无痛胃镜检查对老年患者血压、心率和血氧饱和度的影响

目的:观察无痛胃镜检查对老年患者血压、心率和血氧饱和度的影响,了解老年患者行无痛胃镜检查的安全性.方法:无痛胃镜检查是在胃镜检查前先予以芬太尼及丙泊酚静脉麻醉.以多功能监护仪监测并记录无痛胃镜检查前、检查中、苏醒时和休息10min患者的收缩压、舒张压、心率和血氧饱和度,并记录不良反应(呛咳、呃逆、呼吸抑制等).结果:与...     

胃镜检查时脉率血氧饱和度监测的价值

为了探讨消化道内镜检查时是否需要对病人进行心脏和血氧监测，对６２例患者在胃镜检查时用经皮脉搏血氧计进行监测。术前未给予阿托平和镇静剂，平均脉率为９４．１２次／分，平均血氧饱和度（ＳａＯ２）为９７．６８％。胃镜检查过程中脉率均加快（Ｐ＜０．０１），＞１００次／分者占６１．３％，ＳａＯ２平均降低１．６１％（Ｐ＜０．０５），ＳａＯ２≤９３％者１０例（１６．１％），仅２例低于９０％，ＳａＯ２降低均为暂时性，嘱深呼吸数次后即见改善。作者认为：（１）轻度的ＳａＯ２下降，不影响胃镜的检查；（２）胃镜检查一般无需常规监测血氧和供氧；（３）心动过速在胃镜检查时是常见的，其在诱发心脏并发症的重要性可能大于血氧的变化，因此对高危患者进行心电图监测可能有助于早期发现和及时处理心脏意外。     

胃镜检查时脉率血氧饱和度监测的价值

为了探讨消化道内镜检查时是否需要对病人进行心脏和血氧监测，对６２例患者在胃镜检查时用经皮脉搏血氧计进行监测。术前未给予阿托平和镇静剂，平均脉率为９４．１２次／分，平均血氧饱和度（ＳａＯ２）为９７．６８％。胃镜检查过程中脉率均加快（Ｐ＜０．０１），＞１００次／分者占６１．３％，ＳａＯ２平均降低１．６１％（Ｐ＜０．０５），ＳａＯ２≤９３％者１０例（１６．１％），仅２例低于９０％，ＳａＯ２降低均为暂时性，嘱深呼吸数次后即见改善。作者认为：（１）轻度的ＳａＯ２下降，不影响胃镜的检查；（２）胃镜检查一般无需常规监测血氧和供氧；（３）心动过速在胃镜检查时是常见的，其在诱发心脏并发症的重要性可能大于血氧的变化，因此对高危患者进行心电图监测可能有助于早期发现和及时处理心脏意外。     

胃镜检查时静脉麻醉对高血压肥胖者血氧饱和度的影响

目的研究胃镜检查时丙泊酚联用芬太尼静脉麻醉下对高血压病肥胖患者血氧饱和度的影响。方法收集我院两年来190例高血压病肥胖患者静脉麻醉下胃镜检查的临床资料,另取同期体重、血压均正常的胃镜检查者200例为对照组,比较在相同检查方式下两组患者血氧饱和度（SpO2）的最低值和SpO2最低时的血压、心率变化。结果所有检查者均顺利完成检查;高血压病肥胖组SpO2最低值为（91．8±7．8）％,对照组SpO2最低值为（96．7±1．6）％,高血压病肥胖组SpO2下降程度明显低于对照组（P〈0．05）;SpO2最低时两组血压、心率均相应下降,但变化程度不大,组内前后两观察时点比较差异均无显著性（P〉0．05）。结论高血压病肥胖患者行胃镜检查时,丙泊酚联用芬太尼麻醉可引起血氧饱和度下降,检查前应予充分吸氧,以避免缺氧导致不良后果。     

高海拔地区老年人肠镜检查术中血氧饱和度和心率的变化

老年人行无痛肠镜检查术时,由于手术的创伤、牵拉、侧卧位时肺通气/血流(V/Q)比例失调以及紧张、憋气等容易造成缺氧。但在边远经济欠发达地区,特别是在高海拔地区尚未见有关报道。本文观察高海拔地区老年人行肠镜检查术期间动脉血氧饱和度(SpO2)和心率(HR)的变化,旨在及时发现和干预缺氧及心律失常,减少术中并发症的发生。     

平均心率对心率变异性指标的影响

心率变异性（ＨＲＶ）作为一种心血管疾病预后的独立预测指标与评价心血管自主神经张力及其平衡的重要手段,已引起人们重视。但其判定结果受年龄、昼夜节律、情绪、体位、呼吸、运动的影响［１］。本研究旨在探讨平均心率及年龄对ＨＲＶ参数的影响。１对象与方法１．１对...     

