| Objective1.By collecting the social demographical data and 24-hour ambulatory blood pressure monitoring data from patients with COPD and Elderly Essential Hypertension under mechanical ventilation,as well as observing the morning blood pressure increase and its influential factors,risk rating and clinical care towards the patient crowd will benefit from some guidance.2.To analyse the timing of blood surge in patients with Elderly COPD and EH under mechanical ventilation,and discuss on the measures of reinforcing blood pressure monitoring during this time and applying medication care.Method1.125 samples of COPD and Elderly Essential Hypertension patients who are under mechanical ventilation and electrocardiogram monitoring were collected from the Respiratory and Intense Care Unit in Tianjin Chest Hospital between the January of 2014 and the January of 2017,from whom sociological data,medical record data,types of hypertension drugs used,APACHE II score,24h systolic pressure and 24h diastolic pressure are recorded.Based on the data above,24h average systolic and diastolic pressure,daytime average systolic and diastolic pressure,night-time systolic and diastolic pressure(the research defines daytime as 6:00 to 21:59,and night-time as 22:00 to 5:59)are calculated,the morning blood pressure surge(MBPS)is deduced,the chance of morning pressure increase(MBPS?35mmHg)is observed,and the MBPS is compared between different groups of patients(divided by gender,age,hypertension grading,APACHE ?scores,and types of hypertension drugs used).2.Based on the morning hypertension standard(MBPS?35mmHg),subjects are divided into morning-surge group and non-morning-surge group.From the recorded data of 24h systolic and diastolic pressure,24h pulse pressure,daytime pulse pressure,night-time pulse pressure,and night-time pressure dropping rate are calculated,and basing on the latter the subjects are grouped by their blood pressure rhythm into dipper pressure group,non-dipper pressure group,anti-dipper pressure group,and super-dipper pressure group.By comparing the 24h ambulatory pressure indicator and the types of day-and-night pressure rhythm,the factors influential to the increase of morning blood pressure can be analysed.3.Basing on the records of 24h systolic and diastolic pressure,average systolic and diastolic pressure at every time point are calculated,and the time points of systolic and diastolic pressure peak with COPD and Elderly Essential Hypertension patients under mechanical ventilation are analysed.Results1.Among the 125 patients of COPD and Elderly Essential Hypertension under mechanical ventilation in this research,there are 66 males and 59 females,with age ranging from 62 to 88,averaging at 76.78±5.11,with MBPS ranging from 12 to 62.5 mmHg,averaging at 39.13±9.53mmHg.There is a high ratio of morning pressure surge(?35mmHg)of 64.8%(81 subjects).2.The results of comparing the MBPS of patients with different features shows that the older group displays a higher MBPS than the senior group(43.21 ±9.35mmHg vs 37.67±9.21mmHg),the difference of which has a statistical significance(t=-2.947,P=0.004).The MBPS difference between the APACHE ?higher-scored group and the lower also shows statistical significance(42.04±10.05mmHg vs 37.44±8.85mmHg),with the former having the greater MBPS.The other variables(gender,hypertension grading,types of hypertension drugs used)create no statistical significant difference in MBPS.3.The morning-surge group displays greater values than the non-morning-surge group in 24h average systolic and diastolic pressure,daytime average systolic and pulse pressure,and night-time systolic pressure dropping rate(with the values being respectively 144.72±8.78mmHg vs 139.73±9.52mmHg,68.28±7.10 mmHg vs 64.35±8.25 mmHg,151.75±8.83 mmHg vs 144.71±11.04 mmHg,72.50 ±7.73mmHg vs 66.95±9.21 mmHg,13.95±3.85 mmHg vs 9.93±6.00 mmHg),in which statistical significances are noted(with t being-2.948,-2.789,-3.892,-3.576,-4.015,p<0.01).The day-and-night blood pressure rhythm type also shows statistical significant difference between the two groups(x2= 17.551,P=0.001).4.The result of a multi-factor logistic regression analysis shows that 24h average ambulatory systolic pressure and night-time systolic pressure are the factors responsible for the morning pressure surge,causing 75.2%of the total increase.5.When the average systolic and diastolic pressure at every time point are analysed with repeatedly measured variance analysis,statistical differences are discovered at every time point(p<0.01),and 8 o'clock is found to be the peak of both systolic and diastolic pressure.Applying pairing t test to compare systolic and diastolic pressure at other time points with those at 8,it is found that all the other time points show significant difference(p<0.01)except the systolic pressure at 7(t=-0.663,P=0.509)and the diastolic pressure at 7(t=0.308,P=0.758)and 9(t=1.890,P=0.061).Conclusion1.The fluctuation of morning blood pressure surge in patients with COPD and Elderly Essential Hypertension under mechanical ventilation is greater than the threshold as predefined by previous researches,with a higher morning surge hypertension rate than the rate among senior citizens of our country and among patients with Elderly Essential Hypertension.2.The decreasing rate of average 24h ambulatory systolic pressure and night-time systolic pressure have shown obvious influences over the variation of morning surge hypertension among the patient crowd,implying raised risks of target-organ damage as a result of a higher 24h average ambulatory systolic pressure and an increased decreasing rate of the night-time systolic pressure.Clinical screening for risky crowd of morning pressure surge is advised in order to provide timely medicinal therapy and nursing measures.3.The blood pressure of the patient crowd peak at in-between 7 and 9 a.m.The blood pressure control has not been ideal in this research.Improvements in hypertension medicinal therapy and nursing plan are advised.For patients not achieving an ideal pressure level with a daily intake of long-effect hypertension medicine,adjustments in medicinal and nursing plan are advised,in order to effectively control the 24h blood pressure level and morning surge,so as to reduce the damage to target-organs. |
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