#1
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òåðàïèÿ ÃÁ
Äîêòîðà, ïðîøó ïîìî÷ü â ïîäáîðå ïðåïàðàòîâ äëÿ ÃÁ, âîò êàê áû áàíàëüíî ýòî íå çâó÷àëî...
Ïàöèåíòêà 82 ëåò. ÀÄ äî 200 ìì ðò ìò., àäàïòèðîâàíà ê 110/-120/ ìì ðò ñò, 130- ïåðåíîñèòñÿ òÿæåëî: ãîëîâíàÿ áîëü, ãîëîâîêðóæåíèå, òÿæåñòü â çàòûëêå, òîøíîòà.  òå÷ ìåñÿöà, íà ôîíå ïîñòîÿííîãî ïðèåìà: íîðâàñê 10 ìã/ñ, àêêóïðî 40 ìã/ñ, áèñîïðîëîë 5 ìã/ñ, âåðîøàïèðîí 25 ìã/ñ, ñàìîñòîÿòåëüíî áûë äîáàâëåí ïåêòðîë 60 ìã/ñ. Äîïîëíèòåëüíî ïðèíèìàëà êëîôåëëèí 0,15 äî 3-õ òàáë â äåíü, íà ïîâûøåíèè ÀÄ âûøå 150 ìì ðò ñò.  íàñòîÿùåå âðåìÿ ñìåíèë òåðàïèþ íà (ïîñëåäíèå 2 íåäåëè): ýäàðáè 80 ìã/ñ, íîðâàñê 10 ìã/ñ, âåðîøïèðîí 25ìã/ñ, áèñîïðîëîë 5 ìã/ñ, áðèòîìàð 5 ìã/ñ; Ñíà÷àëà äàë ýäàðáè-êëî 40/25, ïîëó÷èëè îòëè÷íûé äèóðåòè÷åñêèé ýôôåêò, íî ÀÄ íå ñèëüíî óäåðæèâàë (ìåñÿö íàáëþäàëè), ïîòîì ýäàðáè 80. Òåì íå ìåíåå, ÀÄ ïðîäîëæàåò îñòàâàòüñÿ íåñòàáèëüíûì. Íà ïðèëû- êàøåëü; êîðäàôëåêñ âûçûâàåò ïðèëèâû æàðà è âûðàæåííûå îòåêè ëîäûæåê.. ×òî åùå ìîæíî äîáàâèòü èëè ñìåíèòü? |
#2
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Ìîæåò, Âû ïîïðîáóåòå îñòàíîâèòüñÿ íà ýòèõ öèôðàõ? Èçîëèðîâàííàÿ ñèñòîëè÷åñêàÿ ãèïåðòåíçèÿ - âàðèàíò íîðìû äëÿ ïîæèëûõ
3) In fit individuals older than 80 years with an initial SBP ≥ 160 mmHg it is recommended to reduce SBP to between 150 mmHg and 140 mmHg. --- Blood Press. 2016 Dec;25(6):333-336. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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Ìû óæå çàäóìàëèñü íàä ýòèì, ñ ó÷åòîì âîçðàñòà. Ïëîõî ïåðåíîñèò ýòè öèôðû: ãîëîâíûå áîëè, ãîëîâîêðóæåíèå, ÷óâñòâî äóðíîòû...
