高血压患者24h动态血压、随访血压与诊室血压测量结果比较
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摘要
背景血压监测能够帮助高血压患者了解自身血压情况和控制效果,同时也是早期识别高血压异常的一个重要环节。目前社区血压监测方式包括诊室血压、随访血压和24 h动态血压。目的比较高血压患者24 h动态血压、诊室血压、随访血压的差异及诊断结果的一致性,为推广应用24 h动态血压监测提供经验借鉴。方法采用方便抽样法,回顾性分析2017年3月—2018年5月上海市金山工业区社区卫生服务中心在管的、接受24 h动态血压监测的169例高血压患者的病历资料。通过电子病历获得其24 h动态血压(昼间血压、夜间血压、24 h平均血压)、诊室血压、随访血压,比较其差异及一致性。结果差异性分析结果显示,昼间血压、夜间血压、24 h平均血压、诊室血压、随访血压比较,差异有统计学意义(P<0.05)。一致性检验结果显示,昼间血压、夜间血压、24 h平均血压、随访血压与诊室血压的一致性均较差(Kappa值<0.400)。结论要精准监测社区高血压患者的血压情况,需要诊室血压、随访血压与24 h动态血压相结合,并注意指导患者进行动态血压监测时正确的监测方法及注意事项。
Background Blood pressure monitoring is a method that helps hypertensive patients to know their blood pressure level and control effects,and also an important way for early identification of hypertension-associated abnormalities.Community-based blood pressure measurement methods include office and follow-up blood pressure measurements and 24-hour ambulatory blood pressure monitoring(ABPM).Objective To compare the consistencies and differences of 24-hour ABPM,office and follow-up blood pressure measurements for hypertensive patients,offering a reference for the promotion of 24-hour ABPM.Methods This study was carried out in a convenience sample of 169 cases of hypertension who received the management(including 24-hour ABPM) of Jinshan Industrial Area Community Health Center,Shanghai,from March 2017 to May 2018.By reviewing the electronic medical records,the results of 24-hour ABPM(daytime,night-time and average 24-hour blood pressure),and those of office and follow-up blood pressure measurements were collected.Consistencies and differences of these three measurements were compared.Results Significant differences were observed when comparing daytime,night-time and average 24-hour blood pressure,office blood pressure and follow-up blood pressure by difference analysis(P<0.05).Daytime,night-time,average 24-hour blood pressure,and follow-up blood pressure had poor consistency in the measurement of blood pressure with office blood pressure by consistency analysis(Kappa<0.400).Conclusion Combination of 24-hour ABPM,office and follow-up blood pressure measurements can improve the accuracy of community-based blood pressure monitoring for hypertensive patients.Attention should be paid to guide the patients using the appropriate monitoring way and inform them the matters that should be noted during the monitoring.
Background Blood pressure monitoring is a method that helps hypertensive patients to know their blood pressure level and control effects,and also an important way for early identification of hypertension-associated abnormalities.Community-based blood pressure measurement methods include office and follow-up blood pressure measurements and 24-hour ambulatory blood pressure monitoring(ABPM).Objective To compare the consistencies and differences of 24-hour ABPM,office and follow-up blood pressure measurements for hypertensive patients,offering a reference for the promotion of 24-hour ABPM.Methods This study was carried out in a convenience sample of 169 cases of hypertension who received the management(including 24-hour ABPM) of Jinshan Industrial Area Community Health Center,Shanghai,from March 2017 to May 2018.By reviewing the electronic medical records,the results of 24-hour ABPM(daytime,night-time and average 24-hour blood pressure),and those of office and follow-up blood pressure measurements were collected.Consistencies and differences of these three measurements were compared.Results Significant differences were observed when comparing daytime,night-time and average 24-hour blood pressure,office blood pressure and follow-up blood pressure by difference analysis(P<0.05).Daytime,night-time,average 24-hour blood pressure,and follow-up blood pressure had poor consistency in the measurement of blood pressure with office blood pressure by consistency analysis(Kappa<0.400).Conclusion Combination of 24-hour ABPM,office and follow-up blood pressure measurements can improve the accuracy of community-based blood pressure monitoring for hypertensive patients.Attention should be paid to guide the patients using the appropriate monitoring way and inform them the matters that should be noted during the monitoring.
