急诊科1361例高血压急症临床分析

摘要

目的 探讨高血压急症患者并发靶器官损害特点及其与预后的关系.方法 回顾性分析1361例高血压急症患者临床资料,根据患者年龄分为老年组(年龄≥60岁)、中年组(40≤年龄＜60岁)及青年组(＜40岁)三组,分别对不同性别、年龄分组时靶器官损害的构成比及病死率进行统计分析.结果 高血压急症患者占同期入院的高血压患者比例为13.31%,占同期急诊内科抢救患者总数的7.14%.高血压急症发生率最高的是中年高血压患者为16.12%(367/2276),明显高于老年高血压患者(12.81%,932/7278)及青年高血压患者(9.28%,62/668),三组间高血压急症发生率的差异均有统计学意义(χ2=26.62,P＜0.01).各年龄组患者并发靶器官损害的构成比有显著差别,中、青年组颅内出血、主动脉夹层的构成比显著高于老年组(P均＜0.01),而老年组在急性左心衰、不稳定型心绞痛构成比显著高于中、青年组(P＜0.01).高血压急症患者并发靶器官损害中,发生率居前两位的分别是颅内出血(30.05%)和急性左心衰(25.94%),其次是单纯性血压超高(12.93%)和不稳定型心绞痛(12.86%).高血压急症患者中男女发病比例为1:1.01,但不同性别高血压急症靶器官损害因素的构成不同(χ2=41.08,P＜0.01),男性患者合并颅内出血、急性心肌梗死的比率显著高于女性,而女性患者合并高血压脑病、急性左心衰、不稳定型心绞痛的比率显著高于男性(P均＜0.01).高血压急诊患者合并颅内出血是高血压急症最主要的死亡原因.结论 不同年龄层次、性别的高血压急症患者合并靶器官损害的特点不同,保护重要脏器功能仍是高血压急症治疗的核心部分.%Objective To investigate the characteristics of target-organ damages and the relationship between these characteristics and prognosis in the patients with hypertensive urgencies. Methods The clinical materials of 1361 patients were retrospectively analyzed and all patients were divided,according to their ages,into aged group ( ^ 60 ), middle-aged group ( 40 to 60 ) and young group ( <40 ). The constituent ratio of target-organ damages and mortality were counted and analyzed in all groups. Results The patients with hypertensive urgencies accounted for 13. 31% of all hypertension patients hospitalized at the same time,and for 7. 14% of those rescued in emergency department. The occurrence rate of hypertensive urgencies was 16. 12% ( 367/2276 ) in middle-aged group, which was significantly higher than that in aged group ( 12. 81% ,932/7278 ) and young group ( 9. 28% ,62/668 ),and the difference among three groups had statistical significance ( =26. 62,P <0. 01 ). The constituent ratio of target-organ damages was significantly different among three groups, and that of intracranial hemorrhage and aortic dissection was significantly higher in middle-aged group and young group than that in aged group ( all P < 0. 01 ), and that of acute left heart failure and unstable angina was significantly higher in aged group than that in middle-aged group and young group ( P < 0. 01 ). Among the occurrence rates of target-organ damages, the first two were intracranial hemorrhage ( 30.05% ) and acute left heart failure ( 25. 94% ),and second two were simple high blood pressure ( 12. 93% ) and unstable angina ( 12. 86% ). The proportion of male patients to female ones were 1:1.01 ,but the constituent ratio of target-organ damages was different in different gender patients (x = 41.08, P < 0. 01 ). The proportion of intracranial hemorrhage and a-cute myocardial infarction was higher in male patients than that in female ones, and that of hypertensive encephalopa-thy, acute left heart failure and unstable angina was higher in female patients than that in male ones ( all P < 0. 01 ). Intracranial hemorrhage was the major cause of death in patients with hypertensive urgencies. Conclusion The patients with hypertensive urgencies in different ages and sexes have different characteristics in target-organ damages, so the core is to protect important organs in the treatment of hypertensive urgencies.