【摘要】 目的探讨高血压患者发生急性心肌梗死(acute myocardial infarction,AMI)早期血压的动态变化及其相关原因。方法AMI病人分为高血压组、无高血压组各60例,比较两组患者AMI后1个月的血压的动态变化,与原血压水平、左心室肥厚、血浆血管紧张素Ⅱ、β内啡肽、降钙素基因相关肽、心肌酶峰值的关系及对心收缩功能影响。结果发生AMI后,收缩压下降,高血压组71．7％患者下降(37±16)mm Hg (1 mm Hg=0．133 kPa);无高血压组16．7％患者下降(4．3±4．1)mm Hg(P<0．01)。血压下降程度与AMI前血压呈正相关(P<0．05)。左心室肥厚患者AMI后血压下降显著,心功能Ⅲ-Ⅳ级患者较多。高血压组AMI后血压下降患者的血浆血管紧张素、β-内啡肽、降钙素基因相关肽及肌酸激酶、心肌型肌酸激酶活性高于血压未降者(P<0．01);而射血分数、E／A显著低于血压未降者(P<0．05),心功能衰竭发生率高于血压未降者(P<0．05)。结论高血压患者发生急性心肌梗死早期可出现血压下降,血压下降水平与AMI前的血压、是否有左心室肥厚、梗死面积、左心室功能恶化及某些神经内分泌因子相关。更多还原

【Abstract】 Objectives (1)To observe the successive changes of blood pressure in early phase of AMI in patient with hypertension; (2)To study the relative factors about changes of blood pressure in early phase of AMI. Methods Sixty hypertension and sixty normotension with AMI were enrolled in the study. Blood pressure were observed and recorded after AMI within a month. Record situation of with and without LVH according to UCG before AMI. Value of LVEF and E/A were measured with echocardiography after AMI. Heart function was observed after AMI and classified KillipⅠ-Ⅳclasses. Serum CK and CK-MB were measured on day 1, 2 and 3 for all patients. Venous blood for determination of Ang-Ⅱ,β-endorphin and CGRP in 24h after AMI. Results 71.7% and 16.7% of patients presented blood pressure decrease respectively in hypertension group and normotension group, value of decrease in SBP were (36.8±16.1) mmHg, (4.3±4.1 )mmHg. Blood pressure presented decline trend after AMI in hypertension patients. The higher the pressure before AMI the more decrease after AMI. The decrease of SBP in hypertensive patient with LVH and without LVH were respectively (38.8±16.7)mmHg and (27.6±11.5)mmHg (P<0.05). The patients of KillipⅢ-Ⅳwere more in LVH group than in NLVH group. Compared with that of patients who remained hypertensive, the concentration of Ang-Ⅱ, p-endorphin and CGRP and CK,CK-MB were significantly higher and the values of LVEF and E/A were significantly lower in patients with hypertension who presented blood pressure decline (P<0.05). Conclusions In the early phase of myocardial infarction 71.7% of the hypertensive patients present blood pressure decline. The relative factors of decrease of blood pressure were blood pressure before AMI, left ventricular hypertrophy, heart function deterioration, infarct size enlargement and the increase of Ang-Ⅱ,β-endorphin and CGRP.更多还原