儿童和青少年的高血压危机:强化治疗的各个方面

Yu. V. Bykov, A. N. Obedin, A. Muravyeva, V. V. Fischer, E. V. Volkov, I. Yatsuk, O. N. Zinchenko
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引用次数: 0

摘要

在儿科重症监护实践中,高血压危象(HC)是一种急性急症,极有可能导致目标器官受损和器官衰竭,需要进行紧急治疗,以降低动脉血压(BP)并将并发症的风险降至最低。HC 又分为无并发症(急性)和并发症(紧急),前者没有器官损伤的迹象,后者则伴有急性器官损伤(神经、肾或心脏功能障碍)。并发内分泌失调、肾功能损害和服用某些药物是诱发急性肾功能衰竭的主要因素。HC 的临床表现多样且无特异性,取决于患儿的年龄和 HC 的类型。重症监护室为患有 HC 的儿童提供重症监护,主要目的是逐渐降低患者的血压(在最初的 6-8 小时内降低 25%)。对于复杂型高血压,降压药物通过肠外给药,而非复杂型高血压患者可通过肠内或舌下给药。儿童和青少年高血压强化治疗的主要药物有钙通道阻滞剂、血管扩张剂、α 和 β 受体阻滞剂、ACE 抑制剂、中枢作用药物等。每一类降压药在药代动力学、药效学和剂量选择方面都有其自身的特点,也有各自的不良反应和禁忌症。对患有高血压的儿童和青少年进行及时识别和有效的强化治疗,将降低并发症的风险,并改善这种急症的治疗预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hypertensive crisis in children and adolescents: aspects of intensive therapy
In pediatric intensive care practice, a hypertensive crisis (HC) is an acute and urgent condition with a high risk of damage to target organs and organ failure, requiring emergency treatment aimed at decreasing arterial blood pressure (BP) and minimizing the risk of complications. HC is subdivided into uncomplicated (acute), in which no signs of organ damage are present, and complicated (urgent), with acute organ damage (neurological, renal or cardiac dysfunction). The main triggers of HC are concomitant endocrine disorders, renal impairment, and use of certain medications. The clinical signs of HC are diverse and non-specific, and depend on the age of the child and on the type of HC. Intensive care to children with HC is provided in intensive care units and is aimed primarily at gradually decreasing the patient’s BP (by 25% during the first 6–8 hours). In complicated HC, antihypertensive drugs are administered parenterally, whereas patients with uncomplicated HC may receive the drugs in enteral or sublingual form. The main drugs for intensive therapy of HC in children and adolescents are calcium channel blockers, vasodilators, α- and β-blockers, ACE inhibitors, centrally acting agents etc. Each group of antihypertensive drugs has its own peculiarities of pharmacokinetics, pharmacodynamics and dose selection, and its own range of adverse effects and contraindications. Timely recognition and competent intensive treatment of children and adolescents with HC will reduce the risk of complications and improve the therapeutic prognosis of this urgent condition.
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