Tej zaum koj yuav tau hnov txog ntshav siab lossis ntshav siab. Tab sis, koj puas tau hnov hnov mob siab (siab phem) kub siab? Malignant hypertension yog kev tawm tsam ntawm cov ntshav siab uas muaj qhov cuam tshuam sai thiab ua rau ib lossis ntau lub nruab nrog cev hauv lub cev. Tus mob no hnyav heev uas nws suav tias yog xwm txheej ceev. Yog koj xav tias koj lossis lwm tus muaj lub siab kub siab, mus ntsib tsev kho mob ze tshaj tam sim.
Kauj ruam
Ntu 1 ntawm 3: Paub txog Cov tsos mob ntawm Kev Ua Phem Tsis Zoo
Kauj Ruam 1. Paub qhov txawv ntawm qhov kub thiab txias
Hauv kev kub siab zoo ib yam, ntshav siab tuaj yeem qis qis dua ob peb lub lis piam lossis hli nrog kev saib xyuas mob nkeeg. Hauv kev mob ntshav siab hnyav, tus mob yuav tsum raug tswj tam sim nrog cov tshuaj ntshav siab txo qis tshuaj. Yog tias tsis tswj, ntshav siab yuav ua rau cov hlab ntsha hauv lub hlwb, qhov muag, ob lub raum, thiab lub plawv. Yog tias koj muaj lub siab kub siab, koj tus kws kho mob yuav tshuaj xyuas thiab kho qee yam tsos mob uas koj tab tom ntsib.
- Malignant hypertension yog lub sijhawm qub los ntawm xyoo 1920. Niaj hnub no, tus mob no feem ntau raug xa mus rau qhov xwm txheej kub siab. Kev kub ntxhov ceev yog thaum koj cov ntshav siab systolic siab tshaj 180 thiab koj cov ntshav siab diastolic siab dua 120
- Kwv yees li 1/3 ntawm cov neeg Amelikas muaj ntshav siab, tab sis tsuas yog 1% muaj qhov ua rau mob ntshav siab lossis ntshav siab. Tus so tsuas yog muaj ntshav siab ib txwm muaj.
Kauj Ruam 2. Txiav txim seb puas muaj lub hlwb puas
Yog tias koj muaj ntshav siab heev, koj tus kws kho mob tseem yuav tshuaj xyuas cov tsos mob ntawm kev puas tsuaj rau koj lub cev lub hauv paus paj hlwb:
- Mob taub hau hnyav, tshwj xeeb tshaj yog thaum koj sawv. Nov yog cov tsos mob tshwm sim feem ntau pom, txawm tias koj yog tus tsos mob pom.
- Ntuav, tsis muaj lwm cov tsos mob ntawm txoj hnyuv (piv txwv li raws plab).
- Qhov muag tsis pom kev
- mob stroke
- ntuav
- Lub taub hau raug mob.
- Qhov o ntawm qhov muag optic disc hauv qhov muag. Tus kws kho mob yuav nthuav cov tub ntxhais kawm kom pom daim disk, uas feem ntau muaj cov npoo zoo. Yog tias koj muaj lub siab kub siab, koj tus kws kho mob yuav pom lub disc uas qhov muag plooj nrog cov npoo tsis xwm yeem.
- Me ntsis los ntshav hauv qhov muag. Feem ntau qhov no yog tshwm sim los ntawm kev tawg ntawm cov hlab ntshav me me hauv lub qhov muag vim ntshav siab.
Kauj Ruam 3. Txiav txim seb puas muaj kev puas tsuaj rau lub plawv
Cov tsos mob ntawm kev mob ntshav siab tsis tshua muaj cuam tshuam rau lub plawv ntawm tus neeg mob. Cov tsos mob tuaj yeem tshwm sim ua pa luv thaum tsis ua haujlwm, nquag, lossis pw. Qhov no yog vim tias cov kua tuaj yeem sau hauv lub ntsws thaum lub siab sim tso dej tawm tsam nws. Koj kuj tseem yuav hnov mob hauv koj lub hauv siab thaum koj lub siab sim siv ntshav tawm tsam cov ntshav siab ua rau koj lub plawv. Koj tus kws kho mob yuav ua qhov kev kuaj mob lub cev txhawm rau nrhiav cov tsos mob zoo ib yam nrog lub plawv tsis ua haujlwm, xws li:
- Cov hlab ntsha jugular yog qhov tseem ceeb hauv caj dab.