PCI对急性冠脉综合征患者心率变异性的影响

目的观察PCI术对急性冠脉综合征患者心率震荡(HRT)与心率变异性(HRV)的影响。方法选择接受PCI的ACS患者126例,按冠脉造影结果分为中度狭窄(管腔直径狭窄70%～90%)及重度狭窄(管腔直径狭>90%)组。分析其PCI术前及术后1周、3个月HRT指标震荡初始(TO)、震荡斜率(TS)及HRV指标(SDNN、SDANN及RMSSD)。结果 PCI术后1周HRT较术前明显改善(p<0.01);HRV参数与术前比较无显著差异(p>0.05)。PCI术后3个月,HRT较术前明显改善(p<0.01)但与术后1周无显著差异(p>0.05);HRV参数较术前及术后1周均明显降低(p<0.01)。PCI术前重度狭窄组TO值较中度狭窄者升高(p<0.05),TS值较中度狭窄者明显降低(p<0.01),而SDNN、SDANN及RMSSD均较中度狭窄者明显降低(p<0.01)。PCI术后3个月重度狭窄组HRT及SDNN、SDANN、RMSSD与中度狭窄组比较仍有显著差异性(p<0.05)。结论 HRT及HRV异常与ACS患者病情的严重程度密切相关。HRT及HRV对急性冠脉综合征再灌注治疗后血流的恢复情况具有近期及远期预测价值,可望在临床上做为一种有效无创方法评价PCI的疗效及预后。     

老年高血压患者静息心率与心率变异性及动态血压的相关研究

目的探讨老年原发性高血压（EH）患者静息心率（RHR）与心率变异性（HRV）及动态血压的关系。方法106例老年EH患者根据RI-IR水平分为：A组60例,RHR〈80次／min;B组46例,RHR〉80次／min。对入选患者同步监测动态心电图及动态血压,对比分析HRV及动态血压参数的变化。结果B组HRV时域指标SDNN、SDANN、RMssd、PNN50及TI低于A组,而动态血压各参数均高于A组,差异有统计学意义（P〈0．05,P〈0．01）。RHR与HRV指标SDNN、SDANN及TI呈负相关,而与DBP呈正相关（P〈0．05,P〈0．01）。结论RHR增快是老年EH患者的一个危险因子,与HRV降低、血压增高相关密切。     

Effect of pacemaker rate-adaptation on 24 h beat-to-beat heart rate and blood pressure profiles.

AIMS: The aims of the study were to evaluate the 24-h beat-to-beat heart rate (RR) and blood pressure changes during closed loop stimulation (DDD-CLS) pacing and conventional fixed rate DDD pacing with respect to spontaneous activity. METHODS: We simultaneously and continuously measured beat-to-beat heart rate and blood pressure for 24 h in patients implanted with Inos2+ (Biotronik GmbH, Berlin, Germany). A randomised cross-over comparison of DDD-CLS and DDD pacing was performed by short- and long-term analyses. RESULTS: Seventeen patients (10 males, aged 46-85 years) were enroled in the study: 11 completed the protocol. The percentage of atrial stimulation was 72.87% during DDD-CLS and 38.36% in DDD (P=0.003). All patients were 100% stimulated in the ventricle. On average, the percentage increase of paced RR intervals with respect to spontaneous beats was only 7.4% in DDD-CLS but 20.1% in DDD (P=0.0001). A significant correlation between spontaneous and paced RR profiles was obtained only during DDD-CLS (r(DDD-CLS)=0.77, r(DDD)=0.23, P=0.01). Short-term analysis revealed a 3.79% reduction of the escape interval in DDD-CLS and 8.19% in DDD, and the relative fall in diastolic blood pressure was 1.14% in DDD-CLS and 3.81% in DDD. CONCLUSION: DDD-CLS provided physiological heart rate fluctuations throughout the 24-h test. The blood pressure profiles of paced and spontaneous beats were comparable. The onset of paced rhythm in DDD-CLS resulted in a less pronounced decrease in heart rate and fall in diastolic pressure than in DDD.     

