12导联动态心电图与常规心电图P波差别的研究

目的探讨12导联动态心电图(AECG)与常规心电图(RECG)P波的差别,为12导联动态心电图P波的诊断标准提供依据.方法用常规12导联心电图的连接方式和12导联动态心电图的连接方式分别描记心电图,然后比较两种连接方式心电图P波的差别.结果两种测量方法,P波形态、电压、间期完全相同(形态相同指两者P波方向一致;电压相同指两者P波电压差别小于0.05 mV;间期相同指间期差小于0.04 s)共443例(73.8%).形态存在差别共15例(2.5%),电压存在差别共109例(18.2%),间期存在差别共33例(5.5%).结论两种连接方式,P波形态基本一致,不影响绝大多数心律失常的诊断,P波电压的差别较大,P波间期差≥0.04 s 33例,仅占5.5%,而且主要是AECG导联方式大于RECG导联方式,在分析12导联AECG P波时,可适当考虑这几方面因素.     

高血压病人动脉顺应性与家庭偶测血压及动态血压关系

目的　探讨原发性高血压病人家庭测量血压、动态血压与动脉顺应性的关系。方法　共入选 164例受试者 ,其中原发性高血压组 74例 [男 42例 ,女 3 2例 ,平均年龄 ( 4 7 0 5± 10 0 8)岁 ] ;对照组 90例 [男 41例 ,女 49例 ,平均年龄 ( 3 3 81±12 3 5 )岁 ]。对入选者间隔 1～ 3周进行二次家访 ,每次家访由经过专门训练的护士采用汞柱血压计连续测量受试者坐位、左上臂血压 5次 ,每人的家庭测量血压是二次家访、共 10个血压读数的平均值。同时采用SpaceLabs 90 2 0 7动态血压监测仪记录 2 4小时动态血压 ,有效数据应达到 80 %以上。动脉顺应性检查采用动脉脉搏波分析 (PWA)仪。反映大动脉硬化的参数为反射波增强指数 (AIx)。结果　高血压组家庭测量血压及 2 4小时平均收缩压、舒张压、白昼及夜间血压显著高于对照组。与对照组相比 ,高血压组AIx显著升高 ( 2 4 4%± 12 8%vs 12 7%± 18 3 % ,P =0 0 0 0 ) ,经年龄、性别调整后 ,二组间仍有显著性差异 ,提示高血压患者动脉顺应性下降、动脉硬化。将AIx作为因变量 ,年龄、身高、家庭测量血压及动态血压中 2 4小时平均血压、白昼血压、夜间血压、血糖、血酯等作为自变量进行多元回归分析 ,AIx与年龄、家庭血压中的收缩压呈显著的正相关 ,与身高呈负相关     

Current Use and Future Needs of Noninvasive Ambulatory Electrocardiogram Monitoring

Remarkable progress has been seen in monitoring systems using noninvasive ambulatory electrocardiograms (ECGs). In the Holter ECG system, 12-channel formats have been utilized as diagnostic tools, particularly for the detection of transient or silent myocardial ischemia and dynamic electrical disorders. In patients diagnosed with cryptogenic stroke, despite negative results on standard ECG tests, continuous ambulatory ECG monitoring for up to 30 days has been shown to increase the detection rate of transient atrial fibrillation. At present, a waterproof Holter ECG system is available. Recently, continuous late potential measurements using the time domain method and frequency domain T-wave alternans using the spectral analysis method for 24 hours have been applied to the Holter ECG and developed as novel risk stratification markers. Wearable ECG monitors that are built into belts, vests, wristbands, adhesive patches, and mobile smartphones have been used as fitness products for athletes and healthcare products for the general population. In the future, such devices may be used as remote monitoring tools for the detection of arrhythmias.     

24 h动态心电图检测冠心病无症状心肌缺血阈的临床分析

目的探讨动态心电图对冠状动脉粥样硬化性心脏病（冠心痛）病人无症状心肌缺血闽值的临床意义。方法53例冠心病病人24h心电图检测其心肌缺血闽值、心肌缺血闽值的变异度、每阵缺血发作持续时间和ST段最大位移，以及昼夜缺血次数。结果共检出468例缺血发作，以心率加快时心肌缺血居多，达91．2％，夜间心肌缺血闽值较低，且缺血持续时间及ST段压低程度明显长于厦重于白昼。心肌缺血阈的变异度为22．3％。与缺血总阵数呈正相关。结论高心肌缺血阈与心肌耗氧量有关，低心肌缺血闽与冠状动脉张力有关。     

