摘要
目的:通过等长握力试验激发原发性高血压患者的交感神经活性,评价西尼地平对左心室舒张功能的影响。方法:于2004-03/10随机选择山东大学齐鲁医院心内科门诊轻中度原发性高血压患者40例,均自愿参加观察。采用自身对照,经2周的安慰剂期后,给予西尼地平5mg,1次/d口服。患者每2周随访1次。若2周后舒张压仍大于95mmHg(1mmHg=0.133kPa),则增量至10mg,1次/d口服,共治疗8周。于安慰剂期末和用药8周末各进行1次等长握力试验,同时行超声心动图检查,记录静息和负荷状态下的血压、心率、左心室收缩和舒张功能指标,包括左心室射血分数、短轴缩短分数、二尖瓣血流频谱E峰速度、A峰速度,计算E峰速度/A峰速度比值。结果:40例原发性高血压患者全部进入结果分析,无脱落。①西尼地平治疗前及治疗8周后静息及负荷状态下的血压变化:西尼地平治疗8周后患者坐位静息收缩压、舒张压均较治疗前显著下降[(129.0±10.0,87.0±6.4;148.0±13.1,99.0±3.3)mmHg(t=9.68,13.62,P<0.01)];西尼地平治疗8周后握力试验中负荷收缩压、舒张压均比安慰剂期末降低[(163.9±18.22,104.3±9.33;172.1±17.89,111.4±11.86)mmHg(t=3.07,3.22,P<0.01)]。②西尼地平治疗前及治疗8周后静息及负荷状态下的左心室舒张功能变化:与安慰剂期末比较,西尼地平治疗8周后静息A峰速度和负荷A峰速度均显著降低(t=6.89,5.83,P<0.01),静息E峰速度/A峰速度和负荷E峰速度/A峰速度均显著增加(t=-5.89,-5.65,P<0.01)。结论:西尼地平不仅可有效降低静息及负荷状态下的血压,减轻原发性高血压患者交感神经活性;而且可有效改善静息及负荷状态下左心室舒张功能。
AIM： To activate the sympathetic nervous system of patients with essential hypertension by isometric handgrip test, so as to evaluate the effect of Cilnidipine on left ventricular diastolic function.
METHODS： Forty outpatients with mild to moderate essential hypertension were randomly selected from the Department of Cardiology, Qilu Hospital, Shandong University between March and October 2004, and all the patients agreed to join the observation. In the self-control trail, the patients were treated with Cilnidipine 5 mg, orally once every day after 2 weeks of placebo, and the follow up was done once two weeks. The dosage was increased to 10 mg, orally once everyday for 8 weeks if the diastolic pressure was still 〉 95 mm Hg （1 mm Hg=0.133 kPa） after 2 weeks of administration. Isometric handgrip tests were carried out at the end of placebo period and 8 weeks of administration, respectively; at the same time, the echeeardiography was performed to record the indexes of blood pressure, heart rate, left ventricular systolic and diastolic function including left ventricular ejection fraction and minor axis shortening fraction, mitral valve flow pattern E peak, A peak and E/A ratio under the resting and exercising condition.
RESULTS： All the 40 patients were involved in the result analysis with no drop. （1） The changes of blood pressure before and after 8 weeks of Cilnidipine treatment at resting and during exercise： The sitting resting systolic pressure and diastolic pressure were all significantly decreased than those before treatment [（129.0±10.0, 87.0±6.4; 148.0±13.1,99.0±3.3） mm Hg, （t=9.68, 13.62, P 〈 0.01）]; In the isometric handgrip test, the exercise systolic pressure and diastolic pressure were all decreased than those at the end of placebo period [（163.9±18.22, 1043±9.33; 172.1±17.89, 111.4±11.86） mm Hg, （t=3.07, 3.22, P 〈 0.01）]. （2）The changes of diastolic function before and after 8 weeks of Cilnidipine treatment at rest and during exercise： Compared with the period of the end of placebo, the resting and exercise A velocity after 8 weeks of Cilnidipine significantly decreased （t=6.89, 5.83, P 〈 0.01）, and the resting E/A ratio and exercise E/A ratio were significantly increased （t=-5.89, -5.65, P 〈 0.01）.
CONCLUSION： Cilnidipine can decrease the blood pressure not only at rest hut also during a stress event, and release the activation of sympathetic nervous system in patients with essential hypertension. Furthermore, it can effectively improve left ventricular diastolic function, not only at rest hut also during exercise.
出处
《中国临床康复》
CSCD
北大核心
2006年第28期37-39,共3页
Chinese Journal of Clinical Rehabilitation
