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【医学ppt课件】原发性高血压(primary hypertension

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医学ppt课件 高血压ppt课件 原发性高血压 primary hypertension 原发性高血压 p 原发性高血压PPT课件 原发性高血压 Hypertension高血压病 primary
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高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 原发性高血压原发性高血压 ((primary hypertension)primary hypertension) 原发性高血压原发性高血压是以原因不明的是以原因不明的 血压升高血压升高 为主要表现的临床综合征为主要表现的临床综合征 。。 原发性高血压 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 诊断标准诊断标准 血压的标准:血压的标准: 收缩压(收缩压(Systolic pressure Systolic pressure )) ≥140mmHg≥140mmHg和和/ /或或 舒张压(舒张压(Diastolic pressure) Diastolic pressure) ≥90mmHg≥90mmHg ØØ 高血压的分级:高血压的分级: 采用(采用(WHO/ISHWHO/ISH,,19991999年血压的定年血压的定 义和分类,见表义和分类,见表1 1)) 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 表1 血压的定义和分类 类别 收缩压(mmHg) 舒张压( mmHg) 理想血压 <120 和 <80 正常血压 <130 和 <85 正常高值 130~139 或 85~89 高血压 1级(轻度) 140~159 或 90~99 亚组:临界高血压 140~149 或 90~94 2级(中度) 160~179 或 100~109 3级(重度) ≥180 或 ≥110 单纯收缩期高血压 ≥140 和 <90 亚组:临界收缩期高血压 140~149 和 <90 ※ 当收缩压和舒张压分属于不同分级时,以较高的级别为标准 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 流行病学流行病学 ØØ 发病率及患病率总体情况:发病率及患病率总体情况: 国家地区差异:工业化国家>发国家地区差异:工业化国家>发 展中国展中国 家家 种族差异:美国黑人>白人种族差异:美国黑人>白人 年龄差异:老年人最为常见年龄差异:老年人最为常见 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 ØØ 我国的发病及患病情况:我国的发病及患病情况: 总体上升:估计目前患者超过总体上升:估计目前患者超过1 1亿人!亿人! 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 地区差异:地区差异:北方>南方北方>南方 沿海>农村沿海>农村 民族差异:民族差异:高原少数民族患病率高高原少数民族患病率高 性别差异不大性别差异不大 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 病病 因因 ØØ遗传因素:可能存在主要基因显性遗传和多遗传因素:可能存在主要基因显性遗传和多 基因关联遗传基因关联遗传 ØØ环境因素:环境因素: 饮食 l l摄盐过多所致高血压主要见于盐敏感的人群摄盐过多所致高血压主要见于盐敏感的人群 ;; l l钾摄入与血压呈负相关;钾摄入与血压呈负相关; l l多数认为低钙与高血压发生有关;多数认为低钙与高血压发生有关; l l高蛋白、高饱和脂肪酸及酒精摄入。高蛋白、高饱和脂肪酸及酒精摄入。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 精神应激精神应激 l l脑力劳动者发病率高于体力脑力劳动者发病率高于体力 劳动者;劳动者; l l精神紧张的职业发病率高;精神紧张的职业发病率高; l l其他因素:其他因素: 体重体重 、避孕药、阻塞性睡眠呼吸暂停综、避孕药、阻塞性睡眠呼吸暂停综 合症。合症。