高血压急症药物治疗

高血压急症是急诊科及各科室常见的临床现象,是一种危及生命的紧急状态,临床分为高血压急症和高血压亚急症。文章介绍了高血压急症和高血压亚急症的概念、治疗原则和降压目标,重点说明了血管扩张剂、钙离子通道拮抗剂、周围α受体阻滞剂及β受体阻滞剂的适应范围和注意事项。     

55例高血压急症患者院前急救临床分析

高血压急症是急诊内科常见病之一，病情凶险，进展迅速，病人血压急剧升高如不及时有效的降压治疗可严重损害心脏、肾、脑等重要器官，危及生命，尤其在采取适当的院前急救挽救生命非常重要，现将我院急救科2005年2月至2008年12月院前急救的高血压急症55例患者分析如下。     

高血压急症与高血压患者今后发生心血管事件之间的联系

该文比较发生高血压急症的患者与没有发生高血压急症患者，是否以后发生心血管事件的危险性较高（Jhypertens，2008，26（4）：657-662）。方法：总共有384名高血压急症的患者与295个作为对照的患者，在2年之内接受随访研究。高血压急症指收缩压〉220mmHg和（或）舒张压〉120mmHg，但无急性靶器官损害。对照组是进入急诊科收缩压在135～180mmHg且舒张压在85～110mmHg的病人。     

123例原发性高血压患者靶器官损害的临床分析

目的 临床分析原发性高血压患者并发各种心、脑、肾器官损害的发病率和血压升高与靶器官损害的关系.方法 应用无创性血压监测仪对123例原发性高血压患者进行24 h动态血压监测,分析各类高血压患者心、脑、肾损害的发生率及在不同病程的发生率.结果 单纯收缩期高血压占29.3%,单纯舒张期高血压占14.6%,混合性高血压占56.1%.靶器官损害以脑损害为主占37.4%,心脏损害占27.6%,肾损害占9.8%.靶器官损害与高血压病程、血压负荷值呈正相关.结论 原发性高血压患者靶器官损害以脑、心、肾等为主,积极减少靶器官损害,可提高患者的生活质量.     

硝酸甘油静脉注射治疗老年人高血压急症临床分析

高血压急症常需短时间内有效、平稳降血压。传统降压药物硝普钠因其毒副作用，在老年人的临床应用受到一定限制。本文为观察硝酸甘油对老年人高血压急症的降压效果，并将其与硝普钠相比较，分析其疗效和安全性。     

住院青少年高血压患者临床资料分析

目的 评估住院青少年高血压患者的临床特点及相关危险因素.方法 选取2004-2009年我科住院病人青少年患者共233例(年龄14～24岁),收集病史、家族史,测量身高、体质量、腰围、臀围、诊所血压、空腹血糖、三酰甘油、总胆固醇、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)、尿素氮、肌酐、血尿酸、2...     

压宁定治疗高血压急症18例临床观察

本研究的目的为观察压宁定(盐酸乌拉地尔)对高血压急症的降压效果，分析其疗效和安全性，现将结果报告如下。     

如何治疗高血压急症？

高血压急症是由于血压急性升高引起的致命性临床状况,包括高血压危象,急性左心衰竭、高血压并颅内出血、恶性难治性高血压和血管手术后严重高血压,必须紧急降压治疗。高血压危象是指收缩压和舒张压突然升高,舒张压常高于120mmHg,引起中枢神经系统、心脏和肾脏的功能障碍。剧烈的枕部头痛,常是高血压危象的早期症状。另外的症状     

高血压急症

高血压急症是指血压明显升高且伴靶器官损害的临床急重危症.临床表现复杂多样,除血压急剧升高外,靶器官损害可表现为高血压脑病、脑出血、脑梗塞、急性心力衰竭/肺水肿、心肌梗死、不稳定性心绞痛,主动脉夹层等.临床需积极抢救,加强对患者的监护,持续监测血压,尽快适当的降压治疗,短期内缓解病情,降低心血管事件.常需静脉应用降压药物,使血压迅速、有效、安全的下降.降压过程不应影响心率、心输出量及脑血流量,同时需积极的治疗靶器官损害及并发症.     

乌拉地尔与卡托普利治疗高血压急症的疗效观察

目的：探讨乌拉地尔与卡托普利治疗高血压急症的临床效果。方法：将2009年1月--2010年1月间在我院治疗的高血压急症患者60例随机分为观察组和对照组,对照组给予舌下含服卡托普利治疗,观察组给予乌拉地尔静脉应用。结果：治疗后两组患者各时间点SBP、DBP及HR与对照组分别比较差异无统计学意义（P〉0．05）。观察纽总有效率为96．67％,对照组为93．33％,两组比较差畀具有统计学意义（P〈0．05）。两组患者均未见明显的药物不良反应。结论：乌拉地尔与卡托普利治疗高血压急症的临床效果肯定,均可选用。     

Hospital and out‐of‐hospital mortality in 670 hypertensive emergencies and urgencies

