航海人员高血压24小时动态血压变化特征

目的：探讨航海人员（包括水下和水面作业）中血压患者24小时动态血压监测（ABPM）参数变化特征。方法：选择偶测收缩压≥140mmHg和或舒张压≥90mmHg的37例航海人员中高血压患者行24h ABPM，并与94例血压正常的航海人员（＜140／90mmHg）对比观察。结果：航海人员中高血压患者24h平均SBP的DBP、白昼或夜间平均SBP和DBP，白昼或夜间SBP和DBP负荷值，均明显高于血压正常线；高血压患者夜间SBP和DBP均值下降＞10％（＞10mmHg）；水下作业组的高血压患者白昼或夜间SBP和DBP负荷值高于水上作业组。结论：本组航海人员中高血压患者均显示杓型高血压，可能与轻、中度高血压（35／37）较多有关；水下作业组高血压患者负荷值升高明显，提示水下作人员的工作环境与生活条件等复杂因素影响，易产生增压反应有关。     

原发性高血压24小时动态血压分析

目的：分析原发性高血压24小时动态血压变化。方法：应用美国产动态血压监测仪观察40例原发性高血压24小时动态血压并与96例血压正常进行比较。结果：单纯高血压患白天,夜间,平均收缩压,平均舒张压及24小时血压负荷值均比血压正常组高（P＜0．01）,高血压靶器官损害各组收缩压和舒张压又比单纯高压患高（P＜0．01）,结论：24小时动态血压与高血压靶器官损害有关,血压越高,靶器官损害越多,多脏器损害血压最高,脑,肾损害血压次之。     

高血压患者24小时动态血压分析

对１００例高血压患者进行２４ｈ动态血压监测，结果２４ｈ动态血压波动规律呈双峰双谷状，第一高峰在上午７～１１时左右，第二高峰在下午１６～２１时左右，且收缩压第二高峰值明显高于第一高峰值，２４ｈ动态血压均值昼夜为１３９／８３ｍｍＨｇ，日间为１４０／８６ｍｍＨｇ，夜间为１３６／８０ｍｍＨｇ。血压负荷收缩压为４８％，舒张压为３２％。     

107例高血压患者24小时动态血压监测分析

早在60年代就有学者注意到血压的固有波动对高血压病的诊断、治疗和预后的判断等若干问题,并为     

老年糖尿病患者24小时动态血压变化特征探讨

236例老年人,C组50例,HT组90例,DM组96例,DM-A组40例,DM-B组56例,其中诊室血压漏诊11例(19.6%);使用TM-2421动态血压仪(AD)监测记录24小时ABP。结果:C与HT组的大多数ABP昼夜变化呈"勺型"模式,DM-A和DM-B组则多数为"浅勺型"模式,反勺型比率明显增加,其中SBP反勺型比率比C组显著增加(P0.05);HT组的反勺型比率与C组比较也有增加,但无统计学显著差异(P(0.05)。DM-A组夜间PP均值明显高于对照组(P0.05);DM-B组全部ABP参数均明显高于C和DM-A组(P0.01),并且,DBP均值(24小时、白天)、白天DBP负荷明显低于HT组(P0.01或0.05)。HT组全部ABP参数均明显高于C和DM-A组(P0.01)。结论:老年糖尿病患者ABP昼夜变化模式发生明显改变,并且在合并高血压之前部分夜间ABP指标已出现明显异常。     

老年高血压患者24小时动态血压变化与靶器官损害的关系

一、资料与方法观察１９９５年４月至１９９７年１０月在我科住院的１２０例老年高血压患者２４小时血压变化与靶器官损害的关系。诊断及分期采用ＷＨＯ标准,并排除继发性高血压。男１０４例,女１６例。年龄６０～８４岁,平均（７１±６）岁;其中６０～６９岁组５０例...     