Temporal Analysis of Blood Pressure by Ambulatory 24 H Blood Pressure Monitoring

In order to study the circadian rhythm of BP in man. we performed 24-hour non invasive BP on 15 hospitalized patients. Each subject was monitored twice, with an interval of 24–48 h between the two monitorings. In 14 of the 15 subjects MBP showed a statistically significant circadian rhythm. The curve fitted by the single cosinor method to the mean of the first rhythmometric measurements performed on all 15 subjects was characterized by an acrophase at 12.53, an amplitude of 4.68 mmHg and a mesor of 87.49 mmHg. The same parameters for the second rhythmometric measurements were: acrophase at 13.57, amplitude 4.1 mmHg and mesor 88.35 mmHg. In both cases, overall circadian rhythm resulted to be similar in all the subjects (p < 0.01). Multivariate analysis of variance showed that each subject has his own characteristic circadian rhythm. Our findings support the hypothesis of a identifiable circadian rhythm of BP in man.     

习惯性鼾症患者动态血压监测及其临床意义

对４２例习惯性鼾症伴高血压患者进行动态血压监测和晨晚间血浆血管紧张素Ⅰ、血管紧张素Ⅱ测定。结果显示鼾症组夜间血压较白昼无明显降低，昼诳节律消失。晨间ＡｎｇⅠ 和ＡｎｇⅡ比晚间增高。与对照组比较动态血压多项参数和因浆ＡｎｇⅠ、Ａdisplay status     

可乐定透皮控释贴片降压疗效观察

目的用２４ｈ动态血压监测方法评价可乐定透皮控释贴片（Ｃ－ＴＴＳ）的降压疗效。方法轻中度原发性高血压患者１５例，平均年龄５２．１±８．４岁。用安慰剂贴片２周后，改用一贴Ｃ－ＴＴＳ（含量２．５ｍｇ／片，面积２．２７ｃｍ２，日释放量０．１ｍｇ），７天更换贴片。结果６例患者仅用一贴Ｃ－ＴＴＳ血压降至目标血压，１２例患者使用１～３贴血压得到控制，总有效率为８０％。治疗后白天、夜间及２４ｈ平均舒张压均明显降低（Ｐ＜０．０５）；白天、夜间及２４ｈ的收缩压和舒张压负荷明显降低（Ｐ＜０．０１）。结论Ｃ－ＴＴＳ能降低２４ｈ血压，作用时间可达７天，治疗依从性好。     

Long-Term Reproducibility and Usefulness of Daytime Recording of Noninvasive 24-Hour Ambulatory Blood Pressure Monitoring in Borderline Hypertension: A Two-Year Follow-Up Study

We investigated the long-term reproducibility of noninvasive 24-hour ambulatory blood pressure monitoring (ABPM) compared with casual blood pressure measurements in 54 individuals (47±11 years) with borderline hypertension.

ABPM and casual blood pressure measurements were obtained 3 times over 2 year period. ABPM data were analyzed to determine the average 24-hour blood pressure (24-BP), the average blood pressure during the waking hours (Day-BP), and the average blood pressure from the time the subject went to bed until he awoke (Night-BP). ABPM measurements were similar for Year 1,2, and 3 (24-BP: Year 1; 130+10/79+6 mmHg; Year 2; 130+10/79f7mmHg; and Year 3; 130fl0/78 ±7mmHg). Bland-Altman analysis and standard deviation of the difference also indicated the reproducibility of 24-BP was better than casual pressure. The 24-BP was significantly correlated with both Day-BP and Night-BP for each year. Day-BP showed the stronger correlation. Our results suggest that Day-BP provides reproducible estimation in subjects with borderline hypertension.     

Analysis of ambulatory electrocardiograms in 14 patients who experienced sudden cardiac death during monitoring

The Holter monitors of 14 patients (out of 58,000 Holter recordings performed between 1978 and 1984) who experienced cardiac arrest and expired during the recording period were analyzed. Tachyarrhythmic arrest patients frequently had coronary heart disease, congestive heart failure, and prolonged QTc intervals. The highest incidence of intermediately frequent premature ventricular complexes (PVCs) occurred between 15 and 6 hours prior to death. The frequency of ventricular couplets increased toward the time of arrest. The hours with greatest frequency of ventricular tachycardia (VT) were found to be the last 5 hours of life. An increasing incidence of ST-segment changes greater than 2 mm was noted throughout all of the risk periods until the third hour prior to arrest when the incidence diminished. Conversely, the incidence of lower amplitude ST-segment changes (usually elevation) increased over the final 6 hours. The mean time of death was 0228 hours +/- 5:20. In conclusion, we observed two patterns of Holter-monitored changes which usually occurred prior to death and may represent predictors of sudden death: (1) an increasing incidence of intermediately frequent isolated PVCs followed by increased ventricular couplets and runs of VT; (2) return of high amplitude ST-segment changes toward baseline. To our knowledge, the temporal relationship of the degree of ST-segment deviation to sudden death and the time of sudden death have not been reported in large studies of Holter-monitored sudden death patients.     

