高血压急症的相关因素及其靶器官损害的临床特点分析

摘要

目的：分析高血压急症的相关因素及其靶器官损害的临床特点。方法选择2010年3月—2015年3月湖南旺旺医院收治的高血压患者5111例，其中高血压急症680例（研究组），非高血压急症4431例（对照组）。比较两组患者一般资料（包括性别、年龄、病程及高血压类型）和动态血压，并分析高血压并发靶器官损害情况。结果两组患者性别、高血压类型比较，差异无统计学意义（ P ﹥0.05）；研究组患者病程长于对照组，年龄大于对照组（P ﹤0.05）。两组患者24 h 平均收缩压（MSBP）和白天 MSBP 比较，差异无统计学意义（P ﹥0.05）；研究组患者24 h平均舒张压（MDBP）、白天 MDBP、夜间 MDBP 及昼夜血压差值低于对照组，夜间 MSBP 和非杓型血压节律所占比例高于对照组（P ﹤0.05）。680例患者靶器官损害主要为颅内出血（占30.15%）、急性左心衰竭（占25.88%）和不稳定型心绞痛（占12.94%）。其中﹥60岁患者靶器官损害主要为急性左心衰竭（占32.19%）和颅内出血（占22.75%），40~60岁患者靶器官损害主要为颅内出血（占48.09%），﹤40岁患者靶器官损害主要为颅内出血（占35.48%）。结论高龄、高血压病程较长、24 h 和白天及夜间 MDBP 低、夜间 MSBP 高、昼夜血压差缩小及为非杓型节律的高血压患者易发生高血压急症，高血压急症并发靶器官损害以颅内出血、急性左心衰竭和不稳定型心绞痛为主，且与年龄有关。%Objective To analyze the related factors of hypertensive emergencies and clinical characteristics of the target - organ damage. Methods A total of 5,111 patients with hypertension were selected in Wangwang Hospital of Hu'nan Province from March 2010 to March 2015,including 680 patients with hypertensive emergencies(served as case group)and 4, 431 patients without hypertensive emergencies(served as control group). General information(including gender,age,disease course and hypertension types) and ambulatory blood pressure( including 24 - hour MSBP and MDBP,daytime MSBP and MDBP,nighttime MSBP and MDBP,blood pressure difference between daytime and nighttime)were compared between the two groups,and the clinical characteristics of the target - organ damage were analyzed. Results No statistically significant differences of gender or hypertension types was found between the two groups(P ﹥ 0. 05);the disease course of case group was statistically significantly longer than that of control group,and the age of case group was statistically significantly higher than that of control group(P ﹥ 0. 05). No statistically significant differences of 24 - hour MSBP or daytime MSBP was found between the two groups(P ﹥ 0. 05);24 - hour MDBP,daytime MDBP,nighttime MDBP and blood pressure difference between daytime and nighttime of case group were statistically significantly lower than those of control group,while nighttime MSBP and proportion of non - dipper blood pressure rhythm of case group were statistically significantly higher than those of control group(P ﹤ 0. 05). Of case group,205 cases complicated with intracranial hemorrhage(accounted for 30. 15% ),176 cases complicated with acute left ventricular failure(accounted for 25. 88% ),88 cases complicated with unstable angina pectoris(accounted for 12. 94% );among patients aged over 60 years old,150 cases complicated with acute left ventricular failure(accounted for 32. 19% ),106 cases complicated with intracranial hemorrhage(accounted for 22. 75% );among patients aged between 40 and 60 years old,88 cases complicated with intracranial hemorrhage(accounted for 48. 09% ),among patients aged below 40 years old,11 cases complicated with intracranial hemorrhage(accounted for 35. 48% ). Conclusion Aged hypertension patients,or with longer disease course,lower 24 - hour,daytime and nighttime MDBP,higher nighttime MSBP,less blood pressure difference between daytime and nighttime,non - dipper blood pressure rhythm are under high risk of hypertensive emergencies;the target - organ damage mainly includes intracranial hemorrhage,acute left ventricular failure and unstable angina pectoris,and have some correlations with age.