- Ntshav nce cov hlab ntsha jugular hauv lub caj dab thaum koj lub plawv raug thawb (hepatojugular reflux)
- Peb swell (pedal edema)
- Lub suab thib peb lossis plaub lub suab hu ua "gallop" vim qhov ua kom cov hlab ntshav hauv lub plawv nrog ntshav (tuaj yeem pom ntawm EKG)
- Xoo hluav taws xob pov thawj ntawm lub plawv tsis ua haujlwm, kua hauv lub ntsws, lossis lub plawv loj dua.
- Tshuaj lom neeg tsim los ntawm cov hlab plawv congestive (hom B Natriuretic Peptides thiab Troponins). Cov tshuaj no tuaj yeem nrhiav tau nrog kev sim hauv chaw kuaj ntshav thiab qee qhov kev kuaj ntxiv yog tias tus kws kho mob xav tias kev puas tsuaj tshwm sim los ntawm lwm yam.
Kauj Ruam 4. Txiav txim siab seb puas muaj kev puas tsuaj rau ob lub raum
Koj tus kws kho mob yuav kuaj ntsuas koj lub raum kom txiav txim siab koj lub raum ua haujlwm. Kev kuaj lub raum thiab paj hlwb feem ntau pom ua ke nyob rau hauv siab mob siab. Koj tus kws kho mob yuav tshuaj xyuas:
- Tawv ntawm ob txhais ceg (pedal edema).
- Lub suab nrov hauv koj cov hlab ntsha hauv lub raum (lub raum lub cev) uas qhia tias cuam tshuam rau cov ntshav ntws.
- Protein hauv koj cov zis tsom xam. Txij li ob lub raum yuav tsum lim cov protein, qhov no qhia tau tias lub raum lub chaw lim dej tau raug puas tsuaj los ntawm kev nce ntshav siab.
- Qhov piv ntawm Ntshav Urea Nitrogen (Ntshav Urea Nitrogen lossis BUN) thiab Creatinine (Creatinine lossis Cr) hauv cov ntshav. Qhov qub BUN/Cr piv yog 1, thiab nce ntxiv 1 txhua hnub vim yog lub raum puas. Piv txwv li, BUN/Cr piv ntawm 3 qhia tias lub raum puas tau tshwm sim rau 3 hnub.
Kauj Ruam 5. Paub qhov txawv ntawm thawj thiab theem ob mob qog noj ntshav siab
Thawj qhov ua rau lub siab kub siab txhais tau tias yog ntshav siab ib txwm ua sai sai thiab ua rau lub cev puas tsuaj. Secondary malignant hypertension yog tshwm sim los ntawm lwm yam kab mob. Koj tus kws kho mob yuav xaj kom kuaj ntshav ntau ntxiv lossis tshawb fawb duab txhawm rau txheeb xyuas qhov ua rau. Kho cov ntshav siab los ntawm kev txo cov ntshav siab yog qhov tseem ceeb, tab sis kho tus kab mob uas ua rau nws tseem ceeb ib yam. Nov yog qee qhov laj thawj thib ob ntawm kev ua rau lub siab kub siab (thiab lawv cov kev kho mob):
- Cev xeeb tub (piv txwv li preeclampsia): Kev kho mob zoo tshaj plaws yog yug menyuam, tab sis cov tsos mob tuaj yeem kho ib ntus nrog tshuaj yog tias tus menyuam lub ntsws tsis loj hlob thiab leej niam pom cov tsos mob ntawm lub paj hlwb. Thaum cev xeeb tub, qhov xwm txheej kub siab yuav tsum tau kho nrog magnesium sulfate, methyldopa, hydralazine, thiab/lossis labetalol.
- Cocaine siv/siv tshuaj ntau dhau, kho raws li thawj qhov ua rau mob ntshav siab.
- Kev tshem dej cawv: Tshuaj (benzodiazepines) tau siv los kho tus mob ntshav siab vim yog haus cawv.
- Nres beta beta blockers: Nres beta beta blockers lossis tshuaj noj ntshav siab ib ntus yuav ua rau muaj kev thim rov qab yog li beta blockers yuav raug sau tseg los kho tus mob ntshav siab no.
- Ua txhaum alpha blockers (clonidine)
- Lub raum stenosis, lossis nqaim ntawm cov hlab ntsha hauv lub raum ua rau ob lub raum. Kev kho yog phais mob (angioplasty) kom nthuav dav cov hlab ntsha.
- Pheochromocytoma: Tumor ntawm cov qog adrenal uas feem ntau kho los ntawm kev tshem cov qog.
- Coactarition ntawm aorta, uas yog luv luv ntawm aorta uas yog qhov tsis xws luag los. Kev kho yog nqa tawm los ntawm kev phais.
- Hypothyroidism: Kev kho mob nrog tshuaj, phais, lossis beta blockers.
