动态血压监测的启示

动态血压监测的启示文／王有国人们到医院去看病或查体，医生测一次血压，叫偶测血压；家庭购置了血压计常自行测一下血压，叫自测血压，人们发现同一个人在不同环境下的偶测血压与自测血压之间的差异很大。因此，又研制出了动态血压监测仪，像动态心电图一样，用它可以监...     

高血压病患者24小时动态血压的昼夜节律

选择４１例高血压病患者２４小时动态血压记录资料，求得日间６～２２时，夜间２２～６时两个时段的平均血压及每小时的血压均值，比较昼夜时段间的血压差异，描记２４小时动态血压曲线。结果是：（１）夜间血压明显低于白天；（２）动态血压曲线呈“长柄勺”形状。表明测定２４小时动态血压对高血压病的诊断和并发症的防治有重要意义。     

24小时动态血压记录仪常见故障的解决

24小时动态血压监测（ABPM）是让受检者佩带动态血压记录仪，回到日常生活环境中自由行动，记录仪会自动按设置时间间隔进行血压测量，提供24小时期间多达数十次到上百次的血压测量数据，为患者提供全天血压波动水平和趋势信息，以捕捉偶尔测血压所不能检测到的血压信息，有助于判断病人是否需要药物治疗。我院所使用的24小时动态血压记录仪是美国太空实验室（Spacelabs）公司生产的90217型24小时动态血压记录仪，在日常的使用及维护过程中，经常出现下列故障及其解决方法。     

动态血压监测在临床中的应用

血压监测是临床高血压诊断、指导治疗和判断预后的重要手段．自从1962年Sokolow发明动态血压检测仪以来，动态血压监测（ABPM）在临床中已经得到广泛的应用，并且在过去的20年间，动态血压监测仪得到了很大程度的改进，大量的临床资料表明ABPM明显优于传统的血压测量。本文将对ABPM在临床中的直用做一简要的综述     

无袖带腕表式与袖带式动态血压监测仪测值准确性的比较研究

监测血压是临床上对血流动力学监测最常用的指标之一，为临床诊断疾病、观察病情变化与判断治疗效果提供可靠依据。自20世纪60年代末无创性全自动动态血压监测（ABPM）仪诞生以来，ABPM技术经过30多年的发展和完善，目前已在全世界范围内广为应用，但传统的ABPM与目前新兴的无袖带腕表式动态血压监测相比仍存在较多缺点。然而，无袖带腕表式动态血压监测仪的准确性一直为人们所质疑，这在很大程度上影响了该仪器的临床应用。为此，本研究以现有的袖带式ABPM仪器作为对照来检测，以探讨无袖带腕表式动态血压监测仪的准确性。     

高血压病患者动态血压与心脑血管意外关系的研究

为了探讨高血压病患者动态血压与心脑血管意外关系，笔者对１２００例高血压病患者进行２４小时动态血压测定并追踪随访。对后来并发心脑血管意外的１８０例患者的动态血压变化与发生急性左心功能衰竭、脑梗死、脑出血的关系进行研究，１００例未发生心脑血管意外的高血压病患者作比较。结果显示：发生心脑血管意外三组患者收缩压及舒张压夜间血压下降率＜１０％，血压昼夜波动呈非杓形。脑梗死组和急性左心衰组收缩压呈持续性升高，负荷值增大；脑出血组则收缩压和舒张压都持续升高，负荷值亦增大，与对照组比较差异非常显著。提示高血压病患者动态血压变化与心脑血管意外的发生有关。     

动态血压、血浆纤维蛋白原和腔隙性脑梗死的相关性分析

目的24小时动态血压是腔隙性脑梗死的强预测因子。纤维蛋白原是血浆黏度的一个重要决定因素，因此纤维蛋白原水平升高与腔隙性脑梗死危险性之间也存有关联。本文的目的是评价24小时动态血压血浆纤维蛋白原水平与腔隙性脑梗死危险性之间的关联。方法对30例住院患者的年龄、性别、吸烟、饮酒、服用抗高血压药物、体重指数、24小时动态血压、纤维蛋白原水平进行监测分析。结果分析结果显示纤维蛋白原水平与腔隙性脑梗死之间有显著的相关性。24小时动态血压也与腔隙性脑梗死显著、独立相关。即使24小时动态血压在正常范围内（〈130／80mmHg），纤维蛋白原水平升高仍然与脑损伤危险性显著相关。纤维蛋白原和24小时动态血压对脑损伤有相加作用。结论24小时动态血压和血浆纤维蚩白原水平与腔隙性脑梗死密切且独立相关。     

动态血压监测的临床应用进展

动态血压监测是一种无创性的血压监测，可获取24h平均血压、血压昼夜变化节律以及血压变异性等多种重要指标参数，能反映患者全天的血压波动水平和趋势，与偶测血压相比具有明显的优越性。在高血压病诊断、评估高血压靶器官损害和指导、评价降压治疗等方面具有重要作用。     

100例高血压患者动态血压监测结果分析

１００例高血压患者动态血压监测结果分析南京化学工业集团公司医院嵇平动态血压监测（ＡＢＰＭ）作为高血压的诊断和药物疗效的判定应用日趋广泛，它能提供全天血压的变化，而且避免了测血压时精神紧张造成血压波动的现象，且血压重复性好。我们监测了１００例临床诊断为...     

