Tlhophiso ea methati ea khatello ea mali

Tlas'a polelo "khatello ea kelello ea methapo", "khatello ea kelello ea methapo"e bua ka khatello e phahameng ea mali (BP) ho khatello ea mali le matšoao a methapo ea mali.

Ho lokela ho hlakisoa hore phapang ea semantic ho latelakhatello ea mali"le"khatello ea mali"H joalo. Ho latelang ho tsoa ho etymology, hyper - ho tsoa ho Greek. ho ea pele, polelo ea sehlooho - e bontšang ho fetelletseng hoa tloaelo, tensio - ho tloha Lat. - tsitsipano, tonos - ho tsoa ho Greek." Khohlano. Kahoo, mantsoe "hypertension" le " khatello ea mali "ha e le hantle e bolela ntho e tšoanang -" ho fetelletsa litaba ".

Ho latela nalane (ho tloha mehleng ea G.F. Lang) ho hlahile hore lebitso "hypertension", 'me ho ea ka moo, "hypertension hypertension" le sebelisoa Russia, "khatello ea kelello ea methapo".

Hypertension (GB) e utloahala hangata e le lefu le sa foleng, ponahatso ea mantlha ea eona ke lefu la khatello ea methapo, le sa amaneng le boteng ba methapo eo ho eona keketseho ea khatello ea mali (BP) e tsejoang, maemong a mangata e tlositsoeng, lisosa ("matšoao a methapo ea methapo ea mali") (Litlhahiso tsa GFCF, 2004).

I. Mekhahlelo ea khatello ea mali:

  • Mohato oa pele oa Hypertension (GB) e fana ka maikutlo a ho ba teng ha liphetoho ho "litho tsa" sepheo.
  • Mohato oa II oa khatello ea mali e thehiloe boteng ba liphetoho ho tsoa ho "setho se le seng" kapa "tse ling".
  • Sethala sa lefu la Hypertension (GB) III e thehiloe boteng ba maemo a amanang le kliniki.

II. Boemo ba khatello ea methapo ea mali:

Tekanyo ea methapo ea methapo ea methapo ea methapo (khatello ea mali (BP)) e hlahisoa ka har'a tafole ea. Haeba boleng ba khatello ea mali (sy) le khatello ea mali (BP) bo theoha ka mekhahlelo e fapaneng, ho tla thehoa boemo bo phahameng ba khatello ea mali (AH). Ka nepahalo, tekanyo ea Arterial Hypertension (AH) e ka thehwa boemong ba lingaka tse fumanoeng tsa pele tsa lefu la Arterial Hypertension (AH) le ho bakuli ba sa noeng lithethefatsi tse felisang kalafo.

Lenane la 1. Tlhaloso le classified ea khatello ea mali (BP) (mmHg)

Tlhotlhomiso e hlahisoa pele ho selemo sa 2017 le kamora selemo sa 2017 (ka mabekeng)
Likarolo tsa khatello ea mali (BP) Khatello ea mali ea Systolic (BP) Khatello ea mali ea Diastolic (BP)
Khatello e phahameng ea mali = 180 (>= 160*)>= 110 (>= 100*)
Isolated systolic hypertension >= 140* - Tlhotlhomiso e ncha ea tekanyo ea khatello ea mali ho tloha ka 2017 (ACC / AHA Hypertension Tataiso).

I. Liphetoho:

a) Motheo:
- banna> ba lilemo tse 55 ba lilemo li
- ho tsuba.

b) Dyslipidemia
OXS> 6.5 mmol / L (250 mg / dl)
HPSLP> 4.0 mmol / L (> 155 mg / dL)
HSLVP 102 cm bakeng sa banna kapa> 88 cm bakeng sa basali

e) C-protheine e sebetsang:
> 1 mg / dl)

e) Mabaka a mang a kotsi a amang hampe menyetla ea mokuli ea nang le lefu la methapo ea kutlo (AH):
- Ho mamelloa ha tsoekere e matla
- Mokhoa oa bophelo bo kopanetsoeng
- Ho eketseha ha fibrinogen

g) Lefu la tsoekere:
- glucose e potlakisang> 7 mmol / L (126 mg / dL)
- glucose ea mali ka mor'a ho ja kapa lihora tse peli ka mor'a ho nka 75 g ea tsoekere> 11 mmol / l (198 mg / dl)