Long‐term mortality in patients with acute severe hypertension is unclear. The authors aimed to compare short‐term (hospital) and long‐term (12 months) mortality in these patients. A total of 670 adults presenting for acute severe hypertension between January 1, 2015, and December 31, 2015, were included. A total of 57.5% were hypertensive emergencies and 66.1% were hospitalized: 98% and 23.2% of those with hypertensive emergencies and urgencies, respectively (P = .001). Hospital mortality was 7.9% and was significantly higher for hypertensive emergencies (12.5% vs 1.8%, P = .001). At 12 months, 106 patients died (29.4%), mainly from hypertensive emergencies (38.9% vs 8.9%, P = .001). Median survival was 14 days for neurovascular emergencies and 50 days for cardiovascular emergencies. Patients with hypertensive emergencies or urgencies had bad long‐term prognosis. Short‐term mortality is mainly caused by neurovascular emergencies, but cardiovascular emergencies are severe, with high mortality at 12 months. These results justify better follow‐up and treatment for these patients.     

Hypertensive crises in sub-Saharan Africa: Clinical profile and short-term outcome in the medical emergencies department of a national referral hospital in Burkina Faso

BackgroundData on hypertensive crises (HC) are limited in sub-Saharan Africa (SSA). We aimed to characterize the pattern and short-term mortality of hypertensive emergencies (HE) and urgencies (HU).MethodsThis was a prospective cohort study. Consecutive patients with acute and severely elevated blood pressure (systolic > 180 mmHg and/or diastolic >120 mmHg) with or without acute target-organs damage attending the emergency department (ED) of the Teaching Hospital of Yalgado Ouedraogo, Ouagadougou, Burkina Faso were included with a one-month follow-up.ResultsOne hundred and sixty-six of 1254 patients presenting to the ED (January to march 2016) had HC (13.2%) and 113 of them (68.1%) had HE. The mean age was 50.9 ± 15.9 years and males were 63.3% (n = 105). Younger age (< 45 years) accounted for 55% of the cases. History of known HTN was reported in 101 patients (60.8%). Among patients with HE, 62.8% had brain-related events, 30.1% had cardiac involvement and 31% had acute renal impairment. The overall survival rate was 89% within the first 72 hours and 81% at fourteen days follow-up. At one-month follow-up, 36 patients died with a survival rate of 77.8%. Factors independently associated with death were history of known hypertension, acute brain-related damage and renal dysfunction and not being transferred to a specialized department.ConclusionHC are not rare in SSA and are associated with higher morbidity and mortality in HE. Further studies are needed to determine factors that promote HC in African patients in order to better address the prevention and management strategies of such hypertensive entity.     

三种抗高血压药物联合应用方案对高血压患者胰岛素抵抗和代谢的影响

目的 :研究 3种抗高血压药物联合应用方案对高血压患者胰岛素抵抗 (IR)、血糖和血脂代谢等的影响。方法 :138例轻中度高血压患者被随机分为 3组 ,分别用复方降压片治疗 (第 1组 ,n =39) ,尼群地平和阿替洛尔联合治疗 (第 2组 ,n =5 1) ,福辛普利和吲哚帕胺联合治疗 (第 3组 ,n =4 8) ,疗程 14个月。以根据Cederholm公式计算的胰岛素敏感指数 (ISI)为IR指标 ,口服葡萄糖耐量试验开始 30min后胰岛素和血糖变化的比值 (ΔI30 ΔG30 )为 β细胞胰岛素分泌功能指标 ,观察血压、血糖、血脂等的变化。结果 :1 3组间降压总有效率差异无显著性 [分别为第 1组 94 9% (37 39) ,第 2组 88 2 % (4 5 5 1)、第 3组97 9% (4 7 4 8) ,P >0 0 5 ]。 2 第 1组患者治疗后ISI(治疗前后分别为 5 0 6± 11 8和 5 7 0± 15 4 ,P <0 0 5 )和ΔI30 ΔG30 显著提高 ,血糖显著下降 ,血脂无显著变化。 3 第 2组患者治疗后ISI(治疗前后分别为5 2 1± 16 1和 5 0 2± 15 1,P >0 0 5 )和ΔI30 ΔG30 无显著变化 ,空腹血糖升高和低密度脂蛋白显著升高。4 第 3组患者治疗后ISI显著下降 (治疗前后分别为 5 4 8± 15 7和 4 7 5± 12 5 ,P <0 0 5 ) ,ΔI30 ΔG30 无显著变化 ,血糖、胆固醇和甘油三酯显著升高 ,高密度脂     

