医生和护士测量血压时的肌肉和皮肤交感神经活动。
Muscle and skin sympathetic nerve traffic during physician and nurse blood pressure measurement.
机构信息
Clinica Medica, Università Milano-Bicocca, Ospedale S. Gerardo, 20052 Monza, Italy.
出版信息
J Hypertens. 2013 Jun;31(6):1131-5. doi: 10.1097/HJH.0b013e3283605c71.
OBJECTIVE
Previous studies have shown that blood pressure assessment by a nurse markedly attenuates the pressor and tachicardic responses triggered by the physician blood pressure measurement. Whether and to what extent this attenuation reflects a different pattern of the neuroadrenergic responses to doctor or nurse blood pressure evaluation is unknown.
METHODS
In 19 lean untreated mild essential hypertensive patients (age 39.1 ± 2.4 years, mean ± SEM), we measured beat-to-beat mean arterial pressure (Finapres), heart rate (ECG), and efferent postganglionic muscle and skin sympathetic nerve traffic [muscle sympathetic nerve activity (MSNA) and skin sympathetic nerve activity (SSNA), respectively, by microneurography], before, during, and following a 10-min sphygmomanometric BP measurement by a doctor or by a nurse unfamiliar to the patients. Measurements were repeated at a 30-min interval to obtain, in separate periods, muscle and skin sympathetic nerve traffic recordings. Both the sequences (doctor vs. nurse and muscle vs. skin sympathetic nerve traffic) were randomized.
RESULTS
A doctor visit induced sudden, marked, and prolonged blood pressure and heart rate increases, accompanied by a muscle sympathetic nerve traffic inhibition (average response: -18.1 ± 4.3%, P < 0.01) coupled with a skin sympathetic nerve traffic excitation (average response: +46.1 ± 5.5%, P < 0.01). In contrast, a nurse visit elicited blood pressure and heart rate responses markedly and significantly reduced (-72.1 ± 11 and -81.7 ± 13% respectively, P < 0.01) as compared with those seen during the doctor's visit. This was the case also for muscle and skin sympathetic neural responses (-44.3 ± 9 and -65.6 ± 13%, P < 0.01).
CONCLUSION
These data provide the first evidence that the blunted pressor and tachicardic responses to nurse's blood pressure measurements are accompanied by an attenuation of the adrenergic neural responses seen during the alerting reaction accompanying doctor's blood pressure measurement.
目的
先前的研究表明，护士进行血压评估可显著减弱医生测量血压时引发的血压升高和心率加快。然而，这种减弱在多大程度上反映了神经肾上腺素能反应对医生或护士血压评估的不同模式，目前尚不清楚。
方法
在 19 名未经治疗的瘦型原发性高血压患者（年龄 39.1±2.4 岁，平均值±SEM）中，我们使用 Finapres 测量了逐搏平均动脉压、心率（ECG）以及传出节后肌肉和皮肤交感神经活动（通过微神经记录分别为肌肉交感神经活动[MSNA]和皮肤交感神经活动[SSNA]），在医生或不熟悉患者的护士进行 10 分钟的血压测量期间、测量期间和之后进行。为了在不同时期获得肌肉和皮肤交感神经活动记录，在 30 分钟的间隔内重复测量。两个序列（医生与护士和肌肉与皮肤交感神经活动）均随机化。
结果
医生就诊会引起血压和心率的突然、显著和持久升高，同时伴有肌肉交感神经活动抑制（平均反应：-18.1±4.3%，P<0.01），并伴有皮肤交感神经活动兴奋（平均反应：+46.1±5.5%，P<0.01）。相比之下，护士就诊引起的血压和心率反应明显且显著降低（分别为-72.1±11%和-81.7±13%，P<0.01），与医生就诊时相比。这也适用于肌肉和皮肤交感神经反应（-44.3±9%和-65.6±13%，P<0.01）。
结论
这些数据首次提供了证据，表明护士测量血压时血压和心率反应减弱，同时伴随警觉反应中伴随医生测量血压时观察到的肾上腺素能神经反应减弱。
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