II. Ho felisoa ha litho tsa sepheo (khatello ea methapo ea mali):

a) Hypertrophy ea letsoho le letšehali:
ECG: Letšoao la Sokolov-Lyon> 38 mm,
Sehlahisoa sa Cornell> 2440 mm x ms,
Echocardiography: LVMI> 125 g / m2 ea banna le> 110 g / m2 ea basali
Chest Rg - Cardio-Thoracic Index> 50%

b) Matšoao a Ultrasound a bophahamo ba lebota la arterial (botenya ba carotid intima-media layer> 0,9 limilimithara) kapa li-atherosranceotic plaques

c) Keketseho e nyane ea serum creatinine 115-133 μmol / L (1,3-1,5 mg / dl) bakeng sa banna kapa 107-124 μmol / L (1,2-1.4 mg / dl) bakeng sa basali

d) Microalbuminuria: 30-300 mg / ka letsatsi, tekanyo ea urin albumin / creatinine ratio> 22 mg / g (2,5 mg / mmol) bakeng sa banna le> 31 mg / g (3.5 mg / mmol) bakeng sa basali

III. Maemo a amanang le kalafo (a kopaneng)

a) Ka sehloohong:
- banna> ba lilemo tse 55 ba lilemo li
- ho tsuba

b) Dyslipidemia:
OXS> 6.5 mmol / L (> 250 mg / dL)
kapa HLDPL> 4.0 mmol / L (> 155 mg / dL)
kapa HPSLP 102 cm bakeng sa banna kapa> 88 cm bakeng sa basali

e) C-protheine e sebetsang:
> 1 mg / dl)

e) Mabaka a mang a kotsi a amang hampe menyetla ea mokuli ea nang le lefu la methapo ea kutlo (AH):
- Ho mamelloa ha tsoekere e matla
- Mokhoa oa bophelo bo kopanetsoeng
- Ho eketseha ha fibrinogen

g) Hypertrophy ea letsoho le letšehali
ECG: Letšoao la Sokolov-Lyon> 38 mm,
Sehlahisoa sa Cornell> 2440 mm x ms,
Echocardiography: LVMI> 125 g / m2 ea banna le> 110 g / m2 ea basali
Chest Rg - Cardio-Thoracic Index> 50%

h) Matšoao a Ultrasound a mokokotlo oa lerako la mokokotlo (botenya ba carotid intima-media layer> 0,9 limilimithara) kapa li-atherosranceotic plaques

le) Keketseho e nyane ea serum creatinine 115-133 μmol / L (1,3-1,5 mg / dl) bakeng sa banna kapa 107-124 μmol / L (1,2-1.4 mg / dl) bakeng sa basali

k) Microalbuminuria: 30-300 mg / ka letsatsi, tekanyo ea urin albumin / creatinine ratio> 22 mg / g (2,5 mg / mmol) bakeng sa banna le> 31 mg / g (3.5 mg / mmol) bakeng sa basali

l) Lefu la cerebrovascular:
Ischemic stroke
Hemorrhagic stroke
Kotsi ea nakoana ea ts'ebeliso ea methapo ea pelo

m) Lefu la pelo:
Myocardial infarction
Angina pectoris
Coronary Revascularization
Ho hloleha ha pelo ho matla

m) Lefu la fig:
Nephropathy ea lefu la tsoekere
Ho hloleha ha Renal (serum creatinine> 133 μmol / L (> 5 mg / dl) bakeng sa banna kapa> 124 μmol / L (> 1.4 mg / dl) bakeng sa basali
Proteinuria (> 300 mg / letsatsi)

o) Lefu la Artery ea Artery:
Ntoa ea Aortic e khathollang
Tšoaetso ea matšoao a methapo ea kutlo

n) Hypingency retinopathy:
Ho ruruha kapa ho honotha
Edema ea methapo ea kutlo

Lenane la 3. Rat stration ea bakuli ba nang le arterial hypertension (AH)

Litemana tse fumanehang tafoleng e ka tlase:
HP - kotsi e tlase
SD - kotsi e leka-lekaneng,
Letsatsi - likotsi tse phahameng.

