the best measure of risk, but more recently both SBP and DBP, which ever is higher, are used in classifying hypertensive cardiovascular risk. There are problems with the present guidelines, in that SBP and DBP represent only two inflection points on the propagated pulse wave that is measured by cuff readings at the peripheral brachial artery. The heart is exposed to the central aortic pressure not to the brachial artery pressure. Moreover, both peripheral vascular resistance and large artery stiffness contribute to hypertensive cardiovascular risk. In middle-aged and elderly, elevated SBP is a better surrogate measurement of resistance than DBP, but SBP underestimates large artery stiffness. PP, the difference between peak SBP and end DBP, is the single best blood pressure surrogate for large artery stiffness. Epidemiological studies over the past decade point to SBP and DBP as the best cardiovascular risk markers for young subjects, whereas PP takes over as the more powerful risk marker for middle-aged and elderly subjects. These findings support the concept that cardiovascular events are more related to the pulsatile stress of large artery stiffness during systole than the steady-state stress of small vessel resistance during diastole. Therefore, at similar elevations of SBP, subjects with isolated systolic hypertension are at greater risk for cardiovascular events than those with combined systolic/diastolic hypertension.     

New oscillometric method for indirect measurement of systolic and mean arterial pressure in the human finger. Part 2: correlation study

With a new oscillometric method equipped with a transmittance infrared photoelectric plethysmograph, indirect systolic, and mean arterial pressures were measured in 12 normotensive and hypertensive subjects with systolic and mean arterial pressures ranging from 55 to 163 mmHg and from 95 to 200 mmHg, respectively. The pressure values obtained by this method were compared with direct measurements of the brachial intra-arterial pressure recorded simultaneously. A fairly good correlation between the pairs of simultaneous data from these two methods were obtained.     

Effects of sex,age, weight,and heredity on blood pressure in baboons

Using data on a population of 498 pedigreed baboons, the effects of several covariates, including sex, age, weight, and subspecies, on arterial blood pressures were studied. Females had significantly higher systolic and diastolic arterial blood pressure than males. Both systolic and diastolic arterial blood pressures increased significantly with increasing weight, and for diastolic pressure, the increase was significantly greater in females than in males. Systolic arterial blood pressure significantly decreased with increasing age and the decrease was larger in males. There were significant differences in arterial blood pressures that corresponded with degree of subspecies admixture. © 1995 Wiley-Liss, Inc.     

Systolic blood pressure and long-term practice of the Transcendental Meditation and TM-Sidhi program: effects of TM on systolic blood pressure

Systolic blood pressure was measured in 112 subjects practicing the Transcendental Meditation (TM) and TM-Sidhi programs. The subjects were between the ages of 35 and 64 years. A significant difference was found between the systolic blood pressures of subjects (matched for sex, race, and general educational background) practicing the TM and TM-Sidhi programs and norms for the general population. This difference was independent of diet and exercise patterns but related to length of time meditating. A significant difference was also found between short-term (under 5 years) and long-term (over 5 years) participants of the TM program, covarying for age. No previous reports exist concerning the long-term effects of the TM program on blood pressure. Despite methodological problems associated with cross sectional data, the findings suggest the beneficial effects of the long-term practice of the TM and TM-Sidhi programs on systolic blood pressure. Even if self-selection plays a role, the characteristics of an easily identifiable group already showing traits beneficial to the general population deserves further study.     

下肢间血压差值的临床意义及研究进展

下肢间血压差值(inter-leg blood pressure difference,ILBPD)指下肢动脉间血压差的绝对值,是近年引起重视的血压相关指标.研究显示其与心血管病死率及全因病死率显著相关,并且当被加入到传统心血管疾病风险预测因子模型中,能增加对心血管疾病风险的预测.     

An Integrative Model of the Cardiovascular System Coupling Heart Cellular Mechanics with Arterial Network Hemodynamics

The current study proposes a model of the cardiovascular system that couples heart cell mechanics with arterial hemodynamics to examine the physiological role of arterial blood pressure (BP) in left ventricular hypertrophy (LVH). We developed a comprehensive multiphysics and multiscale cardiovascular model of the cardiovascular system that simulates physiological events, from membrane excitation and the contraction of a cardiac cell to heart mechanics and arterial blood hemodynamics. Using this model, we delineated the relationship between arterial BP or pulse wave velocity and LVH. Computed results were compared with existing clinical and experimental observations. To investigate the relationship between arterial hemodynamics and LVH, we performed a parametric study based on arterial wall stiffness, which was obtained in the model. Peak cellular stress of the left ventricle and systolic blood pressure (SBP) in the brachial and central arteries also increased; however, further increases were limited for higher arterial stiffness values. Interestingly, when we doubled the value of arterial stiffness from the baseline value, the percentage increase of SBP in the central artery was about 6.7% whereas that of the brachial artery was about 3.4%. It is suggested that SBP in the central artery is more critical for predicting LVH as compared with other blood pressure measurements.     

