Impact of ambulatory blood pressure monitoring-guided medication and conventional daily single measurement on rehospitalization rates in heart failure patients
态血压监测指导用药与常规每日单次监测两种血压管理策略对心力衰竭患者再入院率的影响研究

摘要

本文旨在评估重症监护室动态血压监测指导用药与常规每日单次监测两种血压管理策略在心力衰竭患者中对再入院率的影响。收集我院重症监护室心力衰竭患者，按血压管理策略平均分为2组各24例。动态监测组采集24小时动态血压数据，依据动态血压参数调整用药；常规监测组每日单次测量血压并按结果用药。统计分析比较两组患者动态血压指标的差异、及其与心功能分级的相关性、两组患者再入院率差异。结果显示动态监测组24小时SBP、DBP、MBP昼夜间变化更显著（P＜0.05），动态血压参数调整更加精准，药物使用合理性显著高于常规监测组；动态监测组昼夜血压变异（DBPV）显著降低，药物调整效果更为优越；动态血压参数与心功能分级具有明显相关性，尤其是昼间SBP、MBP对心功能不同分级患者间差异具有统计学意义（均P＜0.05）；再入院率方面，动态监测组显著低于常规监测组（P＜0.05）。综上，动态血压监测可有效指导心力衰竭患者的个体化用药，改善血压控制效果，显著降低患者再入院率。

Abstract

This study aims to evaluate the impact of two blood pressure management strategies—ambulatory blood pressure monitoring-guided medication and conventional daily single measurement—on the rehospitalization rates of heart failure patients in the intensive care unit. Heart failure patients from our intensive care unit were collected and evenly divided into two groups of 24 cases each according to the blood pressure management strategy. The ambulatory monitoring group collected 24-hour ambulatory blood pressure data and adjusted medication based on ambulatory blood pressure parameters; the conventional monitoring group measured blood pressure once daily and used medication based on the results. Statistical analysis compared the differences in ambulatory blood pressure parameters between the two groups, their correlation with cardiac function classification, and the differences in rehospitalization rates between the two groups. The results showed that the 24-hour SBP, DBP, and MBP changes in the ambulatory monitoring group were more significant during the day and night(P<0.05),with more precise adjustments of ambulatory blood pressure parameters and significantly higher rationality of drug use compared to the conventional monitoring group; the ambulatory monitoring group had a significant reduction in diurnal blood pressure variability(DBPV)and superior drug adjustment effects; ambulatory blood pressure parameters were significantly correlated with cardiac function classification, especially the daytime SBP and MBP, which showed statistical significance among patients with different cardiac function classifications(all P<0.05);in terms of rehospitalization rates, the ambulatory monitoring group was significantly lower than the conventional monitoring group(P<0.05).In summary, ambulatory blood pressure monitoring can effectively guide individualized medication for heart failure patients, improve blood pressure control, and significantly reduce rehospitalization rates.