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 发病机制发病机制 交感神经活性亢进交感神经活性亢进 皮层下神经中皮层下神经中 枢功能变化枢功能变化 神经递质浓度神经递质浓度 与活性异常与活性异常 交感神经系统交感神经系统 活性亢进活性亢进 血浆儿茶酚胺血浆儿茶酚胺 浓度升高浓度升高 小动脉阻力小动脉阻力 增加增加 高血压高血压 各种病因各种病因 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 肾性水钠潴留肾性水钠潴留 各种病因各种病因 肾性水钠潴留肾性水钠潴留 为避免组织过度 灌注机体代偿 小动脉阻力 增加高血压高血压 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 肾素-血管紧张素-醛固酮肾素-血管紧张素-醛固酮 ((RAASRAAS))系统激活系统激活 血管紧张素原血管紧张素原 血管紧张素血管紧张素ⅠⅠ 肾素 血管紧张素血管紧张素ⅡⅡ ACE ATAT 1 1 小动脉收缩小动脉收缩 醛固酮分泌 激活交感神经激活交感神经 高血压高血压 心、血管重构心、血管重构 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 细胞膜离子转运异常细胞膜离子转运异常 细胞膜通透性增细胞膜通透性增强强 钙泵活性降低钙泵活性降低 钠泵活性降钠泵活性降低低 细胞内细胞内NaNa + + 、、CaCa2+ 2+升 升高高 血管收缩血管收缩 心、血管重构心、血管重构 高血压高血压 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 胰岛素抵抗胰岛素抵抗((insulin resisitance,IR)insulin resisitance,IR) 胰岛素抵胰岛素抵抗抗 高胰岛素血症高胰岛素血症 交感神经活性亢进交感神经活性亢进肾脏钠水潴留肾脏钠水潴留 高血压高血压 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 大动脉弹性减退致使外周血管压力大动脉弹性减退致使外周血管压力 反射波提前是单纯收缩期高血压的主要反射波提前是单纯收缩期高血压的主要 机制。机制。 总之,高血压是一组异质性疾总之,高血压是一组异质性疾 病,病因发病机制不尽相同,一些细节病,病因发病机制不尽相同,一些细节 问题尚须进一步研究。问题尚须进一步研究。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 病病 理理 ØØ 小动脉小动脉 中层平滑肌细胞增殖和纤维化中层平滑肌细胞增殖和纤维化 ;; 促进动脉粥样硬化。促进动脉粥样硬化。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 ØØ 心脏心脏 左心室肥厚扩大(高血压左心室肥厚扩大(高血压 心脏病),心衰。心脏病),心衰。 ØØ 脑脑 脑出血、脑血栓、腔隙性脑脑出血、脑血栓、腔隙性脑 梗塞。梗塞。 ØØ 肾脏肾脏 肾小球纤维化、萎缩;肾小球纤维化、萎缩; 肾小动脉硬化;动脉肾小动脉硬化;动脉 增生性内膜炎及纤维增生性内膜炎及纤维 素样坏死。终致肾衰。素样坏死。终致肾衰。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 视网膜视网膜 小动脉痉挛、硬化、视网膜渗小动脉痉挛、硬化、视网膜渗 出、出血、视乳头水肿出、出血、视乳头水肿。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 ØØ 体征体征 血压升高;血压升高;A2A2亢进、收缩期杂音、收亢进、收缩期杂音、收 缩早期喀喇音;颈部或腹部血管杂音缩早期喀喇音;颈部或腹部血管杂音。。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 ØØ 恶性或急进性高血压恶性或急进性高血压 病情进展急骤;病情进展急骤; 舒张压持续舒张压持续≥130≥130mmHgmmHg;; 肾脏损害突出;肾脏损害突出; 进展迅速,治疗不及时多死于进展迅速,治疗不及时多死于 肾衰或心衰。肾衰或心衰。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 ØØ 并发症并发症 高血压危象高血压危象((Crisis of hypertensionCrisis of hypertension)) l l 机制:交感神经活性增高,血儿茶酚胺机制:交感神经活性增高,血儿茶酚胺 增高,外周阻力突然上升。增高,外周阻力突然上升。 l l 症状:血压明显升高,伴靶器官损害者症状:血压明显升高,伴靶器官损害者 可出现心绞痛,左心衰或高血压脑病。可出现心绞痛,左心衰或高血压脑病。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 高血压脑病高血压脑病 ((Hypertensive brain diseaseHypertensive brain disease)) l l 机制:血压突然明显升高,突破脑血管的机制:血压突然明显升高,突破脑血管的 自身调解机制,脑血流灌注过多,造成脑组自身调解机制,脑血流灌注过多,造成脑组 织液形成过多而引起脑水肿。织液形成过多而引起脑水肿。 l l 症状:出现颅内压增高的临床表现。