运动改善血液透析病人症状性低血压的临床观察

[目的]探讨血液透析（HD）过程中运动对低血压发生的影响。[方法]对20例透析中经常发生低血压的维持性血液透析病人（MHD）进行规范运动锻炼6个月，记录透析过程中血压变化，观察透析过程中低血压发生情况。[结果]运动后病人透析耐受性改善，透析过程中症状性低血压发生例次、需要临床处理（补充高渗溶液）例次、需提前结束透析例次较运动前明显减少，透析间歇期血压提高幅度不明显。[结论]运动有预防血液透析中症状性低血压的作用，可提高透析耐受性。     

运动改善血液透析病人症状性低血压的临床观察

[目的]探讨血液透析(HD)过程中运动对低血压发生的影响。[方法]对20例透析中经常发生低血压的维持性血液透析病人(MHD)进行规范运动锻炼6个月,记录透析过程中血压变化,观察透析过程中低血压发生情况。[结果]运动后病人透析耐受性改善,透析过程中症状性低血压发生例次、需要临床处理(补充高渗溶液)例次、需提前结束透析例次较运动前明显减少,透析间歇期血压提高幅度不明显。[结论]运动有预防血液透析中症状性低血压的作用,可提高透析耐受性。     

活动平板运动试验低血压的观察与护理

[目的]探讨门诊病人活动平板运动试验中出现低血压的护理经验。[方法]回顾性统计分析2016年3月—2018年7月在医院门诊及体检中心进行活动平板运动试验的22 356例病人,选取发生低血压的404例病人总结护理经验。[结果]在404例发生低血压的病人中均伴有不同程度的心率异常下降,其中286例伴有面色苍白、眼前黑朦、头晕、恶心、心悸、四肢乏力等症状,16例出现窦性心动过缓或逸搏心律,4例出现晕厥意识丧失,1例伴有5.2 s的心脏停搏。[结论]在门诊进行活动平板试验中护理人员应警惕低血压的出现,严密的观察和护理措施对低血压的救治有重要作用。     

卧式脚踏车运动在预防患者血液透析中低血压的应用研究

目的 观察卧式脚踏车运动对降低患者血液透析中低血压发生率的影响.方法 选取97例维持性血液透析患者作为研究对象,采用随机数字表分为对照组49例及观察组48例,对照组给予常规维持性血液透析护理,观察组在此基础上进行透析中卧式脚踏车运动.比较两组患者干预前3个月及干预3个月期间透析中低血压的发生率,干预3个月后好转率.结果...     

老年住院病人餐后低血压及体位性低血压的临床观察与护理

目的探讨住院老年病人餐后低血压（PPH）及体位性低血压（OH）的发生率及护理对策。方法应用无创心电监护仪测量78例老年病房住院治疗,病情相对平稳的老年病人进餐前后及早晨起床站立3min后血压。结果78例病人中57例出现PPH,餐后血压平均下降（37±6）mmHg,47例出现OH,站立后血压平均下降（41±5）mmHg,36例同时出现PPH及OH;74％的PPH病人出现症状,最常见为思睡及晕厥。有症状的OH占64％,头晕及跌倒危险最常见。结论PPH及OH在住院老年病人中常见,二者临床症状存在显著不同,危害较大,故对于老年住院病人进行健康教育,及时采取合理护理对策防止餐后血压下降及体位性低血压所致意外具有非常重要的意义。     

脑出血后并发持续性低血压临床分析

脑出血仍然是目前死亡率很高的急诊危重病,造成死亡的原因除了血肿压迫形成脑疝外,更多的原因是患者死于各种并发症。多数脑出血患者发病后伴随血压的持续升高,临床多重视降低血压或者尽量控制血压,避免颅压进一步升高导致继续出血和再出血。脑出血后并发持续性低血压临床不多见,往往容易忽视,一旦发生,治疗将更为棘手,死亡率明显增加。本院近10年收治18例脑出血并发持续性低血压的患者,现报道如下。     

直立性低血压的家族临床遗传特征

目的 探讨直立性低血压(OH)的家族临床遗传特征.方法 2001-01～2010-04在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因晕厥或头晕患者1681例进行直立倾斜试验(HUTT),符合OH诊断者73例,年龄6.0~70.0岁,平均(22.30±18.77)岁,男34例,女39例,<18岁45例,≥18岁28例.详细询问OH患者现病史及家族史.结果 ①性别差异:73例OH患者中,19例存在家族遗传史(26.0%),其中男6例(一级亲属5例),女13例(一级亲属10例).女(13/19,68.4%)与男(6/19,31.6%)比较差异无统计学意义(χ2=2.32,P>0.05).②年龄差异:<18岁OH患者存在家族史15例(15/19,78.9%),其中3例为二级亲属;≥18岁OH患者存在家族史4例(4/19,21.1%),其中1例为二级亲属,两组比较差异无统计学意义(χ2=3.25,P>0.05).结论 OH存在一定的家族临床遗传性,一级亲属OH患者后代患该病的比率增加.     

