高血压伴脑梗死急性期患者的动态血压与动态心电图同步监测及临床意义

虞晓武 易兴阳 颜志钦(等)

[摘要] 目的 同时监测原发性高血压伴脑梗死患者急性期的动态心电图和动态血压的变化规律及意义。 方法 将2011年5～11月确诊为高血压伴急性脑梗死的129例患者作为观察组，将确诊为高血压不伴脑卒中的84例患者作为对照组，两组均同步记录24 h动态血压和动态心电图。观察24 h动态血压变化规律，24 h动态心电图检出的房性、室性心律失常及ST段变化。 结果 观察组动态血压以非杓型与反杓型为主。杓型和反杓型与对照组比较，差异均有统计学意义，而非杓型两组比较无统计学意义。两组动态心电图比较，房性早搏、房性心动过速、阵发性房颤、室性早搏和ST段改变检出率均具有显著性差异，室性心动过速、T波检出率无显著性差异。 结论 脑卒中急性期病人血压呈非杓型类型比例大于正常人群，夜间血压反而升高，呈反杓型。由于急性脑卒中患者易并发心脏损害，特别是重症患者，临床医师要高度重视，要进行心电血压监护，急诊心电图检查，必要时心肌酶谱检查，及时发现心脏异常情况，避免并发严重心脏事件。同步监测急性期脑卒中患者的动态血压与动态心电图具有明显的临床意义，值得推广。

[关键词] 脑卒中；动态心电图；动态血压

[中图分类号] R743.33[文献标识码] B[文章编号] 1673—9701（2012）25—0047—03

Monitoring of simultaneous ambulantory blood pressure and Holter and of high blood pressure with cerebral infarction in the acute phase patients

YU Xiaowu1 YI Xingyang2 YAN Zhiqin2 CHI Lifen2 SONG Nanhai1 ZHOU Peng1

1.Department of Electrocardiogram，Ruian City People's Hospital in Zhejiang Province，Ruian 325200，China；2.Department of Neurology，Ruian City Peoples Hospital in Zhejiang Province，Ruian 325200，China

[Abstract] Objective To explore the relationship between hypertensive patients with actute stroke and brood pressure electrocardiogram changes. Methods From 2011 May to November 129 hypertension and stroke patients were analyzed as the observation group，84 hypertensive patients without stroke with matched as control.All the patients were monitored by 24—hour ambulatory blood pressure measurements，24 Holter electrocardiography（ECG），ambulatory blood pressure variation，24 Holter detection of atrial，ventricular arrhythmia and ST segment changes. Results The observation group of non—dipper ambulatory blood pressure. Dipper and anti—dipper compared with the control group the difference was statistically significant，non—dippers showed no statistical significance.Compared with two groups of ambulatory ECG，the result was that atrial tachycardia，paroxysmal atrial fibrillation， premature ventricular beats and ST segment change significantly different，but ventricular tachycardia T—wave was not.Compared with the control group blood pressure variation，cardial arrhythmias and ischemic changes were significantly different. Conclusion Due to acute stroke patients to appear with heart damage，especially in severe cases，it was necessary to blood pressure monitoring，myocardial enzyme check when necessary， timely discovery heart abnormalities. Synchronous monitoring patients with cerebral apoplexy in the acute phase of blood pressure and dynamic ECG has obvious clinical significance，is worthy to be popularized.

[Key words]Stroke；Ambulatory blood pressure；Dynamic electrocardiogram

脑血管病发病率高，是我国人口死亡和致残的最主要原因。高血压与脑血管病的发生密切相关，是脑血管病最重要的病因和危险因素。研究表明：70%～80%脑卒中患者均有高血压或高血压病史[1]。……