| 摘要: |
| 目的：总结住院治疗高血压儿童病例，探讨住院儿童高血压的常见病因、鉴别诊断、治疗方案及疗效，以便更好地指导小儿高血压的诊治。方法：采用回顾性分析方法，对我院2011年至2015年住院的68例高血压患儿的病因、临床症状、治疗方案及疗效等进行分析。结果：68例高血压患儿中，男42 例，女26例，年龄2月~17岁，平均年龄（8.3±4.5）岁。原发性高血压12例，其中学龄期6人，青春期6人；继发性高血压56例，其中婴儿4人，幼儿4人，学龄前16人，学龄期20人，青春期12人。继发性高血压病因：肾脏疾病因素占42.86%（24/56），药物因素占26.79%（15/56），心血管因素占17.86%（10/56），神经性因素占5.36%（3/56），内分泌因素占5.36%（3/56）。原发性高血压患儿中，发病年龄8~17岁，肥胖率100%，有高血压家族史的患儿占58%。68例高血压患儿中，存在靶器官损害患儿11例，9例出现高血压脑病。出现高血压脑病患儿最低血压150/90 mm Hg，出现靶器官损害的患儿最低血压140/90 mm Hg，均远远高于2期高血压标准，原发性高血压首选非药物治疗如饮食改变、增加运动。继发性高血压患儿首先进行病因治疗，同时行药物治疗。本组68例中有2例有效控制血压：1例为尿毒症和1例为白血病移植后排异期患儿合并高血压，其余66例均获得有效治疗。结论：住院儿童高血压以继发性高血压多见，继发性因素依次为肾性因素、药物性因素、心血管因素、神经性因素和内分泌因素。原发性高血压儿童年龄偏大，集中分布在学龄期后，肥胖是原发性高血压的危险因素。出现靶器官损害和高血压脑病的血压值远高于各年龄段2期高血压标准。药物治疗推荐首选卡托普利或硝苯地平单用治疗，无效病例可采用两药联合治疗。 |
| 关键词: 儿童 原发性高血压 继发性高血压 病因 药物治疗 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.11.006 |
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| 基金项目: |
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| Analysis of 68 Cases of Children with Hypertension in Children's Hospital Affiliated to Suzhou University |
| Cao Lei, Sun Ling, Lü Haitao, Yan Wenhua |
| (Children's Hospital Affiliated to Suzhou University, Jiangsu Suzhou 215000, China) |
| Abstract: |
| Objective: To sum up the clinical diagnosis and treatment of hypertension in children, and to explore the etiology, differential diagnosis, treatment plans and effects, in order to better guide the diagnosis and treatment of hypertension. Methods: By using the method of retrospective analysis of 68 cases of our hospital from 2011 to 2015 in the cause of children with high blood pressure, clinical symptoms, treatment and curative effect were analyzed. Results: Of the 68 children, 42 were male and 26 female, aged from 2 months to 17 years, the average age was 8.3± 4.5 years. 12 cases had primary hypertension,including 6 cases of school age and 6 cases of puberty； 56 cases had secondary hypertension，including 4 infants, 4 toddlers, 16 preschoolers, 20 school age and 12 cases of puberty. Cause of secondary hypertension: renal diseases 42.86% (24/56), drug factors 26.79% (15/56), cardiovascular factors 17.86% (10/56), neurologic factors 5.36% (3/56) and endocrine factors 5.36% (3/56). Primary hypertension children: the age of onset is 8-17 years old, the rate of obesity is 100%, family history of hypertension accounted for 58%. Of 68 cases of children with high blood pressure, there are children with target organ damage in 11 cases, 9 cases with hypertensive encephalopathy. Blood pressure in children with hypertensive encephalopathy were all above 150/90mmHg , Blood pressure in children with target organ damage were all above 140/90 mmHg,which are far higher than the 2 phase of high blood pressure standards. Primary hypertension cases were mostly recommended non-pharmacologic measures include dietary changes, increased physical activity. Children with secondary hypertension therapy on the etiologies for first, at the same time line drugs. In this group, 2 cases of 68 cases without effective blood pressure control: 1 cases of uremia and 1 cases of leukemia transplantation still have high blood pressure, and the remaining 66 cases were effective treated. Conclusions: In this group of children with high blood pressure secondary hypertension were most common, the first cause of secondary hypertension was renal diseases, and drug factors, cardiovascular, neurological and endocrine factors were followed. The age of primary hypertension children is elderly, concentrated after the school age, obesity is the risk factor of primary hypertension. The blood pressure of target organ damage and hypertensive encephalopathy was much higher than that of the 2 stage of hypertension. Antihypertensive medications preferred to captopril or nifedipine alone mainly, invalid cases can use the two drug combination therapy. |
| Key words: children primary hypertension secondary hypertension etiology drug treatment |