Mabaka a mang a kotsi (RF) Sekhahla se phahameng
sefako
130-139 / 85 - 89
Tekanyo ea 1 ea boemo bo holimo
140-159 / 90 - 99
Hypertension 2 degrees
160-179 / 100-109
Mehato ea AG 3
> 180/110
Che
HPUreBP
1-2 FR HPUreUreBP haholo
> 3 RF kapa ho lematsa setho sa setho kapa lefu la tsoekere BPBPBPBP haholo
Litloaelano
maemo a kliniki
BP haholoBP haholoBP haholoBP haholo

Litemana tse fumanehang tafoleng e kaholimo:
HP - kotsi e tlase ea khatello ea mali,
UR - Kotsi e loketseng ea khatello ea mali,
Letsatsi - kotsi e phahameng ea khatello ea mali.

Tlhophiso ea khatello ea mali ea methapo

Ka khatello ea mali e phahameng, mokuli o eketsa khatello maemong a tsoang ho 140/90 mm Hg. ho fihlela ho 220/110. Lefu lena le tsamaisana le likotsi tse matla tsa khatello ea mali, kotsi ea ho tšoaroa ke myocardial le stroke. Karolelano e tloaelehileng ea khatello ea mali ea methapo e bakoa ke ketsahalo. Ho ipapisitse le se ileng sa fetoha tsusumetso le sesosa sa keketseho ea khatello ea mali (BP), ho na le:

  • Hypertension ea mantlha ke lefu leo ​​sesosa sa lona se ke keng sa tsejoa ka lebaka la lithuto tsa "pelo" tsa pelo, pelo, le laboratori (tlhahlobo ea mali, urine, plasma). Nalane ea khatello ea mali le sesosa se sa hlalosoang e hlalosoa e le idiopathic, e bohlokoa.

Phaello ea mali e nang le khatello ea methapo ea mantlha e tla tlameha ho boloka khatello e tloaelehileng ea mali (120/80) bophelo bohle. Hobane kamehla ho na le kotsi ea hore lefu lena le tla qala hape. Ka hona, idiopathic arterial hypertension e khetholloa e le mofuta o sa foleng. Hypertension e sa foleng, le eona e aroloa ke likotsi tsa bophelo bo botle, likhato, likhato.

  • Ts'oaetso ea khatello ea kelello ke lefu leo ​​sesosa sa lona se ka khetholloang nakong ea lipatlisiso tsa bongaka. Ho aroloa ha lefu lena ho tsoa ho lefu la methapo kapa ntho e entseng hore khatello ea mali e eketsehe.

Hypertension ea mantlha le ea bobeli e aroloa ho latela khatello ea mali:

  • Systolic, eo ho eona feela systolic, khatello ea mali e phahameng e phahamisoang. Ka mantsoe a mang, matšoao a kaholimo a tla ba fetang 90 mm Hg, e tlase - hangata 90 mm Hg. Maemong a mangata, sesosa sa ketsahalo ena ke tlolo ea tšoelesa ea qoqotho.
  • Diastolic - e eketsehile feela khatello ea mali e tlase (ho tloha ho 90 mm Hg le kaholimo), ha bokaholimo bo sa feta limilimitara tse 130.
  • Systolic-diastolic - Matšoao a 2 a ts'ebetso a fetisoa ka mokhoa oa kelello.

Classified ho latela sebopeho sa lefu lena

Hypertension ea methapo ea methapo e hlaha 'meleng ka mefuta e' meli - sesosa se kotsi. Hangata, foromo e sa tsebeng letho ka ho se phekoloe ka nako e loketseng e fetoha mofuta o kotsi oa lefu la setho.

Ka khatello ea methapo ea kutlo ho motho, khatello ea mali e qala ho eketseha - systolic, diastolic. Ts'ebetso ena ea lieha. Sesosa se tlameha ho batloa methating ea 'mele, ka lebaka leo mosebetsi oa pelo o sitoang. Ho potoloha ha mali ha mokuli ha ho khathatsehe, molumo oa mali a potolohileng oa bolokoa, empa molumo oa likepe, ho phahama ha tsona hoa fokotsoa. Ts'ebetso ena e ka nka lilemo tse ngata 'me ea tšoarella bophelong bohle.

