ABSTRACT
Objective To investigate the correlation between blood pressure rhythm and left ventricular structure and function in elderly hypertensive patients. Methods A total of 147 elderly patients with high blood pressure in the First Hospital of Longyan Affiliated to Fujian Medical University were selected. All the patients received 24h ambulatory blood pressure examination. According to the rhythm of blood pressure, the patients were divided into the dipper blood pressure group,the-non dipper type blood pressure group and the anti-dipper type blood pressure group. All patients were examined by echocardiography. Results According to the results of 24h dynamic blood pressure,the type of dipper blood pressure accounted for 11.56% (17 cases) in 147 elderly patients, non-dipper type blood pressure type accounted for 51.02% (75 cases),and the anti-dipper type of blood pressure type accounted for 37.41% (55 cases).The ventricular septal thickness(IVST),left ventricular diastolic inner diameter (LVEDD),left atrium inner diameter(LAD),left ventricle posterior wall thickness( LVPWT) and left ventricle mass index(LVMI) of the non-dipper blood pressure group were (10.56 ± 1.51)mm,(50.17 ± 4.31) mm,(34.65 ± 5.78)mm,(9.26 ± 0.98)mm,(102.31 ± 23.23)g/m2 ,respectively.The IVST,LVEDD,LAD,LVPWT and LVMI of the anti-dipper blood pressure group were (10.51 ± 1.86)mm,(50.20 ± 3.66)mm,(36.96 ± 4.22)mm,(9.42 ± 0.99)mm,(110.47 ± 31.96) g/m2 ,respectively.The IVST,LVEDD,LAD,LVPWT and LVMI of the dipper blood pressure group were (9.53 ± 1.53) mm,(47.59 ± 2.27) mm,(30.47 ± 4.17) mm,(8.88 ± 1.12) mm,(84.98 ± 15.48) g/m2 , respectively. The differences of IVST, LVEDD, LAD, LVPWT and LVMI in the three groups were statistically significant(F=1.172,3.428,1.006,0.135,all P<0.05).The maximum blood flow velocity in early diastolic period of mitral valve blood flow spectrum(E peak)/maximum blood flow velocity in late diastolic period(A peak)(E/A)of the non-dipper blood pressure group and anti-dipper blood pressure group were (0.89 ± 0.30), (0.80 ± 0.28),respectively,which was significantly lower than that of dipper blood pressure group [(1.35 ± 0.63)] (t= -2.890,-3.440,all P<0.05).The left ventricular ejection score(LVEF) of the anti-dipper blood pressure group was (65.31 ± 6.74)% ,which was significantly lower than that of the dipper blood pressure group[(70.12 ± 10.76)% ],the difference was statistically significant(t= -2.209,P<0.05).The 24 h mean systolic pressure,24 h mean diastolic pressure and daytime mean diastolic pressure in the three groups of dynamic blood pressure parameters had no statistically significant differences (all P>0.05).The average daytime systolic pressure in the dipper blood pressure group was (143.06 ± 13.70) mmHg,which was higher than that in the non-dipper blood pressure group [(133.25 ± 13.28)mmHg] and anti-dipper blood pressure group[(131.16 ± 12.26)mmHg],the differences were statistically significant(t= -2.734,-3.401,all P <0.05).The mean evening systolic pressure and the average nocturnal diastolic pressure of anti -dipper blood pressure group were ( 139.04 ± 15.01 ) mmHg and ( 80.18 ± 10.29) mmHg, respectively, which were higher than those of the dipper and non - dipper blood pressure group [(123.24 ± 14.49)mmHg and (72.24 ± 7.97) mmHg,(127.40 ± 13.30) mmHg,(73.45 ± 11.43) mmHg],the differences were statistically significant ( t =3. 822, 4. 666, 2. 919, 3. 456, all P <0. 05 ). LVMI was positively correlated with age,body mass index(BMI),low density lipoprotein( LDL-C),daytime average systolic pressure, night average systolic pressure,night average diastolic pressure,and 24h average systolic pressure(r=0.256,0.241, 0.687,0.251,0.380,0.203,0.243,all P <0.05). Conclusion Anti -dipper blood pressure and non -dipper blood pressure have more significant damage to cardiac function and structure than dipper blood pressure in elderly patients with hypertension,and the elevation of nocturnal blood pressure is closely related to left heart structure and function damage.There is a high correlation between abnormal circadian rhythm of blood pressure and left ventricular hypertrophy in elderly hypertensive patients.
ABSTRACT
Objective To analyze the bacterial distribution and antibiotic resistance of pathogenic bacteria in elderly patients with hospital-acquired pneumonia (HAP) so as to provide evidence for rational use of antibiotics. Methods The clinical data of 160 elderly patients with HAP in our hospital from June 2006 to September 2009 were analyzed retrospectively. And the pathogenic characteristics and antibiotic resistance were analyzed. Results A total of 180 pathogenic bacteria were separated: 108 Gram-negative bacteria (60.0%), 48 Gram-positive bacteria (26.7%) and 24 fungi (13.3%). In Gram-negative bacteria, Pseudomonas aeruginosa was the major pathogen (20.5%), and Staphylococcus aureus was the most prominent in Gram-positive bacteria (11.1%).The detection rate of fungi was increased in patients with long-term use of antibiotics and broadspectrum antibiotics. The Gram-negative bacilli was resistant to third-generation cephalosporin, and extended-spectrum β-lactamases (ESBLs) producing Escherichia coli and Klebsiella pneumonia were resistant to penicillin, penicillin + enzyme inhibitor, cephalosporin and monobactam antibiotics. The drug resistance of Pseudomonas aeruginosa was severe, but it was still sensitive to Ceftazidime. Gramnegative bacteria showed high sensitivities to Amikacin, Piperacillin + Tazobactam, Cefoperazone +Sulbactam, Imipenem and Meropenem. Methicillin-resistant Staphylococcus aureus (MRSA) occupied 92.6% of Staphylococcal aureus. The resistance rates of Gram-positive bacteria to Azithromycin,Ciprofloxacin, Oxacillin, Ampicillin + Sulbactam were all higher than 76%, but Gram-positive bacteria showed high sensitivities to Vancomycin, Linezolid and Teicoplanin. The staphylococcal strains that were resistant to Vancomycin, Linezolid and Teicoplanin were not found. Conclusions The major pathogen of HAP in elderly patients is Gram-negative bacilli. The detection rate of ESBLs producing Escherichia coil and Klebsiella pneumonia increases annually, and the drug resistances to the above bacteria is becoming more and more serious. But they are still highly sensitive to Amikacin,Piperacillin+ Tazobactam, Cefoperazone+ Sulbactam, Imipenem and Meropenem. The appropriate antibiotics for Gram-positive bacterial infections are Vancomycin, Linezolid and Teicoplanin.