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高血压:诊断 – 译学馆
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高血压:诊断

Hypertension: Diagnosis – Family Medicine | Medical Video

好 现在我们要谈一下高血压 它是我临床诊断中遇到的最常见的疾病之一
All right. Now we are gonna discuss hypertension which is one of most common diagnose in my practice.
不幸的是 随着美国人口的老龄化
And unfortunately across the United States,hypertension is getting more common
高血压越来越普遍了
as our population ages.
而且越来越严重
And also gets heavier.
所以 对高血压的了解是非常重要的
So it’s really important to understand hypertension.
它的诊断及处理
Its diagnosis and management.
正是我们要讨论的
That’s exactly what we are about to do.
我们从这个病例开始吧 我有一个51岁的女患者
So let’s start with the case: I’ve got a fifty-one-year-old female.
没有病史 没有用过药 很好
No past medical history, taking no medications.Good for you.
但是她今天的血压是146/90
But her blood pressure today is 146/90.
脉搏是一分钟86次
And her pulse is 86 beats per minute.
其他体检项目并无异常
The rest of her physical examination is unremarkable.
那么 下一步该怎么对她护理呢
So what’s the next best step in her care?
我们让她改变一下生活方式 一两周后对她的血压复查
Shall we talk about lifestyle changes and recheck her blood pressure in 1 to 2 weeks?
还是用噻嗪类利尿剂治疗
Or shall we start to run a thiazide diuretic?
还是使用血管紧张素转化酶抑制剂 或者血管紧张素受体阻滞剂
Or start an ACE inhibitor or angiotensin receptor blocker?
还是她的血压实际是在正常范围内的
Or is her blood pressure actually within normal limits
所以我们到明年再为她做一次健康检查
and therefore we can just see her next year for another wellness examination.
你会怎么选择呢
What would you choose?
答案是A
Now the answer is A.
很明显 这个案例应该选A
And it’s pretty clearly A in this case.
因为 你要记住 至少经过两次独立测量 血压达到140/90或者更高
Because remember that the diagnosis of hypertension requires a blood pressure reading up 140/90 mm or more
才被诊断为高血压
on at least two separate occasions.
现在数字可能会有一些争议
Now the number maybe a little bit controversial you’ll see
不同的组织会有不同的建议
different recommendations from different groups
但是目前来说140/90是公认的了
But 140/90 is generally the consensus now.
毫无疑问 按照规定 我必须至少独立测量两次
And it’s certainly the consensus broadly that it asks me to measure in at least two occasions.
所以 最好是患者能够在家做测试
So it’s best that if the patient can do some testing at home,
与在办公室测的血压相比 家测血压
home blood pressure is more correlated than office blood pressure,
能够更好地为中风 心肌梗塞此类心血管疾病的发生进行预警
with cardiovascular events like stroke and myocardial infarction
如果他们可以在不同时间 早上和晚上 用不同的胳膊测量
And if they can vary the time, morning and night,on both arms
是的 实际上 很多患者可以做到
Yes,in terms of practicality and can a lot of patients do that,
一些可以 一些不能
some can,some cannot.
你想要看到是 经办公室和家庭测量确认
you want to see a blood pressure that’s high in both office setting
都高的血压
and the home saying that is validating.
我们内科医生唯一能做的事情就是 分别给你的两只胳膊测量血压 并同时站着量与做着量一次
And one thing we can do as physicians is that there’s some value in doing both sitting and standing,
这样数据是有价值的
a blood pressure in both arms in the office
那为我们提供了更真实的数据
And that gives us a slightly truer reading
因此 能更准确地预测未来心血管疾病发生的风险
and therefore a higher accuracy for the future risk of cardiovascular events.
那么记住 对于六十岁以上的患者来说
So remember that among patients who are older than 60 years
这个观点是
this is a controversial
有争议的
idea
但是这是《联合委员会第八次报告》就血压给出的建议的一部分
but It’s a part of what the Joint National Commission Eight recommended for blood pressure
即对他们来说 血压的安全范围上限可以提高到149毫米汞柱
that their blood pressure can be allowed to increase up to 149 mmHg safely.
当然 我们看到过老年人因急于治疗血压而陷入麻烦
Certainly we see older adults getting in trouble with too aggressive a treatment of blood pressure
尤其是在我接触的病例中八十岁以上的患者
and particularly in my practice patients over eighty years old
那些身体更虚弱的人
those who might be a little bit of more frail
他们看起来可能61岁了 但是如果他们身体很虚弱 也许实际只有41岁
who may be 61 years old but they may be 41 years old if they are very frail.
他们急于把血压降到收缩压的标准水平120 我感到很担心
I get nervous about trying to push their blood pressure towards those normal 120 systolic levels.
血压可以再高一些
and they may be allowed to go up a little bit
有人说 我85岁了 仍然精力充沛
That said i’ve got eighty-five-year-olds who are very vital and active
对他们来说 我坚持让他们把血压控制在140以内
and for them I maintain that blood pressure target of less than 140
所以我真的认为 取决于你和患者本人
So it’s really I think up to you and your individual patient
年龄是基本准则
the age provides a basic guideline
但是还要注意 把身体虚弱的患者血压
but it’s more about the risk of pushing your patient too low with their blood pressure
降得过低风险更大
for that individual patient how frail they are.
现在《联合委员会第八次报告》不再建议 我们治疗的时候
Now and the JNC 8 no longer recommends that the systolic blood pressure we treated less than 130 mm of mercury
把糖尿病或者慢性肾病患者的收缩压降到130毫米汞柱以下
among patients with diabetes or with chronic kidney disease
那么《联合委员会第八次报告》不高于140/90的标准适合除老年人
so the 140 over 90 or below standard fits all except for older adults
之外的所有人
for JNC 8.
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视频概述

随着美国人口不断老龄化,高血压越来越普遍。本课程邀请的美国知名内科医生就高血压的诊断及处理做了相关的介绍。

听录译者

打完沁园好睡觉

翻译译者

Jessie

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译学馆审核团J

视频来源

https://www.youtube.com/watch?v=zY4A4GzYAxM

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