常用抗高血压的药物分析讨论

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常用抗高血压的药物分析讨论

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        高血压是我们在基层门诊的常见病之一，很多的高血压患者常伴有心脑血管的疾患，为降高血压是想千法设百计，低档的高档的，价格贵的便宜的，是一试再试，就只想把血压降下来。临床上我们降血压的药物也是五花八门，高低不一，据我在门诊的观察与常用的药物在住院部的反应做了一下归纳，包括分类，适用证，禁忌症，副作用。望同行们指出不足之处，                                                                                                                  高血压病因不明，与发病有关的因素有关：

　　 1.年龄：发病率有随年龄增长而增高的趋势，40岁以上者发病比较率高。但现在<35岁以上发病率也比较普遍. 2.食盐：摄入食盐多者，高血压发病率高，有认为食盐<2g/日，几乎不发生高血压;3-4g/日，高血压发病率3%，4-15g/日，发病率33.15%，>20g/日发病率30%。像我们湖南重口味为多，高血压的趋势也是越来越年轻化。 3.体重：肥胖者发病率高。喜欢宵夜而且是重口味的较多。　　 4.遗传：大约半数高血压患者有家族史。 5.环境与职业：有噪音的工作环境，过度紧张的脑力劳动均易发生高血压，城市中的高压发病率高于农村。那我们现在用的是那些高血压用药呢，现在我为同行们慢慢道来。一，利尿剂分类：1.噻嗪l类利尿剂：氢氯噻嗪，吲哒帕胺， 2.袢利尿剂：呋塞米，布美他尼，托拉塞米，依他尼酸， 3.保钾利尿剂：安体舒通（用于醛固酮增多症），氨苯蝶啶（在降压治疗中常与氢氯噻嗪使用） 4.碳酸酐酶抑制剂：醋氮酰胺（主要作用于近小血管）适应症;小剂量噻嗪类适用于1.轻中度高血压，2.老年单纯收缩期高血压，3.肥胖，盐摄入过多的高血压，4.合并心功能不全的高血压。袢利尿剂：心衰，肾功能不全以及高血压急症是的迅速降压。保钾类利尿剂和噻嗪类的药物合用，安体舒通通常于醛固酮增多症，和合并心衰的患者。禁忌证：1.糖尿病或糖耐量降低者相对禁忌 2.伴有高尿酸血症或有痛风者 3.肾功能不全，鸡肝大于265umoL/L(3mg/3dL)者不宜使用 4.高脂血症及用药前血容量低者慎用。副作用：小剂量的情况下较少发生 1.低钾血症：以噻嗪类利尿剂和呋塞米较为明显，建议联用保钾类降压药物或适量补钾，但该副作用与剂量明显有关。 2.糖代谢异常，氢氯噻嗪可以使空腹血糖耐量洚低，并增加高血压患者的胰岛素抵抗， 3.低镁血症， 4.高尿酸血症 5.高血钙 6.结石形成 7.阳痿疲乏，眩晕恶心，肌肉痉挛和上腹不适等，这些副作用多见于长期大剂量应用利尿剂者。（待续，写的手都麻了，明天再续写）

发布于 2012-06-01 15:53:55 IP 属地·中国|湖南省|益阳市

10条评论

默认

最新

医学无止境

。。。。。。。。。。辛苦了

2012-06-01 18:05:08 · IP属地·中国|山东省|临沂市
回复 0点赞

yzh1009

分析的很好!期待精彩

2012-06-01 21:54:54 · IP属地·中国|青海省|海西
回复 0点赞

杨万军

精彩。谢谢无私奉献精神。

2012-06-02 10:17:09 · IP属地·中国|河南省|安阳市
回复 0点赞

eve592370698

首先一个是密密麻麻的内容排版做得不太好，我看了也犯困。

2013-03-19 16:30:10 · IP属地·中国|河北省|秦皇岛市
回复 0点赞

阿特巴拉的医生

高血压分原发性和继发性，原发性者叫高血压病，继发者叫继发性高血压病，现在继发高血压病有增多趋势，儿童高血压多见于肥胖和继发性高血压，服用降压药效果不好的患者要想到继发性高血压病。

2013-03-19 16:51:06 · IP属地·未知
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阿特巴拉的医生

2013-03-19 16:51:20 · IP属地·未知
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百草堂

总结的很好！

2013-12-18 11:01:16 · IP属地·中国|广东省|惠州市
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1129760387

很系统，温习了一遍，期待下期。

2013-12-19 17:15:06 · IP属地·中国|江苏省|无锡市
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随风@

继续分析辛苦了

2013-12-21 10:14:28 · IP属地·中国|山西省|太原市
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