高血压急症降压治疗原则.ppt

舒张功能不全引起的急性肺水肿理论基础 血压增高引起急性肺水肿原因中，舒张功能不全也是重要的一个原因。 其机制认为可能与血压急剧增加影响冠脉灌注降低心室舒张期顺应性有关。 The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 2001; 344:17–22. 用药选择的依据 利尿剂：通过减少血容量，使回心血量减少，降低肺毛细血管和左房压力，减轻肺淤血，缓解症状 非2氢吡啶类CCB：可降低心肌耗氧量，延缓心肌细胞传导，改善心肌活动的异常非均一性，促进收缩和舒张的协调，通过扩张冠脉和外周血管，增加冠脉充盈，减轻心肌缺血 β-受体阻滞剂：可降低心率，延长舒张期，改善充盈增加舒张末容积，其负性肌力作用可降低耗氧量改善心肌缺血，通过抑制交感神经的血管收缩作用可降低后负荷 2012ESC 急性和慢性心力衰竭的诊断与治疗指南 高血压危象的挑战 1.目前缺少相应的指南，大部分关于高血压急症的治疗推荐都来源于专家意见，缺少相应的循证学证据 2. 缺少一个有效的风险分层策略弥补临床实际和专家共识理论之间的空隙，从而帮助急诊医师进行有效的辅助检查进行鉴别 3.缺少试验评价对于每种高血压急症达到降压目标所需要的时间 谢 谢 * * Objectives.?The purpose of this study was to identify independent risk factors for development of hypertensive crisis. Methods.?This was a retrospective, case-controlled study. Cases were 143 patients who presented during a 3-year period to the Emergency Department with the diagnosis of hypertensive crisis, defined as systolic pressure ≥180 mmHg and/or diastolic pressure ≥110 mmHg and symptoms of hypertensive emergency during the Emergency Department presentation. Controls were 485 patients with hypertension, matched to cases on the basis of age, sex and race, who were not admitted to the Emergency Department with an episode of hypertensive crisis during the study period. Co-morbid conditions were identified from computerized health system databases and medical records. Out-patient blood pressures were obtained from medical records from randomly selected out-patient clinic visits. Results.?The average blood pressure during Emergency Department presentation in patients with hypertensive crisis was 197 ± 21/108 ± 14 mmHg. Less successful out-patient systolic blood pressure control was an independent risk factor for hypertensive crisis [odds ratio (OR) 1.30 (1.18–1.42), per 10 mmHg,?P? 0.001]. Higher out-patient diastolic blood pressures [OR 1.21 (0.99–1.43 per 10 mmHg,?P?= 0.07] and history of heart failure [OR 3.48 (0.94–12.94),?P?= 0.06] trended towards independence as risk factors. Conclusio