Objective: To explore the characteristics of postural blood pressure changes in elderly inpatients and the related factors of orthostatic hypotension (OH). Methods: This study was a clinical case control study. Two hundred and sixty-six elderly patients (≥60 years old), who were hospitalized between April 2016 and November 2017 in Geriatric Department of Peking University First Hospital, were included. They were divided into direct standing group and indirect standing group. Direct standing group involved 102 patients, they changed posture from supine directly to standing position, and the blood pressures at the moments of supine, immediately after standing and the first, second, and third minute after standing were recorded by continuous noninvasive arterial pressure (CNAP) system. Indirect standing group involved 164 patients, and they changed posture from supine to sitting for 3 minutes, and then changed to standing position. Blood pressures at the moments of supine, immediately after sitting, the third minute after sitting, immediately after standing and the third minute after standing was recorded by CNAP. Blood pressure changes after different postural changes mode and the rates of OH were compared. The related factors of OH was analyzed by binary logistic regression analysis. Results: The lowest systolic blood pressures (SBP) mostly occurred immediately after postural change: immediately after standing for direct standing group (86.3%(88/102)), and immediately after sitting for indirect standing group (59.1%(97/164)). The lowest diastolic blood pressures (DBP) mostly occurred immediately after standing in the two groups: 87.3%(89/102) for direct standing group and 43.3% (71/164) for indirect standing group. The maximum SBP drop (SBP of supine minus the lowest SBP during postural changes) of direct standing group was significantly higher than indirect standing group (median 20.5(14.0, 29.3) vs. 18.0(11.0, 26.0) mmHg (1 mmHg=0.133 kPa, P<0.05). The rates of OH occurred immediately and within 3 minutes from supine to standing position were significantly higher in direct standing group than in indirect standing group (65.7% (67/102) vs. 43.9% (72/164), and 70.6% (72/102) vs. 49.4% (81/164), both P<0.05). Binary logistic regression analysis showed that brachial-ankle pulse wave velocity was positively associated with OH after a transition from supine to standing position (immediately and within 3 minutes, OR=1.002 (95%CI 1.000-1.004), 1.003 (95%CI 1.001-1.006), P=0.014, 0.006) in direct standing group. Conclusions: OH is common in elderly hospitalized patients. The most obvious blood pressure changes are likely to occur immediately after position changes. Adding a sitting position during the transition of supine to standing position may decrease the amplitude of SBP drop. Brachial-ankle pulse wave velocity is associated with OH after the transition from the supine to standing position in the elderly inpatients.
目的： 观察老年住院患者体位改变时血压的变化特点，并探讨体位性低血压（OH）的相关因素。 方法： 该研究为病例对照研究。入选2016年4月至2017年11月于北京大学第一医院老年内科住院治疗的年龄≥60岁的患者共266例，分为直接站立位组和间接站立位组，其中直接站立位组患者102例，由平卧位直接改变为站立位，通过每搏即时连续无创血压监测系统（CNAP）测定卧位、站立位即刻以及站立位1、2和3 min时的血压；间接站立位组患者164例，由平卧位改为坐位，维持3 min，然后改为站立位，测定卧位、坐位即刻和3 min以及站立位即刻和3 min时的血压。比较两组患者不同体位改变后血压的变化情况及发生OH的比率，并采用二元多因素logistic回归分析分析住院老年患者发生OH的相关因素。 结果： 两组患者收缩压最低值发生比率最高的体位均为体位变化即刻，直接站立组为站立位即刻[86.3%（88/102）]，间接站立位组为坐位即刻[59.1%（97/164）]；舒张压均为站立位即刻，直接站立组为87.3%（89/102），间接站立组为43.3%（71/164）。直接站立位组患者收缩压下降最大幅度（卧位收缩压-体位变化中收缩压最低值）为20.5（14.0，29.3）mmHg（1 mmHg=0.133 kPa），明显大于间接站立位组的18.0（11.0，26.0）mmHg（P<0.05）。直接站立位组患者卧位改为立位即刻、3 min符合OH诊断标准的比率分别为65.7%（67/102）、70.6%（72/102），明显高于间接站立位组的43.9%（72/164）、49.4%（81/164）（P均<0.05）。对直接站立位组患者的试验数据进行二元多因素logistic回归分析发现臂踝脉搏波传导速度与卧位改为立位发生OH呈正相关[卧位改为立位即刻、3 min，OR值分别为1.002（95%CI 1.000~1.004）、1.003（95%CI 1.001~1.006），P值分别为0.014、0.006]。 结论： 老年住院患者OH常见，多数患者体位改变即刻血压变化最明显。在体位由卧位改为站立位过程中增加坐位状态可能减小血压变化幅度。臂踝脉搏波传导速度与老年住院患者OH相关。.
Keywords: Aged; Hypotension,orthostatic.