糖尿病高血压病患者餐后状态血压及心率变化的研究

餐后状态是指餐后生理状态发生变化持续的一段时间。研究表明，糖尿病患者的餐后代谢状态异常：如餐后血糖血脂升高，是患者发生心肌梗塞及动脉粥样硬化的重要危险因素。餐后血压作为另一餐后状态因子，是老年高血压病患者发生心脑血管病变的危险因素之一。对于糖尿病合并高血压患者的餐后血压变化目前国内尚未见报道。本研究通过对糖尿病、     

高血压病和糖尿病患者餐后状态血压及心率变化的研究

目的　研究高血压病 (EH)和 2型糖尿病 (DM)患者餐后状态血压和心率的变化特点。　方法　 187例患者 ,分 3组 :高血压病组 (EH,71例 ) ,2型糖尿病组 (DM,49例 )和 2型糖尿病伴高血压组 (DM EH,6 7例 )。观察各组 2 4h动态血压和心率 ,进标准定量饮食 ,分析进餐前后收缩压(SBP)、舒张压 (DBP)和心率的变化。　结果　 EH组和 DM EH组 2 4h平均收缩压 (2 4h ABPS)和2 4h平均舒张压 (2 4h ABPD)较 DM组明显增高 (P<0 .0 1) ,而 DM组和 DM EH组 2 4h平均心率较 EH组快 (P<0 .0 1) ;EH组在餐后 30 m in至 6 0 min的 SBP、DBP和心率较餐前对应时间点升高(P<0 .0 1) ,餐后 90 m in SBP、DBP和心率恢复至餐前水平。 DM组和 DM EH组在餐后 30 m in至90 min SBP、DBP和心率下降 (P<0 .0 1) ,餐后 12 0 min SBP、DBP和心率恢复至餐前水平。　结论　高血压病和 2型糖尿病患者餐后状态血压和心率的变化有不同的特点 ,表现为高血压病患者餐后血压升高和心率增快 ,而 2型糖尿病或伴高血压病的 2型糖尿病患者餐后血压和心率下降 ,且其血压和心率恢复至餐前水平较单纯高血压病患者慢。     

老年原发性高血压者昼夜血压及心率变异特点

目的 为探讨老年原发性高血压（EH）昼夜血压及心率变异特点，对46例老年EH患进行动态血压及心率变异功率谱测定，并与正常对照组相比较。结果 老年EH的24h收缩压（SBP），舒张压9DBP），SBP和DBP之负荷值较正常对照组明显升高，且SBP，DBP负荷值均＞30％，老年EH组昼夜血压有显差异，白天比夜间明显或高，老年EH组之心率变异功率谱中高频指标显下降（P＜0．01）。结论 老年EH昼夜血压有明显差异，且迷走神经活性显降低。     

动态血压监测老年高血压患者餐后血压变化及临床意义

应用无创性动态血压监测方法（ＡＢＰＭ）观察１６６例高血压患者及６０例血压正常人自然早餐后收缩压（ＳＢＰ）、舒张压（ＤＢＰ）、平均动脉压（ＭＡＰ）的变化。结果表明：①高血压老年组餐后血压升高、下降发生率各占５０％左右。血压平均下降率、下降幅度以ＳＢＰ、ＭＡＰ明显，与老年前期、青中年组差别非常显著（Ｐ＜０．０１）。老年组ＳＢＰ、ＤＢＰ、ＭＡＰ平均增加幅度大于老年前期、青中年组（分别Ｐ＜０．０５、Ｐ＜０．０１）。②正常组老年人餐后ＳＢＰ、ＤＢＰ、ＭＡＰ下降发生率占７０％～９０％，显著高于老年前期、青中年组及高血压组。③餐后三种血压平均上升、下降幅度高血压老年组大于正常老年组（分别Ｐ＜０．０５、Ｐ＜０．０１）。认为，老年高血压患者这种改变可能与机体昼夜节律有关。     

老年原发性高血压合并脑卒中患者血压昼夜变异与心率的关系

老年原发性高血压合并脑卒中患者血压昼夜变异与心率的关系曹悦鞍龙南展刘桂芳臧贵明张宝和石湘芸为进一步了解老年高血压合并脑卒中患者的血压在除外心率因素的情况下，其日间变动与血压昼夜变异的关系，我们于１９９５年初至１９９６年６月对比分析了５４例老年高血压合...     

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...     

