24小时动态血压监测直立性高血压患儿血压类型的病例对照研究

目的采用24 h动态血压(ABPM)方法探讨直立性高血压(OHT)患儿的血压类型。方法选取2009年10月至2013年9月在中南大学湘雅二医院(我院)儿童晕厥门诊就诊或住院的患儿,以不明原因晕厥及先兆晕厥为主诉,经直立倾斜试验确诊为OHT者为OHT组。与OHT组年龄及性别匹配,选择同期来我院儿童保健门诊检查的健康儿童为对照组。OHT组和对照组均行ABPM监测,观察收缩压昼夜差值、舒张压昼夜差值,24 h、日间、夜间平均收缩压和舒张压参数,并探讨血压类型。结果 OHT组40例,男23例,女17例,年龄(11.5±1.9)岁。对照组40例,男22例,女18例,年龄(10.6±2.4)岁。1收缩压昼夜差值对照组高于OHT组,(9.8±3.3)vs(8.4±4.7)mm Hg,P0.05。OHT组24 h、日间、夜间的平均收缩压和舒张压稍高于对照组(P0.05)。舒张压昼夜差值对照组稍高于OHT组(P0.05)。2OHT组以非勺型血压为主(72.5%),对照组以勺型血压为主(55.0%),两组血压类型差异有统计学意义(P=0.012)。结论 OHT患儿收缩压昼夜差值较正常儿童明显降低,血压类型以非勺型血压多见,多数患儿血压昼夜节律消失。

Exploration of the blood pressure type in orthostatic hypertensive children

Objective Retrospectively analyze the blood pressure type in orthostatic hypertensive (OHT) children with 24h ambulatory blood pressure monitoring (ABPM). Methods Choosing 40 children treated or hospitalized in the syncope department of the Second Xiangya Hospital of Central South University mainly for syncope or pre-syncope with unknown causes during September, 2009 to September, 2013 who were diagnosed by head-up tilt table test (HUTT) as OHT patients (OHT group). In the group, there were 23 boys 17 girls, aging (11.48±1.92) years old. Matching 40 healthy children that came to the hospital for physical examination in the same time period according to age and sex (control group), among which there were 22 boys and 18 girls, ageing (10.60±2.38) years old. Record the ABPM of every child. Result (1) Comparasion of ABPM Parameters: the difference of daytime systolic pressure and night systolic pressure of the control group was higher than that of OHT group [(9.84±3.26) vs (8.37±4.66),t=1.638,P＜0.05], while the average systolic pressure of the whole day, the average diastolic pressure of the whole day, the daytime average systolic pressure, the daytime average diastolic pressure, the night average systolic pressure and the night average diastolic pressure were a little higher than that of the control group (P＞0.05). The difference of daytime diastolic pressure and night diastolic pressure of the control group was a little higher than that of OHT group（P＞0.05）. (2)Blood pressure type: most children of the OTH group had “non-dipper blood pressure type” [29/40(72.5%) vs. 11/40(27.5%)], while most children of the control group had “dipper blood pressure type” [22/40(55.0%) vs. 18/40(45.0%)]. The difference of the two groups has a statistical significance (?2=6.600,P＜0.05). Conclusion There is no significant difference in the ambulatory blood pressures between OHT children and healthy children, but the difference of daytime systolic pressure and night systolic pressure of the OHT group reduce significantly and it’s main blood pressure type is “non-dipper blood pressure type”.