目的 了解动态动脉硬化指数(AASI)对老年高血压患者早期肾损害的预测价值.方法 选取140例老年高血压患者,根据尿白蛋白/肌酐比(ACR)水平分为微量白蛋白尿组与尿白蛋白正常组,对两组间性别、年龄、体质量指数(BMI)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(rG)、估算的肾小球滤过率(eGFR)、AASI等进行比较.根据AASI水平分为AASI≥0.55组与AASI＜ 0.55组,对两组间性别、年龄、BMI、FPG、TC、TG、eGFR、ACR水平及ACR阳性率等进行比较.采用多元逐步回归分析法对老年高血压患者ACR、eGFR与年龄、BMI、AASI等的关系进行分析.结果 微量白蛋白尿组的年龄和AASI显著高于尿白蛋白正常组(P＜0.01),而eGFR、24 h平均舒张压(24 h ADBP)显著低于尿白蛋白正常组(P＜0.01).AASI≥0.55组的年龄、ACR水平、ACR阳性率显著高于AASI＜ 0.55组(P＜ 0.01),而eGFR、24 h ADBP显著低于AASI＜ 0.55组(P＜0.01).ACR与年龄(β=0.351,P=0.000)、AASI(β=0.450,P=0.000)呈显著正相关;而eGFR与年龄(β=-0.150,P=0.037)、AASI(β=-0.587,P=0.000)呈显著负相关.结论 AASI对老年高血压患者的早期肾功能损害可能具有预测价值.

目的 观察老年高血压患者动态动脉硬化指数( AASI)与估测肾小球滤过率(eGFR)的相关性,探讨以AASI大小反应的动脉硬化程度在老年高血压患者肾功能受损中的作用.方法 218例行24小时动态血压检测血肌酐水平基本正常的老年高血压患者,根据文献方法计算AASI,以AASI≤0.55或AASI＞ 0.55分为两组,比较各组间eGFR的差异,以及运用Pearson相关分析及多元线性回归分析eGFR与AASI及年龄、平均收缩压、平均舒张压、血肌酐水平等因素的相关性.结果 与AASI≤0.55组比较,在AASI＞ 0.55组中eGFR值明显降低(P＜0.001).Pearson 相关分析显示,eGFR与AASI呈负相关(r=-0.624,P＜0.001),控制年龄、平均收缩压、平均舒张压、平均脉压、血肌酐水平等因素后,偏相关分析显示,eGFR仍与AASI显著相关(r=-0.343,P＜0.001).多元逐步回归分析显示,eGFR 与肌酐水平、AASI独立相关,标准化偏回归系数分别为-0.770、-0.240,P＜0.001.结论 在老年高血压患者,AASI与eGFR呈独立负相关,AASI值增加是老年高血压患者早期肾功减退的独立危险因素.

目的观察老年高血压患者动态动脉硬化指数(AASI)与颈动脉粥样硬化及微量白蛋白尿(MAU)的相关性及AASI在老年高血压患者心血管风险评估中的作用。方法 172例行24 h动态血压监测的住院老年高血压患者,根据文献方法计算AASI,以AASI<0.55或AASI≥0.55分为两组,比较各组颈动脉内中膜厚度(IMT)、颈动脉斑块指数及MAU的差异,以及与AASI的相关性。结果两组比较,在AASI≥0.55组中,其IMT、颈动脉斑块指数及MAU水平显著高于AASI<0.55组(P<0.001);Pearson相关分析显示,AASI与IMT、颈动脉斑块指数及MAU呈显著正相关,其相关系数分别为:IMT(r=0.560,P<0.001)、颈动脉斑块指数(r=0.591,P<0.001)、MAU(r=0.538,P<0.001);控制年龄、平均收缩压、平均舒张压、血肌酐水平、eGFR等因素后,偏相关分析显示,AASI仍与IMT、颈动脉斑块指数及MAU显著相关;多元逐步回归分析显示IMT、颈动脉斑块指数及MAU均与AASI独立相关,其标准化偏回归系数分别为:0.260、0.252、0.337,P<0.001。结论在老年高血压患者,AASI与IMT、颈动脉斑块指数及MAU水平呈显著正相关,AASI可作为老年高血压患者心脑血管事件风险的独立预测因素。

