高血压合并阻塞性睡眠呼吸暂停综合征患者动态血压观察

目的 观察高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者的24 h动态血压及血压昼夜节律特点.方法 30例单纯高血压及25例高血压合并OSAS的患者进行24 h动态血压和多导睡眠仪监测,比较两组的动态血压、血压昼夜节律.结果 高血压合并OSAS组与单纯高血压组比较,24 h平均收缩压、白天和夜间收缩压以及夜间舒张压升高,夜间收缩压及舒张压下降幅度减少,血压昼夜节律下降,差异有统计学意义 (P＜0.05).结论 阻塞性睡眠呼吸暂停加剧了高血压患者血压的升高及血压昼夜节律异常,应重视对高血压合并阻塞性睡眠呼吸暂停综合征患者24 h动态血压监测.     

睡眠呼吸暂停综合征合并高血压的临床特点观察

目的探讨阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压患者血压的变化。方法对32例单纯高血压病患者（A组）与28例高血压合并睡眠呼吸暂停患者（B组）高血压特点进行比较。结果B组动态血压显示24h平均收缩压、平均舒张压，24h白昼收缩压、舒张压，24h夜间收缩压、舒张压均高于A组，且以舒张压升高明显。B组发病年龄较轻，血压昼夜节律异常明显，对治疗反应差。结论合并高血压的睡眠呼吸暂停患者血压多以舒张压升高为主，发病年龄相对较为年轻，多为难治性高血压。     

阻塞性睡眠呼吸暂停综合征与高血压相关性研究

为探讨阻塞性睡眠呼吸暂停综合征（OSAS）与高血压之间的关系。对50例拟诊为OSAS的病人根据血压水平分为高血压组和正常血压组，均行夜间多导睡眠图检查，均行夜间多导睡眠图检查，监测其呼吸暂停低通气指数，最低血氧饱和度，睡眠期间血压。结果显示：两组病人在年龄，体重指数，呼吸暂停低通气指数，最低血氧饱和度方面存在显著性差异。提示，阻塞性睡眠呼吸暂停综合征与高血压之间有相关性。     

动态监测2型糖尿病和高血压合并睡眠呼吸暂停综合征患者的血糖变化规律

目的 利用动态血糖监测系统探讨2型糖尿病和高血压合并睡眠呼吸暂停综合征患者的血糖变化规律.方法 采用动态血糖监测系统对16例2型糖尿病和高血压合并睡眠呼吸暂停综合征进行连续72 h血糖监测;同时应用多导睡眠仪监测并诊断呼吸暂停的严重程度;同时行24 h动态血压监测.结果 动态血压监测显示患者白天和夜间收缩压、舒张压、平均动脉压的变化差异均无统计学意义(P均＞0.05),血压曲线为"非杓状"曲线.动态血糖监测显示患者血糖水平波动的特征为:血糖以餐后血糖升高为主,睡眠中血糖无明显升高.结论 2型糖尿病和高血压合并睡眠呼吸暂停综合征患者血压昼夜节律异常,夜间血压无下降;睡眠时血糖不升高.     

阻塞性睡眠呼吸暂停低通气综合征对血压的影响及护理干预

目的探讨阻塞性睡眠呼吸暂停低通气综合征（0SAHs）对高血压患者血压的影响及护理干预。方法经睡眠呼吸监测确诊的55例患者分为高血压合并OSAHS组和单纯高血压组,监测24h动态血压。结果2组24h平均收缩压、舒张压,夜间平均收缩压、舒张压差异存在统计学意义（P〈0．05）。2组血压节律变化存在显著差异（P〈0．01）。结论高血压合并OSAHS昼夜血压节律下降,临床护士可通过正确积极的护理干预来提高患者的生活质量。     

高血压合并阻塞性睡眠呼吸暂停综合征患者降压治疗后的动态血压监测

目的探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者降压治疗后血压的变化。方法选择降压治疗期间血压正常的70例高血压患者,其中单纯高血压组21例,合并OSAS组49例,选择健康对照13例。按睡眠呼吸暂紊乱指数将高血压合并OSAS患者分为轻度OSAS组22例,中度OSAS组15例,重度OSAS组12例。采用RS-611床垫式睡眠呼吸监测系统监测睡眠,并进行24 h动态血压监测。比较各组血压水平、昼夜血压节律、晨峰现象。结果在降压治疗期间,单纯高血压或者合并OSAS患者24 h动态血压控制在正常水平(<130/80 mmHg)。夜间血压下降率在单纯高血压组或者合并OSAS组均低于对照组(P<0.05或者P<0.01),合并OSAS组中、重度组下降率最低(P<0.05),合并OSAS组反杓型较单纯高血压组多(P<0.05),以重度OSAS组最多(P<0.05),晨峰现象不明显。结论老年高血压合并OSAS患者降压治疗后,白昼、夜间血压水平达标,但血压昼夜节律紊乱未能改善。     