迟发性羊水栓塞的临床特征和治疗

羊水栓塞(amniotic fluid embolism,AFE)是指分娩过程中羊水进入母体循环而引起的肺栓塞、弥漫性血管内凝血(DIC)、肾衰竭等一系列病理改变的严重综合征,是孕产妇死亡的重要原因之一[1].典型症状是呼吸困难、发绀、出血和昏迷.少数患者在阴道分娩或剖宫产后1h内,不经心肺功能衰竭及肺水肿阶段直接进入凝血功能障碍所致的大量阴道出血或伤口渗血阶段,为迟发型羊水栓塞(delayed amniotic fluid embolism,DAFE)[2].DArE因缺乏急性AFE典型的临床表现,容易误诊而延误治疗.本文就我院2001年1月至2011年12月11年来诊断的DArE进行回顾性分析,探讨其临床特征和早期诊断和治疗方法.     

肾移植术后低血压护理

肾移植术后一部分病人出现低血压。移植肾血流灌注不足,造成尿量减少,急性肾小管坏死,移植肾实质受损,甚至移植肾功能丧失,因此肾移植术后早期观察血压,及时处理低血压,保护移植肾功能,且与急性肾小管坏死,急性排斥反应区别,具有非常重要的意义。我们自1995年～1996年267例肾移植病例中低血压病入35例,术后总结了我们对低血压病人的观察指标及护理体会】临床资料1．1低血压诊断标准根据我院多年的临床经验,提出血压低诊断标准：l）移植肾动脉与骼内动脉端端吻合的病人上肢收缩压低于12OmmHg,移植肾动脉与骼外动脉端侧吻合的病…     

老年人进餐后低血压的临床观察及护理

目的观察101例老年人进餐对血压的影响,以探讨预防老年人进餐后血压下降的护理措施,进一步加强预见性护理。方法选择住院查体或治疗行动态血压检查的老年人116例,其中有效病例101例,观察进餐对血压的影响,以餐后20、40、60、80min所测血压与餐前血压做配对t检验,并记录餐后有无不适。结果101例老年人三餐后血压均呈下降趋势,餐后20、40、60、80min与餐前比较均有统计学差异,平均下降幅度以早餐下降幅度较大;高龄老年人餐后血压下降幅度较低龄老年人下降幅度大,用降压药物组餐后血压下降幅度较大,特别是早餐和晚餐后血压下降幅度较大。结论对老年人进行防止餐后血压下降所致意外的健康教育非常必要,特别对于高龄及服用降压药物的老年人应予以警惕。     

血液透析相关性低血压的观察及护理

目的　探讨血液透析相关性低血压发生的原因和护理措施。方法　采用静滴高渗溶液 ,提高透析液钠浓度 ,减慢透析脱水速度等措施纠正透析相关性低血压 ;采用控制脱水速度 ,低温透析 ,合理使用降压药和镇静剂 ,改变透析模式 ,健康教育等方法预防透析相关性低血压。结果　维持血液透析病人 473例 ,共行 2 3782次血透 ,15 38次 (6 5 % )发生透析相关性低血压 ,治疗处理后 ,1339例次 (87 1% )血压升高 ,可继续血透 ,199例次 (12 9% )低血压持续 ,需结束血透 ,无 1例死亡。结论　透析相关性低血压发生率高 ,及时处理是纠正低血压的关键     