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。     

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。     

老年高血压患者动态血压变化与心率变异性的关系

目前认为血压的短期调节主要是通过交感神经活动的调节实现的，在动脉血压升高时，压力感受器受到刺激，产生反射性心率减慢，血压下降；反之，血压上升。动物实验和人体研究上均获得了同样结论：自主神经功能障碍是高血压患者不能维持正常水平的一个重要原因，高血压初期可能依赖于交感活性增高，血压持续增高后是否继续依赖该机制来维持的报道少见，我们对患者行同步监测24h动态血压（ABPM）和动态心电图，分析自主神经功能在老年高血压患者日常生活中血压的调节作用。     

HEART RATE VARIABILITY IN NORMOTENSIVE HEALTHY CHILDREN WITH AGING

Although the heart rate variability (HRV) values in adults decrease with aging, those in children show a variety of changes. The present study was designed to investigate the relationship between HRV and aging, physique and blood pressure in 70 healthy male school children, between 6 and 12 years of age. The subjects were divided into 3 age groups (6–7, 8–9 and 10–12 years) and 3 other groups according to physique (thin, under ?10%; normal, ?10–20% and obese, over 20% of obesity index). After recording a 24-h ambulatory electrocardiograph, HRV was determined spectrally, using 3 components: the total-frequency (TF) component (0.01 to 0.5 Hz), the low-frequency (LF) component (0.04 to 0.15 Hz), the high-frequency (HF) component (0.15 to 0.5 Hz) and also a two component ratio (LF/HF). The HRV values between the 3 age groups had a significant effect on TF, LF and LF/HF during the 24-h period, with the values increasing with age. The HRV values between the 3 physique groups had no significant effect. Therefore, changes in HRV in school children are affected by age and not physique. It is possible that the increase in HRV values with age is caused by the development of the autonomic nervous system.     

EFFECTS OF NONPEPTIDE V1a AND V2 ANTAGONISTS ON BLOOD PRESSURE FAST OSCILLATIONS IN CONSCIOUS RATS

This paper describes the effects of vasopressin nonpeptide selective V_1a (OPC-21268) and V₂ (OPC-31260) antagonists on fast blood pressure (BP) oscillations in conscious non-haemorrhaged and haemorrhaged rats. Equidistant sampling at 20 Hz allowed direct spectral analysis of BP on 30 overlapping 2048 point-time series. In non-haemorrhaged rats, V_1a antagonist (5 mg/kg; i.v) reduced BP and low-frequency (LF-BP) component while subsequent administration of V₂ antagonist (1 mg/kg; i.v) reversed these changes and enhanced the very low-frequency (VLF-BP) component. In haemorrhaged rats (5-15 ml/kg/min) V₂ antagonist pre-treatment enhanced the VLF-BP component during normotensive bleeding, while the V_1a antagonist pre-treatment modified BP variability after hypotensive haemorrhage by enhancing the HF-SBP component. The results suggest that under normotensive conditions vasopressin by the stimulation of both V_1a and V₂ receptors buffers BP variability in the VLF-BP frequency domain. In addition, under hypotensive conditions vasopressin, by the stimulation of V_1a receptors buffers the respiration-induced HF-BP oscillation.     

糖尿病肾病患者血糖,血压的控制与尿蛋白排泄的关系

作者对67例不同临床状态的糖尿病肾病患者血、尿糖及血压控制情况与24小时尿蛋白排泄关系进行了观察。微量白蛋白尿及血压正常患者,无论血、尿糖严格控制或一般控制,尿白蛋白排泄量均明显下降;高血压患者血、尿糖严格控制者,尿白蛋白排泄量下降,而一般控制者则不明显。临床白蛋白尿患者,控制血压,尿蛋白及总蛋白排泄下降率非常显著高于控制血、尿糖的下降率,但都不能降至正常。眼底微血管病变阴性患者,严格控制血糖在正常范围,不仅尿白蛋白排量下降,而且50％左右患者可逆转为正常。结果提示早期检出高危患者对治疗和预后均有重要意义。     

急性心肌梗塞的血液流变学变化及其与病情的关系

本文观察50例急性心肌梗塞(AMI)、30例陈旧心肌梗塞(OMI)、34例其他心脏病并发心力衰竭(简称心衰)、休克者和40例正常人的血液流变学指标。结果表明,AMI可导致血液流变性异常改变,7项流变学指标显著高于正常组(P<0.05～0.001);除红细胞压积(HCT)和高切全血粘度外,其余指标显著高于OMI组(P<0.05～0.001)。随病程进展,诸指标逐渐降低。AMI并发心衰、休克者全血粘度、血浆纤维蛋白原(Fb)和红细胞刚性T_k值显著高于无并发症和其他心脏病并心衰、休克者(P<0.05～0.001);AMI和其他心脏病并休克者的红细胞T_k值无差异(P>0.05),提示血液流变学指标可作为AMI判断病情、估计预后的重要参数。     

冠心病血清胰岛素浓度与心率变异性的变化及其关系

检测冠心病３４例，对照组３０例糖耐量前后血糖、胰岛素、Ｃ肽的变化，并测定２４小时动态心电图心率变异性（ＨＲＶ）。结果冠心病组空腹与服糖后胰岛素、Ｃ肽均明显升高，ＨＲＶ显著下降。进行血糖、胰岛素、Ｃ肽同ＨＲＶ相关分析，仅显示服糖后２小时胰岛素和胰岛素曲线下面积与ＨＲＶ呈负相关，ＨＲＶ≤１００ｍｓ的冠心病组显示更高的胰岛素水平，提示高胰岛素血症的交感神经兴奋作用可能是冠心病患者ＨＲＶ降低的原因之一。     

