社区护理干预对高血压患者血压及生活质量的影响

目的探讨社区护理干预对高血压患者血压及生活质量的影响。方法将80例社区高血压患者随机分为观察组和对照组各40例,观察组给予有效的护理干预,对照组不给予任何的社区护理干预,比较两组患者的降压效果以及生活质量。结果观察组患者的降压效果以及生活质量均明显优于对照组,差异有统计学意义(P<0.05)。结论社区护理干预可以有效降低患者的血压,提高患者的生活质量。     

Comparison of Effects of Endurance and Strength Training Programs in Patients with COPD

ABSTRACT

Comparisons between endurance and strength training in chronic obstructive pulmonary disease (COPD) patients have produced equivocal findings when examining physical function and health-related quality of life (HRQL). One reason for these differences may be due to individual patient responses to the different training modalities. PURPOSE: To compare changes in physical function and HRQL in a group of COPD patients completing both an endurance and a strength training program. METHODS: Eleven mildly diseased patients completed a three month endurance training program and, approximately 5 years later, completed a three month strength training program. Changes in 6 minute walk distance (6 MW), time to rise from a chair five times (CRT), and the total score and subscores from the SF-36 and Chronic Respiratory Disease Questionnaire (CRQ) were examined. RESULTS: The forced expiratory volume as a percent of predicted remained relatively constant over the 5 years (61.1 ± 5.9 vs. 60.0 ± 10.3). Endurance and strength training increased 6 MW by 48.2 ± 11.2 (p = 0.008) and 39.8 ± 9.8 (p = 0.001) meters, respectively. Endurance and strength training decreased CRT by 4.8 ± 0.7 (p = 0.001) and 1.3 ± 1.2 (p = 0.056) seconds, respectively. Endurance training resulted in greater improvements in HRQL as compared to strength training. CONCLUSION: These results show that walk distance improves as a result of participating in either an endurance or a strength training program. However, an endurance training program leads to greater improvements in both general and disease specific measures of HRQL.     

社区综合防治对高血压患者生活质量的影响

目的评价在社区实施综合防治对高血压患者生活质量及其血压控制效果的影响。方法对120例社区综合防治管理的原发性高血压患者采用问卷卷方式调查其生活质量指标,并检测其动态血压指标。比较实施前、后动态血压及生活质量的变化。结果实施社区综合管理前后高血压患者的合理膳食、坚持锻炼、定期检测、遵医用药卫生行为间差异有统计学意义（P〈0．01）。实施社区综合管理前后高血压患者的躯体感觉、认识功能、社会参与能力、生活满足感评分间差异均有统计学意义（P〈0．01）,睡眠状态管理前后差异无统计学意义（P〉0．05）。120例患者高血压的总有效率为87．5％。实施社区综合防治管理后高血压患者的24hSBP、24hDBP、dSBP、dDBP、nSBP、nDBP、SBP load及DBP load均有明显的降低,前后比较差异有统计学意义（P〈0．01）。结论社区综合防治管理对高血压患者实施的行为干预。在改善高血压患者行为生活方式、提高生活质量、提高其血压控制率等方面有积极作用。     

自我效能训练对脑卒中后抑郁患者生活质量的影响研究

目的探讨自我效能训练对脑卒中后抑郁患者生活质量的影响。方法将84例脑卒中后抑郁患者随机分为训练组和对照组,训练组在常规治疗和护理的基础上增加自我效能训练的干预措施,对照组只接受常规的治疗和护理,比较两组患者1个月后生活质量的差异。结果训练组的生活质量高于对照组,SSQOL总分比较差异有统计学意义。结论自我效能训练对临床疾病的康复,尤其是对生活质量的提高有很大的帮助,值得在临床上推广使用。     

强化健康认知护理对高血压合并糖尿病患者生活质量的改善作用

目的探究强化健康认知护理对高血压合并糖尿病患者生活质量的改善效果。方法选取该院2018年1—12月收治的高血压合并糖尿病患者94例,采用摸球法分为研究组和常规组,各47例。研究组采用强化健康认知护理,常规组采用常规护理。护理2个月开展随访,观察健康认知程度评分、生活质量评分及空腹血糖、糖化血红蛋白、收缩压、舒张压变化。结果研究组健康认知程度评分、生活质量评分均高于常规组,对比差异有统计学意义(P<0.05)。研究组空腹血糖、糖化血红蛋白等血糖指标及收缩压、舒张压等血压指标均低于常规组,对比差异有统计学意义(P<0.05)。结论强化健康认知护理在高血压合并糖尿病患者中具有显著效果,可改善患者认知及生活质量,有效控制血压、血糖,值得临床推广。     