- Aortic dissection, uas yog kua muag hauv aorta. Kev kho mob yog ua tiav nrog kev phais tsis pub dhau ob peb teev vim tias tus mob no ua rau neeg tuag taus.
Ntu 2 ntawm 3: Siv Tshuaj
Kauj Ruam 1. Tham nrog koj tus kws kho mob txog kev siv tshuaj kho tus mob ntshav siab
Vim tias muaj ntau yam los txiav txim siab thaum kuaj ntshav siab, tsis muaj cov txheej txheem txheej txheem hauv chaw muag tshuaj lossis kho mob uas tuaj yeem pom zoo. Koj tus kws kho mob yuav tshuaj xyuas koj li keeb kwm kev kho mob thiab mob tam sim no ua ntej pib kho tam sim.
Koj tus kws kho mob yuav tsum paub siv cov tshuaj (tshwj xeeb tshaj yog tias muaj qhov ua rau muaj ntshav siab tsis zoo), cov peev txheej muaj nyob ntawm chaw kho mob, thiab qib kev paub kho mob muaj
Kauj Ruam 2. Npaj rau kev kho mob
Tus kws kho mob yuav sim txo cov ntshav siab mus rau qib nyab xeeb hauv 1 teev (feem ntau yog txo qis ntawm 10-15%). Koj cov ntshav siab yuav tsum txo qis ntxiv hauv 24-48 teev tom ntej, thaum koj tseem nyob hauv kev saib xyuas hnyav. Tom qab ntawv koj tus kws kho mob yuav tsum tsis txhob siv cov tshuaj tua kab mob los yog qhov ncauj los npaj koj rau kev tso tawm.
Kev kho mob siab rau siab yog ib txwm siv tshuaj/tus neeg sawv cev tso tshuaj. Thaum qhov kev siv tas lawm, koj yuav tau txais tshuaj nyob rau tib chav kawm hauv qhov me me
Kauj Ruam 3. Pib nrog labetalol
Labetalol yog beta blocker uas tiv thaiv kev cuam tshuam ntawm epinephrine thiab adrenaline. Koj yuav tau txais cov tshuaj no yog tias koj muaj lub plawv nres (myocardial infarction lossis angina) vim muaj kev kub siab. Cov tshuaj no ua haujlwm sai los txo cov ntshav siab thiab yog ib qho yooj yim-rau-hloov kho tshuaj txhaj tshuaj.
Vim tias lub ntsws tseem muaj beta-receptors, labetalol tsis tau muab ncaj qha rau cov neeg mob ntsws ntsws los ntawm kev mob ntshav siab
Kauj Ruam 4. Siv nitroprusside los nthuav cov hlab ntsha thiab txhim kho cov ntshav ntws
Nitroprusside yog vasodilator, tshuaj siv los qhib lossis qhib cov hlab ntshav kom cov ntshav siab sai sai. Vim tias cov tshuaj tso kua dej tso rau hauv (IV) txuas ntxiv mus tas li, qhov koob tshuaj tuaj yeem hloov pauv hauv thaj tsam ntawm 0.25-8.0 g/kg/min. Ib txoj kab sensor yuav tsum tau muab tso rau hauv cov hlab ntsha femoral kom nws tuaj yeem saib xyuas tas li.
- Koj yuav raug saib xyuas txuas ntxiv thaum tau txais nitroprusside. Vim tias cov tshuaj no ua haujlwm sai, qhov poob ntawm cov ntshav siab tuaj yeem tshwm sim sai dhau. Qhov mob no tuaj yeem tsim kev phom sij rau cov ntshav uas nkag mus rau hauv lub hlwb. Hmoov zoo, qhov ntau npaum ntawm cov tshuaj no yooj yim los kho.
- Fenoldopam yog lwm tus neeg sawv cev vasodilator nrawm thiab pom zoo rau cov neeg mob uas lub raum tsis ua haujlwm.
Kauj Ruam 5. Dilate cov hlab ntsha siv Nicardipine
Nicardipine yog calcium-channel blocker (calcium-channel blocker) uas ua haujlwm nrog calcium channel cells hauv cov leeg nqaij hauv cov hlab ntshav.
Nicardipine tau yooj yim hloov kho rau kev tswj ntshav siab. Cov tshuaj no tseem yooj yim hloov mus rau noj tshuaj, xws li Verapamil
Kauj Ruam 6. Siv tshuaj uas tsis tshua muaj neeg siv
Nyob ntawm koj qhov kev xav tau kev kho mob, koj tus kws kho mob yuav kho koj nrog ib qho ntawm cov tshuaj hauv qab no:
- Hydralazine: Siv los tswj kev kub siab ua phem rau poj niam cev xeeb tub kom muaj kev nyab xeeb ntawm tus menyuam hauv plab.