苍山县居民食用大蒜与血压、血脂关系的研究

苍山县为山东省肿瘤和心血管疾病死亡率的低发区,该县1985～1987年期间死因资料按产蒜区和非产蒜区分析表明,脑血管病、鼻咽癌、食管癌、胃癌和肺癌死亡率在产蒜区低于非产蒜区。为了探讨大蒜对群体预防心血管病的作用,本研究以整群抽样法,在产蒜区和非产蒜区调查了781例40～69岁居民,以血压和血清总胆固醇为指标,分析与大蒜摄入量的关系。结果表明,产蒜区居民收缩压和胆固醇水平低于非产蒜区,大蒜摄入量与收缩压及胆固醇呈负相关。     

正常心脏11种元素的分布及与血液中含量的关系

30例正常心肌中11种元素含量测定结果发现,左室硒含量最高,右室、室间隔次之,左、右房最低。红细胞钾、钙、硒含量及钾/钠比值和血浆钠、镉、钢、锌、锰含量及镉/硒、钢/锌比值可作为估算心肌中相应元素含量和比值的指标。     

心率变异性能谱分析法对评价急性心肌梗死预后的临床意义

本文运用心率能谱分析法（ＨＲＰＳ）研究急性心肌梗死不同病程患者的心率变异性（ＨＲＶ），发现两周内急性心肌梗死患者存在明显植物神经调节失衡，表现交感神经功能亢进，迷走神经张力受损。在１年追踪观察中，发现其心率能谱图的低频峰逐渐降低，高频峰逐渐升高，提示这种植物神经调节逐渐恢复平衡；而急性期合并休克、心力衰竭或室性心动过速患者，心率能谱图各频峰均降低，且无明显恢复。这说明植物神经调节失衡同各种疾病发展过程关系密切，且提示ＨＲＰＳ分析法是一种敏感的、非侵入性检测植物神经活性定量方法。     

AMBULATORY BLOOD PRESSURE MONITORING AND CLINICAL CHARACTERISTICS OF THE TRUE AND WHITE-COAT RESISTANT HYPERTENSION

The resistant hypertension has been differentiated in true resistant hypertension and white-coat resistant hypertension by using ambulatory blood pressure monitoring. White-coat resistant hypertension was defined as high clinic blood pressure, despite triple treatment for at least 3 months, but day-time blood pressure values < 135/85 mmHg. The aim of this study was to evaluate the presence of different clinical characteristics between two types of resistant hypertension.

The study group consisted of 49 patients with essential hypertension, resistant to an adequate and appropriate triple-drug therapy, that included a diuretic, with all 3 drugs prescribed in near maximal doses and that had persistently elevated clinic blood pressure (>140/90 mm Hg), for at least 3 months. They represented the 2% of 2500 hypertensive outpatients that referred at our Hypertension Unit. Patients with white-coat resistant hypertension (n=19) were older (p<0.05) than those with true resistant hypertension (n=30). The sodium intake (p<0.05) and alcohol intake (p<0.05) were significantly higher in patients with true resistant hypertension than in those with white-coat resistant hypertension. The renin plasma activity and plasma aldosterone were higher (p<0.05) in patients with true resistant hypertension than in those with white-coat resistant hypertension with normal plasma electrolyte balance. There were no significant differences in mean values of office systolic and diastolic blood pressures between white coat resistant hypertensives and true resistant hypertensives (165+17 vs 172+28 and 98+12 vs 102+14 mmHg).

Day-time and night-time ambulatory 24-h-systolic and diastolic blood pressures were significantly higher in the true resistant hypertensive patients when compared with white-coat resistant hypertensives (153+15 vs 124+10 mmHg and 97+9 vs 76+6 mmHg all p<0.001). Day-time and night-time ambulatory 24-h-heart rate were significantly higher in the true resistant hypertensive patients when compared with white-coat resistant hypertensives (79+11 vs 71+9 beats/min;p<0.01; 68+9 vs 60+6 beats/min. p<0.001). The ABP readings were analysed by a Fourier series with 4 harmonics. According to the runs test both two groups of patients showed a circadian rhythm for both systolic and diastolic blood pressure. The nocturnal fall in SBP, DBP and HR was not different in both groups of patients.

In conclusion, our findings showed that true resistant hypertensive patients were characterized both by higher heart rate and higher plasma renin activity values as an expression of a possible increased sympathetic activity. Thus, the combination of ABPM with the assessment of the clinical characteristics allow to differentiate better the true drug-resistant hypertension from the white coat resistant hypertension.     

心脏直视手术中输自体血前后脑电图和颈动脉血流变化的观察

采用输自体血，可减少术后库血的用量，减少了因输库血引起的并发症，有明显的社会意义和经济效益。为观察输自体血前后对脑电图的变化，我们进行一系列的观察，结果显示：在体外循环开始前脑电波波率、波幅两组无明显差异（Ｐ＞０．０５）。放血后颈动脉平均流速、流量较放血前明显加快，这与同时输入液体，血液稀释有关。在手术结束时各项指标表明输自体血对患者脑电图无影响。