Mofuta o mobe oa khatello ea mali o tsoela pele ka potlako. Mohlala: kajeno mokuli o na le khatello ea mali ea 150/100 mm Hg, kamora matsatsi a 7 a se a ntse a le 180/120 mm Hg. Nakong ena, 'mele oa mokuli o angoa ke lefu le kotsi le "etsang hore" pelo e otle ka makhetlo a leshome kapele. Marako a likepe a boloka molumo, ho bopa. Empa, lisele tsa myocardial ha li khone ho sebetsana le sekhahla se eketsehileng sa phallo ea mali. Ts'ebetso ea pelo le methapo e ke ke ea khona ho mamella, likepe li spasmodic. Bophelo bo botle ba khatello ea mali bo eketseha haholo, khatello ea mali e phahama ho fihlela e e-ba teng, menyetla ea ho tšoaroa ke myocardial, ho ba le lefu la sethoathoa, ho holofala, komello e eketseha.

Ka mofuta o mobe oa khatello ea mali, khatello ea mali e nyolohela ho 220/130 mm Hg. Litho tsa kahare le lits'ebetso tsa bohlokoa li ba le liphetoho tse kholo: fundus e tletse mali, retina e ruruhile, methapo ea kutlo ea khanya e kenelletse, 'me likepe li fokotsehile. Pelo, liphio le lisele tsa boko li kenella ho necrosis. Mokuli o tletleba ka bohloko bo sa feleng ba pelo, hlooho e bohloko, ho lahleheloa ke pono, ho tsekela, ho akheha.

Mokhahlelo oa khatello ea methapo

Hypertension e arotsoe ka mekhahlelo e fapaneng le khatello ea mali, matšoao, kotsi, mathata, ho holofala. Tlhophiso ea methati ea khatello ea mali e tjena:

  • Mokhahlelo oa 1 oa khatello ea mali o etsahala ka litekanyetso tsa 140/90 mm Hg. le holimo. Melao ena e ka fetoloa ntle le meriana, ka thuso ea ho phomola, ho hloka khatello ea maikutlo, ho tšoha, ho ikoetlisa ka matla.

Lefu lena le asymptomatic. Hypertonic ha e hlokomele liphetoho bophelong. Litho tse lebelletsoeng sethaleng sa pele sa ho eketsa khatello ea mali ha li utloe bohloko. Ho sithabela ha bophelo bo botle ka lebaka la ho hloka boroko, pelo, hlooho e bohloko ha li bonoe hangata.

Likoluoa ​​tse nang le khatello e matla li ka hlaha khahlano le boemo ba leholimo ba leholimo bo fetohang, kamora ho tšoha, khatello ea maikutlo, ts'abo, ts'ebetso ea 'mele. Phekolo e kenyelletsa ho boloka bophelo bo botle, pheko ea lithethefatsi. Bo-ramatiki ba ho hlaphoheloa bo monate.

  • Mokhahlelo oa khatello ea methapo ea methapo 2 o bonts'a khatello ea mali ho tloha 140-180 / 90-110 mm Hg. Tsamaiso e tloaelehileng ea khatello e fumanoa feela ka meriana. Hypertonic e tletleba ka bohloko ba pelo, ho hloleha ho phefumoloha, ho khathatsoa ke boroko, angina pectoris, kizunguzungu. Litho tsa kahare tse amehang: pelo, boko, liphio. Haholo-holo, ho latela liphetho tsa tlhahlobo, mokuli o tla ba le hypertrophy ea "ventricle" ea leqele la myocardium, spasm ea methapo ea mali, ho latela lipatlisiso - protheine ka har'a moroto, palo e fetelletseng ea "metabolinine" maling.

Tlokotsi ea khatello ea mali e lebisa ho otloa ke lefu la pelo. Mokuli o hloka kalafo e sa feleng. Hypertgency e ka etsa sehlopha sa bokooa ka mabaka a bophelo bo botle.