动态血压监测评价贝尼地平治疗原发性高血压的疗效观察

目的　应用动态血压监测 (ABPM )的方法评价贝尼地平治疗原发性高血压的降压疗效、谷 /峰比值及不良反应。方法　采用开放的方法 ,2 0例研究对象经 2周洗脱期 ,服用贝尼地平 4mg/d一次 ,2周末坐位舒张压 (SeDBP)≥ 90mmHg者加量至贝尼地平 8mg/d一次 ,继续服用 6周。于洗脱期末及治疗 8周末各行ABPM和实验室检查一次。结果　ABPM显示 8周末 2 4h、日间、夜间收缩压 (SBP/DBP)较洗脱期末分别下降 (9.4± 5 .4 / 6 .2± 4 .1)mmHg、(10 7± 6 .7/ 6 8± 3 8)mmHg、(6 9± 9 0 / 5 1± 7 7)mmHg。降压T/P值SBP为 5 8% ,DBP为 5 9%。无严重不良反应。 结论　贝尼地平 4～ 8mg/d一次为疗效确切的降压药物。     

Twenty-Four Hour Ambulatory Blood Pressure Monitoring in Adolescents with Type 1 Diabetes: Getting Started

Twenty-four hour ambulatory blood pressure monitoring (ABPM) is a valuable tool in the pediatric and adolescent population with type 1 diabetes. It provides useful information not readily available from sporadic clinic blood pressure (BP) measurements and a more reliable estimation of the subject''s BP over an extended period of time. Ambulatory blood pressure monitoring is gaining popularity with clinicians and investigators alike. The American Heart Association has recently issued recommendations for the use of ABPM in children and adolescents. We have incorporated ABPM into our adolescent diabetes practice and present useful information for clinicians planning to initiate 24 h ABPM in their clinical practice.     

Ambulatory Versus Casual Blood Pressure in the Diagnosis of Hypertensive Patients

Recent advances in medical technology have enabled the development of fully automatic portable noninvasive blood pressure recorders which can reliably monitor changes of blood pressure over periods of 24 hour or more. The commercial availability of such recorders raises the question of their relevance to the practical management of hypertensive patients.

The rationale for the use of Ambulatory Blood Pressure monitoring (ABPM) is the enormous variability of blood pressure. This has been amply demonstrated with both invasive and noninvasive ABPM, and is not a matter of dispute (1,2). Since the adverse effects of blood pressure on the circulation are thought to depend either on the average level of pressure over time or possibly also on the peak levels of pressure, there is a sound theoretical reason for thinking that multiple measurementspage missing 258-258     

妊娠高血压综合征动态血压监测及其意义

目的探讨妊娠高血压综合征动态血压监测的特征变化。方法用动态血压仪测定３２例妊娠高血压患者的血压，并和２０例正常妊娠和２０例正常相当年龄的健康妇女作对照。结果正常孕妇ＡＢＰＭ各参数均高于同龄健康妇女；妊娠高血压ＡＢＰＭ各参数均高于正常孕妇。妊娠高血压蛋白尿阳性者的昼夜血压比值及血压负荷数均较无蛋白尿者明显增高，且与病情严重度相关。结论正常中、晚期妊娠的收缩压有增高趋势，舒张压升高对妊娠高血压更具特征性。ＡＢＰＭ测定所出现的血压昼夜节律变化和血压负荷增高和病情的严重度相关。     

Relationship of Ambulatory Blood Pressure and the Heart Rate Profile with Renal Function Parameters in Hypertensive Patients with Chronic Kidney Disease

Strict blood pressure (BP) control is reportedly important for the management of hypertensive patients with chronic kidney disease (CKD). The purpose of this cross-sectional study was to examine whether the variables of ambulatory BP and the heart rate (HR) profile, central hemodynamics, and arterial stiffness were closely related to the renal function parameters (urine albumin excretion rate [UACR] and estimated glomerular filtration rate [eGFR]) observed in 25 consecutive hospitalized hypertensive patients with CKD. There were significant positive relationships between UACR and 24-hour, daytime, and nighttime ambulatory systolic BP. In addition, there were significant negative relationships between UACR and 24-hour and daytime HR variability. The circulating B-type natriuretic peptide level and hemoglobin A1c were also positively related to UACR. With respect to eGFR, although the 24-hour and nighttime HR variability were positively associated with eGFR, the circulating pentosidine and nighttime HR had a negative relationship with eGFR. On the other hand, central hemodynamics and arterial stiffness did not exhibit any significant association with renal function parameters. These results indicate that ambulatory BP and the HR profile are closely modulated by renal function deterioration. Further studies are needed to investigate the causal relationship between ambulatory BP and the HR profile and renal function parameters in hypertensive patients with CKD.     

