从高血压角度认识头晕
|
摘要
近年来全国各地于神经内科、耳鼻喉科门诊就诊的头晕患者越来越多。由于头晕是一个复杂的临床症候群,其涉及的领域包括临床各科室,这就导致了临床误诊、漏诊率很高,并且人们在一些基本概念和分类上很难达成共识。本文基于高血压的病理生理特点,分析了高血压和血管性头晕的关系;并以高血压和头晕共病疾病(颈椎病、焦虑和抑郁、脑供血不足/椎基底动脉供血不足)为衔接点,提出了几个关于头晕诊断、定义上的新见解。
In recent years, more and more patients suffering from dizziness visit the Neurology or ENT clinic, which leads to a research focus on dizziness. Since dizziness is a complex clinical syndrome involving areas of many clinical departments, it has a high misdiagnosis rate clinically, and it is difficult to reach a consensus on some basic concepts and classifications. Based on the pathophysiological characteristics of hypertension, this paper analyzed the relationship between hypertension and vascular dizziness; and taking hypertension and dizziness comorbid diseases(cervical disease, anxiety, depression, cerebral insufficiency/vertebrobasilar insufficiency) as a convergence point, we raised several new insights into the diagnosis and definition of dizziness.
In recent years, more and more patients suffering from dizziness visit the Neurology or ENT clinic, which leads to a research focus on dizziness. Since dizziness is a complex clinical syndrome involving areas of many clinical departments, it has a high misdiagnosis rate clinically, and it is difficult to reach a consensus on some basic concepts and classifications. Based on the pathophysiological characteristics of hypertension, this paper analyzed the relationship between hypertension and vascular dizziness; and taking hypertension and dizziness comorbid diseases(cervical disease, anxiety, depression, cerebral insufficiency/vertebrobasilar insufficiency) as a convergence point, we raised several new insights into the diagnosis and definition of dizziness.
引文
[1]迟相林,于永鹏,张昭强.血压波动是混沌吗?[J].医学争鸣,2013,4(2):45-48.
[2]Rothwell PM,Howard SC,Dolan E,et al.Prognostic significance of visit-to-visit variability,maximum systolic blood pressure,and episodic hypertension[J].Lancet,2010,375(9718):895-905.
[3]Lee CC,Su YC,Ho HC,et al.Risk of stroke in patients hospitalized for isolated vertigo:a four-year follow-up study[J].Stroke,2011,42(1):48-52.
[4]粟秀初,孔繁元,黄如训.有关眩晕诊断中几个问题的再认识[J].中国神经精神疾病杂志,2010,36(12):705-707.
[5]叶利斌,卢婷婷,吴汉元.颈源性高血压的临床研究新进展[J].中国全科医学,2013,16(26):3146-3149.
[6]杨彬,何宗宝.颈上神经节与颈源性高血压的研究进展[J].中华高血压杂志,2014,22(2):129-131.
[7]巩浩然.颈性高血压发病机制研究及中医药治疗进展[J].长春中医药大学学报,2011,27(4):677-678.
[8]中华医学会神经病学分会,中华神经科杂志编辑委员会.眩晕诊治专家共识[J].中华神经科杂志,2010,43(5):369-374.
[9]戚晓昆.重视头晕与眩晕的正确诊断[J].中华内科杂志,2014,53(10):761-763.
[10]李晓荟,姜树军.头晕的现代概念及分类[J].中华老年心脑血管病杂志,2011,13(8):765-766.
[11]廖金敏,王希林,刘粹,等.社区人群高血压共病焦虑抑郁障碍患病率和危险因素分析[J].中华高血压杂志,2014,22(4):400.
[12]Symonides B,Holas P,Schram M,et al.Does the control of negative emotions influence blood pressure control and its variability[J].Blood Press,2014,23(6):323-329.
[13]Greenage M,Kulaksizoglu B,Cilingiroglu M,et al.The role of anxiety and emotional stress as a risk factor in treatmentresistant hypertension[J].Curr Atheroscler Rep,2011,13(2):129-131.
[14]Schmieder RE,Grassi G,Kjeldsen SE.Patients with treatmentresistant hypertension report increased stress and anxiety:a worldwide study[J].J Hypertens,2013,31(3):610-615.