  • Stage 3 khatello ea mali e thata, matšoao a khatello ea mali a mokuli - 180/110 mm Hg le holimo. Ho bakuli ba nang le lefu la khatello ea mali, litho tsa sepheo sa bona li ameha: liphio, mahlo, pelo, methapo ea mali, bokong, mokhoa oa ho hema. Lithethefatsi tse thibelang antihypertensive ha li fokotse khatello ea mali e phahameng kamehla. Motho ha a khone ho sebeletsa ka boeena, o fetoha ea sa sebetseng. Ho eketseha ha khatello ea mali ho isa ho 230/120 ho eketsa kotsi ea lefu.

Tlhophiso ea WHO ea phallo ea mali (ka holimo) ea hlokahala bakeng sa tlhahlobo e kholo ea lefu lena e le ho khetha mekhoa e nepahetseng ea kalafo. Mokhoa oa phekolo ea lithethefatsi o khethiloeng ka nepo o ka tsitsisa bophelo bo botle ba khatello ea mali, oa qoba likotsi tse matla, kotsi ea khatello ea mali, lefu.

Boemo ba khatello ea mali

Hypertension e arotsoe ho latela 'malo oa khatello ea mali ka likhato: ho tloha ho 1 ho ea ho la 3. Ho tseba tšekamelo ea khatello ea mali, ho hlokahala hore u lekanye khatello ea mali matsohong ka bobeli. Phapang ke 10-15 mm Hg. lipakeng tsa litekanyo, khatello ea mali e bontša lefu la pelo.

Ngaka e etsang opereishene ea methapo e ile ea hlahisa mokhoa oa molumo, o matlafatsang oa khatello ea mali. Khatello e nepahetseng e nkuoa e le 120/80 mm Hg, le e tloaelehileng - 129/89 (boemo ba prehypertension). Ho na le mohopolo oa khatello e phahameng ea mali e phahameng: 139/89. Ho hlophisoa hantle ha khatello ea mali ka li-degree (mmHg) ke ka tsela e latelang:

  • Sekala sa pele: 140-159 / 85-99,
  • Sekala sa Bobeli: 160-179 / 100-109,
  • Degree ea 3: ka holimo ho 180/110.

Ho lekola boemo ba khatello ea mali ho etsahala khahlanong le semelo sa ho se sebetse ka botlalo ha lithethefatsi ka li-antihypertensive. Haeba mokuli a qobelloa ho sebelisa meriana ka mabaka a bophelo bo botle, joale tekanyo e etsoa ka phokotso e phahameng ea litekanyetso tsa bona.

Mehloling e meng ea bongaka, ho ka boleloa hore ho na le phallo ea khatello ea methapo ea mali (grade 4 arterial hypertension). Boemo bo khetholloa ke keketseho ea khatello e holimo le e tlaase e tloaelehileng - 140/90. Tleliniki e fumanoa ho batho ba baholo le ho bakuli ba nang le mathata a lihormone (hyperthyroidism).

Pehelo ea kotsi

Hypertonic botonong ba hae ha e bone lefu lena feela, empa le tekanyo ea kotsi. Kotsi ea khatello ea mali e kotsi ke efe? Ka kotsi, re hloka ho utloisisa karolo ea menyetla ea ho ba le lefu la stroke, lefu la pelo, methapo e meng e khahlanong le semelo sa khatello ea mali. Ts'oaretso ea khatello ea mali ka maemo a kotsi:

  • Kotsi e tlase 1 ke 15% ea 'nete ea hore lilemong tse 10 tse tlang, khatello ea mali e tla baka lefu la pelo, setorouku,
  • Kotsi e mahareng ea 2 e fana ka monyetla oa 20% oa mathata,
  • Kotsi e kholo ea 3 ke 30%,
  • Kotsi e phahameng haholo ea 4 e eketsa menyetla ea mathata a ho phela hantle ka 30-40% le ho feta.

Ho na le litekanyetso tse tharo tsa mantlha tsa ho arohana hoa kotsi ho bakuli ba nang le khatello ea mali: lintlha tsa kotsi, tekanyo ea tšenyo ho litho tsa sepheo (ho hlaha ka methapo ea 2 ea khatello ea mali), maemo a eketsehileng a kliniki ea kalafo (a fumanoeng maemong a 3 a lefu lena).