- Phentolamine: Siv tshwj xeeb yog tias koj tau lees paub tias koj muaj lub siab kub siab vim yog qog ntawm cov qog adrenal (pheochromocytoma).
- Lasix: Siv los ua kom tiav kev kho mob ntshav siab. Cov tshuaj no yog diuretic, yog li nws ua rau tso zis ntau. Cov tshuaj no muaj txiaj ntsig yog tias koj muaj mob ntsws lossis ua rau lub raum tsis ua haujlwm raws li cov tsos mob ntawm ntshav siab.
- Enalapril: ACE inhibitor uas ua haujlwm los ntawm kev thaiv cov hlab ntshav, tab sis nws tseem tuaj yeem siv rau lub raum tsis ua haujlwm.
Ntu 3 ntawm 3: Tswj ntshav siab
Kauj Ruam 1. Ua haujlwm ze nrog koj tus kws kho mob
Koj yuav tsum ua raws li kev qhia kho tus kws kho mob. Tsis txhob ncua thiab zoo ib yam txog kev mus ntsib koj tus kws kho mob. Koj yuav tsum tau ua haujlwm ua ke kom ua tiav lub hom phiaj rau koj cov ntshav siab, feem ntau, lub hom phiaj ntshav siab tsawg dua 140/90.
Kauj Ruam 2. Tswj cov zaub mov muaj sodium tsawg
Nco ntsoov tias koj haus ntau tshaj 2,000 mg ntawm sodium txhua hnub. Cov sodium ntau dhau yuav ua rau kom ntshav siab thiab ua rau koj muaj kev pheej hmoo ntawm kev mob plawv nres thiab mob stroke. Nco ntsoov tias koj noj cov txiv hmab txiv ntoo thiab zaub tshiab thiab nyob deb ntawm cov zaub mov tiav. Cov zaub mov no tuaj yeem muaj sodium ntau.
Tiv thaiv kev ntxias kom yuav cov zaub mov kaus poom, vim nws feem ntau muaj ntsev kom khaws cov xim thiab tshiab ntawm cov zaub mov. Yog tias koj yuav cov zaub mov kaus poom, saib cov zaub mov kaus poom uas muaj sodium tsawg thiab tsis muaj ntsev
Kauj Ruam 3. Ua kom lub cev ua haujlwm zoo
Txawm hais tias koj cov dej num yuav raug txwv kom txog thaum koj raug tso tawm hauv tsev kho mob, koj tuaj yeem rov pib ua haujlwm ib txwm muaj thiab tawm dag zog thaum koj cov ntshav siab tau ruaj khov. Koj tuaj yeem ua aerobics (cardio), hnyav lossis qhia ua haujlwm hnyav, thiab kev qhia ua haujlwm tiv thaiv isometric. Txhua qhov kev tawm dag zog no yuav txo qis ntshav siab thiab systolic. Systolic ntshav siab ntsuas lub siab thaum lub plawv sib cog lus thaum diastolic ntshav siab ntsuas lub siab thaum lub plawv so ntawm kev ntaus.
Cov neeg laus yuav tsum ua haujlwm tag nrho li 2 teev 30 feeb hauv ib lub lis piam, raws li Tus Kws phais neeg mob. Sim ua kom qoj ib ce muaj zog, xws li taug kev, caij tsheb kauj vab, lossis ua luam dej
Kauj Ruam 4. Poob qhov hnyav, yog tias koj rog
Yog tias koj rog, koj cov hlab ntsha yuav tsum ua haujlwm hnyav dua kom muab lub cev nrog cov ntshav, ua kom ntshav siab ntxiv. Txiav txim siab koj lub cev qhov hnyav (BMI) siv lub laij lej online. Raws li Lub Chaw Tiv Thaiv Kab Mob, koj rog dhau yog tias koj muaj BMI ntawm 30 lossis ntau dua. Sim ua kom poob phaus thiab BMI rau ntawm 25-30.
Txo cov calories kom tsawg thiab ua haujlwm tsis tu ncua. Qhov no yog txoj kev nyab xeeb tshaj plaws kom poob phaus
Kauj Ruam 5. Txiav luam yeeb
Kev haus luam yeeb txo qis cov pa oxygen uas nkag mus rau hauv lub plawv, nce ntshav siab, ua rau cov ntshav khov, thiab ua rau cov cell puas tsuaj uas ua rau cov hlab plawv thiab lwm cov hlab ntshav. Yog tias koj yog tus neeg haus luam yeeb, koj yuav muaj kev pheej hmoo loj hlob tuaj ntxiv, uas tuaj yeem ua rau muaj kev kub siab tsis zoo.