Effects of music on systolic blood pressure, diastolic blood pressure, and heart rate: a meta-analysis

There are a handful of studies that have been done investigating the effect of music on various vital signs, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Many studies have also assessed effects of music on self-reported anxiety level, attributing some degree of music-induced anxiety relief to the beneficial impacts of music on vital signs. Several randomised studies have shown varying effects of music on these vital parameters and so a metaanalysis was done to compare the effect of music on them. The fixed effects model was used as studies were homogenous. A two-sided alpha error < 0.05 was considered to be statistically significant. Compared to those who did not receive music therapy, those who did receive music therapy had a significantly greater decrease in SBP before and after (difference in means, -2.629, confidence interval (CI), -3.914 to -1.344, P < 0.001), a significantly greater decrease in DBP (difference in means, -1.112, CI, -1.692 to -0.532, P < 0.001), and a significantly greater decrease in HR (difference in means, -3.422, CI, -5.032 to -1.812, P < 0.001).     

糖代谢异常对高血压患者心率变异性及血压变异性的影响

目的：研究糖代谢异常对高血压患者心率变异性（heart rate variability，HRV）及血压变异性（blood pressure variability，BPV）的影响，以分析其对心血管系统植物神经功能的作用。方法：选取36例单纯高血压及33例合并2型糖尿病的高血压患者，行24h动态心电及血压监测，对两组患者的HRV及BPV进行对比分析。结果：与单纯高血压患者相比，合并糖尿病的高血压患者HRV减少（P〈0．05～〈0．01）；而BPV增大（dSBPSD、dSBPCV、24SBPSD．P〈0．05～〈0．01）。结论：糖尿病患者存在心血管系统植物神经病变，进而造成心血管的结构与功能异常，改善其心血管系统植物神经功能，可能有助于减少心血管并发症的发生。     

Joint symbolic analyses of heart rate,blood pressure,and respiratory dynamics

Introduction

The dynamics of cardiovascular variables are modulated by respiration. The aim of this study was to assess baroreflex function in normal subjects based on the joint symbolic dynamics of heart rate, blood pressure and respiration.

Methods

ECG, continuous blood pressure and respiration were recorded in ten healthy subjects during rest in the supine position and upon standing. Beat-to-beat time series of heart rate, systolic blood pressure and respiratory phase were extracted and transformed into binary symbol sequences. Words of length two that were reflective of baroreflex activity were statistically analysed with respect to the respiratory phase.

Results

Symbolic analysis showed a significant influence of the respiratory phase on the occurrence of baroreflex patterns. Upon standing, the frequency of baroreflex words increased and the effect of respiration appeared to be reduced.

Conclusions

Symbolic dynamics provide a simple representation of cardiovascular dynamics and may be useful for assessing baroreflex function.     

经皮无创血气监测的临床应用及研究进展

经皮无创血气监测具有无创、持续、动态监测等特点,弥补了传统血气分析的许多不足。经皮氧分压、经皮二氧化碳分压与PaO2、PaCO2有很好的相关性,故能够反映患者PaO2、PaCO2的即刻变化,广泛应用于临床的许多领域中,为许多疾病的早期发现,早期诊治及预后评估提供有价值的信息。     

动脉导管未闭导管封堵与外科缝扎术对心率血压的影响

目的：观察动脉导管未闭（PDA）导管封堵与外科缝扎术对心率、血压的影响。方法：119例PDA患者中62例做外科缝扎手术，57例做Amplatzer封堵器封堵。观察术前、术后其心率、血压的变化情况。结果：（1）对心率的影响：手术组：术前、后有明显差异（P〈0．05）；介入组：术前、后没有明显差异（P〉0．05）。两组术前没有明显差异（P〉0．05），术后介入组心率明显低于手术组（P〈0．05）；（2）对血压影响：两组术前、后收缩压与舒张压均无显著性差异（P〉0．05）。两组间术前收缩压及舒张压无显著性差异（P〉0．05），但术后均出现显著性差异（P〈0.05）。结论：手术组术后心率增快比介入组明显。介入组术后收缩压和舒张压明显比手术组高。