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【医学ppt课件】原发性高血压(EssentialHypertension)

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医学ppt课件 essential hypertension 原发性高血压 【essential hypertensionessential 原发性高血压EssentialHypertension
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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 (Essential Hypertension) 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. Ⅰ. General Considerations 原发性高血压是常见的疾病. 原发性高血压所引起的心血管病发病 率及死亡率最高. 原发性高血压主要引起心、脑、肾的 损害.  95%高血压病因不明称为原发性高血压 .  5%高血压是某种疾病的表现称为继发 性高血压(secondary hypertension). 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. Ⅱ. Definition 高血压判定标准 (WHO 1978) SBP(mmHg) DBP(mmHg) 正常  140 and  90 临临界高血压压 141-159 or 91-94 高血压压  160 and/or  95 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. Definition and classification of Hypertension (WHO 1999) Category SBP(mmHg) DBP(mmHg) 理想血压压 55岁 • 女性65岁 • 吸烟 • 总胆固醇6.5mmol/L(250mg/dl) • 糖尿病 • 早发心血管疾病家族史 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. B.影响预后的其他危险因素 • HDL胆固醇降低;LDL胆固醇升高 • 糖尿病伴微量白蛋白尿 • 葡萄糖耐量异常 • 肥胖 • 久坐不动的生活方式 • 纤维蛋白增高 • 高危社会经济人群 • 高危种族人群;高危地区 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. 2.靶器官损害 •左心室肥厚(心电图、超声心动图及 X线) •蛋白尿和/或轻度血浆肌酐浓度升 高(1.2-2.0mg/dl) •超声或X线证实有动脉粥样斑块(颈 、髂、股或主动脉) •视网膜动脉狭窄 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. 3.相关临床情况 脑血管疾病 缺血性中风 脑出血 TIA 心脏疾病 心肌梗死 心绞痛 心力衰竭 肾脏疾病 糖尿病肾病 肾功能衰竭( 血浆肌酐 浓度2.0mg/dl) 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. 血管疾病 夹层动脉瘤 症状性动脉疾病 重度高血压性视网膜病变 •出血或渗出 •视乳头水肿 定量预后的危险分层 其他危险险 因素和病史 血 压压 1级级 轻轻度高血压压 SBP140-159 或DBP90-99 2级级 中度高血压压 SBP160-179 DBP100-109 3级级 重度高血压压 SBP≥180 DBP≥110 I 无其他危险险因素 II 1-2个危险险因素 III 3个危险险因素 或 TOD或糖尿病 IV ACC 低危 中危 高危 极高危 中危 中危 高危 极高危 高危 极高危 极高危 极高危 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. Ⅸ 治疗 治疗的目的: ①降低血压,使血压下降到或接近 正常范围; ②防止或减少心脑血管并发症所 致的病死率和病残率。 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. 改良生活方式  戒烟  减轻体重  节制饮酒  限制钠盐  改变饮食结构  增加体力活动  心理因素和环境压力 一、 非药物治疗 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. 二、降压药物治疗 (一)降压药物的种类 1. 利尿剂 氢氯噻嗪 12.5mg BID 2.ß受体阻滞剂 美托洛尔(倍他乐克) 12.5mg BID 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. 3. 钙通道阻滞剂 (CCB) 硝苯地平(心痛定) 10mg TID 非洛地平(波依定) 5mg QD 氨氯地平(络活喜) 5mg QD 4. 血管紧张素转换酶抑制剂(ACE-I) 卡托普利 12.5mg BID 5. α1受体阻滞剂 哌唑嗪 6. 血管紧张素Ⅱ受体阻滞剂 芦沙坦 50 mg QD 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. (二)降压药物治疗原则 (1)小剂量开始 (2)24小时内稳定降压,最好使用一 天一次给药而有持续24小时降压 作用的药物。 (3)联合治疗。 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. (三)降压药物的选择 左心室肥厚 首选ACE-I,其次为CCB和ß阻滞剂 胰岛素抵抗 ACE-I和ß阻滞剂 冠心病 ß阻滞剂、CCB和ACE-I 肾功能异常 ACE-I 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. 三、降压目标 目标: 将血压降低至“正常” 或“理想”水平 危险性越高,将血压控制至目标值就越重要, 对已发现的其他危险因素进行治疗也越重要。 宜降至130/85mmHg的 理想或正常血压围。 老年患者 至少降到140/90mmHg的 正常高值血压范围内。 中青年或糖尿病患者 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. 有效的联合用药组合 利尿剂和-阻滞剂 利尿剂和ACEI 钙拮抗剂(二氢吡啶类)和-阻滞剂 钙拮抗剂和ACEI -阻滞剂和-阻滞剂 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. 五、停药问题 经过治疗,血压得到满意控制后,可 以逐步减少降压药的剂量,甚至可以考 虑停药。但必须注意到突然停药,可发 生停药综合征即出现血压迅速升高和交 感神经活性增高的表现如心悸、烦躁、 多汗、头痛、心动过速、心绞痛、心肌 梗死。 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. 高血压急症的治疗 • 硝普钠 • 硝酸甘油 • 硝苯地平
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