【平平医生聊血压】血压居高不下，小心是原醛症
<p style="white-space: normal;"></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"> 目前市面上的降压药对大多数的高血压患者，都有很好的降压效果，但是临床仍有部分的高血压病人无法通过降压药将血压降到正常，其中有一部分人很可能是“原醛症”引起的。</span></p><p><section data-support="96编辑器" data-style-id="26976" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="width: 102px;height: 65px;border-top: 2px dotted rgb(0, 82, 255);border-left: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section><section style="margin-top: -55px;padding-right: 12px;padding-left: 12px;box-sizing: border-box;"></section><section style="margin-top: -55px;display: flex;justify-content: flex-end;"><section style="width: 102px;height: 65px;border-bottom: 2px dotted rgb(0, 82, 255);border-right: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section><section style="margin-top: -2px;width: 48px;height: 2px;border-bottom: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section></section><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section><section style="padding-top: 0.65em;text-align: center;box-sizing: border-box;"><section style="width: 676.994px;height: 1px;background-color: rgb(7, 48, 196);"><br/></section><section style="margin-top: -0.65em;"><section style="padding-top: 1px;padding-right: 8px;padding-left: 8px;display: inline-block;vertical-align: top;height: 1.3em;line-height: 1.3em;border-left: 3px solid rgb(7, 48, 196);border-right: 3px solid rgb(7, 48, 196);background-color: rgb(254, 255, 255);border-top-color: rgb(7, 48, 196);border-bottom-color: rgb(7, 48, 196);color: rgb(7, 48, 196);box-sizing: border-box;"><p><strong>原 醛 症</strong></p></section></section></section></section></section><section data-support="96编辑器" data-style-id="6150" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="padding: 15px;background-color: rgb(243, 243, 246);color: rgb(255, 255, 255);box-sizing: border-box;"><p style="letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;color: rgb(0, 0, 0);"> 原醛症又叫原发性醛固酮增多症，是由激素水平紊乱导致的一类继发性高血压，主要是肾上腺皮质自主分泌醛固酮，导致体内潴钠排钾，血容量增多，RAAS（肾素-血管紧张素-醛固酮系统）系统活性受抑制，临床表现为高血压和低血钾。研究发现，醛固酮过多是导致心肌肥厚、心力衰竭和肾功能受损的重要危险因素，与原发性高血压患者相比，原醛症患者心脏、肾脏等靶器官损害更为严重，因此早期诊断、早期治疗至关重要。<br/> 在过去的数十年里，原醛症一直被认为是少见病，但是近年来随着对继发性高血压筛查的重视以及诊断技术的提高，原醛症的患病率远远超出了我们的想象。国外报道，在1.2.3级高血压患者中，原醛的患病率分别为1.99%、8.02%、13.2%；而在难治性高血压中这种患病率可高达17-23%，国内研究报道较少，在亚洲普通高血压人群中，其患病率约为5%，2010年由中华医学会内分泌学分会牵头，在全国11个省19个中心对1656例难治性高血压患者进行了原醛症的筛查，报道其患病率为7.1%。</span></p></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"></span></p><p><section data-support="96编辑器" data-style-id="26976" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="width: 102px;height: 65px;border-top: 2px dotted rgb(0, 82, 255);border-left: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section><section style="margin-top: -55px;padding-right: 12px;padding-left: 12px;box-sizing: border-box;"></section><section style="margin-top: -55px;display: flex;justify-content: flex-end;"><section style="width: 102px;height: 65px;border-bottom: 2px dotted rgb(0, 82, 255);border-right: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section><section style="margin-top: -2px;width: 48px;height: 2px;border-bottom: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"> 原醛症是继发性高血压中较常见原因，那么哪些人群应该进行原醛症的筛查呢？根据原发性醛固酮增多症诊断治疗专家共识（2020版）建议下列人群进行原醛症的筛查：</span></p><p><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section><section style="padding-top: 0.65em;text-align: center;box-sizing: border-box;"><section style="width: 676.994px;height: 1px;background-color: rgb(7, 48, 196);"><br/></section><section style="margin-top: -0.65em;"><section style="padding-top: 1px;padding-right: 8px;padding-left: 8px;display: inline-block;vertical-align: top;height: 1.3em;line-height: 1.3em;border-left: 3px solid rgb(7, 48, 196);border-right: 3px solid rgb(7, 48, 196);background-color: rgb(254, 255, 255);border-top-color: rgb(7, 48, 196);border-bottom-color: rgb(7, 48, 196);color: rgb(7, 48, 196);box-sizing: border-box;"><p><strong>筛 查 人 