Effect of Different Endurance Training Protocols During Cardiac Rehabilitation on Quality of Life

BackgroundThis study aimed to assess the effect of different types of endurance training during outpatient cardiac rehabilitation on patients’ health-related quality of life (HRQL).MethodsThe MacNew Heart Disease HRQL questionnaire and the Hospital Anxiety and Depression Scale were used to assess changes in HRQL in 66 patients before and after 6 weeks of cardiac rehabilitation. Patients were randomized to 1 of 3 types of supervised endurance training: continuous endurance training, high-intensity interval training, and pyramid training. Two-way analysis of variance for repeated measure and chi-square test were used to analyze changes before and after rehabilitation.ResultsAttendance rate during the 6 weeks of exercise training was 99.2%. Physical work capacity increased from 136.1 to 165.5 watts (+22.9%; P < .001), and there were no statistical differences between training protocols. Fully completed questionnaires at both time points were available in 46 patients (73.9%; 61.3±11.6 years, 34 males, 12 females). Regardless of the type of supervised endurance training, there was significant improvement during rehabilitation in each of the categories of the MacNew questionnaire (ie, emotion, physical, social, global; all P < .05) and the Hospital Anxiety and Depression Scale (anxiety: P = .05; depression: P = .032), without significant differences between protocols.ConclusionsAll 3 types of endurance training led to significant and well comparable increases in physical work capacity, which was associated with an increase in HRQL independent of the type of training. Our findings support further individualization of training regimes, which could possibly lead to better compliance during life-long home-based exercise training.     

抑郁对冠心病患者生存质量和运动耐力的影响

目的：探讨抑郁对冠心病（CHD ）患者生存质量、运动耐力的影响程度。方法131例CHD患者由本人独立填写完成贝克抑郁自评量表（BDI）和简明健康测量量表（SF-36）。根据BDI评分将患者分为抑郁组（n＝34）、非抑郁组（n＝97）并分别行心肺运动试验（CPET ）。结果（1）131例CHD患者SF-36各维度均低于中国常模,除社会功能外各维度有显著差异（ P＜0.01）,抑郁组CHD患者SF-36各维度得分均低于非抑郁组患者,除生理功能、生理职能外各维度有显著差异（ P＜0.05,或 P＜0.01）。（2）抑郁组CHD患者CPET结果中峰值氧耗量（VO2 peak ）、无氧代谢阈值氧耗量（VO2AT）、无氧代谢阈值负荷（LoadAT）均低于非抑郁组,分别为VO2peak：（17.3±1.7）ml·kg^-1·min^-1比（18.6±2.9）ml· kg^-1·min^-1,P＜0.05;VO2AT：（12.0±1.7）ml·kg^-1·min^-1比（13.2±2.2）ml·kg^-1·min^-1,P＜0.01;LoadAT ：（30.7±11.4）J ·s^-1比（36.0±13.9）J·s^-1,P＜0.05。（3）CHD患者SF-36与运动耐力有相关性（ P＜0.05）;SF-36各维度得分与BDI评分有显著负相关性（ P＜0.05）;BDI评分与CPET结果中VO2 peak、VO2 AT、LoadAT有显著负相关性（ P＜0.05）。结论合并抑郁的冠心病患者生存质量和运动耐力下降,抑郁与冠心病患者生存质量和运动耐力密切相关。     

高血压与老年人的生活质量

目的分析高血压对老年人生活质量的影响。方法抽样调查北京城乡社区老年人1847例,并且进行血压测量及评估躯体健康、心理健康、认知能力、生活活动能力和生活满意度。结果已患高血压的老年人生活质量显著低于血压正常者;随着高血压病程的延长,高血压相关疾病患病率增高,认知能力变差;高血压水平越高者,抑郁症状增加,生活活动能力进一步下降。结论积极防治高血压,可提高全民人口素质,提高老年人的健康相关生活质量。     