阻塞性睡眠呼吸暂停综合征合并高血压患者的血压节律变化

阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见的睡眠呼吸紊乱，据统计，4%中年男性和2%的中年女性患有OSAS。然而，由于临床医生和患者的认识不足，仅有10%的OSAS患者得到了正规诊治。近年，许多研究表明，OSAS与高血压密切相关，但OSAS合并高血压患者其昼夜血压曲线的变化却很少报道。本文通过24h动态血压监测（ABPM）和多导睡眠仪监测（PSG）对OSAS合并高血压患者低通气指数（AHI）与昼夜血压曲线的相关性进行探讨。     

睡眠体位对不同睡眠阶段阻塞性睡眠呼吸暂停低通气综合征患者睡眠参数及其结构的影响

目的：观察体位疗法对阻塞性睡眠呼吸暂停低通气综合征患者夜间多导睡眠图监测参数的影响.方法：[1]选择2001-10/2003-01在南京医科大学第一附属医院睡眠中心就诊的阻塞性睡眠呼吸暂停低通气综合征患者38例.患者对实验目的均知情,并同意配合.[2]采用多导睡眠监测系统对患者行整夜多导睡眠监测.连续进行2 d的监测.第1夜,分别记录睡眠第1阶段（21：30～24：00）、第2阶段（0：00～2：30）和第3阶段（2：30～5：00）.监测项目：总清醒时间、整夜睡眠结构包括快动眼睡眠和非快动眼睡眠中的Ⅰ～Ⅳ期以及占总睡眠时间的百分比、呼吸暂停次数、最长呼吸暂停时间、呼吸暂停低通气指数、最低脉氧饱和度及血压.第2夜,给患者穿上背后带小口袋的特制背心,并于口袋中放置一只高尔夫球.同时加强巡视督促取侧卧位.再次观察记录上述各指标,进行治疗前后比较.[3]数据间差异比较采用多因素随机方差分析.结果：阻塞性睡眠呼吸暂停低通气综合征患者38例均进入结果分析.[1]不同睡眠阶段多导睡眠图监测结果：呼吸暂停低通气指数、最长呼吸暂停时间、平均动脉压：睡眠第2和3阶段明显大于/长于睡眠第1阶段（P＜0.05～0.01）,睡眠第3阶段明显高于睡眠第2阶段（P＜0.01）;最低血氧饱和度：睡眠第2和3阶段明显小于睡眠第1阶段（P＜0.05）.睡眠结构：睡眠各阶段差异不明显.[2]治疗前后多导睡眠图监测参数比较：呼吸暂停低通气指数、最长呼吸暂停时间、平均动脉压：治疗后明显小于/短于治疗前（P＜0.01）.最低血氧饱和度：治疗后明显高于治疗前（P＜0.01）.睡眠结构：睡眠各阶段差异不明显.结论：采取高尔夫球背心的睡眠侧卧位体位疗法可明显改善阻塞性睡眠呼吸暂停低通气综合征不同睡眠阶段多导睡眠图监测参数,且不影响睡眠结构.     

阻塞性睡眠呼吸暂停综合征对高血压患者心功能的影响

临床有许多高血压患者合并阻塞性睡眠呼吸暂停综合征,且随着病情发展,逐渐出现心功能不全,同时研究发现,心功能不全合并阻塞性睡眠呼吸暂停的比例达37％,阻塞性睡眠呼吸暂停是否成为高血压患者心功能恶化的原因之一,这是研究的关键问题.我们通过对高血压患者进行多导联睡眠诊断仪(PSG)、动态血压监测及心脏彩色多普勒超声检查,探讨阻塞性睡眠呼吸暂停综合征对高血压患者心功能的影响以及内在的发生机制,以指导临床治疗.     

高血压合并阻塞性睡眠呼吸暂停综合征与血清5-羟色胺水平的关系

目的:探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者血浆5-羟色胺(5-HT)水平的变化。方法:应用放射免疫法测定45例高血压合并阻塞性睡眠呼吸暂停综合征患者血清5-HT浓度。结果:高血压合并阻塞性睡眠呼吸暂停综合症患者与单纯高血压不合并OSAS的患者相比,血压控制较差,而血浆5-HT水平明显增高(P<0.05),轻、中、重度阻塞性睡眠呼吸暂停综合征患者血浆5-HT水平之间相比较有差异(P<0.05)。结论:5-HT水平可能与血压控制和阻塞性睡眠呼吸暂停综合征的发病有关。     

Characteristics of hypotensive effect in patients with arterial hypertension and desaturation signs of obstructive sleep apnea syndrome during sleep