动态血压监测技术

动态血压测量装置有袖带式和指套式两种，目前国内临床上常用的是袖带武装置。动态血压监测技术对了解患者的血压的平均水平优于常规的测量方法，并且可对患者血压的变化进行动态观察。但由于袖带式测量装置存在重复性差的缺点，它的动态测量值还不能作为评价患者血压的昼夜变化的依据。本文以袖带式测量装置为例，分析了血压的测量原理及袖带的大小，患者的体位，测量的频率，患者的活动这些主要因素对测量结果的影响。     

Ambulatory blood pressure monitoring

During the last decades non-invasive 24-hour ambulatory blood pressure monitoring has evolved from a research tool of limited clinical use into an important method for stratifying cardiovascular risk and guiding therapeutic decisions. Until recently, clinical use of ambulatory blood pressure monitoring focused on identifying patients with white-coat hypertension, but accumulated evidence now points to its greater prognostic significance in determining risk for target-organ damage compared with that of office blood pressure measurements. Ambulatory measurement of blood pressure using automated devices has also demonstrated benefit in other indications, such as treatment resistance and borderline hypertension, or in hypertension during pregnancy. Future directions for hypertension research and treatment will need to consider the circadian cycle of blood pressure, the effect of treatment on blood pressure variability, and the magnitude of blood pressure changes in daily life.     

High job strain and ambulatory blood pressure in middle-aged men and women from the Belgian job stress study

OBJECTIVE: The aim of this study was to assess whether job strain is associated with 24-hour ambulatory blood pressure measurements within a subsample of the Belgian Job Stress Project (BELSTRESS) population. METHODS: A group of 89 middle-aged male and female workers perceiving high job strain and an equally large group of workers perceiving no high job strain wore an ambulatory blood pressure monitor for 24 hours on a regular working day. RESULTS: Mean ambulatory blood pressure at work, at home, and while asleep was significantly higher in workers with job strain as compared with others. The associations between job strain and ambulatory blood pressure were independent from the covariates. CONCLUSIONS: Within this study, high job strain was an important independent risk factor for higher ambulatory blood pressure at work, at home, and during sleep in a group of men and women.     

Repeatability of automated ambulatory blood pressure measurements.

BACKGROUND. The repeatability of 24-hour automatic ambulatory blood pressure measurements recorded by noninvasive equipment (Del Mar Pressurometer IV) was assessed to determine the intrapatient variability of this test. METHODS. The usual antihypertensive medications of 73 patients with documented essential hypertension (supine diastolic blood pressure of 95 to 119 mm Hg) were withdrawn, and the patients were treated with placebo medication for 6 weeks. At the end of the placebo period, ambulatory blood pressure measurements of each patient were recorded every 15 minutes for 24 hours on two separate occasions 1 week apart. RESULTS. There was no significant difference in either the 24-hour systolic or diastolic blood pressure for the entire group between weeks. A mean difference for individual patients between the first and second recording within 5 mm Hg was observed in 49.3% and 52.1% of patients for 24-hour systolic and diastolic blood pressure, respectively. The correlation coefficient for 24-hour systolic blood pressure was greater than 24-hour diastolic blood pressure (r = .87 vs r = .67). A difference greater than 18.1/14.9 mm Hg for systolic/diastolic blood pressure would be required to assign a significant (P less than .05) change in blood pressure between two recordings in the same patient. CONCLUSIONS. These data quantify the usefulness of 24-hour ambulatory blood pressure measurements for a group of subjects. However, mean 24-hour ambulatory blood pressure varies significantly for individuals. Intrapatient variability may limit the usefulness of a single 24-hour ambulatory recording for an individual patient and suggests the need for more than one measurement to establish a level of blood pressure.     

老年高血压伴脑梗死24h动态血压的临床分析

目的探讨老年高血压脑梗死24h动态血压的临床分析方法将2012年10）~--2013年10月我院收治的老年高血压病人分为高血压并发症梗死患者和非并发脑梗死病人两个组别,并分别对两组病人的动态血压进行测量,比较两组病人的脉压和血压。结果两组患者的动态血压相比差异具有统计学意义（P〈0．05）。结论脑梗死病人的ABPP增加非常的明显,对老年高血压病人的脉压进行监测,可以更好的对老年高血压病人的疾病的状态以及预后进行更加准确的判断。     

24小时动态血压监测与高血压

高血压与各种心血管疾病的发生密切相关,准确真实血压测量不仅有利于高血压病的控制,更能减少各种心血管疾病发生的几率。24h动态血压较传统的偶测血压更能准确地反映病人血压一天中的波动。本文主要对近年来24h动态血压监测的研究进展进行综述。     