肥胖对高血压患者血压变异性的影响

目的评估肥胖对原发性高血压患者血压变异性(BPV)的影响。方法选择2014年1月至2014年4月我院就诊的单纯性高血压患者159例,根据腹围和体质指数(BMI)分别分组,进行24 h动态血压监测(ABPM),观察BPV特点。结果按照体质指数分组,观察组(BMI≥28 kg/m2,男性40例,女性40例)24 h平均收缩压变异系数、日间平均收缩压变异系数高于对照组(BMI28 kg/m2,男性43例,女性36例),差异有统计学意义(P0.05);两组男性患者夜间平均收缩压变异系数、夜间平均舒张压变异系数均高于女性患者(P0.05),且观察组男性患者24 h平均收缩压变异系数高于女性患者(P0.05)。按照腹围分组,观察组(男性腹围≥90 cm 45例,女性腹围≥85 cm 42例)24 h平均收缩压变异系数、日间平均收缩压变异系数高于对照组(男性腹围90 cm 38例,女性腹围85 cm 34例),差异有统计学意义(P0.05),两组男性患者夜间平均舒张压变异系数高于女性患者(P0.05),且观察组男性患者24 h平均收缩压变异系数高于女性患者(P0.05)。结论肥胖时,高血压患者BPV增高,且男性患者较女性患者明显,提示在控制血压的同时,还应注意调节BPV,特别是男性肥胖患者。     

抗阻训练对原发性高血压患者血压影响的Meta分析

背景随着社会经济水平发展和人们生活节奏的加快,原发性高血压患病率逐年上升,近年已有研究证实了抗阻训练的降压效果,但临床尚缺乏具体的运动方案,在训练周期、频率等方面缺少循证证据。目的系统评价抗阻训练对原发性高血压患者血压的影响。方法计算机检索Cochrane Library、PubMed、Embase、Web of Science及中国知网、中国生物医学文献数据库、万方数据知识服务平台、维普网公开发表的抗阻训练对原发性高血压患者血压影响的随机对照研究,其中试验组患者接受抗阻训练,对照组患者接受常规宣教。采用Cochrane手册中的偏倚风险评价工具对纳入文献进行方法学质量评价。采用RevMan 5.3软件进行Meta分析,采用Egger检验评估纳入文献是否存在发表偏倚,采用敏感性分析评价本研究结果的稳定性。结果初步检索文献2542篇,经逐层筛选后最终纳入文献9篇,共包含514例患者,其中试验组259例、对照组255例。Meta分析结果显示,试验组患者干预后收缩压(SBP)〔加权均数差(WMD)=-8.21,95%CI(-13.30,-3.13)〕、舒张压(DBP)〔WMD=-4.51,95%CI(-6.39,-2.63)〕低于对照组(P<0.001)。亚组分析结果显示,训练周期≤12周及不同训练频率、训练时间的试验组患者干预后SBP、DBP分别低于对照组患者(P<0.05)。Egger检验结果显示,报道抗阻训练对原发性高血压患者SBP(P=0.207)、DBP(P=0.151)影响的文献无明显发表偏倚。敏感性分析结果显示,逐一剔除各项研究后的点估计值均在合并效应量的95%CI范围内,表明本Meta分析结果较稳定。结论本Meta分析结果表明,抗阻训练可有效降低原发性高血压患者血压,且将抗阻训练周期控制在≤12周的降压效果更佳。     

原发性高血压血压昼夜节律与运动血压的关系

目的 :探讨原发性高血压患者血压昼夜节律与运动血压的关系。方法 :检测 30 3例 1、2级原发性高血压患者的运动血压和动态血压 ,根据夜间血压下降率不同分为杓型组 (n =2 0 0 )和非杓型组 (n =10 3) ,比较两组运动血压各参数 ,并行相关分析。结果 :①非杓型组最大运动量时收缩压、舒张压和运动后恢复期收缩压、舒张压均高于杓型组 ,有极显著性差异(P <0 .0 1或 0 .0 0 1)。②夜间收缩压下降率与最大运动量时收缩压、舒张压存在明显负相关 (γ =-0 40 7、-0 361,P均<0 .0 0 1) ;夜间舒张压下降率与最大运动量时收缩压、舒张压、运动后恢复期收缩压存在明显负相关 (γ =-0 499、-0 479、-0 183,P均 <0 0 1或 0 0 0 1)。结论 :非杓型原发性高血压患者容易出现运动血压过度升高     

