临床荟萃 ›› 2021, Vol. 36 ›› Issue (3): 270-276.doi: 10.3969/j.issn.1004-583X.2021.03.017
王艳军, 崔炜(
)
收稿日期:2020-09-15
出版日期:2021-03-20
发布日期:2021-03-29
通讯作者:
崔炜
E-mail:cuiwei21c@163.com
Received:2020-09-15
Online:2021-03-20
Published:2021-03-29
摘要：
高血压的患病率呈逐渐升高趋势,常出现冠心病、心力衰竭、心房颤动、卒中及慢性肾病等并发症。降压治疗可以有效减少心脑肾及血管并发症。在治疗高血压的过程中,部分患者会出现低血压。本文将从降压过度所致的低血压、药物所致的体位性低血压、餐后低血压、治疗错误所致的低血压及环境/季节的改变对血压的影响等方面介绍降压过程中低血压的成因及处理,指导临床医生更为科学合理地治疗高血压。
中图分类号:
王艳军, 崔炜. 降压治疗中低血压的成因及处理[J]. 临床荟萃, 2021, 36(3): 270-276.
图1 随着收缩压基线值越大血压下降幅度随之增加[9]
图2 自主神经功能障碍与心血管疾病级联反应[27] 自主神经功能障碍、体位性低血压参与心血管事件发生的不同机制,既是心血管疾病的危险因素,又是导致心血管疾病的死亡风险增加的亚临床改变
| 神经源性 | 非神经源性 |
|---|---|
| 自主神经功能衰竭 脑干损伤/肿瘤 颈动脉窦过敏症 脑血管意外 多巴胺β-羟化酶缺乏症 多发性硬化 多系统萎缩 神经心源性晕厥 帕金森病 周围神经系统 HIV/AIDS,淀粉样变性,糖尿病,吉兰-巴雷综合征,肾衰竭,维生素 B12或叶酸缺乏症 脊髓(脊髓空洞症,脊髓痨,肿瘤,脊髓炎) 延髓空洞症 | 心血管疾病(主动脉狭窄,心力衰竭,心肌梗死,心肌炎,心包炎,快速性心律失常) 血容量下降 (出血,烧伤,脱水,尿崩症,腹泻,失盐肾病,呕吐) 静脉池(饮酒、发烧、发热、长时间卧床或站立、败血症) 药物 |
表1 体位性低血压的分类[32]
| 神经源性 | 非神经源性 |
|---|---|
| 自主神经功能衰竭 脑干损伤/肿瘤 颈动脉窦过敏症 脑血管意外 多巴胺β-羟化酶缺乏症 多发性硬化 多系统萎缩 神经心源性晕厥 帕金森病 周围神经系统 HIV/AIDS,淀粉样变性,糖尿病,吉兰-巴雷综合征,肾衰竭,维生素 B12或叶酸缺乏症 脊髓(脊髓空洞症,脊髓痨,肿瘤,脊髓炎) 延髓空洞症 | 心血管疾病(主动脉狭窄,心力衰竭,心肌梗死,心肌炎,心包炎,快速性心律失常) 血容量下降 (出血,烧伤,脱水,尿崩症,腹泻,失盐肾病,呕吐) 静脉池(饮酒、发烧、发热、长时间卧床或站立、败血症) 药物 |
| 药物种类 | 药物 |
|---|---|
| α-受体阻滞剂 降压药 | 特拉唑嗪,多沙唑嗪,哌唑嗪,坦索罗辛利尿药(噻嗪类和袢类),β-受体阻断剂,可乐定,长效钙通道阻断剂 |
| 抗精神病药 | 奥氮平,利培酮 |
| 单胺氧化酶抑制剂 | 雷沙吉兰,司来吉兰 |
| 麻醉剂 | 吗啡 |
| 帕金森病 | 溴隐亭,左旋多巴 |
| 三环类抗抑郁药 | 阿米替林,去甲替林 |
| 血管扩张剂 | 肼苯哒嗪,硝酸酯 |
表2 引起体位性低血压的常见药物[32]
| 药物种类 | 药物 |
|---|---|
| α-受体阻滞剂 降压药 | 特拉唑嗪,多沙唑嗪,哌唑嗪,坦索罗辛利尿药(噻嗪类和袢类),β-受体阻断剂,可乐定,长效钙通道阻断剂 |
| 抗精神病药 | 奥氮平,利培酮 |
| 单胺氧化酶抑制剂 | 雷沙吉兰,司来吉兰 |
| 麻醉剂 | 吗啡 |
| 帕金森病 | 溴隐亭,左旋多巴 |
| 三环类抗抑郁药 | 阿米替林,去甲替林 |
| 血管扩张剂 | 肼苯哒嗪,硝酸酯 |
图3 体位性低血压的诊断流程[3]
图4 体位性低血压的治疗流程[3]
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