24小时动态血压监测在高血压诊断与治疗中的作用

本文对24小时动态血压监测仪的由来、发展及24小时动态血压监测在高血压诊断、治疗及预后中的作用作一介绍。     

健康人、糖尿病及高血压患者24小时动态血压比较

155例研究对象,其中正常组50例：男性20例,女性30例,平均60．0±10．3（SD）岁;糖尿病组（2型,临床血压正常及未接受胰岛素治疗）47例：男性28例,女性19例,61．0±8．5岁;高血压组（轻中度）58例：男性33例,女性25例,59．4±8．0岁。采用TM-2421动态血压监测仪（A＆D,日本）监测记录24小时ABP。采用SPSSl0．0软件分析实验数据。结果：（1）三组ABP均呈勺型变化,糖尿病和高血压组SBP水平显著高于正常组（P〈0．01,P〈0．05）。高血压组DBP水平显著高于正常组和糖尿病组（P〈0．01,或P〈0．05）。余弦法证实三组ABP变化的显著昼夜节律性,糖尿病和高血压组的夜间血压（SBP、DBP）下降率明显低于正常组（P〈0．01,或P〈0．05）。（2）ABP参数：糖尿病和高血压组ABP均值和负荷明显高于正常组（P〈0．01,或P〈0．05）;ABP变异性三组之间无显著性差异;高血压组ABP曲线下面积显著性高于正常组（P〈0．01）,与糖尿病组无显著性差别。结论：高血压和临床正常血压的糖尿病患者均出现ABP部分参数与正常对照组的显著性差异,提示：糖尿病患者在临床明确诊断高血压前已发生血压调节的明显病理改变。     

继发性高血压24小时动态血压研究

目的研究继发性高血压（ＳＨ）２４小时动态血压变化。方法应用美国Ｓｐａｃｅｌａｂｓ９０２０７动态血压监测仪观察了８０例ＳＨ２４小时动态血压并与年龄、性别相配对的８０例高血压病（ＥＨ）患者进行比较。结果ＳＨ患２４小时血压节律与ＥＨ患者不同,ＳＨ患者夜间血压下降不明显,夜间血压明显高于ＥＨ患者（Ｐ＜００１）;ＳＨ患者夜间血压负荷在６０％左右,而ＥＨ患者夜间血压负荷则在１５％左右;ＳＨ患者与ＥＨ患者２４小时血压曲线：白昼（６：００～２２：００）曲线呈重叠、交叉状态,而夜间（２２：００～６：００）曲线呈分离状态,ＥＨ夜间曲线段明显降低。ＳＨ组非杓型明显多于ＥＴ组（Ｐ＜００１）。ＳＨ患者夜间血压／日间血压的比值大于９０％的例数明显多于ＥＨ患者。结论２４小时动态血压监测显示夜间血压下降不明显,夜间血压负荷在５０％以上,呈非杓型,夜间血压／日间血压的比值大于９０％,提示有ＳＨ可能,应作进一步检查。     

First 24 Hours of Acute Pancreatitis

Differences in metabolic Iiomeostasis in 12 patients with initial vs. eight patients with repeated attacks of acute pancreatitis have been compared during the acute phase of the disease. As a group, subjects vvitli a previous history of pancreatitis had significantly lower glucagon concfiitrations (P < 0.002) for the over all 24-hour study period. Conversely, the serum concentrations of blood sugar, insulin. growth hormone, gastrin, cortisol. nonesterified fatty acids, triglycerides and cholesterol failed to distinguish between the two patient groups. Likewise, immunoreactive plasma parathyroid hormone and calcitonin levels were comparable in both patient populations. Of the measurements considered. it would appear therefore that plasma immunoreactive glucagon is the best indicator of previous pancreatic inflanunation. Evaluation of parenchymal integrity during an episode of acute pancreatitis would he ol prognostic therapeutic value in this disease.     

24 h食管pH监测在小儿临床的应用

目的：探讨24h食管pH监测在小儿临床的应用及其意义。方法：对43例患儿进行24h食管pH监测，其中反复呕吐症状为主者29例和以反复呼吸道症状或哮喘发作为主者11例。并对12例诊断为病理性胃食管反流患儿经治疗后进行复查。以11例无消化道症状并排除消化系统疾病和肺支气管疾病儿童作为对照。监测指标有食管pH＜4．0的次数、反流时间≥5min的次数 、最长反流时间、反流时间、立位和卧位pH值＜4的时间占总监测时间的百分比以及Biox-0choa评分。结果：32例存在胃食管反流（GER），占74．4％。各项反应指标的监测结果与对照组的比较和治疗前后反流指标的变化均有显著性差异。结论：通过24h食管pH监测判定反流类型，不仅提高了病理性GER的诊断率，而且不不同临床类型的反流治疗方案的确定提供了根据，尤其是反复呕吐、反复呼吸道病变及新生儿呕吐的病因诊断和疗效观察中具有重要意义。     