目的探讨老年高血压患者肾功能不全的相关危险因素。方法比较高血压合并慢性肾病患者(CKD组)与非CKD者(对照组)心血管病、糖尿病、高尿酸血症等患病情况和24 h动态血压参数,分析疾病和代谢异常与CKD的关系。结果 CKD组冠心病、慢性心力衰竭(CHF)、糖尿病和高尿酸血症患病例数明显多于对照组(均P<0.05);Logistic多元回归分析显示,高尿酸血症、冠心病、CHF、糖尿病与CKD相关,是高血压患者CKD的独立危险因素。CKD组血清尿酸水平明显高于对照组;糖尿病病程显著长于对照组(均P<0.01)。患者血清尿酸水平、糖尿病病程与GFR呈显著负相关(r=-0.377,P<0.01,r=-0.437,P<0.05)。血清尿酸水平与脉压、日间收缩压负荷正相关,与平均舒张压、夜间舒张压呈负相关;糖尿病病程与夜间收缩压呈正相关(均P<0.05)。结论在老年高血压患者中,冠心病、CHF、高尿酸血症、糖尿病与CKD密切相关。降压治疗的同时应注意多重危险因素的管理并注意药物的选择。

Objective To investigate the changes of ambulatory arterial stiffness index(AASI)and the relation of AASI to carotid atherosclerosis in elderly patients with essential hypertension(EH). Methods Twenty four hour ambulatory blood pressure was measured in 228 hypertensive patients and 238 healthy subjects. AASI was calculated as 1 minus regression slope of diastolic on systolic blood pressure values. The hypertensive patients were allocated to the elderly hypertensive patients group and the middle-young aged cases group. According to carotid artery intima-media thickness(IMT),the elderly hypertensive patients were further divided into 2 subgroups,which were the normal IMT group and thick IMT group. Comparison of AASI was done in different groups. Results There was a significantly higher AASI in hypertensive group than the healthy group(t=5.158,P0.001),in elderly hypertensive patients than the middle-young patients(t=8.939,P0.001),and in thick IMT group than the normal IMT group(t=4.112,P0.001). AASI was positively correlated with IMT in elderly hypertensive patients(r=0.213,P0.01). Conclusions AASI,derived from 24h ambulatory pressure monitoring,is closely correlated with the severity of the carotid atherosclerosis in elderly patients with EH.

目的评价老年高血压患者动态脉压(PP)及脉压指数(PPI)与估测肾小球滤过率(eGFR)的相关性,探讨PP及PPI在老年高血压患者肾功能受损中的作用。方法218例行24h动态血压检查的老年高血压患者,根据PP(≤55mmHg或>55mmHg)和PPI(≤0.45或>0.45)进行分组,比较各组间eGFR的差异,以及与PP、PPI的相关性。结果与PP≤55mmHg组或PPI≤0.45组比较,在PP>55mmHg或PPI>0.45组中eGFR值明显降低(P<0.01)。Pearson相关分析显示,eGFR与PP及PPI呈显著负相关;控制年龄、平均收缩压、平均舒张压、血肌酐水平等因素后,偏相关分析显示,eGFR仍与PP(r=-0.230,P<0.01)及PPI(r=-0.250,P<0.01)相关。多元逐步回归分析显示eGFR与肌酐水平、PPI及PP独立相关,标准化偏回归系数分别为-0.827、-0.177和-0.170,P<0.001。结论老年高血压患者随着PP及PPI水平的升高,eGFR值明显降低,PP和PPI是老年高血压患者肾功能受损的独立危险因素。