引文
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[3]卢永萍,潘颖,王曼.24小时动态血压监测的临床应用及评价[J].医学理论与实践,2011,24(3):275-277.DOI:10.3969/j.issn.1001-7585.2011.03.013.LU Y P,PAN Y,WANG M.Clinical application and evaluation of24-hour ambulatory blood pressure monitoring[J].The Journal of Medical Theory and Practice,2011,24(3):275-277.DOI:10.3969/j.issn.1001-7585.2011.03.013.
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[5]包安华.基层高血压的诊断及治疗亟需推广24小时动态血压监测[J].中外健康文摘,2011,8(29):5-6.DOI:10.3969/j.issn.1672-5085.2011.29.001.BAO A H.Diagnosis and treatment of primary hypertension is urgently needed to promote 24-hour ambulatory blood pressure monitoring[J].World Health Digest,2011,8(29):5-6.DOI:10.3969/j.issn.1672-5085.2011.29.001.
[6]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中国医学前沿杂志:电子版,2011,3(5):42-93.DOI:10.3969/j.issn.1674-7372.2011.05.011.Chinese Hypertension Prevention Guidelines Revision Committee.2010 Chinese guidelines for the management of hypertension[J].Chinese Journal of the Frontiers of Medical Science:Electronic Version,2011,3(5):42-93.DOI:10.3969/j.issn.1674-7372.2011.05.011.
[7]国家基本公共卫生服务项目基层高血压管理办公室.国家基层高血压防治管理指南[J].中国循环杂志,2017,32(11):1041-1048.DOI:10.3969/j.issn.1000-3614.2017.11.001.National Basic Public Health Service Project Basic Health Management Office.National grassroots hypertension prevention and management guide[J].Chinese Circulation Journal,2017,32(11):1041-1048.DOI:10.3969/j.issn.1000-3614.2017.11.001.
[8]华琳,阎岩,张建.关于对诊断一致性Kappa系统的探讨[J].数理医药学杂志,2006,19(5):518-520.DOI:10.3969/j.issn.1004-4337.2006.05.033.HUA L,YAN Y,ZHANG J.The discussion on Kappa coefficient for diagnosis coherence[J].Journal of Mathematical Medicine,2006,19(5):518-520.DOI:10.3969/j.issn.1004-4337.2006.05.033.
[9]徐立中.高血压监测结果分析[J].现代医院,2006,6(9):155-156.XU L Z.Analysis of monitoring results of hypertension[J].Modern Hospital,2006,6(9):155-156.
[10]张云,王树贤,王莉,等.诊室血压与动态血压诊断高血压符合率的比较[J].中国医药导刊,2011,13(6):950-951.DOI:10.3969/j.issn.1009-0959.2011.06.018.ZHANG Y,WANG S X,WANG L,et al.Comparing the results of office blood pressure and ambulatory blood pressure monitoring in diagnosis of hypertension[J].Chinese Journal of Medical Guide,2011,13(6):950-951.DOI:10.3969/j.issn.1009-0959.2011.06.018.
[11]老年高血压的诊断与治疗中国专家共识(2017版)诊治要点[J].实用心脑肺血管病杂志,2017,25(11):70.Diagnosis and treatment of senile hypertension:key points of Chinese expert consensus(2017 edition)[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2017,25(11):70.
[12]魏芳,杨振,路方红.诊室血压,动态血压及自测血压的临床应用及比较[J].河北医药,2001,23(9):710-711.DOI:10.3969/j.issn.1002-7386.2001.09.048.WEI F,YANG Z,LU F H.Clinical application and comparison of blood pressure,ambulatory blood pressure and self-test blood pressure in the office[J].Hebei Medical Journal,2001,23(9):710-711.DOI:10.3969/j.issn.1002-7386.2001.09.048.