正常孕妇24小时的心率变异分析

为观察正常孕妇的HRV以及室性心律失常的发生率 ,探讨孕妇心脏自主神经功能的平衡情况 ,对 6 9例孕妇(按妊娠周期分成 3组 )和 30例正常未孕妇女进行 2 4h动态心电图检查 ,监测 2 4h的室性心律失常 (PVC) ,对其时域、频域结果进行分析。结果显示 :与对照组相比 ,怀孕各组大部分时域、频域指标均明显降低 (P <0 .0 5 ) ,但与妊娠周期无关 ;而怀孕伴PVC与怀孕无PVCHRV比较有显著性差异 (P <0 .0 5 )。提示怀孕伴PVC可能与心脏自主神经功能失衡有关。HRV分析对临床评价孕妇心脏自主神经功能有一定的参考意义。     

高龄老年高血压患者颈动脉内膜中膜厚度与动态血压参数的关系

目的 探讨高龄老年高血压患者颈动脉内膜中膜厚度(IMT)及其与动态血压参数特点相关性的研究.方法 将205例患者根据颈动脉超声检查结果分为3组:对照组为非颈动脉内膜中膜增厚(IMT＜1.0 mm),硬化组颈动脉内膜中膜增厚(1.0 mm＜IMT＜1.2 mm),斑块组为颈动脉内膜中膜增厚合并斑块(IMT≥1.2 mm),应用无创24 h动态血压监测系统记录24 h平均收缩压、24 h平均舒张压、白天平均收缩压、白天平均舒张压、夜间平均收缩压、夜间平均舒张压、24 h脉压及白天脉压、夜间脉压值,记录其中杓型高血压和非杓型高血压的比例和合并冠心病比例.用各组IMT均值与24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h脉压、白天脉压、夜间脉压及冠心病发生率作相关分析.结果 斑块组和硬化组24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h脉压、白天脉压及夜间脉压均高于对照组(P＜0.05).其中非杓型高血压在对照组中占54.3%,在硬化组占62.9%,斑块组占77.6%,差异有统计学意义(P＜0.05).各组冠心病发生率对照组为42.1%,硬化组为53.1%,斑块组89.5%,差异有统计学意义(P＜0.05).各组IMT均值与冠心病发生率及24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h脉压、白天脉压和夜间脉压均呈正相关(r值分别为r=0.878,r=0.487,r=0.514,r=0.469,=0.448,r=0.492,r=0.435,P＜0.05).结论 高龄老年高血压患者动态血压的平均收缩压升高、平均脉压增大和血压昼夜节律消失是造成颈动脉内膜中膜厚度增厚及斑块形成的重要因素.颈动脉内膜中膜厚度斑块形成与冠心病的发生有良好的相关性.     

Quantitative Angiography of Coronary Artery Dimensions 24 Hours After Rotational Atherectomy

Rotational atherectomy results in platelet activation and heat generation, which may impact artery size immediately after treatment. In addition, arteries treated with balloon angioplasty may exhibit recoil within 24 hours. In this study, arteries treated with rotational atherectomy, with and without adjunctive balloon angioplasty, were analyzed by quantitative coronary angiography to determine the effect of rotational atherectomy on the dynamic behavior of the arterial wall within 24 hours after the procedure. Quantitative coronary angiography was performed at a core laboratory. Coronary angiogram acquisitions were preceded by intracoronary nitroglycerin injections and were repeated using identical angles of projection. Proximal and distal reference vessel diameters were 2.55 ± 0.60 and 2.28 ± 0.51 mm, respectively, and did not change from pre- to postprocedure. Both were larger the following day increasing to 2.72 ± 0.65 and 2.52 ± 0.52 mm, respectively, (p <0.001). Minimum luminal diameter (MLD) increased from 0.70 ± 0.28 mm before to 1.49 ± 0.34 mm after the procedure and to 1.72 ± 0.37 mm at 24-hour follow-up (p <0.001). Subset analysis of patients treated with rotational atherectomy alone or rotational atherectomy with adjunctive balloon angioplasty revealed that the increase in luminal diameters occurred in both subsets. Patients treated with adjunctive angioplasty had a smaller initial MLD, a larger postprocedure MLD, and no difference in MLD at 24-hour follow-up compared with stand-alone rotational atherectomy. Subset analysis of 100 patients who had 6-month follow-up angiography revealed that both a calculated acute gain and chronic late loss, based on a 24-hour film, differed significantly from values using a film acquired immediately after the procedure. However, the slope of the linear regression between acute gain and chronic late loss did not differ. Coronary arteries treated with rotational atherectomy with or without adjunctive balloon angioplasty increase significantly in size during the first 24 hours after the procedure. This phenomenon has implications for the calculation of absolute gain and chronic late loss, but not for the linear relation between the 2 quantitative outcomes.     