Objective To investigate the effect of high serum uric acid(SUA) level on ambulatory blood pressure and renal function in elderly patients.with hypertension.Methods The data of a matched case-control study in 90 elderly patients(age: 61-87 years) with hypertension were analyzed.The detection of serum uric acid(SUA),serum creatinine(SCr),and ambulatory blood pressure monitoring(AMBP) were performed.The glomerular filtration rate(GRF) was estimated with the simplified modification of diet in renal disease study(MDRD) equation.The 45 patients with GFR less than 60 ml/min per 1.73m2 were definited to renal dysfunction.Results The GFR was negatively correlated with SUA level in all the patients.The significantly increased SUA level and more hyperuricaemia cases were found in the group with renal dysfunction in contrast with the control,(413.7±97.5) μmol/L vs(340.8±90.6) μmol/L.The rate of patients with high SUA were 36(40%).The levels of SUA were negatively correlated with mean diastolic blood pressure(DBP) and nocturnal DBP(nDBP)(r=-0.255 and-0.233) and positively correlated with pulse pressure(PP),daytime PP(dPP) and nocturnal PP(nPP)(r=0.228,0.217 and 0.220,P0.05).Among them,the DBP was significantly lower,but the pulse pressure(PP) and(nPP) were significantly higher in renal dysfunction group compared with the control(P0.05).Conclusion The level of SUA remarkably increased in elderly hypertension patients with renal dysfunction.The increased level of SUA had adverse effects on blood pressure and renal function of these patients.It is shown that decreasing SUA level in the therapy of hypertension should benefit to renal function and blood pressure control.

Objective To investigate the relationship between ambulatory blood pressure (ABP) and renal dysfunction in patients aged ≥70 years with cardiovascular diseases(CVD). Methods Eighty-four patients aged 70-87 years with CVD were included. The glomerular filtration rate (GFR) was estimated with the simplified Modification of Diet in Renal Disease study (MDRD) equation,and GER 60 ml/(min·1.73 m2) was considered as renal dysfunction. The patients were divided into renal dysfunction group (n=44) and control group with normal renal function (n=40). The 24-hour ABP parameters were compared between two groups. Results There were more patients with coronary artery disease,diabetes,heart failure or mean systolic blood pressure(SBP) 130 mmHg in renal dysfunction group than in control group. There was no significant difference in numbers of hypertension cases and non-dipper blood pressure cases. The mean pulse pressure (PP) was significantly higher,while maximal diastolic blood pressure (DBPmax) and wave amplitude of DBP (ΔDBP) were lower in renal dysfunction group than in control group. Mean SBP,PP,nocturnal SBP (nSBP) and nSBP load were positively correlated with the patients age. Serum creatinine(SCr) was positively correlated with PP,nSBP and minimum SBP (SBPmin),and negatively correlated with DBPmax and ΔDBP. GFR changed correspondingly. The correlation of SCr with PP and nSBP remained significant after age-matching. Conclusion The increase in PP and nSBP and the decline in DBPmax and ΔDBP are correlated with renal dysfunction in aged patients with CVD. Patients with renal dysfunction are more vulnerable to suffer from coronary artery disease,diabetes,and heart failure. They also displayed more remarkable changes of ABP.

Objective To investigate the antihypertension treatment quality in elderly hypertensive patients with isolated systolic hypertension.Methods Two hundred thirty patients of elderly with isolated systolic hypertension were devided into three age groups and observed,the first group has 74 patients whose ages are from 60 to 69,the second 84 patients whose ages are from 70 to 79,the third 72 patients whose ages are older than 80.In addition to 32 health persons as a control group.24h ambulatory blood pressure of all people were monitored,blood pressure level were compared between hypertensive patients and health persons,the blood pressure level,the nighttime circadian rhythm,phenomena of morning blood pressure surge were compared among three patients groups.Results During antihypertensive treatment,the fluctuation of 24h ambulatory blood pressure of the hypertensive patients leveled in just(130/80 mmHg).With advaning age the pressures were increased(P0.01),manifold in the daytime and the nighttime circadian rhythm were increased(P0.05),morning manifold blood pressure surge were increased(P0.05),and diastolic blood pressure were decreased(P0.01,P0.05).Conclusions Based on the fact that the blood pressure of elderly hypertensive patients,especially those older than 80,the quality of antihypertension treatment should be further improved

