内科学高血压病课件ppt自动保存的连锁药店.ppt

血压测量的注意事项 1、 要求受试者坐位安静休息5分钟后开始测量。 2、应相隔1-2分钟重复测量，取2次读数的平均值记录。如果收缩压或舒张压的2次读数相差5mmHg以上，应再次测量，取3次读数的平均值记录。 3首诊时要测量两上臂血压，以后通常测量较高读数一侧的上臂血压。 * Macroscopic section through a grossly hypertrophied left ventricle in hypertensive left heart failure. 尿液浓缩 * * * Magnetic resonance imaging (MRI) used to localize pheochromocytomas: coronal MRI section of the abdomen. Pheochromocytomas demonstrate high signal intensity on a T2-weighted image, unlike a benign tumor, which has a low signal intensity. MRI is nearly 100 percent sensitive but only 67 percent specific. Ninety-seven percent of pheochromocytomas are found in the abdominal region, with most found in the adrenal glands. Less likely sites are the thorax (2 percent to 3 percent) and the neck (1 percent). Multiple tumors may arise in 10 percent of adults. Familial pheochromocytomas are frequently bilateral or arise from multiple sites. In children, pheochromocytomas are more commonly bilateral and more frequently lie outside the adrenal glands than in adults. Tumor localization not only confirms the diagnosis of pheochromocytoma but also assists the surgeon in planning the surgical strategy. Advances in noninvasive imaging techniques now provide safe and reliable means of localizing pheochromocytomas regardless of their location. (Adapted from Bravo EL: Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma. Endocr Rev 15:356-368, 1994.) W.B. Saunders Company items and * Total+mortality 总死亡率 * 交感神经是植物性神经的一部分。由中枢部、交感干、神经节、神经和神经丛组成。中枢部位于脊髓胸段全长及腰髓1～3节段的灰质侧角。交感干位于脊柱两侧，由交感干神经节和节间支连接而成，可分颈、胸、腰、骶和尾5部分。调节心脏及其他内脏器官的活动。交感神经系统的活动比较广泛，刺激交感神经能引起腹腔内脏及皮肤末梢血管收缩、心搏加强和加速、瞳孔散大、疲乏的肌肉工作能力增加等。交感神经的活动主要保证人体紧张状态时的生理需要。 人体在正常情况下，功能相反的交感和副交感神经处于相互平衡制约中。  * COPO 慢性阻塞性肺气肿 * 不良反应 心悸 足部水肿 有牙龈炎和牙周炎的患者可出现牙龈轻度肿大。 * * * 肾素是一种水解蛋白酶，由肾脏入球小动脉的近球细胞合成，贮存并释放到血液中，它直接作用于肝脏所分泌的血管紧张素原(α2球蛋白)，使血管紧张素原转变成血管紧张素Ⅰ。血管紧张素Ⅰ是一种10肽物质，在正常血浆浓度下无生理活性，经过肺、肾等脏器时，在血管紧张素转换酶的作用下，形成血管紧张素Ⅱ(8肽)，此酶又称激肽酶Ⅱ，尚有降解缓激肽的作用。血管紧张素Ⅱ可经酶作用，脱去一个天门冬氨酸，转化为血管紧张素