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#4
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Íåïîíÿòíî, çà÷åì åùå -ïðèëû? è íèôåäèïèí, êîãäà óæå ïàöèåíòêà ïîëó÷àåò àìëîäèïèí/íîðâàñê
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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Êàøåëü íà -ïðèëàõ, áûâàåò èç-çà äåôèöèòà æåëåçà, íåò ëè ó ïàöèåíòêè ÆÄÀ? Åå êîððåêöèÿ ìîæåò äàòü íåêîòîðûå áåíåôèòû â íîðìàëèçàöèè ÀÄ, íåäàâíî êîðåéöû îïóáëèêîâàëè, ÷òî àíåìèÿ àññîöèèðóåòñÿ ñ áîëåå âûñîêèì ïóëüñîâûì äàâëåíèåì:
...the odds ratio (OR) of anemia (hemoglobin <13 and <12 g/dL, in men and women, respectively), using the normal PP group (PP ≤61 mmHg) as a reference, was significant for the high PP cohort (PP >61 mmHg; OR, 1.517; 95% confidence interval [CI], 1.270-1.812)... --- Clin Exp Hypertens. 2018 Jan 10:1-6. The relationship between anemia and pulse pressure and hypertension: The Korea National Health and Nutrition Examination Survey 2010-2012.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
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#7
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Öèòàòà:
æåëåçî íå ñìîòðåëè, ó÷òó. |
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#8
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Òàêîé ãåìîãëîáèí äî íà÷àëà ëå÷åíèÿ, èëè óæå ïîñëå? Äèóðåòèêè ìîãóò ñíèæàòü îáüåì ïëàçìû è òåîðåòè÷åñêè ìàñêèðîâàòü àíåìèçàöèþ; äåôèöèò æåëåçà - èëè ïî ñûâ. æåëåçî/îæññ ìåíåå 0,2, èëè ïî ôåððèòèíó ìåíåå 50
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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#10
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âîò çäåñü íàøè ïèøóò, ÷òî ÷åðåç 5-7 äíåé ïðèåìà ïåòëåâûõ äèóðåòèêîâ ïðè ÕÑÍ ãåìîãëîáèí ïîâûøàåòñÿ ñ 112 äî 123 (áîëåå 10 ã/ë ó 2/3 ïàöèåíòîâ è áîëåå 15 ã/ë ó ïîëîâèíû)
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#11
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Ó÷èòûâàÿ âîçðàñò, èìååòñÿ îïðåäåëåííûé ðèñê è îáíàðóæåíèÿ Â12 äåôèöèòíîé àíåìèè; íåò ïîä ðóêîé èíûõ äàííûõ, íî âîò ÷òî ïèøóò òóðåöêèå êîëëåãè î ñâîèõ ïîæèëûõ:
Prevalence of anemia was found 7.3%. Prevalence of iron deficiency, vitamin B12, and folic acid deficiency were found 7.1%, 64.2% and 10.9%, respectively. Prevalence of iron deficiency anemia was found 2.8%. Prevalence of vitamin B12 deficiency anemia was found 4.4% and folic acid deficiency anemia was found 1%. Arch Gerontol Geriatr. 2015 Mar-Apr;60(2):344-8. The prevalence of anemia, iron, vitamin B12, and folic acid deficiencies in community dwelling elderly in Ankara, Turkey.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#12
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ÎÊ. Çàâòðà ïåðåñìîòðþ âñå àíàëèçû è âîçüìó ôåððèòèí.
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#13
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À Âû óâåðåíû, ÷òî "ãîëîâíàÿ áîëü, ãîëîâîêðóæåíèå, òÿæåñòü â çàòûëêå, òîøíîòà." âûçâàíû ïîâûøåíèåì àðòåðèàëüíîãî äàâëåíèÿ? Ãîëîâîêðóæåíèå ó íå¸ ñèñòåìíîå èëè íåñèñòåìíîå?
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#14
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Ïî÷åìó-òî ñóùåñòâóåò ðàñõîæåå ìíåíèå, ÷òî ïîâûøåííîå äàâëåíèå äàåò êàêèå-òî æàëîáû (ãîëîâíàÿ áîëü, òÿæåñòü â ãîëîâå è ò.ä.). Íà ñàìîì äåëå ïîâûøåííîå äàâëåíèå âîîáùå íèêàê íå ïðîÿâëÿåòñÿ, ëþäè ñåáÿ ïðåêðàñíî ÷óâñòâóþò. Êîãäà äàâëåíèå íà÷èíàåò ïðîÿâëÿòüñÿ, òî ýòî óæå íà÷èíàþòñÿ îñëîæíåíèÿ òå÷åíèÿ ãèïåðòåíçèè, ò.å. ÷òî-òî òèïà ÒÈÀ èëè ïðèâû÷íîå äëÿ Ðîññèè ïîíÿòèå "ãèïåðòåíçèâíûé êðèç".
Äðóãîå äåëî, ÷òî çàáîëåâàíèå ãîëîâû/ìîçãà ìîæåò áûòü ïàðàëëåëüíûì è íå ñâÿçàííûì ñ ïîâûøåííûì äàâëåíèåì.
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#15
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Öèòàòà:
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Ñ óâàæåíèåì |