症状:出现颅内压增高的临床表现。 脑血管病脑血管病 心力衰竭心力衰竭 慢性肾功能衰竭慢性肾功能衰竭 主动脉夹层主动脉夹层 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 l l其他心血管病危险因素其他心血管病危险因素 男性>男性>5555岁、女性>岁、女性>6565岁;岁; 吸烟;血胆固醇> 吸烟;血胆固醇> 5.72 5.72mmolmmol/L/L;; 糖尿病;糖尿病; 早发心血管疾病家族史 早发心血管疾病家族史 (发病年龄(发病年龄 女女6565岁岁 男男5555岁)。岁)。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 l l靶器官损害靶器官损害 左室肥厚(心电图或超声心动图);左室肥厚(心电图或超声心动图); 蛋白尿和/或血肌酐轻度升高;蛋白尿和/或血肌酐轻度升高; 超声或超声或X X线证实有动脉粥样硬化斑块;线证实有动脉粥样硬化斑块; 视网膜局灶或广泛狭窄。视网膜局灶或广泛狭窄。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 l l并发症并发症 心脏疾病心脏疾病 (心绞痛、心肌梗死、冠脉(心绞痛、心肌梗死、冠脉 血运重建术后或心力衰竭);血运重建术后或心力衰竭); 脑脑 (卒中或(卒中或TIATIA);); 肾脏肾脏( (糖尿病肾病、血肌糖尿病肾病、血肌酐>酐>177177μμmol/Lmol/L)) 血管疾病(主动脉夹层、外周血管血管疾病(主动脉夹层、外周血管病);病); 视网膜病变视网膜病变≥ ≥ⅢⅢ级。级。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 原发性高血压 ØØ 诊断诊断 诊断依据:安静休息、坐位、非降压药物诊断依据:安静休息、坐位、非降压药物 状态下状态下2 2次/次/2 2次以上非同日测定的血压平均次以上非同日测定的血压平均 值高于正常。值高于正常。 分层依据分层依据: l l 血压升高水平;血压升高水平; l l 其他心血管病危险因素;其他心血管病危险因素; l l 靶器官损害情况;靶器官损害情况; l l 并发症。并发症。 诊断和鉴别诊断诊断和鉴别诊断 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 表2表2 高血压患者心血管危险分层标准高血压患者心血管危险分层标准 其他危险因素和病史其他危险因素和病史 高血压高血压 1级1级 2级 2级 3级3级 无危险因素无危险因素 低危低危 中中 高危高危 1-2个危险因素1-2个危险因素 中危中危 中危中危 极高危极高危 3 3个以上危险因素或个以上危险因素或 糖尿病,或靶器官损害糖尿病,或靶器官损害 高危高危 高危高危 极高危极高危 有并发症有并发症 极高危极高危 极高危极高危 极高危极高危 ※※ 低、中、高、极高危低、中、高、极高危1010年内心脑血管事件的概率年内心脑血管事件的概率 为<为<1515%、%、1515--2020%、%、 20 20--3030%及>%及>3030%。%。 Ø 鉴别诊断:见继发性高血压继发性高血压 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 实验室检查实验室检查 ØØ 常常规项目常常规项目 血脂、血糖、肾功、尿常规、超血脂、血糖、肾功、尿常规、超 声心动图、心电。声心动图、心电。 ØØ 特特殊检查特特殊检查 动态血压监测、踝/臂血压比值动态血压监测、踝/臂血压比值 、心律变异、颈动脉内层中膜厚度、动、心律变异、颈动脉内层中膜厚度、动 脉弹性测定、血浆肾素活性。脉弹性测定、血浆肾素活性。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 高血压高血压 hypertensionhypertension 原发性高血压 治治 疗疗 ØØ 降压治疗的目标值降压治疗的目标值 一般一般 主张控制血压<主张控制血压<140/90140/90mmHg;mmHg; 糖尿病或慢性肾病糖尿病或慢性肾病 合并高血压控制血合并高血压控制血 压<压<130/80130/80mmHg;mmHg; 老年人老年人 SBPSBP在在140140~~150150mmHgmmHg,,DBP DBP <<90mmHg90mmHg ,,但不低于但不低于6565~~7070mmHgmmHg。。 高血压高血压 hypertensionhypertension Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated
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本文标题:【医学ppt课件】原发性高血压(primary hypertension
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