[13]王继光.进一步提高高血压的诊治水平,预防心脑血管并发症[J].中国医学前沿杂志:电子版,2011,3(4):37-38.DOI:10.3969/j.issn.1674-7372.2011.04.011.WANG J G.Further improve the diagnosis and treatment of hypertension,prevent cardiovascular and cerebrovascular complications[J].Chinese Journal of the Frontiers of Medical Science:Electronic Version,2011,3(4):37-38.DOI:10.3969/j.issn.1674-7372.2011.04.011.
[14]胡雪芳,沈春兰,朱奇志.24小时动态血压监测在高血压患者中的临床检测意义[J].吉林医学,2010,31(12):1614-1615.DOI:10.3969/j.issn.1004-0412.2010.12.020.HU X F,SHEN C L,ZHU Q Z.Clinical significance of 24-hour ambulatory blood pressure monitoring in patients with hypertension[J].Jilin Medical Journal,2010,31(12):1614-1615.DOI:10.3969/j.issn.1004-0412.2010.12.020.
[15]李献良.老年高血压晨峰与尿微量白蛋白的关系[J].中华高血压杂志,2010,18(8):787-789.LI X L.Relationship between morning peak of senile hypertension and microalbuminuria in urine[J].Chinese Journal of Hypertension,2010,18(8):787-789.
[16]王登芹.焦虑抑郁状态对老年高血压患者动态血压影响的研究[J].中华老年心脑血管病杂志,2014,16(7):723-725.DOI:10.3969/j.issn.1009-0126.2014.07.014.WANG D Q.Effect of anxiety depression on ambulatory blood pressure in elderly hypertension patients[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2014,16(7):723-725.DOI:10.3969/j.issn.1009-0126.2014.07.014.
[17]英俊岐,高春燕,侯丽萍,等.900例中老年高血压患者服药情况及动态血压监测的调查[J].实用心脑肺血管病杂志,2012,20(11):1796-1798.DOI:10.3969/j.issn.1008-5971.2012.11.023.YING J Q,GAO C Y,HOU L P,et al.The situation of the taking medicine compliance in 900 case older hypertension suffer and the analysis of the ambulatory blood pressure monitoring[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2012,20(11):1796-1798.DOI:10.3969/j.issn.1008-5971.2012.11.023.
[18]邢燕燕.运动对24小时动态血压的影响及其机制探讨[D].济南:山东师范大学,2008.
[19]杨晨,郭志荣,胡晓抒,等.血压控制与糖尿病发病关系的前瞻性研究[J].中华流行病学杂志,2010,31(3):260-263.DOI:10.3760/cma.j.issn.0254-6450.2010.03.005.YANG C,GUO Z R,HU X S,et al.A prospective study on the association between control of blood pressure and incidence of type 2diabetes mellitus[J].Chinese Journal of Epidemiology,2010,31(3):260-263.DOI:10.3760/cma.j.issn.0254-6450.2010.03.005.
[20]黄玲,蒋晓芳.动态血压监测的护理体会[J].中国中医药现代远程教育,2011,9(2):146.DOI:10.3969/j.issn.1672-2779.2011.02.114.HUANG L,JIANG X F.Nursing experience of ambulatory blood pressure monitoring[J].Chinese Medicine Modern Distance Education of China,2011,9(2):146.DOI:10.3969/j.issn.1672-2779.2011.02.114.
[2]周丽,吴庆昌.诊室血压与电子血压计自测血压对高血压治疗的影响及健康教育的意义[J].广东医学,2005,26(1):136-137.DOI:10.3969/j.issn.1001-9448.2005.01.079.ZHOU L,WU Q C.The effect of blood pressure in the office and self-test blood pressure of electronic sphygmomanometer on the treatment of hypertension and the significance of health education[J].Guangdong Medical Journal,2005,26(1):136-137.DOI:10.3969/j.issn.1001-9448.2005.01.079.