群</strong></p></section></section></section></section></section><section data-support="96编辑器" data-style-id="26976" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="width: 102px;height: 65px;border-top: 2px dotted rgb(0, 82, 255);border-left: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section><section style="margin-top: -55px;padding-right: 12px;padding-left: 12px;box-sizing: border-box;"></section><section style="margin-top: -55px;display: flex;justify-content: flex-end;"><section style="width: 102px;height: 65px;border-bottom: 2px dotted rgb(0, 82, 255);border-right: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section><section style="margin-top: -2px;width: 48px;height: 2px;border-bottom: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"></span></p><p><section data-support="96编辑器" data-style-id="6150" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="padding: 15px;background-color: rgb(243, 243, 246);color: rgb(255, 255, 255);box-sizing: border-box;"><p style="letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;color: rgb(0, 0, 0);">1、持续性高血压（＞150/100mmhg）者及难治性高血压患者，即使用3种常规降压药（包括利尿剂）无法控制血压（＞140/90mmHg）的患者；使用≥4种降压药才能控制血压（＜140/90mmhg的患者及新诊断的高血压患者。<br/>2、高血压合并自发性或利尿剂所致的低钾血症的患者。<br/>3、高血压合并肾上腺意外瘤的患者。<br/>4、早发性高血压家族史或早发（＜40）岁脑血管意外家族史的高血压患者。<br/>5、原醛症患者中存在高血压的一级亲属。<br/>6、高血压合并阻塞性睡眠呼吸暂停的患者。</span></p></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"></span></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"> 那么这些患者到医院去要经历什么呢？</span></p><p><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section><section style="padding-top: 0.65em;text-align: center;box-sizing: border-box;"><section style="width: 676.994px;height: 1px;background-color: rgb(7, 48, 196);"><br/></section><section style="margin-top: -0.65em;"><section style="padding-top: 1px;padding-right: 8px;padding-left: 8px;display: inline-block;vertical-align: top;height: 1.3em;line-height: 1.3em;border-left: 3px solid rgb(7, 48, 196);border-right: 3px solid rgb(7, 48, 196);background-color: rgb(254, 255, 255);border-top-color: rgb(7, 48, 196);border-bottom-color: rgb(7, 48, 196);color: rgb(7, 48, 196);box-sizing: border-box;"><p><strong>一、筛查前准备</strong></p></section></section></section></section></section><section data-support="96编辑器" data-style-id="26976" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="width: 102px;height: 65px;border-top: 2px dotted rgb(0, 82, 255);border-left: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section><section style="margin-top: -55px;padding-right: 12px;padding-left: 12px;box-sizing: border-box;"></section><section style="margin-top: -55px;display: flex;justify-content: flex-end;"><section style="width: 102px;height: 65px;border-bottom: 2px dotted rgb(0, 82, 255);border-right: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section><section style="margin-top: -2px;width: 48px;height: 2px;border-bottom: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section></section><section data-support="96编辑器" data-style-id="6150" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="padding: 15px;background-color: rgb(243, 243, 246);color: rgb(255, 255, 255);box-sizing: border-box;"><p style="letter-spacing: 1px;line-height: 2em;"><span style="color: rgb(0, 0, 0);"><span style="font-size: 16px;">1、尽量将血</span><span style="font-size: 16px;">钾纠正至正常范围（那么医生可能会要您抽个血、留个尿钾后给您开一些氯化钾，告诉您回去多吃香蕉这些高钾食品，过几天再来复诊）。<br/>2、维持正常钠盐摄入。<br/>3、停用对ARR（醛固酮与肾素的比值）影响较大药物4周（这是很多病人不能理解的，但确实是很重要的，所以很多病人停药后来住院），包括醛固酮拮抗剂，经典代表就是螺内酯和依普利酮，保钾利尿剂阿米洛利、氨苯蝶啶，排钾利尿剂氢氯噻嗪、呋塞米及甘草提炼物。对ARR影响较大的药物如我们常用的ACE（**普利）I、ARB（**沙坦）及二氢吡啶CCB（**地平）类药物，至少要停用2周。（这是医生为了您的检查结果的可靠性才给出的专业意见，那肯定有人问吃了一堆药血压都控制不好，停药后血压会不会更加难以控制？请不用担心，关注下一条）。<br/>4、如果血压控制不佳，建议使用a法受体阻滞剂（**唑嗪，服用此类药物首次建议睡前服用，避免体位性低血压带来的危害）和非二氢吡啶类CCB（维拉帕米、地尔硫卓等）；如因冠心病或心律失常等原因长期服用β受体阻滞剂，建议临床医师根据患者情况决定是否停药。<br/>5、口服避孕或人工激素替代治疗的对肾素浓度有一定影响，一般无需停服避孕药，除非有更好的避孕措施。