基于“互联网+”的高血压管理服务模式对高血压患者血压管理效果观察

目的：探讨基于“互联网+”的高血压管理服务模式对高血压患者的健康管理效果。 方法：选取2016年9月至2017年2月重医附一院高血压患者110例分为试验组和对照组,试验组接受健康管理平台管理,管理流程包括建立电子健康档案并评估、制定健康计划、患者自测血压等指标并上传平台、阶段性评估、健康宣教等,对照组接受门诊常规管理,随访12周。比较两组干预前后血压、血压控制率、服药依从性、生活质量、体力活动改变。 结果：随访干预12周后,两组的血压水平均较入组时下降,平台管理组收缩压、舒张压分别为（132.7±9.9）mm Hg、（80.6±9.9）mm Hg,对照组分别为（140.7±14.2）mm Hg、（77.6±14.3）mm Hg,但平台管理组收缩压下降更显著（P<0.05）。平台管理组血压控制率（64.3%）明显高于对照组（33.3%）,差异有统计学意义（P<0.05）。单因素和多元线性回归分析均显示平台管理与收缩压变化值显著相关,回归系数为-8.9。两组服药依从性评价、12条目简易健康量表评分、体力活动水平无统计学差异（P＞0.05）。 结论：基于“互联网+”的高血压管理服务模式可以显著降低高血压患者收缩压水平,提高血压控制率。     

Effect of Endurance Exercise on Cardiac Secretion and Renal Clearance of Atrial Natriuretic Peptide in Normal Humans

Previous work from our laboratory has shown that (i) regular endurance exercise lowers blood pressure (BP), and (ii) acute exercise increases circulating levels of atrial natriuretic peptide (ANP). We hypothesised that increased ANP release may contribute to the antihypertensive effect of regular exercise. Using arterial and selective venous (coronary sinus and renal vein) catheterization and sampling, we measured cardiac secretion and renal clearance of ANP at rest in 7 normal healthy males (mean age 36 years), before and after 4 weeks of training. Body weight and haematocrit remained unchanged. Systolic BP fell by 10 mmHg with training (p=0.008), diastolic BP fell by 6 mmHg (p=0.006) and heart rate decreased by 9 beats/minute (p=0.002), but central venous pressure remained unchanged. Arterial, coronary sinus and renal vein ANP concentrations did not change with training. There was no significant rise in cardiac secretion of ANP with training (sedentary: 42.613.2 ng/ml, trained: 47.417.9 ng/ml, p n.s.). Renal extraction of ANP was 724% before training, and unchanged (665%) after the exercise period. Renal clearance of ANP was also     

等长运动对原发性高血压患者交感肾上腺素能系统的影响

目的通过等长(握力)运动前后原发性高血压患者心率、血压及血浆儿茶酚胺水平的变化,探讨等长运动对原发性高血压患者交感肾上腺素能系统的影响.方法分别观察38例原发性高血压患者(高血压组)及40例健康对照者(对照组)等长运动前后心率、血压及血浆儿茶酚胺(去甲肾上腺素、肾上腺素)水平;其中高血压组经硝苯地平治疗4周,再次进行等长运动试验.结果两组试验对象在等长运动后,心率、血压及血浆儿茶酚胺水平的增加较运动前均有非常显著性差异(P＜0.01).运动后高血压组的血压及血浆儿茶酚胺水平治疗后较治疗前升高显著,有非常显著性差异(P＜0.01).结论等长运动对原发性高血压患者交感肾上腺素能系统有激活作用;经硝苯地平治疗后血压虽有下降,但患者血浆儿茶酚胺水平却较治疗前显著升高,提示交感肾上腺素能系统的激活更为明显.     

