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目的观察透析治疗、降压药物治疗及肾移植对慢性肾功能衰竭(CRF)尿毒症期高血压的降压效果。方法我院2000年1月~2006年3月收治慢性肾功能衰竭尿毒症期高血压患者36例,分透析组、非透析组和肾移植组治疗,并观察其疗效。结果①透析组3例达干体重而使血压正常,其余14例加用血管紧张素转换酶抑制剂(ACEI)+钙离子通道阻滞剂(CCB)仍有6例难以降至130/80 mm Hg(1 mm Hg=0.133 kPa),再用利尿剂及β-受体阻滞剂后4例难以降至目标血压以下。②非透析均服用CCB,11例难以降至130/80 mm Hg,加用利尿剂、β-受体阻滞剂后5例降至目标血压以下。③1例行肾移植,血压恢复正常。结论肾移植是解除CRF高血压的根本替代治疗,充分透析可有效降压。ACEI和CCB联用,纠正钙磷比例失调,控制甲状旁腺功能亢进及利尿剂、β-阻滞剂应用均可起到良好的降压效果。
Objective To observe the antihypertensive effects of dialysis, antihypertensive drugs and renal transplantation on hypertension in patients with chronic renal failure (CRF). Methods From January 2000 to March 2006 in our hospital, 36 patients with chronic renal failure and uremia hypertension were divided into dialysis group, non-dialysis group and renal transplantation group, and the curative effect was observed. Results ① In the dialysis group, the blood pressure was normal in 3 cases of up to dry weight, and the remaining 14 cases were still hard to reduce to 130/80 mm with addition of angiotensin converting enzyme inhibitor (ACEI) + calcium channel blocker (CCB) Hg (1 mm Hg = 0.133 kPa), and then diuretics and β-blockers in 4 cases difficult to fall below the target blood pressure. ② Non-dialysis were taken CCB, 11 cases difficult to reduce to 130/80 mm Hg, plus diuretics, β-blockers, 5 cases fell below the target blood pressure. ③ routine renal transplantation, blood pressure returned to normal. Conclusion Kidney transplantation is the fundamental alternative treatment of CRF hypertension, adequate dialysis can effectively reduce blood pressure. ACEI and CCB combined to correct the imbalance of calcium and phosphorus, hyperparathyroidism and diuretics, β-blockers can play a good antihypertensive effect.