SCS评分在急诊高血压脑出血患者预后预测中的应用价值

目的研究简单临床评分(SCS)在急诊高血压脑出血患者预后预测中的应用价值。 方法选取2015年1—12月收治的350例高血压脑出血患者,入急诊科后分别采用MEWS和SCS评分,对比存活组和死亡组评分。比较SCS评分≤5、6～11、≥12分各组的病死率。研究SCS与MEWS评分的差异及相关性。比较SCS评分与MEWS评分的准确性。 结果随SCS分值增加,患者病死率和MEWS分值均增加(P<0.05),各组间两两比较,差异有统计学意义(P<0.05)。死亡组SCS评分和MEWS评分均高于存活组(P<0.05)。SCS与MEWS评分呈正相关(r＝0.647,P<0.01)。AUC_SCS＝0.908,AUC_MEWS＝0.896,差异有统计学意义(P<0.05)。 结论采用SCS评分评估急诊高血压脑出血患者的病情及预后较可靠,准确性更高,值得临床推广。     

血压变异性的研究进展

高血压一直以来作为心血管疾病的传统危险因素,受到众多专家学者的关注。如何有效降低血压以减轻对靶器官的损伤成为研究的重点。近年来,很多学者进行了广泛的研究,他们不再局限于偶侧血压,开始更加注重动态血压的变化。通过血压的动态监测,     

Predictors of poor outcome in gastrointestinal bleeding in emergency department

AIM: To determine the prognostic risk factors of gastrointestinal bleeding in emergency department cases.METHODS: The trial was a retrospective single-center study involving 600 patients over 18-years-old and carried out with approval by the Institutional Ethics Committee. Patient data included demographic characteristics, symptoms at admission, past medical history, vital signs, laboratory results, endoscopy and colonoscopy results, length of hospital stay, need of intensive care unit(ICU) admission, and mortality. Mortality rate was the principal endpoint of the study, while duration of hospital stay, required interventional treatment, and admission to the ICU were secondary endpoints.RESULTS: The mean age of patients was 61.92-yearsold. Among the 600 total patients, 363(60.5%) underwent upper gastrointestinal endoscopy and the most frequent diagnoses were duodenal ulcer(19.2%) and gastric ulcer(12.8%). One-hundred-and-fifteen(19.2%) patients required endoscopic treatment, 20(3.3%) required surgical treatment, and 5(0.8%) required angiographic embolization. The mean length of hospital stay was 5.21 ± 5.85 d. The mortality rate was 6.3%. The ICU admission rate was 5.3%. Patients with syncope, higher blood glucose levels, and coronary artery disease had significantly higher ICU admission rates(P = 0.029, P = 0.043, and P = 0.002, respectively). Patients with low thrombocyte levels, high creatinine, high international normalized ratio, and high serum transaminase levels had significantly longer hospital stay(P = 0.02, P = 0.001, P = 0.019, and P = 0.005, respectively). Patients who died had significantly higher serum blood urea nitrogen and creatinine levels(P = 0.016 and P = 0.038), and significantly lower mean blood pressure and oxygen saturation(P = 0.004 and P = 0.049). Malignancy and low Glasgow coma scale(GCS) were independent predictive factors of mortality.CONCLUSION: Prognostic factors for gastrointestinal bleeding in emergency room cases are malignancy, hypotension on admission, low GCS, and impaired kidney function.     

尼卡地平治疗重症高血压临床观察

目的 :观察尼卡地平静脉给药治疗重症高血压临床疗效及不良反应。方法 :31例重症高血压患者持续静脉滴注尼卡地平 2～ 4h ,速度为 0 .5～ 6 μg/ (kg·min)。结果 :尼卡地平静脉给药后 10min血压开始下降 ,30min时血压已得到满意控制 ,血压下降时心率无明显增快 ,副作用轻微。结论 :尼卡地平能迅速有效地降低血压 ,副作用少 ,用药安全 ,疗效显著 ,应用范围广 ,适于脑血管意外及心功能不全并重症高血压者。     

高血压性心脏病血清微量元素的测定及意义

目的研究老年高血压性心脏病（ＨＨＤ）血清中铜、锌、铁、钙、镁含量变化及意义。方法２４例老年ＨＨＤ患者血清中微量元素均采用原子吸收分光光度计测定。结果ＨＨＤ患者血清钙含量高于对照组（Ｐ＜０．０１），铜、锌、铁、镁的含量低于对照组（Ｐ＜０．０５，Ｐ＜０．０１）；ＨＨＤ患者血清铜含量明显低于高血压病组（Ｐ＜０．０１），钙、锌、铁、镁含量变化不显著（Ｐ＞０．０５）。结论低铜可促进老年ＨＨＤ的发生     

高血压脑出血超早期手术的疗效分析

目的探讨高血压脑出血超早期手术的疗效。方法对我院2004年3月至2006年3月30例高血压脑出血行超早期手术患者进行回顾性总结、分析。结果本组30例中死亡4例,死亡率13.3%。术后随访6月以上,根据日常生活能力（activity of daily living,ADL）分级法,I级3例,Ⅱ级8例,Ⅲ级9例,Ⅳ级5例,V级1例,生存质量良好率76.9%。结论高血压脑出血采取超早期手术,应用快速、简单的手术方式,能降低死亡率,改善生存质量。因此有手术指征患者应积极争取超早期手术。