Blood pressure and nephrosclerosis in black and white men and women aged 25 to 54.

Kidney samples obtained at autopsy were evaluated for nephrosclerosis by quantitatively measuring the severity of intimal fibroplasia in the interlobular arteries and counting the number of hyalinized arterioles. Most cases were obtained from the coroner and had violent causes of death; subjects with cardiovascular diseases were excluded. Blood pressures in Health Survey data were obtained from published sources. Measures of nephrosclerosis in 365 black and white men and women in age groups 25 to 34, 35 to 44, and 45 to 54 yr were examined by three-way Analysis of Variance (ANOVA). Blacks exceeded whites in fibroplasia at all ages and in both sexes; this excess was paralleled by mean blood pressure in all comparisons. White women were not different from white men in fibroplasia; black women significantly exceeded black men at all ages. Women had lower blood pressures than men when matched for age, race, and fibroplasia; the average magnitude of this difference was 5.5 mm Hg. Since women are known to have as much hypertensive disease as men after age 50 yr, it seems possible that the arterial fibroplasia seen in young women may represent progression toward the hypertensive state, even through blood pressure does not reveal the equality of the sexes in this respect until after menopause. Hence, in women arterial fibroplasia is seen to precede a later rise in blood pressure. Arteriolar hyalinization was greater in men than in women but did not differ significantly between races. Hyalinization did not consistently follow blood pressure in comparisons between subgroups of subjects.     

Relationship between thigh muscle mass and augmented pressure from wave reflections in healthy adults

Skeletal muscle may be viewed as an endocrine organ that releases numerous factors with the potential to influence vascular tone. Previous cross-sectional studies have shown an inverse relationship between muscle mass and arterial stiffness. We examined the relationship between muscle mass, arterial pressure in the aorta and brachial artery, and pressure from wave reflections [characterized as heart rate corrected augmentation pressure (AP)] and augmentation index (AIx). Twenty-seven (13 male, 14 female) subjects who were non-smokers and had no known cardiovascular or metabolic diseases visited the laboratory for two sessions of testing. Upon arriving for the first session, mid-thigh muscle (mCSA) and fat (fCSA) cross-sectional area were assessed using peripheral Quantitative Computed Tomography. Following this, concentric one-repetition maximum (1-RM) testing was completed to assess knee extensor strength. The second visit consisted of taking brachial and aortic blood pressure measurements. A significant positive relationship was found between mCSA and brachial systolic blood pressure (r = 0.47, p = 0.02), but not between mCSA and aortic systolic blood pressure (r = 0.35, p = 0.09). There was an inverse association between mCSA and AP75 (?0.49, p = 0.01) and AIx75 (?0.49, p = 0.01). In conclusion, muscle mass is associated with brachial systolic blood pressure and inversely associated with pressure from wave reflections. Our findings suggest a link between global musculo-skeletal integrity and cardiovascular hemodynamics in young healthy adults.     

Relationship between urinary sodium and potassium, and arterial blood pressure: an epidemiologic study

An epidemiologic study was conducted to ascertain the relationship between urinary sodium and potassium, and arterial blood pressure in normal, nonhospitalized adults. Random samples of 1,939 adult residents, 35 to 54 years of age, of Savannah, Georgia; Hagerstown, Maryland; and Pueblo, Colorado, were interviewed and examined. Arterial blood pressures were taken with a standardized zero-muddler in a standard fashion by a specially trained, experienced nurse. Casual urine specimens were collected and analyzed for their sodium and potassium content. The relationship between urinary sodium potassium and the sodium-to-potassium ratio and arterial blood pressure was calculated. Systolic and diastolic pressure increased with increasing levels of urinary sodium and the sodium-to-potassium ratio, and decreased with increasing levels of urinary potassium. The data suggest that dietary potassium provides some protection against the hypertensive effects of dietary sodium in humans as in animals.     

An epidemiological study of blood pressure and lipid levels among Marwaris of Calcutta,India

This population based study was conducted among the Marwaris of Calcutta, India. A total of 1,096 individuals from 151 randomly selected families were studied. Mean blood pressures were high. About 17% of the population was hypertensive, i.e., systolic blood pressure > 160 mm Hg and/or diastolic blood pressure > 95 mm Hg. The mean value of the ratio of total cholesterol to HDL cholesterol was 4.75. Comparison with a rural agricultural population showed that unadjusted blood pressure profiles differed significantly, but not when the profiles were adjusted for variation in concomitants (e.g., age, weight, fatness, etc.). It is hypothesized that the “intrinsic” blood pressure profiles of both populations are similar and that genes influencing physical variables (e.g., fatness) do not directly influence blood pressure. © 1994 Wiley-Liss, Inc.