Objective:To investigate the relationship between the ambulatory blood pressure and renal function in elderly patients with hypertension.Methods:A 1:1 matched cases-control study was performed in 90 elderly patients with treated hypertension.45 cases with glomerular filtration rate(GFR) < 60 mL/min per 1.73 m2 estimated with the simplified modification of diet in renal disease study(MDRD) equation were definited to renal disfunction and the others with GFR > 60 mL/min per 1.73 m2,year and gender matched-pairs were as controls.Results:There were 71 cases with non-dipping blood pressure in all of patients and was no significant difference in cases distribution between two groups.Comparing with the patients in control group,The patients with renal dysfunction had significantly increased pulse pressure(PP),nocturnal PP(nPP) and declined levels of diastolic blood pressure(DBP),maximal DBP(DBPmax) and DBP fluctuated amplitude(△DBP).In multivariate logistic regression analysis,the decline of △DBP and increase of nPP were independent risk factors for renal disfunction,(odds ratio[OR],0.941,1.043,95% confidence interval[CI],0.894 to 0.991,1.006 to 1.081,respectively).The GFR was positive correlated with DBPmax,△DBP and nagetive correlated with PP,nPP,nocturnal systolic blood pressure(nSBP),P < 0.05.The △DBP was positive correlated with DBPmax(r = 0.820,P < 0.01)and no relative to DBPmin.Conclusion:The elderly patients of treated hypertension with renal dysfunction had more increased PP and declined DBP than the cases with normal renal function.The nPP was an independent risk factor for renal dysfunction.It is suggested that the increase of nPP and decline of DBP may have a detrimental influence on the decline in GFR in elderly patients with treated hypertension.

Objective To investigate characteristics of heart rate turbulencer(HRT)in elderly patients with hypertension to evaluate significance of HRT on cardiac autonomic nerves dysfunction.Methods 58 patients,17 patients with dippers,22 patients with non-dippers,19 patients with reverse-dippers,18 healthy people as control.Turbulence onset(TO)and turbulence slope(TS)were measured among four groups,and relativities were analyzed between TO,TS and the 24 hour mean systolic,mean diastolic,mean pulse pressure and heart rate variability.Results TO was significantly higher [-7.1～6.8(-0.3)] in patients than in healthy people [-5.8～-0.1(-1.9)](P0.01).TS was significantly lower in patients(7.53±4.05)than in healthy people(10.01±3.72)(P 0.05);TO was significantly higher in patients with non-dippers-6.7～6.5(-0.3)and reverse-dippers-7.1～6.8(0.5)than in healthy people[-5.8～-0.1(-1.9)](P0.05).TS was significantly lower in patients with non-dippers(6.79±2.99)than in healthy people(10.01±3.72)(P0.05);TS was significantly lower in patients with reverse-dippers(6.51±3.71)than in healthy people(10.01±3.72)(P0.01);TO is negatively correlation to SDNN(P0.05).TO is irrelative to SDANN,and TS is irrelative to SDNN and SDANN(P 0.05),TO、TS is irrelative to 24 hour mean systolic,mean diastolic and mean pulse pressure(P0.05).Conclusions Statistics significance was found in the variables of HRT in the elderly patients with hypertension and significance decreased in patients of abnormal blood pressure circadian rhythm.HRT can be used as an evaluation of cardiac autonomic nerves dysfunction in elderly patients with hypertension.

护理工作,主要体现在护理操作中,即在护理理论指导下进行美的操作.一个护理操作的美,必须遵循5个原则:①省时原则;②省力原则;③生理原则;④医学原则;⑤美学原则.

Objective To study phenomenon of heart rate turbulencer(HRT)in patients with senile degenerative heart valvular disease(SDHVD).Methods 46 elderly patients with SDHVD were observed.They were divided into two groups,22 patients with valvular regurgitation,24 patients with no valvular regurgitation,20 healthy people were recruited as normal control.Turbulence onset(TO) and turbulence slope(TS)were measured among three groups,and relativities were analyzed between TO,TS and the degree of valvular disease,left ventricular ejection fraction(LVEF) and heart rate variability(HRV).Results TO was significantly higher in patients than that in healthy people(P0.05).TS was significantly lower in patients than that in healthy people(P0.05);TO was significantly higher in patients with valvular regurgitation than it was in healthy people(P0.05).TS in patients with valvular regurgitation was significantly lower than it was in healthy people(P0.05);TO was positively correlated to the number of diseased valves and the degree of valvular regurgitation(P0.05),and was negatively correlated to LVEF and SDANN(P0.05).TS was negatively correlated to the number of diseased valves and valvular regurgitation(P0.05),and is positively correlated to LVEF and SDANN(P0.05).Conclusions Statistical significance was found in the variables of HRT in the patients with SDHVD in contrast with the healthy people,and HRT is well correlated with the traditional risk factors LVEF and SDANN.HRT can be used as a potential risk predictor in SDHVD patients.

