gipertonicheskaya bolezn

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zagolovok slayda otsutstvuet gipertonicheskaya bolezn * * arterialnaya gipertoniya. opredelenie sostoyanie, pri kotorom otmechaetsya stabilnoe povishenie klinicheskogo sad > 140 mm rt st i/ili dad > 90 mm rt st u lyudey, ne poluchayushix antigipertenzivnuyu terapiyu. * etiologiya gb nasledstvennaya predraspolojennost ogranichenie fizicheskoy aktivnosti (gipodinamiya). ojirenie. izbitochnoe potreblenie povarennoy soli (nasl). defitsit kaltsiya i magniya. chrezmernoe potreblenie alkogolya giperlipidemiya kurenie. vozrast. * mozaichnaya teoriya patogeneza ag * stoykoe i dlitelnoe povishenie ad obuslovleno izmeneniem sootnosheniya trex gemodinamicheskix pokazateley: rost opss; uvelichenie serdechnogo vibrosa (mo); uvelichenie ob'ema tsirkuliruyushey krovi (otsk). * naibolee vajnie patogeneticheskie zvenya formirovaniya i progressirovaniya essentsialnoy ag: aktivatsiya sas aktivatsiya raas povishenie produktsii mineralokortikoidov chrezmernaya virabotka adg; narushenie ekskretsii na+ pochkami; disfunktsiya endoteliya strukturnie izmeneniya srednix i melkix arteriy (gipertrofiya, gialinoz i t.d.); narushenie baroretseptornogo zvena sistemi tsentralnoy regulyatsii urovnya ad. * angiotenzinogen angiotenzin i angiotenzin ii renin apf bradikinin neaktivnie substantsii alternativniy apf put (ximaza, katepsin g, …

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2, fyhrquist f et al j hum hypertens 1995; 9(suppl 5): s19s24, booz gw, baker km heart fail rev 1998; 3: 125130, beers mh, berkow r, eds. the merck manual of diagnosis and therapy. 17th ed. whitehouse station, nj: merck research laboratories 1999: 16821704, anderson s exp nephrol 1996; 4(suppl 1): 3440, fogo ab am j kidney dis 2000; 35(2):179188 a ii at1 retseptori ateroskleroz* vazokonstriktsiya gipertrofiya sosudov endotelialnaya disfunktsiya glj fibroz remodelirovanie apoptoz smert insult ag xsn im xpn * barorefleksi ob'em/ad renin/angiotenzin prednagruzka sv ad katexolamini nadpochechniki tsns napolnyaemost ven vliyanie tsns na uroven ad serdtse pochki postnagruzka rezistentnost arteriy * vzaimodeystvie renin-angiotenzinovoy i simpatoadrenalovoy sistem * zabolevaniya, soprovojdayushiesya povisheniem ad essentsialnaya gipertoniya (gipertonicheskaya bolezn) - 90-95% vtorichnie (simptomaticheskie) gipertenzii - 5-10% renalnie (renovaskulyarnie i renoparinximatoznie) gemodinamicheskie endokrinnie nevrologicheskie prochie (lekarstvennie i t.d.) * klassifikatsiya urovney ad (vnok, 2004) esli znachenie sad ili dad popadaet v raznie kategorii, …

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nebolshoe povishenie sivorotochnogo kreatinina: mujchini 115-133 mkmol/l (1,3-1,5 mg/dl) jenshini 107-124 mkmol/l (1,2-1,4 mg/dl) mikroalbuminuriya (30-300 mg/sut); otnoshenie albumin/kreatinin v moche mujchini ≥22 mg/g(2,5 mg/mmol) jenshini ≥31 mg/g (3,5 mg/mmol) * saxarniy diabet, vnok 2004 uroven glyukozi natoshak > 7,0 mmol/l (126 mg/dl) postprandialniy uroven glyukozi > 11,0 mmol/l (198 mg/dl) * assotsiirovannie klinicheskie sostoyaniya, vnok 2004 zabolevaniya serdtsa im stenokardiya koronarnaya revaskulyarizatsiya xsn * assotsiirovannie klinicheskie sostoyaniya, vnok 2004 tserebrovaskulyarnaya bolezn ishemicheskiy mi gemorragicheskiy mi tia * assotsiirovannie klinicheskie sostoyaniya, vnok 2004 porajenie pochek diabeticheskaya nefropatiya pochechnaya nedostatochnost (sivorotochniy kreatinin u mujchin > 133 mkmol/l(1,5 mg/dl),u jenshin >124 mkmol/l(1,4 mg/dl) proteinuriya (>300 mg/sut) * assotsiirovannie klinicheskie sostoyaniya, vnok 2004 zabolevanie perifericheskix arteriy rasslaivayushaya anevrizma aorti simptomaticheskoe porajenie perifericheskix arteriy * assotsiirovannie klinicheskie sostoyaniya, vnok 2004 gipertonicheskaya retinopatiya krovoizliyaniya ili ekssudati otek soska zritelnogo nerva * stratifikatsiya po risku razvitiya serdechno-sosudistix oslojneniy, vnok (2004) fr, pom ili aks kategoriya ad, …

