胸阻抗法无创血流动力学监测在难治性高血压患者治疗中的应用

伍勇; 余汀; 彭敏; 石留芬; 虞桂芳; 袁晓晨; 龚开政; 徐敏芝

doi:10.16766/j.cnki.issn.1674-4152.001900

胸阻抗法无创血流动力学监测在难治性高血压患者治疗中的应用

doi: 10.16766/j.cnki.issn.1674-4152.001900

扬州大学附属医院扬州市第一人民医院心内科，江苏扬州 225001

基金项目:

国家自然科学基金 81970225

江苏省卫计委指导性项目 Z2017020

详细信息

通讯作者:
徐敏芝，E-mail: 2764942696@qq.com

中图分类号: R544.1
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- 被引次数: 0
出版历程
- 收稿日期: 2020-11-26
- 网络出版日期: 2022-02-16

Application of non-invasive impedance cardiography with transthoracic impedance cardiography in the treatment of refractory hypertension

Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225001, China

摘要

摘要: 目的探讨胸阻抗法无创血流动力学监测对指导难治性高血压(RH)患者降压治疗的有效性。方法选取2018年11月—2019年10月在扬州大学附属医院门诊和住院诊断为RH患者120例，依据治疗方案的不同分组，对照组(60例)采用RH常规治疗，研究组(60例)定期给予胸阻抗法无创血流动力学监测辅助指导治疗。治疗随访1年，对比2组患者血压控制水平、血流动力学指标包括心率(HR)、心脏功能的加速度指数(ACI)、外周血管阻力(SVR)及胸腔液体水平(TFC)以及心功能指标。结果治疗观察1年后，2组24小时平均收缩压与舒张压均下降，且研究组24小时平均收缩压[(129.50±7.41)mm Hg vs. (153.69±6.22)mm Hg]与24小时平均舒张压[(80.21±5.20)mm Hg vs. (98.62±6.11)mm Hg]均低于对照组(均P＜0.05)；研究组HR、TFC、SVR均低于对照组，ACI高于对照组(均P＜0.05)；研究组LVEF高于对照组，LVESD及LVEDD水平低于对照组(均P＜0.05)；研究组新发心脑血管事件发生率(6.7% vs. 21.7%)低于对照组(P＜0.05)。结论将胸阻抗法无创血流动力学监测应用至RH患者的辅助治疗中，可有效指导RH降压治疗，降低血压及血流动力学水平，更利于心功能的改善，减少心脑血管疾病发生，值得借鉴。
- 胸阻抗法 /
- 无创血流动力学监测 /
- 难治性高血压 /
- 心功能 /
- 心脑血管事件
Abstract: Objective To explore the effectiveness of non-invasive hemodynamic monitoring with transthoracic impedance cardiography (ICG) to guide the antihypertensive treatment of patients with refractory hypertension (RH). Methods From November 2018 to October 2019, 120 patients diagnosed with RH (outpatients and inpatients) of the Affiliated Hospital of Yangzhou University were selected. According to the treatments they were assigned into different groups, the control group (n=60) was given routine treatment, and the study group (n=60) was given the treatment guided by the non-invasive hemodynamic monitoring with ICG. The treatment was followed up for a year. The blood pressure control level and hemodynamic indices including heart rate (HR), acceleration of cardiac function index (ACI), peripheral vascular resistance (systemic vascular resistance, SVR) and pleural fluid composition (thoracic fluid content, TFC) of the two groups were compared. The levels of cardiac function indexes and the incidence of cardiovascular and cerebrovascular events were also compared. Results After the treatment, the 24 h average systolic and diastolic blood pressure of the two groups were improved, and the systolic blood pressure [(129.50±7.41) mm Hg vs.(153.69±6.22) mm Hg] and diastolic blood pressure [(80.21±5.20) mm Hg of the study group was lower than that of the control group (98.62±6.11) mm Hg, P < 0.05]. The hemodynamic levels of the two groups were improved, the levels of HR, TFC and SVR in the study group were lower than those in the control group and the ACI level was higher than that in the control group (all P < 0.05). The cardiac function of the two groups was improved, the left ventricular ejection fraction (LVEF) level of the study group was higher than that of the control group and the level of left ventricular end-systolic dimension (LVESD) and left ventricular end-diastolic dimension (LVEDD) was lower than that of the control group (all P < 0.05). The incidence of cardiovascular and cerebrovascular events in the study group was lower than that in the control group(6.7% vs. 21.7%, P < 0.05). Conclusion The application of non-invasive hemodynamic monitoring with Transthoracic ICG to the adjuvant treatment of RH patients can effectively guide RH antihypertensive therapy, reduce blood pressure and hemodynamic levels and is more conducive to the improvement of cardiac function. It can also reduce the occurrence of cardiovascular and cerebrovascular diseases.
- Transthoracic Impedance Cardiography /
- Non-invasive hemodynamic monitoring /
- Refractory hypertension /
- Cardiac function /
- Cardiovascular and cerebrovascular events

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表 1 2组难治性高血压患者血压水平对比(x ±s，mm Hg)

组别	例数	24小时平均收缩压		24小时平均舒张压
组别	例数	干预前	干预后	干预前	干预后
对照组	60	194.12±7.25	153.69±6.22^a	107.58±6.31	98.62±6.11^a
研究组	60	193.11±7.31	129.50±7.41^a	107.66±6.36	80.21±5.20^a
t值		0.760	19.368	0.069	17.774
P值		0.449	< 0.001	0.945	< 0.001
注：与干预前比较，^aP < 0.05。1 mm Hg=0.133 kPa。

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表 2 2组难治性高血压患者血流动力学指标水平对比(x ±s)

组别	例数	HR(次/min)		ACI(1 000·s^-2)		TFC(Kohm)		SVR(dyne-sec-cm^-5)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	60	122.3±2.5	115.3±3.1^a	64.3±5.2	70.2±2.4^a	46.4±3.4	43.4±2.7^a	2 798.6±65.3	1 726.7±53.1^a
研究组	60	121.8±2.1	98.8±4.2^a	63.9±5.4	74.6±1.5^a	46.5±3.6	38.5±2.3^a	2 786.3±63.2	1 256.2±32.5^a
t值		1.186	24.484	0.413	12.042	0.156	10.701	1.048	58.540
P值		0.238	0.003	0.680	< 0.001	0.876	< 0.001	1.297	< 0.001
注：与干预前比较，^aP < 0.05。

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表 3 2组难治性高血压患者心功能指标水平对比(x ±s)

组别	例数	LVESD(mm)		LVEDD(mm)		LVEF(%)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	60	53.66±1.44	48.52±1.04^a	64.52±3.12	59.52±2.02^a	41.22±2.14	47.89±3.26^a
研究组	60	53.69±1.42	43.62±1.02^a	64.55±3.14	54.11±2.11^a	41.24±2.13	54.26±3.17^a
t值		0.115	26.055	0.052	14.346	0.051	10.851
P值		0.909	< 0.001	0.958	< 0.001	0.959	< 0.001
注：与干预前比较，^aP < 0.05。

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表 4 2组难治性高血压患者心脑血管事件发生情况对比[例(%)]

组别	例数	冠心病	脑卒中	心力衰竭	主动脉夹层	总发生率(%)
对照组	60	6(10.0)	2(3.2)	2(3.3)	3(5.0)	21.7(13/60)
研究组	60	2(3.3)	0(0.0)	1(1.7)	1(1.7)	6.7(4/60)
注：2组总心脑血管事件发生率比较，χ²=5.551, P=0.018。

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