充血性心力衰竭的昼夜动态血压特征及临床意义

本文观察了 ４４ 例非瓣膜性充血性心力衰竭（ Ｃ Ｈ Ｆ）患者的昼夜血压变化及其与心功能受损程度的关系。　结果： Ｃ Ｈ Ｆ患者中有 ８１．８％ 血压昼夜节律减弱或消失，这种血压昼夜节律的改变在有高血压史与无高血压史两组间无显著差异。在心功能级的 １１ 例中有 ６ 例（５４．５％ ）发生血压昼夜节律的改变，而心功能级和级的 ３３ 例中则有 ３０ 例（９０．９％ ）。这表明相当一部分的 Ｃ Ｈ Ｆ患者有血压昼夜节律的改变，且与心功能受损的严重程度有一定相关。     

胃食管反流病食管测压与24小时pH监测的相关性研究

目的：对５２例有胃食管反流症状的患者进行食管测压及２４小时ｐＨ监测，运用统计学方法分析测压和ｐＨ结果，研究其相关性。方法：应用多导胃肠功能测定仪及便携式ｐＨ监测记录仪，对５２例有胃食管反流症状的患者进行食管测压及２４小时ｐＨ监测。结果：应用多元回归分析发现，ｐＨ的百分比和腹段下食管括约肌（ＬＥＳ）的长度、ＬＥＳ静息压及远端食管的蠕动压明显相关。依据测压及ｐＨ结果，使用ｔ检验方法，结果提示食管蠕动压不仅与ｐＨ＜４的百分化相关，也与酸反流大于５分钟的时间、最长反流时间有关（Ｐ＜００１）。结论：腹段ＬＥＳ的长度及食管下段的蠕动收缩是重要的抗反流屏障。食管酸暴露时间延长减弱食管体部酸清除能力     

动态血压监测探讨体重指数与血压的关系

目的:动态血压监测探讨患者体重指数与血压变化情况。方法:选择门诊和病房住院的患者共691例(其中男性417例,女性274例),年龄范围13~90岁,平均年龄为55岁。所有观察对象测量诊室血压、心率、身高、体重和监测24小时动态血压等指标,按照体重指数分为3组,体重指数<24为正常体重组;24≤体重指数<28为超重组;体重指数≥28为肥胖组。结果:肥胖组患者24小时和白天的平均收缩压/舒张压、夜间平均舒张压以及24小时、白天和夜间心率均高于正常体重组,有显著性差异(P<0.05~0.01)。此外,血压负荷也随着体重指数的增加而增加,有显著性差异(P<0.05~0.01)。结论:体重指数与动态血压和血压负荷有较密切的关系;与正常体重组、超重组比较,肥胖组患者的血压最高、心率最快;动态血压提供的数据信息量大,结论更可靠、准确。     

Comparison of 44‐Hour and Fixed 24‐Hour Ambulatory Blood Pressure Monitoring in Dialysis Patients

The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44‐hour and 24‐hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24‐hour period that correlated well with the 44‐hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44‐hour ABPM and extracted data for a fixed 24‐hour ABPM. The fixed 24‐hour ABPM started at 6 am on the nondialysis day. A strong correlation was found between all parameters of 44‐hour and the fixed 24‐hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters. Both 24‐hour ABPM and 44‐hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44‐hour ambulatory arterial stiffness index (AASI), but not 24‐hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44‐hour systolic blood pressure, this association disappeared. Fixed 24‐hour ABPM is a good surrogate of 44‐hour ABPM to some extent, while 44‐hour ABPM can provide more accurate and detailed information.     

Comparison of ST depression recorded by Holter monitors and 12-lead ECGs during coronary angiography and exercise testing

Data from previous studies are debatable regarding whether Holter monitors are a reliable electrocardiographic indicator of ischemia, for which the 12-lead electrocardiogram (ECG) is the standard. Simultaneous 12-lead and Holter ECGs were performed on 30 patients with typical angina pectoris during coronary angiography or exercise testing. ST depression recorded by both methods was directly compared, using the 12-lead ECG as the reference. The Holter tapes were also scanned by two automated ST analysis programs and the results were compared to 12-lead ECGs. Only 66 of the 178 12-lead ECG ST depression events were also present on the Holter recordings (37.1% Holter sensitivity). ST depression was underestimated by the Holter recordings compared to the 12-lead ECGs (p < 0.0001). The majority (67.0%) of ST depression events identified by one computer program were false positive events. The degree of ST depression was overestimated compared to 12-lead ECGs by the second program (p = 0.0033). Holter-detected ST depression may not be a reliable ECG indicator of myocardial ischemia.