高血压患者运动试验风险因素探讨

目的:初步探讨高血压患者运动试验中的风险因素。方法:选取国家体育总局运动医学研究所体育医院门诊高血压患者98例,进行心电图平板运动试验。将患者按照既往运动习惯分为运动组(n=52)和运动不足组(每周运动少于3次,每次少于30 min,n=46);将患者按照运动试验终止时出现的风险因素分组:(1)收缩压显著增高组(运动中最大收缩压≥220 mmHg,n=28)及其对照组(运动中最大收缩压<220 mmHg,n=70);(2)舒张压显著增高组(运动中最大舒张压≥110mmHg,n=30)及其对照组(运动中最大舒张压<110 mmHg,n=68);(3)ST段降低组(运动中ST段降低≥1 mm,n=20)及其对照组(运动中ST段降低不足1 mm或未见降低,n=78)。分别比较上述三组及其对照组安静时、运动中以及恢复期心率、血压的变化情况。结果:(1)运动组高血压患者安静时和运动时最高舒张压显著低于运动不足组(P=0.019,P=0.029)。(2)运动试验中,收缩压显著增高组和舒张压显著增高组安静时舒张压分别显著高于各自对照组(P=0.00,P=0.00),且收缩压和舒张压显著增高组安静时舒张压均值均高于临床诊断标准(90 mmHg)。(3)运动试验中ST段降低组运动后2分钟收缩压恢复率(rSBP)显著高于其对照组(P=0.006)。结论:(1)参与规律体育锻炼的高血压患者运动前及运动中的舒张压较低。(2)运动前舒张压控制不佳的高血压患者运动中易发生风险。(3)运动后收缩压恢复率可作为提示高血压患者运动风险的指标。

The Risks of Exercise Stress Test for Hypertensive Patients

Objective To investigate the risks of exercise stress test for hypertensive patients.Methods Data of ninety eight hypertensive patients who performed graded exercise test on treadmill were retrospectively analyzed.The patients were divided into habitual exercise group(E,n = 52) and lack of exercise group(less than 3 times per a week,NE,n = 46) according to their daily activity.Meanwhile the patients were categorized as SBP exaggerated response group(the SBP during exercise test ≥220 mmHg,n = 28) and normal SBP response group(n = 70),exaggerated DBP response group(the DBP during exercise test ≥110 mmHg,n = 30) and the normal DBP response groups(n = 68),depressed ST segment group(ST segment depression during exercise test ≥1 mm,n = 20) and normal ST segment group(n = 78).Results(1)The DBP before exercise and the maximum DBP during exercise in group E were significantly lower than in group NE(P = 0.019,P = 0.029).(2)The DBP before exercise in the SBP exaggerated response group and the DBP exaggerated response group were significantly higher than in the respective control groups(P = 0.00 and P = 0.00).The average values of the DBP before exercise in the SBP exaggerated response group and DBP exaggerated response group was abnormal(≥90 mmHg).(3)The SBP 2 minute after exercise in the group ST was significantly higher than in respective control group(P = 0.006).Conclusions(1)The hypertensive patients with habitual exercise have lower DBP at rest and the lower DBP response during exercise test.(2)The hypertensive patients with higher resting DBP could be at higher risks during exercise test.(3)The SBP 2 minutes after exercise test could be used as a risk indicator for hypertensive patients.