标题：血压昼夜节律变化、心率变异性与老年高血压合并脑梗死后遗症发生的关系

      作者：张克举 1，张晓杰 1，王灵灵 2，王兴 3    1.武警陕西省总队医院老干部病区，陕西 西安 710016；2.武警陕西省总队医院急诊科，陕西 西安 710016；3.延安市人民医院综合内科，陕西 延安 716000

      卷次： 2023年34卷21期

      【摘要】 目的 分析血压昼夜节律变化、心率变异性与老年高血压合并脑梗死后遗症发生的关系。方法 回顾性分析2020年5月至2021年5月武警陕西省总队医院收治的90例老年高血压合并脑梗死患者的临床资料，按是否出现后遗症分为后遗症组37例和无后遗症组53例，比较两组患者24 h动态血压变化、昼夜节律变化分型及心率变异性，并运用多因素Logistic回归分析导致高血压合并脑梗死后遗症发生的危险因素。结果 后遗症组患者入院卒中量表(NIHSS)评分为(12.41±1.58)分，明显高于无后遗症组的(10.33±1.49)分，差异有统计学意义(P<0.05)。后遗症组患者24 h平均收缩压(24 hSBP)及舒张压(24 hDBP)、日间平均收缩压(dSBP)及舒张压(dDBP)、夜间平均收缩压(nSBP)及舒张压(nDBP)分别为(140.10±14.26) mmHg、(82.56±9.33) mmHg、(144.17±13.42) mmHg、(84.75±8.17) mmHg、(131.97±12.11) mmHg、(78.17±4.19) mmHg，明显高于无后遗症组的(132.57±14.83) mmHg、(77.53±9.19) mmHg、(137.44±12.31) mmHg、(80.18±9.36) mmHg、(122.83±12.36) mmHg、(72.22±4.36) mmHg，差异均具有统计学意义(P<0.05)；后遗症组患者的SBP及DBP夜间下降率分别为(8.66±1.79)%、(7.13±2.18)%，明显低于无后遗症组的(11.39±2.17)%、(10.13±2.32)%，差异具有统计学意义(P<0.05)；两组昼夜节律变化分型比较，后遗症组患者的总非构型占比为62.16%，明显高于无后遗症组的35.85%，差异有统计学意义(P<0.05) 。后遗症组患者24 h窦性RR间期标准差(SDNN)、邻近窦性RR间期长度差值均方根(rMSSD)、24 h连续 5 min窦性RR间期均值标准差(SDANN)及邻近窦性RR间期差值>50 ms心搏数与总RR间期个数百分比(pNN50)分别为(91.85±11.36) ms、(26.69±4.17) ms、(33.85±3.71) ms、(6.84±2.01)%，明显低于无后遗症组的(101.37±13.44) ms、(33.74±5.29) ms、(39.52±3.12) ms、(9.45±3.15)%，差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，入院NIHSS评分、SBP夜间下降率、DBP夜间下降率、昼夜节律变化分型、SDNN、rMSSD、SDANN、pNN50均为高血压合并脑梗死后遗症发生的危险因素(P<0.05)。结论 高血压合并脑梗死后遗症患者血压状态不稳定，患者存在减弱甚至消失的昼夜节律，心率变异性各参数值降低，血压昼夜节律变化及心率变异性均与后遗症的发生有一定的关系。
      【关键词】 脑梗死；后遗症；血压昼夜节律；心率变异性；高血压；危险因素
      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2023）21—3064—05

Relationship of circadian rhythm variation in blood pressure and heart rate variability with occurrence ofsequelae in elderly patients of hypertension with cerebral infarction.
ZHANG Ke-ju 1, ZHANG Xiao-jie 1, WANGLing-ling 2, WANG Xing 3. 1.Veteran Cadre Ward, Shaanxi Armed Police Corps Hospital, Xi'an 710016, Shaanxi, CHINA; 2.Department of Emergency, Shaanxi Armed Police Corps Hospital, Xi'an 710016, Shaanxi, CHINA; 3. Department of GeneralInternal Medicine, Yan'an People's Hospital, Yan'an 716000, Shaanxi, CHINA
【Abstract】 Objective To analyze the relationship between circadian rhythm variation of blood pressure, heartrate variability and occurrence of sequelae in elderly patients of hypertension with cerebral infarction. Methods Theclinical data of 90 elderly patients of hypertension complicated with cerebral infarction admitted to Shaanxi Armed PoliceCorps Hospital from May 2020 to May 2021 was retrospectively analyzed. According to presence or absence of sequelae,the patients were divided into sequelae group (37 cases) and non?sequelae group (53 cases). 24 h ambulatory blood pres?sure changes, circadian rhythm variation types, and heart rate variability were compared between the two groups. Therisk factors of occurrence of sequelae in hypertension with cerebral infarction were analyzed by multivariate Logistic re?gression analysis. Results The score of National Institutes of Health Stroke Scale (NIHSS) at admission in sequelagroup was (12.41±1.58) points, which was significantly higher than (10.33±1.49) points in non?sequela group (P<0.05).The 24 h systolic blood pressure (24 hSBP), 24 h diastolic blood pressure (24 hDBP), daytime systolic blood pressure(dSBP), daytime diastolic blood pressure (dDBP), nighttime systolic blood pressure (nSBP), and nighttime diastolic bloodpressure (nDBP) were (140.10 ± 14.26) mmHg, (82.56 ± 9.33) mmHg, (144.17 ± 13.42) mmHg, (84.75 ± 8.17) mmHg,(131.97±12.11) mmHg, and (78.17±4.19) mmHg, which were significantly higher than (132.57±14.83) mmHg, (77.53±9.19) mmHg, (137.44±12.31) mmHg, (80.18±9.36) mmHg, (122.83±12.36) mmHg, and (72.22±4.36) mmHg in non?se?quelae group (P<0.05). The nocturnal decline rates of SBP and DBP in sequela group were (8.66±1.79)% and (7.13±2.18)%, which were significantly lower than (11.39±2.17)% and (10.13±2.32)% in non?sequela group (P<0.05). Compar?ison of types of circadian rhythm variation revealed that the proportion of total non?configuration in sequela group wassignificantly higher than that in non?sequela group (62.16% vs 35.85%, P<0.05). The standard deviation of average NNintervals (SDNN), root mean square of the difference between all adjacent sinus RR intervals (rMSSD), standard devia?tion of average 5 min NN intervals (SDANN), and percent of the number whose difference between adjacent NN intervalwere more than 50 ms (pNN50) in sequelae group were (91.85±11.36) ms, (26.69±4.17) ms, (33.85±3.71) ms, and (6.84±2.01)%, which were significantly lower than (101.37±13.44) ms, (33.74±5.29) ms, (39.52±3.12) ms, and (9.45±3.15)%in non?sequelae group (P<0.05). Multivariate Logistic regression analysis showed that NIHSS score at admission, noctur?nal decline rate of SBP, nocturnal decline rate of DBP, circadian rhythm variation types, SDNN, rMSSD, SDANN, andpNN50 were all risk factors for sequelae in hypertension with cerebral infarction (P<0.05). Conclusion The blood pres?sure status of hypertensive patients with cerebral infarction and sequelae is unstable. Patients have weakened or even dis?appeared circadian rhythm and reduced heart rate variability parameters. Circadian rhythm variation of blood pressureand heart rate variability have certain relationship with the occurrence of sequelae.
      【Key words】 Cerebral infarction; Sequelae; Circadian rhythm of blood pressure; Heart rate variability; Hyperten?sion; Risk factors