AIM: To estimate the efficacy of 8-week antihypertensive monotherapy in patients with arterial hypertension (AH) regarding the presence of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: We analysed the results of 24-h blood pressure (BP) monitoring of 26 inpatients (mean age 54 +/- 2 years) with mild (n = 18) and moderate (n = 8) AH before and after 8 weeks of treatment with 5-10 mg amlodipine or 50-100 mg of losartan once daily to assess blood pressure profile parameters. The patients underwent nocturnal monitoring of arterial oxygen saturation (pulsoximeter NONIN-8500 M, USA). The presence of OSAS was confirmed when a characteristic clinical picture was combined with the presence of significant (> 4%) sleep desaturation episodes > 15 episodes per hour or the presence of group desaturation episodes below 90%. Seven hypertensive patients with OSAS were assigned to group 1, nineteen patients without OSAS--to group 2. The differences in estimated parameters between the groups were tested by Mann-Whitney U test, the dynamics of BP profile parameters--by Wilcoxon matched pairs test. RESULTS: In group 1 there were no significant differences by most of BP profile parameters before and after antihypertensive treatment, except mean nocturnal systolic BP. In group 2 a significant hypotensive effect was seen by all parameters of BP profile except BP variability. Hypotensive efficacy in group 2 was 1.5-2 times higher vs group 1, but the difficulties were not significant. CONCLUSION: Antihypertensive therapy in hypertensive patients with OSAS is less effective than in those without OSAS but it is not uneffective.     

时间因素对血压测量结果的影响

本文对４５例正常人、不同时间的血压数值进行分析。结果表明，收缩压在９：００和１３：００两时间段内血压值较稳定。舒张压在９：００、１１：００、１７：００三个时间段内血压值较稳定，故而认为最佳的血压测量时间为９：００。     

Mortality among patients admitted to intensive care units during weekday day shifts compared with "off" hours

OBJECTIVE: To determine whether mortality rates among intensive care unit (ICU) patients differ according to the time of ICU admission, we compared the death rates for patients admitted during weekday day shifts and off hours (from 6:30 pm to 8:29 am the next day for night shifts, from Saturday 1:00 pm to Monday 8:29 am for weekends, and from 8:30 am to 8:29 am the following morning for public holidays). METHODS: Retrospective cohort study of data collected prospectively from 23 ICUs located in the Paris metropolitan region, France. Between January 2000 and December 2003, 51,643 patients were admitted to these ICUs. Patients were grouped according to their day and time of admission and compared using univariable and multivariable analyses. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 51,643 patients admitted to ICUs, 33,857 (65.6%) were admitted during off hours. These latter patients were less critically ill than those admitted during day shifts, had fewer failed organs, required fewer support procedures, and their crude in-hospital mortality was lower (20.7 vs. 24.5%, p < .0001). After adjustment for initial disease severity, in-hospital mortality was not higher for off-hours admissions than weekday day admissions and even remained slightly lower (adjusted odds ratio, 0.93; 95% confidence interval, 0.87-0.98). CONCLUSIONS: Admission during off hours is common. In our ICUs, off-hours admissions were not associated with higher mortality and might even be associated with a lower death rate.     

缺血性中风发病与死亡时间探讨--附1 597例病例及90例死亡病例统计学分析

目的:用数学统计法探讨缺血性中风发病及死亡与时间的关系.方法:将1 597例缺血性中风病例的发病时间以及其中90例死亡病例的死亡时间以每日0～24时化为角度坐标,作圆形统计分析,观察缺血性中风的发病与死亡时间的特点.结果:1 597例缺血性中风病例的发病时间在午时11:00～13:00时段有明显的集中趋势,发病高峰时间点在11:32:41(P<0.005);90例死亡病例发病时间在午时11:00～13:00时段有明显的集中趋势,发病高峰时间点在12:03:03(P<0.005),死亡时间在上午4:00～6:00时段有相对的集中趋势(P>0.05);1 507例非死亡病例发病高峰时间点为午时11:31:12(P<0.005).结论:日中午时是缺血性中风的易发病时段,注意日中午时的治疗和护理,可减少缺血性中风的发病率;缺血性中风相对死亡高峰期在上午4:00～6:00时段,该时段应加强治疗和护理,以降低病死率.     

