摘要
目的研究不同类型高血压病患者心功能状况及预后,为患者的诊疗提供指导。方法选择2013年3月至2016年4月广东医科大学附属第三医院心血管内科收治的160例高血压患者为研究对象,按照病因状况分为原发组120例和继发组40例。入院后,所有患者针对病情采取健康生活方式和定期服用降压药物等治疗。比较两组患者的血流动力学状况[左室射血分数(LVEF)、左室舒张末期压力(LVEDP)、心肌耗氧量(MOC)、左室射血阻抗(LVER)],超声心动图参数[室间隔厚度(IVS)、左心室收缩末期内径(LVDs)、左心室后壁厚度(LVPW)]及血浆脑利钠肽(BNP)水平。定期随访患者3年,比较两组患者第1、2、3年的血压水平、合并症发生率和存活率,分析患者预后情况。结果原发组患者的LVEF、LVEDP、MOC、LVER分别为(68.13±5.25)%、(1.48±0.59) kPa、(27.83±1.86) mL、(13.36±2.44) kPa·s/L,明显高于继发组的(63.77±6.77)%、(1.23±0.27) kPa、(17.68±4.79) mL、(11.23±0.39) kPa·s/L,差异均有统计学意义(P<0.05);原发组患者血浆中BNP水平为(2339.50±1131.20) pg/mL,明显高于继发组的(1943.54±481.56) pg/mL,差异有统计学意义(P<0.05);原发组患者的IVS、LVDs、LVPW水平分别为(10.06±0.95) mm、(58.66±7.67) mm、(11.65±0.88) mm,明显高于继发组的(9.16±0.88) mm、(49.54±3.82) mm、(9.12±0.93) mm,差异均有统计学意义(P<0.05);原发组患者第1年、第2年、第3年的血压均值明显高于继发组,差异均有统计学意义(P<0.05);原发组和继发组患者3年后存活率均为100.0%,差异无统计学意义(P>0.05);原发组患者的合并症发生率为35.0%,明显高于继发组的12.5%,差异有统计学意义(P<0.05)。结论原发性高血压患者的血流动力学、超声心动图参数、血浆BNP水平检查结果更差,3年内血压水平和合并症发生更高,因此临床上对高血压患者的血压类型需准确诊断,及时评估患者心功能状况,降低心血管不良事件的发生风险。
Objective To study the cardiac function and prognosis of patients with different types of hypertension,and to provide guidance for the diagnosis and treatment of patients.Methods From March 2013 to April 2016,160 patients admitted to the Department of Cardiovascular Medicine,Third Affiliated Hospital of Guangdong Medical University were selected as the study objects.According to the etiology,the patients were divided into primary group(120 cases)and secondary group(40 cases).After admission,all patients were treated with healthy lifestyle and regular antihypertensive drugs.The hemodynamics(left ventricular ejection fraction[LVEF],left ventricular end-diastolic pressure[LVEDP],myocardial oxygen consumption[MOC],left ventricular ejection fraction rate[LVER]),echocardiographic parameters(interventricular septal thickness[IVS],left ventricular end systolic diameter[LVDS],left ventricular posterior wall thickness[LVPW]),and brain natriuretic peptide(BNP)levels were observed and recorded.The patients were followed up regularly for 3 years.The blood pressure level,the incidence of complications,and the survival rate in the first,second,and third year were recorded to analyze the prognosis of the patients.Results The LVEF,LVEDP,MOC,and LVER of the primary group were(68.13±5.25)%,(1.48±0.59)kPa,(27.83±1.86)mL,and(13.36±2.44)kPa·s/L,significantly higher than(63.77±6.77)%,(1.23±0.27)kPa,(17.68±4.79)mL,(11.23±0.39)kPa·s/L in the secondary group(P<0.05).The plasma BNP concentration was(2339.50±1131.20)pg/mL in the primary group,significantly higher than(1943.54±481.56)pg/mL in the secondary group(P<0.05).The IVS,LVDs,and LVPW of the primary group were(10.06±0.95)mm,(58.66±7.67)mm,(11.65±0.88)mm,which were significantly higher than(9.16±0.88)mm,(49.54±3.82)mm,(9.12±0.93)mm of the secondary group(P<0.05).The mean blood pressure levels of patients in the primary group in the first,second,and third year were significantly higher than those in the secondary group(P<0.05).The survival rate of primary group and secondary group was 100.0%and 100.0%respectively after 3 years,and there was no significant difference between the two groups(P>0.05).The incidence of complications was 35.0%in the primary group,which was significantly higher than 12.5%of secondary group(P<0.05).Conclusion The results of hemodynamics,echocardiographic parameters,and BNP concentration in plasma were worse.The blood pressure level and complications were higher in the third year.Therefore,it is necessary to accurately diagnose the type of hypertension,evaluate the cardiac function of patients in time,and reduce the risk of cardiovascular adverse events.
作者
张光平
程卓
李锦良
ZHANG Guang-ping;CHENG Zhuo;LI Jin-liang(Department of Cardiovascular Medicine,Third Affiliated Hospital of Guangdong Medical University(Shunde Longjiang Hospital),Foshan 528318,Guangdong,CHINA)
出处
《海南医学》
CAS
2020年第12期1513-1516,共4页
Hainan Medical Journal
关键词
原发性高血压
继发性高血压
心功能
彩色多普勒超声
超声心动图
预后
Primary hypertension
Secondary hypertension
Cardiac function
Color Doppler ultrasound
Echocardiography
Prognosis
