课件：内科学高血压病ppt.ppt

THANK YOU SUCCESS * * 可编辑 * Macroscopic section through a grossly hypertrophied left ventricle in hypertensive left heart failure. * 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 * 幻灯片46. 导致心血管死亡的事件链 高血压，以及高脂血症、糖尿病和吸烟，均为导致心血管死亡的事件链上最初的始动危险因子（Dzau, et al, 1991）。左心室肥厚是典型的例子，其发生发展是早期而重要的发现，并可能对从早期高血压至心血管死亡的进展过程有着直接的病理生理学影响（Dzau, et al, 1991; Levy, et al, 1996）。通过Dzau等这种对导致心血管死亡因子的精巧评价，可以看出左心室肥厚的重要作用。左心室肥厚，与粥样硬化一起，代表着心力衰竭（在某些情况下，死亡）渐进发展过程的真正起始。确实，左心室肥厚是比吸烟，吸烟或胆固醇更强的心血管病预后因子，可增加心血管事件的危险2～4倍（Kanell, et al, 1972; Levy, et al, 1996; Ghali, et al, 1992; Koren, et al, 1991）。左心室肥厚或粥样硬化发展以后，患者通常发展成冠状动脉疾病，以血栓形成和缺血为标志，逐渐发展至心肌梗死。就在此时交感神经活化产生重要作用，引起心肌重构。心肌重构可能是随后心力衰竭进展的关键。因此，左心室肥厚、粥样硬化、心肌梗死以及心力衰竭对心血管死亡的重要性不必赘述。预防或逆转出现这些因子的治疗策略，能够打断导致心血管病死和病残的事件链上的重要环节。 * 从图中我们可以看到，适合普通高血压人群首选的联合用药有：噻嗪类利尿剂和ACE抑制剂，噻嗪类利尿剂和血管紧张素受体拮抗剂，钙拮抗剂和ACE抑制剂，钙拮抗剂和