斜床站立和生脉饮对兔脊髓损伤后体位性低血压的影响

目的建立兔脊髓损伤(SCI)后体位性低血压(OH)动物模型,探讨斜床站立训练和生脉饮对兔SCI后OH的影响。方法应用胸5脊髓完全横断和斜床抬高60°的方法建立兔SCI后OH模型,各组动物分别于术后第4天开始斜床站立训练和/或服用生脉饮,共治疗28d。用无创兔耳血压仪检测各组动物术后3d、10d、17d、24d、31d平卧位和60°体位收缩压(SBP)和脉率(PR)变化,用高压液相色谱-电化学法检测术后31d平卧位和60°体位血浆肾上腺素(E)和去甲肾上腺素(NE)浓度变化。结果联合治疗组术后24d60°体位收缩压高于损伤组,60°体位较平卧位收缩压平均下降值明显低于损伤组。术后31d训练组、联合治疗组60°体位收缩压高于损伤组,生脉饮组、训练组、联合治疗组60°体位收缩压较平卧位收缩压平均下降值均显著低于损伤组;损伤组、生脉饮组、训练组及联合治疗组平卧位和60°体位血浆肾上腺素、去甲肾上腺素浓度均低于假手术组,生脉饮组、训练组、联合治疗组平卧位和60°体位下血浆E、NE浓度与损伤组比较无显著性差异。结论斜床站立训练和生脉饮治疗能部分改善兔SCI后OH,联合两种治疗可缩短疗程,但均不影响交感神经活动度。     

A Multicenter, Case-Control Study of the Effects of Antihypertensive Therapy on Orthostatic Hypotension, Postprandial Hypotension, and Falls in Octo- and Nonagenarians in Residential Care Facilities

Background: Orthostatic hypotension, postprandial hypotension, and falls are considered to be adverse drug reactions of antihypertensive therapy in older people with comorbidities. Concerns regarding these adverse events may limit the use of antihypertensive agents in this group of people.Objective: The aim of this study was to determine the relationship between antihypertensive therapy in octo- and nonagenarians and the risk for orthostatic hypotension, postprandial hypotension, and falls.Methods: This was a case-control study of octo- and nonagenarians living in residential care facilities who were receiving antihypertensive therapy and a control group who were not receiving antihypertensive therapy.Results: A total of 119 patients, 77 who were receiving regular antihypertensive therapy and 42 who were not taking any antihypertensive agents, were enrolled in the study. The prevalence of antihypertensive use, orthostatic hypotension, postprandial hypotension, and falls was high (65%, 29%, 57%, and 45%, respectively). There were no associations between antihypertensive therapy and orthostatic hypotension, postprandial hypotension, and falls. When individual classes of antihypertensive agents were examined, the only observed association was a negative association (ie, a protective effect) between potassium-sparing diuretics and falls (odds ratio, 0.2; 95% CI, 0.04-1.0).Conclusion: Antihypertensive therapy was not associated with an increased risk for orthostatic hypotension, postprandial hypotension, or falls in this case-control study of octo- and nonagenarians living in residential care facilities.     

不典型自发性低颅压综合征四例分析

目的总结不典型自发性低颅压综合征的诊治要点。方法对我院2009年10月—2011年10月收治的4例临床表现不典型低颅压综合征临床资料进行回顾性分析。结果本组4例均无明显体位性头痛,表现为复视2例,眩晕发作和精神异常各1例。4例腰椎穿刺发现脑脊液压力均<60 mmH2O,3例脑脊液红细胞计数增多,2例脑脊液蛋白升高。颅脑、脊柱MRI检查示双侧额、顶、颞部慢性硬膜下血肿1例,双侧半卵圆中心多发少量脱髓鞘1例,部分脑膜呈线状强化、胸段脊膜异常强化1例,未见明显异常1例;2例行核素脑脊液显像检查,结果示胸髓脑脊液漏及脑脊液循环障碍各1例。4例均确诊为不典型自发性低颅压综合征,予相应治疗后1周～1个月症状均消失,随访1～2年无复发。结论不典型自发性低颅压综合征易漏诊,临床医师应提高对本病认识,及早行腰椎穿刺检查,必要时可结合颅脑MRI、核素脑脊液显像等检查,以提高检出率。     

维持性血液透析患者透析中低血压的发生情况及原因分析

目的：观察维持性血液透析（maintenance hemodialysis, MHD）患者透析中低血压（intradialytic hypotension, IDH）的发生情况和原因,为预防、治疗提供依据。方法收集2014年2月～2014年5月MHD治疗患者87例,连续30次血液透析过程中血压下降情况,分为低血压组和无低血压组,回顾分析各个指标与透析中低血压发生的相关性。结果血液透析过程中低血压发生共30例（34.5%）,低血压组患者的年龄、透析龄、超滤量、血N末端B型利钠肽原（NT-proBNP）水平显著高于无低血压组（P＜0.05）。而低血压组患者的血浆白蛋白水平显著低于无低血压组（P＜0.05）。低血压组糖尿病肾病比例显著高于无低血压组（P＜0.05）。结论高龄、高超滤量、低血浆白蛋白、血NT-proBNP升高,均为引起透析中低血压的原因。     