[3]卢永萍,潘颖,王曼.24小时动态血压监测的临床应用及评价[J].医学理论与实践,2011,24(3):275-277.DOI:10.3969/j.issn.1001-7585.2011.03.013.LU Y P,PAN Y,WANG M.Clinical application and evaluation of24-hour ambulatory blood pressure monitoring[J].The Journal of Medical Theory and Practice,2011,24(3):275-277.DOI:10.3969/j.issn.1001-7585.2011.03.013.
[4]王鑫,李文华.24小时动态血压监测临床应用研究进展[J].国外医学(老年医学分册),2006,27(4):175-178.DOI:10.3969/j.issn.1674-7593.2006.04.010.WANG X,LI W H.Progress in clinical application of 24-hour ambulatory blood pressure monitoring[J].Foreign Medical Sciences(Geriatrics),2006,27(4):175-178.DOI:10.3969/j.issn.1674-7593.2006.04.010.
[5]包安华.基层高血压的诊断及治疗亟需推广24小时动态血压监测[J].中外健康文摘,2011,8(29):5-6.DOI:10.3969/j.issn.1672-5085.2011.29.001.BAO A H.Diagnosis and treatment of primary hypertension is urgently needed to promote 24-hour ambulatory blood pressure monitoring[J].World Health Digest,2011,8(29):5-6.DOI:10.3969/j.issn.1672-5085.2011.29.001.
[6]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中国医学前沿杂志:电子版,2011,3(5):42-93.DOI:10.3969/j.issn.1674-7372.2011.05.011.Chinese Hypertension Prevention Guidelines Revision Committee.2010 Chinese guidelines for the management of hypertension[J].Chinese Journal of the Frontiers of Medical Science:Electronic Version,2011,3(5):42-93.DOI:10.3969/j.issn.1674-7372.2011.05.011.
[7]国家基本公共卫生服务项目基层高血压管理办公室.国家基层高血压防治管理指南[J].中国循环杂志,2017,32(11):1041-1048.DOI:10.3969/j.issn.1000-3614.2017.11.001.National Basic Public Health Service Project Basic Health Management Office.National grassroots hypertension prevention and management guide[J].Chinese Circulation Journal,2017,32(11):1041-1048.DOI:10.3969/j.issn.1000-3614.2017.11.001.
[8]华琳,阎岩,张建.关于对诊断一致性Kappa系统的探讨[J].数理医药学杂志,2006,19(5):518-520.DOI:10.3969/j.issn.1004-4337.2006.05.033.HUA L,YAN Y,ZHANG J.The discussion on Kappa coefficient for diagnosis coherence[J].Journal of Mathematical Medicine,2006,19(5):518-520.DOI:10.3969/j.issn.1004-4337.2006.05.033.
[9]徐立中.高血压监测结果分析[J].现代医院,2006,6(9):155-156.XU L Z.Analysis of monitoring results of hypertension[J].Modern Hospital,2006,6(9):155-156.
[10]张云,王树贤,王莉,等.诊室血压与动态血压诊断高血压符合率的比较[J].中国医药导刊,2011,13(6):950-951.DOI:10.3969/j.issn.1009-0959.2011.06.018.ZHANG Y,WANG S X,WANG L,et al.Comparing the results of office blood pressure and ambulatory blood pressure monitoring in diagnosis of hypertension[J].Chinese Journal of Medical Guide,2011,13(6):950-951.DOI:10.3969/j.issn.1009-0959.2011.06.018.
[11]老年高血压的诊断与治疗中国专家共识(2017版)诊治要点[J].实用心脑肺血管病杂志,2017,25(11):70.Diagnosis and treatment of senile hypertension:key points of Chinese expert consensus(2017 edition)[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2017,25(11):70.