The accuracy and precision of the Accutracker ambulatory blood pressure monitor

Prerequisite to the use of ambulatory blood pressure monitors in epidemiologic research is demonstration of a satisfactory level of accuracy and precision. Previous evaluations of these devices raise a number of methodological concerns which complicate interpretation of their findings. Also, important issues regarding the precision of blood pressure measurements and the identification of factors associated with measurement inaccuracies remain unaddressed. To assess the accuracy and precision of the Accutracker ambulatory blood pressure monitor, we obtained five serial estimates of resting blood pressure on 120 ambulatory subjects in The Johns Hopkins Medical Institutions in 1987. Two Accutrackers and two manual observers independently recorded blood pressure with the order determined at random. The fourth observer in each sequence obtained a replicate measurement. For both systolic and diastolic blood pressures, the mean difference between Accutracker and manual measurements was less than 3 mmHg for each pairwise comparison. Scatter plots and regression analyses demonstrated that both Accutrackers tended to underestimate high systolic and diastolic blood pressures. In bivariate and multivariate analyses, increased age was significantly associated with underestimation of systolic blood pressures by both Accutrackers. With respect to the precision of blood pressure measurement, no significant differences were present among the four observers. In summary, our data suggest that the Accutracker has satisfactory accuracy and precision, but that accuracy is not uniform across patient subgroups.     

The relationship between ambulatory blood pressure variation and symptoms of depression and sleep disturbance in community-dwelling elderly persons with independent activities of daily living

OBJECTIVE: To clarify the relationship between ambulatory blood pressure variation and symptoms of depression and sleep disturbance in community-dwelling elderly persons with independent activities of daily living. METHODS: The subjects were 41 volunteers in a health education class for the elderly in a rural community. We carried out: (1) an interview about symptoms of depression using the Geriatric Depression Scale (GDS), competence of daily living, subjective daily sleep complaints and past history of disease,; (2) ambulatory blood pressure measurements over 24 hours with a portable device,; (3) sleep-awake judgment by wrist actigrams,; and (4) instructions for self-records of his/her life activities. RESULTS: (1) The average value for 24 hour-mean diastolic blood pressure was significantly higher in subjects undergoing hypertension treatment. (2) No significant relationship was observed between subjective sleep disturbance and ambulatory blood pressure variation. (3) No significant relationship was observed between objective sleep disturbance assessed by wrist-actigraphy and ambulatory blood pressure variation. (4) Severe depression was related to a lower degree of night decrease in both systolic and diastolic blood pressure in subjects undergoing hypertension treatment, while it was associated with higher average values for 24 hour- and awaking-mean systolic and diastolic blood pressure in subjects not receiving such treatment. CONCLUSIONS: In community-dwelling elderly persons with independent activities of daily living, severer depression was associated with the higher mean blood pressure in subjects not taking medicine for hypertension and with a low degree of night decrease in diastolic blood pressure in those receiving hypertension treatment, while no significant relationship was observed between sleep disturbance and ambulatory blood pressure variation.     

某农机厂噪声作业男工健康状况的动态分析

目的调查分析职业性噪声对工人心血管系统的动态影响。方法以常州某农机厂150名接触噪声的作业男工为噪声组,以企业行政、后勤及不接触噪声男工125人为对照组。采用现场环境噪声测试和班前班后职业性健康检查等方法进行调查研究,比较其血压、心率、心电图的变化情况。结果噪声组班前班后动态收缩压改变差异有统计学意义(P0.05),噪声组与对照组班前收缩压、舒张压、心率比较,差异均有统计学意义(P0.01)。结论噪声对作业工人的动态血压、脉率、心电图有一定影响,需进一步采取措施预防。     

慢性肾功能衰竭患者血压变化特点的临床研究

目的探讨慢性肾功能衰竭(肾衰)合并高血压的非透析患者血压昼夜节律特点,以及与肾功能、钙、磷、白蛋白、血脂、心脏结构和功能的关系。方法慢性肾衰合并高血压的非透析患者(A组)30例,男16例,女14例,血肌酐(307.93±97.13)μmol/L;肾功能正常的原发性高血压患者(B组)30例,男、女各15例,分别检测24h动态血压、血生化,计算肌酐清除率,行心脏彩超检查,记录左心房内径、左心室舒张末期内径、室间隔舒张期厚度和左室后壁舒张期厚度,计算射血分数,6个月后重复上述检查。分析血压节律改变的影响因素,昼夜血压的改变对肾功能及心脏结构和功能的影响。按夜间与日间平均动脉压比值是否大于0.9,根据血压昼夜变化曲线分为杓型组(A1和B1)与非杓型组(A2和B2)。结果A2组和B2组患者夜间血压明显升高;A组非杓型比例高于B组,其夜间高血压对肾功能及心脏结构和功能均有影响。结论慢性肾衰合并高血压患者与肾功能正常的原发性高血压患者相比,非杓型比例增加,夜间血压水平对肾功能及心脏结构和功能均有影响。     

Assessment of blood pressure measuring techniques

The recommended techniques to measure blood pressure for assessment of hypertension are seldom followed in the ambulatory care setting. This study has found that interns and first-year family practice residents have significant deficits in their knowledge and use of the recommended techniques to measure blood pressure. The results suggest that inadequacies exist in the teaching of blood pressure measuring techniques in our medical schools, the consequences of which are misdiagnosis and improper treatment of high blood pressure.