医学常见的心血管内科常用药物、常见病处置、心肺复苏.ppt

* 中国高血压防治指南 利尿剂作为降压药已有近半个世纪的历史，大量的临床实践和是试验,证实了它的有效性和安全性，因而利尿剂在降压药物中占有重要的位置。 * 根据利尿剂作用于肾小管的部位不同分为三类： 一般在用药4-8周内，降低的血容量和心输出量，使机体血管和组织内的液体逐渐恢复到正常水平。4-8周后,利尿剂的降压作用主要和周围血管阻力下降有关。 Thiazide-type diuretics such as hydrochlorothiazide act on the distal convoluted tubule and inhibit the Sodium-chloride symporter leading to a retention of water in the urine as water normally follows penetrating solutes. Frequent urination is due to the increase loss of water that has not being retained from the body as a result of concomitant relationship with sodium loss from the convoluted tubule. 人有两个肾脏，每个肾脏大约有100万个肾单位，所谓肾单位就是过滤血液和产生尿液的微观单位。这就是一个肾单位，由肾小球、肾小管和集合管组成。每个肾小管又有是有三个相互连接的部分：近曲小管、亨利袢和远曲小管。从肾小球滤过进入肾小管的液体，大部分的K、Na、Cl、水在近曲小管被重吸收回血液，余下的有20%左右的K、Na、Cl又在亨利袢这段被重吸收，剩下的液体迅速被稀释，在通过远曲小管的时候，Na被进一步重吸收，以交换K和酸，也就是说K和酸在远曲小管被分泌排出。 所有利尿剂开始都是通过肾脏排钠排水，降低血容量和心输出量而发挥降压作用。 * Thiazides are often used to treat hypertension, although they are also used to treat congestive heart failure and symptomatic edema. 轻、中度高血压、老年人单纯收缩性高血压、高血压合并心功能不全者 心力衰竭、水肿、或肾脏损害的高血压 * Side effects include hypokalemia, increased serum cholesterol, triglyceride, impaired glucose tolerance, diabetes mellitus[11] and impotence. The side effect of hypokalemia has motivated combining thiazides with potassium chloride supplements, potassium sparing diuretics (eg with amiloride in co-amilozide) and with the newer ACE inhibitors, which also lower blood pressure but cause hyperkalemia as a side effect. Long-term usage of thiazides is also linked to increased levels of homocysteine, a toxic amino acid byproduct that has been associated with atherosclerosis. However, there is no evidence that people receiving long-term thiazide treatments should also receive folic acid supplements. Thiazides have been known to cause a paradoxical effect in diabetes insipidus, where they may reduce the volume of urine, possibly due to their capability to inhibit urate secretion. 低血钾、低血镁、高血钙、高尿酸；血脂代谢异常，LDL升高和HDL降低；糖耐量降低，血糖升高；血尿酸增高，甚者可促发急性痛风，尤常见于肾功能受损、肥胖和