IR@PKUHSC  > 北京大学深圳医院
学科主题外科学
原发性醛固酮增多症术后高血压相关因素的分析与研究
张恩溥
2016-05-13
导师李贤新
专业外科学
授予单位北京大学
授予地点北京大学深圳医院
学位硕士
关键词原发性醛固酮增多症 肾上腺切除术 术后高血压 危险因素
其他题名Analysis of risk factors associated with primary hyperaldosteronism postoperative hypertension
分类号R586.2
摘要

目的 概述原发性醛固酮增多症的诊断和治疗情况,探究原醛患者术后血压恢复情况的相关影响因素。 方法 回顾性收集了2010-2016年北京大学深圳医院泌尿外科手术治疗的原发性醛固酮增多症患者资料共 45 例,然后随访患者术后血压的恢复情况,根据患者术后血压状况分为两组,分别是治愈组和术后高血压组,然后根据计数资料使用 t 检验及计量资料使用卡方检验,分别分析两组间临床资料有无差异性,同时应用 Logistic 回归分析具有组间差异性的影响因素对患者术后血压恢复情况的影响,具有统计学意义的为独立危险因素。 结果 45 例接受手术的患者中男性 29 例,女性 16 例;手术时年龄为 24-80 岁,平均年龄 47岁;肾上腺肿物直径 9-30mm,平均 15.3cm。术前出现低血钾患者 41 例( 91%),平均值 2.44mmol/L;术后病理提示肾上腺皮质腺瘤 33 例( 73%),皮质增生12 例( 27%)。 患者术后随访时间为 3 个月至6 年,平均 25 个月, 结果发现其中16 例( 35%)术后血压恢复正常,29 例( 65%)术后高血压情况有所改善,但仍高于正常或需服降压药物,同时所有患者术后低血钾症状均得以纠正。随访中未发现术后需激素替代治疗的病例,亦无高血压不改善抑或恶化的病例。综合分析,初步发现术后高血压相关的独立危险因素有以下三种: 术前高血压病程长( OR=1.265,95%CI= 1.010-1.413,P=0.045)、BMI高( OR=1.154,95%CI= 1.008-1.528,P=0.041)和术前服用多种降压药 ( OR=14.372, 95%CI= 2.148-110.856,P=0.017)。结论 初步考虑术前高血压病程长、BMI高和术前服用多种降压药为原发性醛固酮增多症术后高血压的独立危险因素。

英文摘要

[Objective]: To overview the diagnosis and treatment for primary hyperaldosteronism and explore the risk factors associated with hypertension after adrenalectomy.[Methods]: We have collected 45 patients who received surgical treatment for primary hyperaldosteronism in Peking University Shenzhen Hospital between 2010-2016. According to their postoperative blood pressure ,They were divided into two groups : the recovery group and the hypertention group. The clinical data were compared between the two groups and the risk factors associated with postoperative hypertension with Logistic regression were analyzed as well.[Results]: There were 29 males and 16 females among 45 patients. Average age was 47 years old (from 24 to 80) and mean tumor size was 15.3mm (9-30mm). 33 cases (73%) were diagnosed as adenoma pathologically, 12 cases (27%) were hyperplasia. After an average follow-up time of 25 months (3months to 6 years), among 45 patients ,only 16 patients(35%) acquired normal blood pressure, while the remaider (62%) need medications to control their blood pressure,Fortunately, all of them benefited from the treatment. No corticoid replacement therapy was needed. 3 independent factors related to postoperative hypertension were considered: long duration of hypertension(OR=1.265,95%CI= 1.010-1.413,P=0.045), high body mass index( OR=1.154,95%CI= 1.008-1.528,P=0.041) and too many antihypertensive medications(OR=14.372,95%CI= 2.148-110.856,P=0.017).[Conclusion]: long duration of hypertension, high body mass index and too many antihypertensive medications were considered as independent factors associated with postoperative  hypertension.

 

语种中文
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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/125372
专题北京大学深圳医院
作者单位北京大学深圳医院
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张恩溥. 原发性醛固酮增多症术后高血压相关因素的分析与研究[D]. 北京大学深圳医院. 北京大学,2016.
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