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高血压:特殊治疗 – 译学馆
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高血压:特殊治疗

Hypertension: Specific Treatment – Family Medicine | Medical Video

当然了 针对临床可能遇到的情况
And of course, there is JNC 8 includes some specific recommendations
高血压指南给出了一些具体的建议
based on the patient you may see.
这些建议有利于高血压检查
And these are good things that may come up on your examination,
当然也有利于临床治疗
certainly come up in clinic.
黑人病人对钙通道阻滞剂和噻嗪类利尿剂
Black patients respond better to drugs like calcium channel blockers and thiazide diuretics
比对血管紧张素转换酶抑制剂更敏感
versus drugs like ACE inhibitors.
如果他们患有慢性肾病
If they have chronic kidney disease,
可以使用血管紧张素转换酶抑制剂或者血管紧张素Ⅱ受体拮抗剂
try to initiate an ACE inhibitor or an ARB
并滴定适度的剂量
and titrate to at least moderate doses,
这样可以减缓慢性肾病发展的进程
it will slow the progression of chronic kidney disease.
当然 还应密切关注这些患者肌酐和钾的情况
Of course, watch the creatinine and watch the potassium in those patients, too.
对患有冠心病的患者来说
Among patients with coronary artery disease,
最好的药物是β-受体阻滞剂
the best drugs are a β-blocker
以及血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂
and an ACE inhibitor or an angiotensin receptor blocker
用以预防心脏病的复发
for preventing recurrent cardiac events.
对糖尿病患者 可以使用血管紧张素转换酶抑制剂或者血管紧张素Ⅱ受体拮抗剂
And diabetes, start an ACE inhibitor or ARB,
因为它有利于缓解肾病
because it can help with nephropathy.
但是 要记得 对于没有肾病的患者
Interestingly though, remember that patients who don’t have nephropathy,
他们患有糖尿病时 不一定能从血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂中获益
don’t necessarily benefit from an ACEI or ARB when they have diabetes.
所以确实只有在患者出现肾病之后
So it’s really only after they develop nephropathy
或者在患者患有糖尿病和高血压的情况下
or when they have diabetes and hypertension,
你才应采用血管紧张素转换酶抑制剂或者血管紧张素Ⅱ受体拮抗剂
that you introduce an ACEI or ARB.
还有就是非双氢吡啶类钙通道阻滞剂也能有效
And then, finally, non-dihydropyridine calcium channel blockers can be effective.
糖尿病患者无法耐受血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂
They can’t tolerate an ACEI or an ARB in those patients with diabetes.
接下来我们讲一讲心衰时需要用到的几种药物
And I’ll talk a heart failure requires a few different drugs.
核心药物有
The core drugs are listed there:
血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂二选一 再加上β-受体阻滞剂
either an ACEI or an ARB plus a beta blocker,
同时还要考虑给患者用上螺内酯
and then consider spironolactone for those patients, too.
内容的确很多
That’s a lot.
你或许感觉很累很迷茫
And you can feel really stressed out and lost,
我懂
and I understand that.
但你没必要太过关注最初的选择
But you don’t want to get too overly focused on the initial choice.
我看到许多临床医生特别纠结
I see a lot of clinicians really struggling,
到底那种办法对患者最好
okay, what’s the best choice for my patient.
指南给出了不同的级别药物之间的界限
JNC8 gives you latitude between several different classes of drugs,
不过不用太担心
but don’t worry about too much.
因为通常你会考虑加上二线药物
Because oftentimes, you’re going to be adding a second,
甚至三线药物给高血压患者使用
or even a third agent onto those patients with hypertension.
所以你最开始用的这种药的独角戏唱到
So the one you start now will be a solo act
二到四周后患者来复诊的时候也就结束了
for only the next two to four weeks till you evaluate the patient again.
如果他们的血压居高不下 你或许会加用二线药物
If their blood pressure is still up, you might add a second agent.
然后 还有 当你选择药物时
And then, also, when choosing drugs,
切记
don’t forget that,
一定记得那个数字是最重要的
really it’s that number is the most important thing.
当你面对一个患有糖尿病和肾病的病人
So say you have a patient with diabetes and nephropathy,
当你给他们用这些药物中的任何一种都有问题
but they really have a hard time taking any of those drugs,
非双氢吡啶类钙通道阻滞剂 ACE抑制剂 ARB
the non-dihydropyridine calcium channel blocker, ACE inhibitor, ARB.
他们不能耐受其中任何一个的时候
They can’t tolerate either.
他们唯一能耐受并且好用的是
But they really enjoy what they, the only thing they can tolerate is,
α拮抗剂或β受体阻滞剂
an alpha antagonist or a beta blocker.
你明白这对他们来讲并不是最理想的药物
You know it’s not the ideal drug for that patient,
但如果这样做能让他们的血压降到目标值
but if it gets their blood pressure down towards goal,
对他们长期的身体状况来说
that’s much more important than getting them just
这比单纯追求用药的准确性重要的多
the the right drug for their chronic medical condition.
希望今天对高血压的简短回顾能够帮到大家
Hopefully, that was really helpful in our brief review of hypertension.
我喜欢它 我很乐意准备这些
I enjoyed it. I enjoyed preparing it.
相信这能帮到你的许多病人
And I think it will help a lot of your patients.
谢谢
Thanks!
现在继续收看我的课程 或者查看我的YouTube播放列表
Continue my course now! Or check out my YouTube playlist.

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视频概述

该视频介绍了高血压指南中的高血压治疗方法。

听录译者

【MED】小勇

翻译译者

【MED】清泉

审核员

审核员E

视频来源

https://www.youtube.com/watch?v=2uQAQmi4REk

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