Parrish M D, Torres E, Peshock R, Fixler D E
Children's Medical Center, Dallas, TX 75235, USA.
Pediatr Cardiol. 1995 Jul-Aug;16(4):166-71. doi: 10.1007/BF00794187.
The hypothesis that mild recurrent aortic obstruction produces subtle changes in ambulatory blood pressure was investigated by performing 24-hour monitoring on 11 postoperative coarctation patients. Patients (age 16.1 +/- 2.7 years) were compared with normal controls (age 15.7 +/- 2.5 years, n = 15). Surgery (end-to-end anastomosis) was performed at 6.0 +/- 1.0 years of age. There were no significant differences between patients and controls in terms of baseline blood pressure (right arm 123/78 +/- 4/3 mmHg versus 120/75 +/- 3/2 mmHg) or right leg systolic pressure (125 +/- 6 mmHg versus 123 +/- 4 mmHg). Of the 11 patients 8 had recoarctation by Doppler study (mean gradient 25.3 +/- 2.1 mmHg), 5 of 11 had a postexercise arm-leg pressure difference of > 30 mmHg, and 6 patients had aortic diameters at the site of surgery < 70% of the descending aortic diameter (by magnetic resonance imaging). There were no significant differences between the coarctation and control groups in terms of mean ambulatory systolic (125 +/- 3 mmHg versus 119 +/- 2 mmHg) or diastolic (69 +/- 2 mmHg versus 72 +/- 2 mmHg) pressures throughout the day. However, coarctation patients had a larger number of systolic pressures that exceeded the 95th percentile (18.2 +/- 5.6% versus 6.8 +/- 1.2%). These labile increases in systolic pressure correlated with residual coarctation (r = 0.642, p = 0.003). Ambulatory monitoring is a useful tool for detecting and monitoring subtle abnormalities of blood pressure control after coarctation repair.
通过对11例主动脉缩窄术后患者进行24小时监测，研究了轻度复发性主动脉梗阻导致动态血压细微变化的假说。将患者（年龄16.1±2.7岁）与正常对照组（年龄15.7±2.5岁，n = 15）进行比较。手术（端端吻合）在6.0±1.0岁时进行。患者和对照组在基线血压（右臂123/78±4/3 mmHg对120/75±3/2 mmHg）或右腿收缩压（125±6 mmHg对123±4 mmHg）方面无显著差异。在11例患者中，8例经多普勒研究发现有再缩窄（平均压差25.3±2.1 mmHg），11例中有5例运动后臂腿压差>30 mmHg，6例患者手术部位的主动脉直径<降主动脉直径的70%（通过磁共振成像）。在全天的动态收缩压（125±3 mmHg对119±2 mmHg）或舒张压（69±2 mmHg对72±2 mmHg）方面，缩窄组和对照组之间无显著差异。然而，缩窄患者收缩压超过第95百分位数的次数更多（18.2±5.6%对6.8±1.2%）。这些收缩压的不稳定升高与残余缩窄相关（r = 0.642，p = 0.003）。动态监测是检测和监测主动脉缩窄修复后血压控制细微异常的有用工具。
