肾上腺切除术治疗高血压合并肾上腺疾病的临床研究

发布时间：2018-05-23 19:33

  本文选题：继发性高血压 + 肾上腺疾病　； 参考：《山东大学》2017年硕士论文

【摘要】：背景:高血压疾病是临床上最常见的疾病之一,全世界范围内约14亿的成人患病,在我国估计至少有2亿患者饱受其困扰。长期高血压状态极易引起心脏、脑、肾脏等靶器官的损害,表现出头晕、头痛、心悸、耳鸣等症状,极大地影响生活质量,危害生命健康。对于继发性高血压,特别是肾上腺疾病所致的高血压者,其发病率在近年来逐渐升高,而此类患者手术治疗效果较为显著。因此,鉴别高血压的发病原因,使治疗有的放矢,改善患者预后,显得尤为重要。目的:研究高血压患者肾上腺切除术后血压的变化,探讨其影响影响因素方法:本文统计了本病区从2014-2016年患肾上腺疾病合并高血压的181例临床资料,所有患者均行肾上腺切除术,所有影响因素均通过logistics回归分析。结果:经过分析研究,有107(59.1%)例完全缓解,而67(37.0%)例部分缓解,最后有7(3.9%)例的患者仍为抵抗性高血压。多于2种抗高血压药物的使用P0.001),高血压病程p0.001),低血钾病程(p= 0.038),收缩压(p = 0.016)以及醛固酮水平(p0.001)可能与之密切相关。但是logistics曲线分析显示只有术前抗高血压药物使用的种类2种(OR = 0.602,95%CI 0.410-0.783,p = 0.001),高血压病程≥6年(OR = 0.496,95%Cl 0.323-0.762,p=0.001)以及血浆醛固酮水平 ≥ 35 ng/dl(OR = 0.503,95%CI 0.326-0.776,;p = 0.001)才是特异性的指标。结论:这项研究涵盖众多患者,显示只有高血压病程,术前服药数量以及血浆醛固酮水平才是影响肾上腺切除术后患者的血压水平的因素。因此这项研究最终强调了肾上腺性高血压需要早发现,早治疗,以免引起不理想的降压的效果。
[Abstract]:Background: hypertension is one of the most common diseases in clinic. About 1.4 billion adults worldwide suffer from hypertension. Long-term hypertension is easy to cause heart, brain, kidney and other target organ damage, showing dizziness, headache, palpitations, tinnitus and other symptoms, greatly affect the quality of life, endangering life and health. The incidence of secondary hypertension, especially that caused by adrenal diseases, has increased gradually in recent years. Therefore, it is very important to distinguish the causes of hypertension, to improve the prognosis of patients. Objective: to study the changes of blood pressure after adrenalectomy in patients with hypertension. Methods: 181 cases of adrenal diseases complicated with hypertension from 2014-2016 in our hospital were analyzed. All patients underwent adrenalectomy and all influencing factors were analyzed by logistics regression analysis. Results: after analysis, there were 107 cases of complete remission, 67 cases of partial remission, and finally 7 cases of 3. 9% of the patients were still resistant to hypertension. The use of more than 2 antihypertensive drugs, the course of hypertension, the course of hypokalemia, the course of hypokalemia and systolic blood pressure (P = 0.016) and aldosterone level (p 0.001) may be closely related to it. But the logistics curve analysis showed that only the two kinds of antihypertensive drugs used before operation, CI 0.410-0.783p = 0.001, the duration of hypertension 鈮，

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