[15]钟久昌.ACE2/Ang-(1-7)信号与高血压伴发抑郁症研究现状[J].遵义医学院学报,2014,37(3):241-243.
[16]董秦雯,戚晓昆.心因性头晕患者临床症候及治疗方法分析[J].中华内科杂志,2014,53(10):768-771.
[17]李焰生.脑供血不足及颈椎病并非导致头晕、眩晕的主要病因[J].中国社区医师,2014,30(25):5-6.
[18]李焰生.中国后循环缺血的专家共识[J].中华内科杂志,2006,45(9):786-787.
[19]Wu C,Liao L,Yan X,et al.Effects of Yangxue Qingnao Granules on chronic cerebral circulation insufficiency:a randomized,double-blind,double-dummy,controlled multicentre trial[J].Psychogeriatrics,2013,13(1):29-34.
[20]Paul NL,Simoni M,Rothwell PM,et al.Transient isolated brainstem symptoms preceding posterior circulation stroke:a population-based study[J].Lancet Neurol,2013,12(1):65-71.
[2]Rothwell PM,Howard SC,Dolan E,et al.Prognostic significance of visit-to-visit variability,maximum systolic blood pressure,and episodic hypertension[J].Lancet,2010,375(9718):895-905.
[3]Lee CC,Su YC,Ho HC,et al.Risk of stroke in patients hospitalized for isolated vertigo:a four-year follow-up study[J].Stroke,2011,42(1):48-52.
[4]粟秀初,孔繁元,黄如训.有关眩晕诊断中几个问题的再认识[J].中国神经精神疾病杂志,2010,36(12):705-707.
[5]叶利斌,卢婷婷,吴汉元.颈源性高血压的临床研究新进展[J].中国全科医学,2013,16(26):3146-3149.
[6]杨彬,何宗宝.颈上神经节与颈源性高血压的研究进展[J].中华高血压杂志,2014,22(2):129-131.
[7]巩浩然.颈性高血压发病机制研究及中医药治疗进展[J].长春中医药大学学报,2011,27(4):677-678.
[8]中华医学会神经病学分会,中华神经科杂志编辑委员会.眩晕诊治专家共识[J].中华神经科杂志,2010,43(5):369-374.
[9]戚晓昆.重视头晕与眩晕的正确诊断[J].中华内科杂志,2014,53(10):761-763.
[10]李晓荟,姜树军.头晕的现代概念及分类[J].中华老年心脑血管病杂志,2011,13(8):765-766.
[11]廖金敏,王希林,刘粹,等.社区人群高血压共病焦虑抑郁障碍患病率和危险因素分析[J].中华高血压杂志,2014,22(4):400.
[12]Symonides B,Holas P,Schram M,et al.Does the control of negative emotions influence blood pressure control and its variability[J].Blood Press,2014,23(6):323-329.
[13]Greenage M,Kulaksizoglu B,Cilingiroglu M,et al.The role of anxiety and emotional stress as a risk factor in treatmentresistant hypertension[J].Curr Atheroscler Rep,2011,13(2):129-131.
[14]Schmieder RE,Grassi G,Kjeldsen SE.Patients with treatmentresistant hypertension report increased stress and anxiety:a worldwide study[J].J Hypertens,2013,31(3):610-615.
[15]钟久昌.ACE2/Ang-(1-7)信号与高血压伴发抑郁症研究现状[J].遵义医学院学报,2014,37(3):241-243.
[16]董秦雯,戚晓昆.心因性头晕患者临床症候及治疗方法分析[J].中华内科杂志,2014,53(10):768-771.
[17]李焰生.脑供血不足及颈椎病并非导致头晕、眩晕的主要病因[J].中国社区医师,2014,30(25):5-6.
[18]李焰生.中国后循环缺血的专家共识[J].中华内科杂志,2006,45(9):786-787.
[19]Wu C,Liao L,Yan X,et al.Effects of Yangxue Qingnao Granules on chronic cerebral circulation insufficiency:a randomized,double-blind,double-dummy,controlled multicentre trial[J].Psychogeriatrics,2013,13(1):29-34.
[20]Paul NL,Simoni M,Rothwell PM,et al.Transient isolated brainstem symptoms preceding posterior circulation stroke:a population-based study[J].Lancet Neurol,2013,12(1):65-71.