</span></span></p></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"></span></p><p><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section><section style="padding-top: 0.65em;text-align: center;box-sizing: border-box;"><section style="width: 676.994px;height: 1px;background-color: rgb(7, 48, 196);"><br/></section><section style="margin-top: -0.65em;"><section style="padding-top: 1px;padding-right: 8px;padding-left: 8px;display: inline-block;vertical-align: top;height: 1.3em;line-height: 1.3em;border-left: 3px solid rgb(7, 48, 196);border-right: 3px solid rgb(7, 48, 196);background-color: rgb(254, 255, 255);border-top-color: rgb(7, 48, 196);border-bottom-color: rgb(7, 48, 196);color: rgb(7, 48, 196);box-sizing: border-box;"><p><strong>二、入院后</strong></p></section></section></section></section></section><section data-support="96编辑器" data-style-id="26976" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="width: 102px;height: 65px;border-top: 2px dotted rgb(0, 82, 255);border-left: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section><section style="margin-top: -55px;padding-right: 12px;padding-left: 12px;box-sizing: border-box;"></section><section style="margin-top: -55px;display: flex;justify-content: flex-end;"><section style="width: 102px;height: 65px;border-bottom: 2px dotted rgb(0, 82, 255);border-right: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section><section style="margin-top: -2px;width: 48px;height: 2px;border-bottom: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"> 入院后您将面临的是一系列的抽血、留尿检查，这是为确诊原醛症而做的盐水滴注；之后，您还会做个有创检查，医学术语肾静脉取血（AVS），通过这一“金标准检查”来确诊。</span></p><p><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section><section style="padding-top: 0.65em;text-align: center;box-sizing: border-box;"><section style="width: 676.994px;height: 1px;background-color: rgb(7, 48, 196);"><br/></section><section style="margin-top: -0.65em;"><section style="padding-top: 1px;padding-right: 8px;padding-left: 8px;display: inline-block;vertical-align: top;height: 1.3em;line-height: 1.3em;border-left: 3px solid rgb(7, 48, 196);border-right: 3px solid rgb(7, 48, 196);background-color: rgb(254, 255, 255);border-top-color: rgb(7, 48, 196);border-bottom-color: rgb(7, 48, 196);color: rgb(7, 48, 196);box-sizing: border-box;"><p><strong>三、出院后</strong></p></section></section></section></section></section><section data-support="96编辑器" data-style-id="26976" style="white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="width: 102px;height: 65px;border-top: 2px dotted rgb(0, 82, 255);border-left: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section><section style="margin-top: -55px;padding-right: 12px;padding-left: 12px;box-sizing: border-box;"></section><section style="margin-top: -55px;display: flex;justify-content: flex-end;"><section style="width: 102px;height: 65px;border-bottom: 2px dotted rgb(0, 82, 255);border-right: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section><section style="margin-top: -2px;width: 48px;height: 2px;border-bottom: 2px dotted rgb(0, 82, 255);box-sizing: border-box;"><br/></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"> 只要您最终确诊为原醛，无论您最终选择手术还是药物治疗，出院后仍要记住定期随访，这样通过治疗之后部分患者可以减少降压药物使用的种类或者用量，甚至有部分患者可以停用药物。</span></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"> 如果患者有以上的特点，建议来高血压专科门诊进行筛查和诊治。</span></p><p><section data-support="96编辑器" data-style-id="30285" style="white-space: normal;"><section style="padding-top: 20px;padding-bottom: 20px;box-sizing: border-box;"><section style="display: flex;justify-content: space-between;align-items: flex-start;"><section><section style="width: 60px;height: 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rgb(0, 82, 255);"><br/></section></section></section></section></section></p><p style="white-space: normal;letter-spacing: 1px;line-height: 2em;"></p><p><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section style="font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;font-size: 16px;"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="padding-left: 11px;display: inline-block;width: 676.997px;vertical-align: top;box-sizing: border-box;"><section><section style="display: inline-block;width: 666.005px;vertical-align: top;background-color: rgba(255, 255, 255, 0);border-style: solid;border-width: 1px;border-radius: 0px;border-color: rgb(7, 48, 196);box-sizing: border-box;"><section><section style="margin-top: 10px;display: flex;flex-flow: row nowrap;text-align: left;justify-content: flex-start;transform: translate3d(-8px, 0px, 0px);"><section style="display: inline-block;vertical-align: top;width: auto;line-height: 0;letter-spacing: 0px;flex: 0 0 0%;height: auto;align-self: flex-start;"><section style="text-align: right;justify-content: flex-end;"><section style="display: inline-block;width: 8px;height: 45px;vertical-align: top;overflow: hidden;"><section style="text-align: center;"><section style="vertical-align: middle;display: inline-block;line-height: 0;width: 7.8267px;height: auto;"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 1.5 8.7" style="vertical-align: middle;width: 100%;" width="100%" data-width="100%"><g><path d="M1.5,0.2C0.8,0.2,0.2,0.6,0.2,1v6.2C0.5,6.9,1,6.8,1.5,6.8V0.2z" fill="rgb(255,255,255)"></path></g><g><path d="M0.2,7.7H0V1c0-0.5,0.7-1,1.5-1v0.2C0.8,0.2,0.2,0.6,0.2,1v6.2C0.5,6.9,1,6.8,1.5,6.8V7C0.8,7,0.2,7.3,0.2,7.7 z" fill="rgb(7,48,196)"></path></g><g><path d="M1.5,8.7C0.7,8.7,0,8.3,0,7.7s0.7-0.9,1.5-0.9V7C0.8,7,0.2,7.3,0.2,7.7s0.6,0.7,1.3,0.7V8.7z" fill="rgb(7,48,196)"></path></g><g><path d="M1.5,7C0.8,7,0.2,7.3,0.2,7.7s0.6,0.7,1.3,0.7V7z" fill="#5f9cef"></path></g></svg></section></section></section></section></section><section style="margin-left: -1px;display: inline-block;vertical-align: top;width: auto;flex: 100 100 0%;align-self: flex-start;height: auto;"><section style="justify-content: flex-start;"><section style="padding-right: 20px;padding-left: 10px;display: inline-block;vertical-align: top;overflow: hidden;height: 36px;width: auto;min-width: 10%;border-width: 1px;border-bottom-right-radius: 100px;border-style: solid solid solid none;border-color: rgb(7, 48, 196) rgb(7, 48, 196) rgb(7, 48, 196) rgb(138, 50, 222);border-top-right-radius: 100px;border-bottom-left-radius: 0px;box-sizing: border-box;"><section style="color: rgb(7, 48, 196);text-align: center;letter-spacing: 2px;line-height: 2.2;"><p><strong>联系方式</strong></p></section></section></section></section></section></section><section style="margin-bottom: 10px;"><section style="padding-right: 20px;padding-left: 20px;color: rgb(62, 62, 62);letter-spacing: 1.8px;line-height: 1.8;box-sizing: border-box;"><section style="line-height: 2em;">1、咨询株洲恺德心血管病医院订阅号<strong><span style="color: rgb(7, 48, 196);">在线客服；</span></strong><br/>2、咨询电话：<strong><span style="color: rgb(7, 48, 196);">0731-28265873</span></strong></section><section style="line-height: 2em;">3、联系地址：株洲恺德心血管病医院<span style="color: rgb(7, 48, 196);"><strong>第三住院大楼2楼（心血管内三科）</strong></span></section></section></section></section></section></section></section></section><section style="font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section style="letter-spacing: 0.544px;text-align: right;font-size: 12px;"><section style="margin-top: 10px;margin-bottom: 10px;font-size: 16px;letter-spacing: 0.544px;"><section style="border-top: 1px solid rgb(7, 48, 196);line-height: 0;box-sizing: border-box;"><section style="line-height: 0;width: 0px;"><svg viewbox="0 0 1 1" style="vertical-align:top;"></svg></section></section><section style="margin-top: 3px;border-top: 4px solid rgb(7, 48, 196);line-height: 0;box-sizing: border-box;"><section style="line-height: 0;width: 0px;"><svg viewbox="0 0 1 1" style="vertical-align:top;"></svg></section></section></section><section style="letter-spacing: 0.544px;"><p><span style="letter-spacing: 0.544px;">文案：刘平平</span></p></section></section><p></p></section></section></p><p><br/></p><link rel="stylesheet" href="//bbs.zhuzhou.com/source/plugin/wcn_editor/public/wcn_editor_fit.css?v134_PGX" id="wcn_editor_css"/>
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