Rhythmic pattern of PCA opioid demand in adults with cancer pain

Introduction: Patient‐controlled analgesia (PCA) has an established role in managing postoperative pain and has been successfully used in‐patients with cancer pain. The variation of opioid requirement over a 24h period for patients with cancer pain is debated with suggestions of reduced need over night. Methods: Retrospective review of 10years (1997–2006) data of all in‐patients with cancer pain treated with strong opioids delivered by PCA. Results: 141 patients with cancer pain had a mean cumulative 10day morphine equivalent dose per patient of 671mg (median 470mg; range 10–2170mg). At night (10:01pm to 06:00am) the patient's self administered less bolus doses (69mg, (25%)) than during the other two 8h periods (06:01am to 02:00pm, 91mg (33%) and 02:01pm to 10:00pm, 116mg (42%)). In 8 out of 10days a significant variation in bolus requests was observed with significantly less bolus requests during the night (Friedman test, p<0.05). Furthermore, the median number of delivered bolus requests per patient, at night, was 2–3 compared to the morning and afternoon periods of 3–7 and 3.5–6, respectively. Conclusion: PCA met individual patient's opioid needs in a safe and effective manner despite a large inter‐individual variability in opioid consumption. Moreover, the study indicated a pattern of less opioid requirement at night.     

Tropisetron and dexamethasone administered twice daily for the prevention of acute emesis in patients treated with continuous infusion of Cisplatin-Doxorubicin and high-dose Ifosfamide over 48, 24, and 120 hours

The antiemetic effectiveness of 5-HT3 receptor antagonists in combination with dexamethasone in patients receiving short-term infusion chemotherapy has been well demonstrated. Less information is available about the efficacy of the same antiemetic combination in patients treated with regimens of chemotherapy in which the drugs are delivered in continuous infusion of several hours. The purpose of this study was to report the effectiveness of a double administration of antiemetic drugs in patients treated with strong emesis-inducing drugs for several days. In this study, 19 male and 13 female patients with osteosarcoma, ages 9 to 45 years, treated with chemotherapy, received intravenous tropisetron 5 mg plus dexamethasone 8 mg every 12 hours during the first two cycles of the preoperative treatment: cisplatin 120 mg/m2 over 48 hours followed by Adriamycin 75 mg/m2 delivered in 24 hours and continuous infusion of ifosfamide 15 g/m2 over 120 hours. The assessment of the antiemetic efficacy was performed three times every day: from 8:00 am to 4:00 pm, from 4:00 pm to 12:00 am, and from 12:00 am to 8:00 am. The patients were followed from the beginning of the treatment until 2 hours after its end, when they were discharged from hospital. Complete protection from emesis was obtained in 80% of the 256 days of treatment: 81% during the first cycle (cisplatin 120 mg/m2 in 48 hours followed by Adriamycin 75 mg/m2 delivered in 24 hours) and 79% during the second cycle (continuous infusion of ifosfamide 15 g/m2 in 120 hours). In both cycles, complete protection declined from the first to the last day of treatment (from 100% to 62% during the first cycle and from 100% to 63% during the second cycle). These results indicate that when chemotherapy is administered in a protracted infusion, higher doses of antiemetic agents are necessary to achieve acceptable antiemetic activity.     

不同给药方法对高血压患者疗效及血压稳定性的影响

目的观察不同给药方法对高血压患者疗效及其血压控制的影响。方法将90例2级及以上原发性高血压患者随机分为3组,分别接受不同给药方法：A组每天7：00口服缬沙坦80nag和非洛地平5mg;B组每天早7：00口服缬沙坦80mg,晚7：00口服非洛地平5mg;C组每人早7：00口服非洛地平5nag,晚7：00口服缬沙坦80mg。观察并对比2组患者疗效及血压控制稳定性。结果3组患者血压控制疗效明显,无显著差异,B、C组患者血压控制稳定性优于A组。结论早晚分次给药对于夜间血压的控制效果更为稳定,可以避免清晨血压峰值对于靶器官的损害,为临床治疗高血压的口服给药方式提供参考。     

Urine albumin excretion in acute ischaemic stroke is related to serum interleukin-6.

BACKGROUND AND PURPOSE: Several studies show a link between microalbuminuria and markers of inflammation. Increased urine albumin excretion accompanies acute ischaemic stroke. The mechanisms responsible for microalbuminuria in acute stroke patients remain unclear. The goal of this study was to determine if there is a relationship between urine albumin excretion and interleukin-6, a key mediator of acute phase reaction. METHODS: Nineteen acute ischaemic stroke patients and 13 controls matched for age, sex and cardiovascular risk factors were included. Serum interleukin-6 level was measured on the 2nd day of stroke at 06:00 am, 10:00 am, 06:00 pm and 10:00 pm using ELISA method. Urine albumin excretion was determined using immunonephelometric method. RESULTS: Interleukin-6 level and urine albumin excretion were significantly higher in stroke patients than in controls. There was a significant correlation between interleukin-6 level and urine albumin excretion in stroke patients (R = -0.60 at 06:00 am; R = -0.49 at 10:00 am; R = -0.64 at 06:00 pm; R = -0.54 at 10:00 pm) but not in controls. CONCLUSIONS: Urine albumin excretion in acute ischaemic stroke is related to serum interleukin-6.