Nahana ka lintlha tsa bohlokoa, le maemo a kotsi:

  • Taba ea mantlha: ho basali, banna ba fetang lilemo tse 55, ba tsubang,
  • Dyslipidemia: cholesterol e felletseng ho feta 250 mgdl, density lipoprotein cholesterol (HPLPL) e fetang 155 mg / dl, HLDPV (density e phahameng) ho feta 40 mg / dl,
  • Nalane ea lefutso (khatello e phahameng ea mali ho ba lelapa ka mola o otlolohileng),
  • C-index ea protheine e sebetsang e feta 1 mg / dl,
  • Ho ba le mpa ka mpeng - boemo ha karolo ea basali ea basali e feta 88 cm, banna - 102 cm,
  • Ho hloka boikoetliso
  • Ho mamella tsoekere e sa sebetseng hantle,
  • Ho fetella hoa febrinogen maling,
  • Lefu la tsoekere.

Boemong ba bobeli ba lefu lena, tšenyo ea litho tsa ka hare e qala (tlasa ts'usumetso ea mali a ntseng a eketseha, spasm ea methapo ea mali, oksijene le khaello ea phepo ea limatlafatsi), ts'ebetso ea litho tsa ka hare e senyehile. Setšoantšo sa kliniki ea khatello ea methapo ea 2 se ka tsela e latelang:

  • Liphetoho tsa trophic ho "ventricle ea pelo" e tlohang ka letsohong le letšehali,
  • Ho ts'oaroa ha karolo e kaholimo ea mokokotlo oa carotid,
  • Sebopeho
  • Keketseho ea litekanyetso tsa serumin tse kaholimo ho 1.5 mg / dl,
  • Karolelano ea pathological ea albin le creatinine ka har'a moroto.

Letšoao la ho qetela la 2 le bonts'a ho senyeha ha meno.

Tlas'a maemo a kliniki a kopaneng (ho khethollang tšokelo ea khatello ea mali) utloisisa:

  • Lefu la pelo
  • Phekolo ea liphio,
  • Kotlo ea 'mele ho methapo ea methapo ea kutlo, methapo, likepe,
  • Ts'oaetso ea mokokotlo oa "optic nerve"

Kotsi ea 1 e thehiloe bakeng sa bakuli ba tsofetseng ba fetang lilemo tse 55 ntle le li-pathologies tse mpefatsang. Kotsi ea bobeli e laetsoe tlhahlobisong ea khatello ea mali le ho ba le lintlha tse 'maloa tse hlalositsoeng ka holimo. Kotsi ea 3 e mpefatsa lefu la bakuli ba nang le lefu la tsoekere, lefu la ho fokola ha masapo, leqhubu la methapo ea pelo, ho se sebetse hantle hantle le litho tse ling tsa pono.

Ha re phethela, re hopola hore khatello ea methapo ea kutlo e nkuoa e le lefu le ipatileng le le kotsi ka lebaka la ho se be le matšoao a mantlha. Tleliniki ea li-pathologies hangata e sebetsa hantle. Empa, sena ha se bolele hore bokuli bo ke ke ba tloha sethaleng sa pele (ka khatello ea mali 140/90) ho ea bobeli (khatello ea mali 160/100 le holimo). Haeba mohato oa 1 o emisitsoe ke meriana, ea bobeli e tlisa mokuli haufi le bokooa, 'me ea boraro e ea - holofala bophelo bohle. Phekolo ea methapo ea mali ha ho e-na le kalafo e lekaneng e fumanehang ka nako e baka tšenyo ea litho tsa lona, ​​lefu. Se ke oa beha bophelo ba hao bo botle kotsing, lula o le tonometer!

Lintlha le lihlopha tsa kotsi

* Mabaka a tlatsetso a "ncha" hape (a sa tsotelloe maemong a kotsi).

Tekanyo ea kotsi ea khatello ea mali:

Rat stration ho lekola tsoelo-pele ea bakuli ba khatello ea mali

Khatello ea mali, mmHg
Kotsi e tlaseKotsi e maharengKotsi e kholo
II. Lintho tse ka u beha kotsingKotsi e maharengKotsi e maharengKotsi e kholoKotsi e kholo

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