目的探讨利尿剂降压治疗对老年高血压糖、脂代谢、血尿酸及肾功能的影响。方法选择老年高血压患者46例,口服利尿剂前、后测定血糖,血脂,血尿素氮,血肌酐,血尿酸,计算肌酐清除率并进行比较。结果口服双氢克脲噻后17例患者代谢指标和(或)肾功能轻度异常;≥80岁和每日口服双氢克脲噻25 mg其代谢指标和(或)肾功能异常者增多。结论长期联合利尿剂治疗老年高血压应使用小剂量以减少对血糖、血尿酸及肾功的影响。

目前,对婴幼儿的喂药方法多采用小杯、小勺喂服.由于患儿不配合,往往导致药液浪费、患儿呛咳等情况发生,甚至导致患儿误吸而引起窒息.因此,许多家长担忧,甚至恐惧给孩子喂药.现介绍一种简便又实用的婴幼儿喂药方法:

近年许多研究证实急性心肌梗死后出现QT离散度(QTd)延长是一种普遍现象,并且与恶性心律失常和心脏性猝死的发生密切相关[1,2].成功直接冠脉介入干预(PCI)可重建冠脉血运,改善心肌灌注,使QTd缩短,进而减少室性心律失常及猝死.本文通过回顾性分析PCI前后QTd的变化,探讨PCI对老年急性冠脉综合征(ACS)患者QTd的影响.

目的研究老年原发性高血压(EH)患者动态脉压(PP)的特点并探讨其临床意义。方法对388例EH患者及167例健康对照者进行24 h动态血压监测,并按年龄分为老年EH组与中青年EH组,老年健康组与中青年健康组,对各组的动态PP、动态收缩压(SBP)、舒张压(DBP)进行比较。结果①在不考虑年龄的情况下,EH组动态PP、SBP、DBP显著高于健康对照组。②无论是老年EH组还是中青年EH组,动态PP、SBP、DBP水平均显著高于同年龄健康对照组。③老年EH组动态PP显著高于中青年EH组,两组间动态SBP比较无明显差异,而老年EH组动态DBP显著低于中青年EH组。④老年健康对照组与中青年健康对照组比较,动态PP水平显著增高;SBP水平无明显差异;DBP水平显著下降。结论动态PP随增龄而增大。老年EH与健康对照组动态PP增高主要与动态DBP下降有关。

Objective To study the characterization and clinic significance of ambulatory pulse pressure change in elderly essential hypertension(EH) patients and healthy subjects. Methods 24h ambulatory blood pressure was measured in 338 patients with EH and 167 healthy subjects. All cases were allocated to different groups, including the elderly EH group, the elderly healthy subjects group, the middle-young aged EH and healthy subjects group. Comparing of ambulatory pulse pressure (PP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were finished in different groups.Results (1)Ambulatory PP, SBP and DBP of EH group were significantly higher than healthy subject group when the age was not considered.(2)Ambulatory PP, SBP and DBP were significantly higher in both elderly EH group and middle-young aged than the same aged healthy subjects group.(3)Ambulatory PP was significantly higher in elderly EH group than middle-young aged EH group, ambulatory DBP was significantly lower in elderly EH group than middle-young aged group.(4)Ambulatory PP increased and DBP decreased in elderly healthy subjects group comparing with middle-young aged healthy subjects group.Conclusions Ambulatory PP increases with aging. In elderly EH and elderly healthy subjects groups, the increment in ambulatory PP was primarily related to decrease in ambulatory DBP.

随着高性能战斗机逐步装备部队,高性能战斗机飞行员的医学选拔显得尤为重要.在新机飞行员改装体检过程中,护理工作是不可缺少的重要环节.在高性能战斗机飞行员的医学选拔过程中,护理人员要做好入院前的各项准备工作;指导飞行员的饮食起居、医院各种规章制度的执行;引导飞行员到各有关科室进行检查;对飞行员进行有关体检的问卷调查;对部分飞行员进行体能训练、抗荷动作的指导.

甲状腺机能亢进合并重度黄疸临床上很少见.我科于2001年3月收治了1例甲状腺机能亢进合并黄疸的飞行员患者,现将其临床特点及护理要点总结如下.