动态血压监测临床应用进展

目的对动态血压监测临床应用进展作一综述.方法查阅国内外文献.结果动态血压在研究白大衣高血压、运动血压及评价降压药物疗效、预测高血压靶器官损害方面优于偶测血压.结论动态血压亦有不足之处,提出了目前动态血压监测的临床应用指征.     

24小时动态血压负荷程度与心功能的关系分析

目的;探讨２４小时动态血压负荷程度,对轻、中度高血压患者心脏收缩及舒张功能有何影响。 方法：选择轻、中度原发性高血压患者２０例,应用２４小时动态血压监测及放射性核素心血池显像分析及超声心动图监测心功能,将血压负荷程度按＜３０％和＞３０％分Ａ、Ｂ、Ｃ、Ｄ ４组,比较各组间心功能有无差异。 结果：Ａ、Ｂ组相比,Ｃ、Ｄ组相比及 Ｂ、Ｄ组相比,高峰充盈率（ＰＦＲ）均有显著差异（Ｐ＜０． ０５）;Ｃ、Ｄ组相比,左心室射血分数（ＬＶＥＦ）有非常显著差异（Ｐ＜０．０１）。超声心动图分析心功能结果与核素心血池显像分析相同。 结论;收缩压或舒张压负荷程度的升高均可显著影响轻、中度高血压病患者的心室舒张功能,而后者为著。同时舒张压负荷程度与心室收缩功能明显相关,可作为预测这类患者心功能改变的敏感指标。     

神经内分泌因素与原发性高血压动态血压曲线的关系

目的探讨神经内分泌因素与原发性高血压患者24小时血压节律的关系.方法 78例原发性高血压患者均检测血浆去甲肾上腺素(NE)、肾上腺素(AD)、血管紧张素Ⅱ(AT Ⅱ)、内皮素(ET)、神经肽Y(NPY),应用统计学方法对化验结果进行分析,观察其与24小时血压节律正常组(杓型组)及异常组(非杓型组)的关系.结果原发性高血压非杓型血压特点患者去甲肾上腺素水平明显增高(P<0.01),而肾上腺素、血管紧张素Ⅱ、内皮素、神经肽Y无明显变化(P>0.05).结论原发性高血压患者血浆去甲肾上腺素水平对24小时血压节律的改变起着重要的作用,而肾上腺素、血管紧张素Ⅱ、内皮素及神经肽Y无明显影响.     

Outcome of Discharge Within 24 to 72 Hours After Laparoscopic Colorectal Surgery

Purpose Although laparoscopic colorectal surgery may permit early recovery and discharge from hospital, short lengths of stay are not routinely achieved. This is partly because accelerated recovery programs with early discharge are associated with high readmission and complication rates, especially after open colorectal surgery. Methods This study was designed to examine safety and outcomes after laparoscopic colectomy in cases discharged within 72 hours of surgery. A total of 118 consecutive patients (mean age 60 years) underwent elective laparoscopic colectomy by a single surgeon. An accelerated recovery program included an overnight intravenous patient- controlled analgesia pump, diet and oral analgesia on postoperative Day 1, and standardized discharge criteria. Results Mean body mass index was 28.5 (range, 20–45), and mean operative time was 142 minutes with no mortality. Median stay was 3 days, and 20 percent had a complication within 30 days. Eighty-two patients (70 percent) were discharged within 72 hours of surgery (10 Day 1; 46 Day 2; 26 Day 3). Patients were grouped and analyzed by day of discharge. Discharge on Days 1 to 2 was associated with significantly lower complication rates than seen for the overall group. Although patients discharged on Days 1 to 2 had the lowest readmission rate, this did not reach statistical significance. Conclusions Readmission and complication rates are low in patients discharged on Days 1, 2, or 3 after laparoscopic colectomy when using standardized postoperative care protocols and standardized discharge criteria. Dr. Delaney received a research grant and is a consultant to U.S. Surgical, Ethicon and Adolar. Read at the meeting of the America Society of Colon and Rectal Surgeons, June 2 to 6, St. Louis, Missouri. Reprints are not available.