简介:Hypertensionisaleadingriskfactorforcardiovasculardisease,theleadingcauseofdeathandmorbidityinoursocietyandonaglobalscale.Majorcomponentsofcardiovasculardiseaseincludestroke,coronaryarterydisease,heartfailure,andchronickidneydisease,inallofwhichhypertensionplaysamajorrole.Theriskofthesecomplicationsincreasesdirectlyandlinearlywithsystolicbloodpressurestartingat115mmHg.Althoughusuallyasymptomatic,hypertensionisreadilydetectableonphysicalexaminationandisamenabletobothlifestylemodificationandpharmacologictreatmentinmostpatients.However,largeproportionsofthehypertensivepopulationremainundetectedandundertreated.Numerousguidelineshavebeenissuedduringthepastfewdecadestopromotedetectionandoptimaltherapy.Despitetheincreaseinriskwithsystolicbloodpressuregreaterthan115mmHg,thegenerallyacceptedthresholdfordiagnosisandtreatmenthasbeensystolicbloodpressuregreaterthan139mmHganddiastolicbloodpressuregreaterthan80mmHgbecauseuntilrecentlytreatmenttolowerlevelshasbeenassociatedwithanunfavorablerelationbetweenclinicalbenefitandharm.Inthepastseveralyears,newguidelines,advisories,commentaries,andclinicaltrialshaveprovidedevidenceforapotentialchangeincurrentrecommendationsforthemanagementofhypertension.Inthisregard,thelong-awaitedeighthreportoftheJointNationalCommitteeonthePrevention,Detection,Evaluation,andTreatmentofHighBloodPressurerecommendedpatientsolderthan60yearsbetreatedtoasystolicbloodpressureoflessthan150mmHg,whichhasgeneratedconsiderablecontroversyandcaution.ThestrikingfindingsoftheSystolicBloodPressureInterventionTrial(SPRINT)havereceivedconsiderableattentionbecauseofthedemonstrationthatintensivetherapytoatargetsystolicbloodpressurebelow120mmHgdecreasescardiovascularmortalityandmorbiditymorethanlessintensivetreatmenttoatargetsystolicbloodpressurebelow140mmHg
简介:摘要目的探讨钩吻中毒的诊治方法。方法分析2003年8月本院救治的8例钩吻集体中毒患者临床资料。8例患者入院后均予清水洗胃,禁食,给予西咪替丁保护胃粘膜,预防消化道出血,呼吸困难者及时吸氧,症状无改善或进行性加重者立即行气管插管,表现为阿托品中毒样症状时予新斯的明1mg肌注,表现为毒蕈碱样症状时予阿托品0.5mg静注,必要时重复给药至症状消失。同时给予细胞色素C、三磷酸腺苷、辅酶A静滴营养脑细胞及心肌,速尿利尿排毒,纠正水电解质酸碱平衡及对症支持治疗。结果(一)临床表现主要表现为口角流涎、恶心、呕吐、腹痛、咽喉梗阻感、面色潮红、苍白、烦躁不安、视物不清、复视、牙关紧闭、步态不稳、尿潴留等。其中2例重症者出现呼吸肌麻痹,呼吸骤停。体格检查血压正常4例,血压降低4例,神志模糊6例,谵妄2例,瞳孔散大4例,缩小2例。颈软,心率在110~140次/min4例,心率40~50次/min3例,肺部检查正常。腹部压痛4例,肝脾不大。神经系统未引出病理征。实验室检查血钾、钠、氯均降低。(二)治疗结果8例患者中2例重症病人出现呼吸骤停立即给予人工呼吸,胸外按压等抢救处理后呼吸恢复。5例患者住院3天痊愈出院,3例5天痊愈出院,随诊一月各项检查无异常。结论钩吻中毒病情危重,临床症状复杂多样,早期诊断、及时采取综合的抢救方法是救治成功的关键。