Exercise Training in Patients with Chronic Heart Failure

Historically, patients with heart failure were advised to avoid exertion due to fear that the added myocardial stress would worsen heart function. However, between 1979 and 1991, five uncontrolled trials demonstrated that moderate exercise training can partially reverse the exercise intolerance common among patients with heart failure. Since 1991, numerous randomized exercise trials demonstrated a 12% to 33% improvement in exercise capacity, as measured by oxygen consumption. The mechanisms by which this improvement occurs are now being studied. Potential mechanisms include improved cardiac output due to increases in both peak stroke volume and reversal of chronotropic incompetence; improved regional blood flow to the metabolically more active skeletal muscle; and partial reversal of skeletal muscle histochemical abnormalities such as increased oxidative enzymes and a re-shift in fiber type toward increased type I fibers. Improved sympathetic function has also been noted with exercise training, evidenced by decreased norepinephrine spillover and increased heart rate variability. Exercise training can be of benefit in selected patients with stable New York Heart Association class II or III heart failure.     

缓解期慢性支气管炎对高血压患者血压变异性的影响研究

背景 慢性支气管炎与高血压存在共同的危险因素,但目前国内外尚缺乏关于缓解期慢性支气管炎与高血压患者血压变异性关系的研究.目的 探讨缓解期慢性支气管炎对高血压患者血压变异性的影响.方法 选取2019年7月—2020年2月在宣城市人民医院心血管内科治疗的高血压患者160例为研究对象.根据患者临床诊断是否合并缓解期慢性支气管...     

III度房室阻滞患者VVI起搏时运动耐力和心力储备的研究

采用心肺运动试验的方法，对１６例ＶＶＩ起搏的ＩＩ度房室阻滞患者行最大症状限制性运动试验，以测定病人的心力储备和耐力储备。结果表明病人运动时心脏指数较运动前增加１倍。最大作功８８．６±１６．３６Ｗ／ｍｉｎ，最大氧耗量１７．３８±４．４８ｍｌ／ｍｉｎ。１６例中有９例未测出无氧阈。极量运动时每个病人都出现运动性心律失常。认为ＶＶＩ起搏的患者极量运动时病理生理特点是低无氧阈、低最大氧耗量、低心输出量、低全身耐力。     

Endurance Exercise Training Improves Heart Rate Recovery in Patients with COPD

Background: Abnormalities of autonomic function have been reported in patients with chronic obstructive pulmonary disease. The effect of the exercise training in heart rate recovery (HRR) has not been established in patients with COPD. Objective: To assess the effects of 8-weeks’ endurance training program on parasympathetic nervous system response measured as heart rate recovery in a sample of moderate-to-severe COPD patients. Methods: We recruited a consecutive sample of patients with COPD candidates to participate in a pulmonary rehabilitation program from respiratory outpatient clinics of a tertiary hospital. HRR was calculated, before and after training, as the difference in heart rate between end-exercise and one minute thereafter (HRR₁) in a constant-work rate protocol. Results: A total of 73 COPD patients were included: mean (SD) age 66 (8) years, median (P₂₅-P₇₅) post-bronchodilator FEV₁ 39 (29–53)%. The prevalence of slow HRR₁ (≤12 beats) at baseline was 63%, and was associated with spirometric severity (mean FEV₁ 35% in slow HRR₁ vs 53 in normal HRR₁, p < 0.001). After 8-weeks training, HRR₁ improved from mean (SD) 10 (7) to 12 (7) beats (p = 0.0127). Multivariate linear regression models showed that the only variable related to post-training HRR₁ was pre-training HRR₁ (p < 0.001). Conclusions: These results suggest that training enhances HRR in patients with moderate-to-severe COPD. HRR is an easy tool to evaluate ANS such that it may be a useful clinical marker of parasympathetic nervous system response in patients with COPD.     

拉贝洛尔对妊娠高血压患者血压及并发症的影响

目的探讨拉贝洛尔对妊娠高血压患者血压及并发症的影响。方法随机选择2012—2013年在本院住院治疗的妊娠高血压患者90例,将患者随机分为对照组和观察组,各45例。对照组患者给予硫酸镁常规治疗,观察组在对照组治疗的基础上应用拉贝洛尔,观察两组患者治疗期间平均收缩压和舒张压、平均24 h蛋白尿、并发症发生情况及妊娠结局。结果观察组患者治疗期间平均收缩压、平均舒张压和24 h蛋白尿低于对照组(P0.05);观察组患者胎儿窘迫、新生儿窒息和产后出血发生率均低于对照组(P0.05)。结论拉贝洛尔可有效降低妊娠高血压患者血压,并减少并发症发生率。