老年高血压患者的无创血流动力学参数与心脏结构变化的关系

目的探讨老年高血压患者的无创血流动力学参数与心脏结构变化的关系。方法入选天津市人民医院心内科住院的老年原发性高血压患者261例,分为高血压Ⅰ组84例、高血压Ⅱ组100例和高血压Ⅲ组77例,选择同期住院的血压正常者58例为对照组,收集一般临床资料,心脏超声检查左心室舒张末期内径(LVEDD)、室间隔厚度、左心室后壁厚度、LVEF,计数左心室质量指数(LVMI),无创血流动力学检测每搏量、外周血管阻力(SVR)、外周血管阻力指数(SVRI)、左心做功指数(LCWI)、无创LVEF等。结果对照组、高血压Ⅰ、Ⅱ、Ⅲ组高血压史、收缩压、舒张压、脉压、左心房内径和LVMI呈明显升高趋势(P<0.05),高血压Ⅰ、Ⅱ、Ⅲ组每搏指数、每搏量、心脏指数、LVEF、LCWI呈明显降低趋势(P<0.05),SVR、SVRI呈明显升高趋势(P<0.05)。SVR和SVRI与每搏量、心排血量、心脏指数、每搏指数、LCWI、无创LVEF呈负相关(P<0.01),与高血压史、收缩压、舒张压、脉压、左心房内径、LVEDD、LVMI呈正相关(P<0.01)。SVRI的ROC曲线下面积为0.676(95%CI:0.610~0.742),诊断左心室肥厚的价值较高(P=0.000)。结论老年高血压患者的无创血流动力学呈现"减排高阻"的现象,临床可用无创血流动力学参数作为心脏结构的评估参考指标。

Relationship between noninvasive hemodynamic parameters and cardiac structural changes in elderly hypertensive patients

Objective To study the relationship between noninvasive hemodynamic parameters and cardiac structural changes in elderly hypertensive patients.Methods Two hundred and sixty-one primary hypertension patients were divided into hypertension group Ⅰ (n=84),hypertension groupⅡ (n=100)and hypertension group Ⅲ (n=77)with 58 normal blood pressure persons served as a control group.The general clinical,LVEDD,IVST,LVPWT,LVEF,LVMI,stroke output,SVR,SVRI and noninvasive LVEF were recorded.Results The history of hypertension,SBP,DBP,PP,LAD and LVMI showed a significant tendency to increase in control group and hypertension groupsⅠ-Ⅲ (P<0.05).The stroke index,stroke output,cardiac index,LVEF and LCWI revealed a significant tendency to decrease while the SVR and SVRI displayed a significant tendency to increase in hypertension groupsⅠ-Ⅲ (P<0.05).The SVR and SVRI were negatively related with the stroke output,cardiac output,cardiac index,LCWI,noninvasive LVEF and positively related with the history of hypertension,SBP,DBP,PP,LAD,LVEDD and LVMI(P<0.01).The area under the SVRI curve was 0.676 with a high value for the diagnosis of left ventricular hypertrophy(P=0.000).Conclusion Noninvasive hemodynamic parameters can be used as a reference index in evaluating the cardiac structure of elderly patients.