Cerebral Venous Thrombosis in Spontaneous Intracranial Hypotension

Background and Objective.— The occurrence of cerebral venous thrombosis has been reported among patients with spontaneous intracranial hypotension, but a causal relationship has not been clearly established. We reviewed our experience with spontaneous intracranial hypotension and cerebral venous thrombosis and we reviewed the relevant literature to evaluate the relationship between these 2 entities. Methods.— We reviewed the medical records and imaging studies of a consecutive group of patients with spontaneous intracranial hypotension evaluated at a tertiary care center between 1/1/2001 and 12/31/2007. The main search strategy was a systemic review of journal articles in MEDLINE (1966 to January 2008). Results.— Among 141 patients with spontaneous intracranial hypotension, 3 (2.1%) were also diagnosed with cerebral venous thrombosis. Among these 3 patients and the 17 reported in the literature there were 11 men and 9 women with a mean age of 39.5 years. Radiographic or clinical evidence for spontaneous intracranial hypotension preceding cerebral venous thrombosis was found in most patients, while there was no evidence for cerebral venous thrombosis preceding spontaneous intracranial hypotension in any patient. Eight (40%) of the 20 patients were found to have a change in their headache pattern believed to be due to the development of cerebral venous thrombosis. Complications of cerebral venous thrombosis, eg, cerebral venous infarction, occurred in 8 patients (40%). Conclusions.— Spontaneous intracranial hypotension is a risk factor for cerebral venous thrombosis, but cerebral venous thrombosis is found in only about 2% of patients with spontaneous intracranial hypotension. A change in headache pattern is not a reliable predictor of the development of cerebral venous thrombosis in patients with spontaneous intracranial hypotension.     

Iatrogenic Intracranial Hypotension: A Case Study

Cerebrospinal fluid (CSF) leaks due to spinal procedures are commonly reported and can result in a condition known as intracranial hypotension. In rare cases, this can lead to a life-threatening situation if not properly diagnosed and treated. This case study discusses a rapidly decompensating patient that was found to have a CSF leak after an epidural placement for childbirth and made a full recovery after treatment with an epidural blood patch.     

Successful Treatment of Severe Orthostatic Hypotension with Erythropoietin

KAWAKAMI, K., et al .: Successful Treatment of Severe Orthostatic Hypotension with Erythropoietin. A 71-year-old man, who was diagnosed with familial amyloidosis type I, was admitted for treatment of severe orthostatic hypotension associated with recurrent syncopal attacks. Head-up tilt testing demonstrated severe orthostatic hypotension (114/72 mmHg in the supine position and 62/34 mmHg in the upright position) with syncope or presyncope. Oral midodorine and fludrocortisone therapies failed to prevent his symptoms. After administration of subcutaneous erythropoietin, his blood pressure drop in the upright position was decreased and symptoms disappeared unassociated with improvement of anemia. Although previous reports have shown that the mechanism by which erythropoietin improves orthostatic hypotension is related to improvement in anemia, other mechanisms may also play a role. (PACE 2003; 26[Pt. I]:105–107)     

下降型可调钠透析在血透中的应用观察

目的 :观察可调钠血液透析在透析低血压的作用。方法 :14例稳定的维持性血液透析患者进行观察。7例患者先进行标准钠透析 (透析液浓度 14 0mmol/L) 2周 ,然后进行可调钠透析 (钠浓度由 14 8mmol/L呈阶梯下降至 138mmol/L) 2周 ,7例先行可调钠透析 2周 ,标准钠透析 2周 ,观察透析前后血钠浓度和血容量变化 ,透析中心率和透析低血压的发生。结果 :可调钠透析能够明显减少透析低血压及相关症状的发生 (P <0 0 5 ) ,可调钠组血容量改变较标准钠明显减少 (P <0 0 5 ) ,且透前透后血钠浓度无明显改变 (P >0 0 5 )。结论 :可调钠透析能有效减少透析低血压的发生 ,且不造成透析间期体重增加