[12]魏芳,杨振,路方红.诊室血压,动态血压及自测血压的临床应用及比较[J].河北医药,2001,23(9):710-711.DOI:10.3969/j.issn.1002-7386.2001.09.048.WEI F,YANG Z,LU F H.Clinical application and comparison of blood pressure,ambulatory blood pressure and self-test blood pressure in the office[J].Hebei Medical Journal,2001,23(9):710-711.DOI:10.3969/j.issn.1002-7386.2001.09.048.
[13]王继光.进一步提高高血压的诊治水平,预防心脑血管并发症[J].中国医学前沿杂志:电子版,2011,3(4):37-38.DOI:10.3969/j.issn.1674-7372.2011.04.011.WANG J G.Further improve the diagnosis and treatment of hypertension,prevent cardiovascular and cerebrovascular complications[J].Chinese Journal of the Frontiers of Medical Science:Electronic Version,2011,3(4):37-38.DOI:10.3969/j.issn.1674-7372.2011.04.011.
[14]胡雪芳,沈春兰,朱奇志.24小时动态血压监测在高血压患者中的临床检测意义[J].吉林医学,2010,31(12):1614-1615.DOI:10.3969/j.issn.1004-0412.2010.12.020.HU X F,SHEN C L,ZHU Q Z.Clinical significance of 24-hour ambulatory blood pressure monitoring in patients with hypertension[J].Jilin Medical Journal,2010,31(12):1614-1615.DOI:10.3969/j.issn.1004-0412.2010.12.020.
[15]李献良.老年高血压晨峰与尿微量白蛋白的关系[J].中华高血压杂志,2010,18(8):787-789.LI X L.Relationship between morning peak of senile hypertension and microalbuminuria in urine[J].Chinese Journal of Hypertension,2010,18(8):787-789.
[16]王登芹.焦虑抑郁状态对老年高血压患者动态血压影响的研究[J].中华老年心脑血管病杂志,2014,16(7):723-725.DOI:10.3969/j.issn.1009-0126.2014.07.014.WANG D Q.Effect of anxiety depression on ambulatory blood pressure in elderly hypertension patients[J].Chinese Journal of Geriatric Heart Brain and Vessel Diseases,2014,16(7):723-725.DOI:10.3969/j.issn.1009-0126.2014.07.014.
[17]英俊岐,高春燕,侯丽萍,等.900例中老年高血压患者服药情况及动态血压监测的调查[J].实用心脑肺血管病杂志,2012,20(11):1796-1798.DOI:10.3969/j.issn.1008-5971.2012.11.023.YING J Q,GAO C Y,HOU L P,et al.The situation of the taking medicine compliance in 900 case older hypertension suffer and the analysis of the ambulatory blood pressure monitoring[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2012,20(11):1796-1798.DOI:10.3969/j.issn.1008-5971.2012.11.023.
[18]邢燕燕.运动对24小时动态血压的影响及其机制探讨[D].济南:山东师范大学,2008.
[19]杨晨,郭志荣,胡晓抒,等.血压控制与糖尿病发病关系的前瞻性研究[J].中华流行病学杂志,2010,31(3):260-263.DOI:10.3760/cma.j.issn.0254-6450.2010.03.005.YANG C,GUO Z R,HU X S,et al.A prospective study on the association between control of blood pressure and incidence of type 2diabetes mellitus[J].Chinese Journal of Epidemiology,2010,31(3):260-263.DOI:10.3760/cma.j.issn.0254-6450.2010.03.005.
[20]黄玲,蒋晓芳.动态血压监测的护理体会[J].中国中医药现代远程教育,2011,9(2):146.DOI:10.3969/j.issn.1672-2779.2011.02.114.HUANG L,JIANG X F.Nursing experience of ambulatory blood pressure monitoring[J].Chinese Medicine Modern Distance Education of China,2011,9(2):146.DOI:10.3969/j.issn.1672-2779.2011.02.114.
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