经皮冠状动脉介入治疗术后患者非杓型高血压与心率变异性及预后的关系

目的：探讨经皮冠状动脉介入治疗（PCI）术后患者非杓型高血压与心率变异性（HRV）及预后的关系。方法选择2010年1月至2012年6月上海市同济医院心内科收治的急性冠状动脉综合征行PCI术的高血压患者106例，根据PCI术后1周内24h动态血压监测结果分为非杓型高血压组和杓型高血压组，每组各53例。比较两组患者昼夜间收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）以及夜间血压下降率，分析HRV指标，评价HRV指标选择表示时域指标的24h全部NN间期的标准差（SDNN）、每5min时段NN间期的均值和标准差（SDANN）以及全程相邻NN间期之差的平方根（RMSSD），记录随访1年内心血管事件发生率及再次住院率。结果非杓型高血压组夜间SBP、DBP及MAP明显高于杓型高血压组（P＜0．05），杓型高血压组夜间SBP、DBP及MAP明显低于昼间，与杓型高血压组比较，非杓型高血压组SBP、DBP、MAP夜间下降率明显降低（P＜0．01）。非杓型高血压组SDNN、SDANN、RMSSD较杓型高血压组降低，差异有统计学意义（P＜0．01）。非杓型高血压组1年内心血管事件发生率及再次住院率明显高于杓型高血压组（P＜0．05）。结论PCI术后非杓型高血压患者易发生HRV降低，预后不良。

Relationship between non-dipper hypertension with heart rate variability and prognosis in patients after PCI

Objective To explore the relationship between non-dipper hypertension and heart rate variability （HRV）and prognosis in the patients after percutaneous coronary intervention（PCI）. Methods 106 cases of hyper- tension were performed PCI due to acute coronary syndrome in the cardiology department of Tongji hospital from January 2010 to June 2012 and divided into the non-dipper hypertension group and the dipper hypertension group ac- cording to the results of 24 h ambulatory blood pressure monitoring,53 cases in each group. The day and night de- scent rate of systolic blood pressure（SBP）, diastolic blood pressure（DBP）and mean arterial pressure（MAP）and the night descent rate of blood pressure were compared between the non-dipper hypertension group and the dipper hyper- tension group. The HRV indicators such as SDNN,SDANN and RMSSD were analyzed. The incidence of cardiovas- cular events and re-admission rate were recorded within 1 years after PCI. Results SBP,DBP and MAP at night in the non-dipper hypertension group were significantly higher than those in the dipper hypertension group（P〈0.05）. SBP,DBP and MAP at night in the dipper hypertension group were significantly lower than those at daytime（P〈0.05）. Compared with the dipper hypertension group,the night descent rate of SBP,DBP and MAP in the non-dipper hypertension group was remarkably reduced（P〈0.01）. SDNN,SDANN and RMSSD in the non-dipper hypertension group were significantly decreased compared with the dipper hypertension group,the difference had statistical signifi- cance（P〈0.01）. The incidence rates of cardiovascular events and re-admission rate within 1 year after PCI in the non-clipper hypertension group were markedly higher than those in the dipper hypertension group（P〈0.05）. Conclu- sion The patients with non-dipper hypertension are prone to decrease of HRV after PCI,and the prognosis is poor.