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tadii gb stadiya i net porajeniya organov-misheney i assotsiirovannix klinicheskix sostoyaniy stadiya ii est porajeniya organov-misheney, net assotsiirovannix klinicheskix sostoyaniy stadiya iii est assotsiirovannie klinicheskie sostoyaniya * diagnostika ag i posleduyushee obsledovanie vklyuchaet sleduyushie etapi: povtornie izmereniya ad; sbor anamneza; fizikalnoe obsledovanie; laboratorno-instrumentalnie metodi issledovaniya: bolee prostie na pervom etape i slojnie — na vtorom etape obsledovaniya. * naibolee xarakternie jalobi bolnix gb: golovnie boli razlichnogo xaraktera i geneza; golovokrujeniya, narusheniya pamyati, shum v golove, razdrajitelnost, bistraya utomlyaemost, podavlennost nastroeniya; melkanie “mushek” pered glazami i drugie priznaki narusheniya zreniya; boli v oblasti serdtsa, nebolshaya pastoznost podkojnoy kletchatki. * laboratornie i instrumentalnie metodi issledovaniya issledovaniya, rekomenduemie obyazatelno: obshiy analiz krovi i mochi; soderjanie v plazme krovi glyukozi (natoshak); soderjanie v sivorotke krovi oxs, xs lvp, tg, kreatinina, mochevoy kisloti, kaliya; ekg; issledovanie glaznogo dna; exokg. * laboratornie i instrumentalnie metodi issledovaniya dopolnitelno rekomenduemie issledovaniya: rentgenografiya grudnoy kletki; uzi pochek i nadpochechnikov; …

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anie v krovi kontsentratsii aldosterona, kortikosteroidov, aktivnosti renina; opredelenie katexolaminov i ix metabolitov v sutochnoy moche; bryushnaya aortografiya; kt ili mrt nadpochechnikov i golovnogo mozga. * ekg elektrokardiograficheskie priznaki gipertrofii levogo jeludochka: 1. uvelichenie amplitudi zubtsa r v levix grudnix otvedeniyax (v5, v6) i amplitudi zubtsa s — v pravix grudnix otvedeniyax (v1, v2). 2. priznaki povorota serdtsa vokrug prodolnoy osi protiv chasovoy strelki: a) smeshenie perexodnoy zoni vpravo — v otvedenie v2; b) uglublenie zubtsa qv5, 6; v) ischeznovenie ili rezkoe umenshenie amplitudi zubtsov s v levix grudnix otvedeniyax (v5, v6). 3. smeshenie elektricheskoy osi serdtsa vlevo. pri etom ri > 15 mm, ravl > 11 mm ili ri + riii > 25 mm. 4. smeshenie segmenta r–st v otvedeniyax v5, v6, i, avl nije izoelektricheskoy linii i formirovanie otritsatelnogo ili dvuxfaznogo (–+) zubtsa t v otvedeniyax i, avl, v5 i v6. 5. uvelichenie dlitelnosti intervala vnutrennego otkloneniya qrs …

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zagolovok slayda otsutstvuet gipertonicheskaya bolezn * * arterialnaya gipertoniya. opredelenie sostoyanie, pri kotorom otmechaetsya stabilnoe povishenie klinicheskogo sad > 140 mm rt st i/ili dad > 90 mm rt st u lyudey, ne poluchayushix antigipertenzivnuyu terapiyu. * etiologiya gb nasledstvennaya predraspolojennost ogranichenie fizicheskoy aktivnosti (gipodinamiya). ojirenie. izbitochnoe potreblenie povarennoy soli (nasl). defitsit kaltsiya i magniya. chrezmernoe potreblenie alkogolya giperlipidemiya kurenie. vozrast. * mozaichnaya teoriya patogeneza ag * stoykoe i dlitelnoe povishenie ad obuslovleno izmeneniem sootnosheniya trex gemodinamicheskix pokazateley: rost opss; uvelichenie serdechnogo vibrosa (mo); uvelichenie ob'ema tsirkuliruyushey krovi (otsk). * naibolee vajnie patogenetich...

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