General treatment of hypertensive encephalopathy
Western medicine treatment for hypertensive encephalopathy
The disease is treated in a timely manner and the prognosis is good,Improper handling can lead to death,Therefore we should strive for an early diagnosis,rest on the bedAs fast as m?like lowering blood pressureAre you reducing intracranial pressure and reducing the brain?the.Beginningcontrol allPrevent Heart Failure, etc.The specific treatments and treatment measurestook are:
1.W?During the onset of hypertensive encephalopathy, diastolic blood pressure should be reduced rapidly to 110 mmHg (for hypertensive patients) or below 80 mmHg (for normal blood pressure) within a few minutes to 1 hour.
Restore the self-regulatory mechanism of the cerebral blood vessels.But don’t step back too quickly or too low.To prevent cerebral hypoperfusion,Induces a cerebral infarction, there are bige individual differences at?elderly people,Blood pressure fluctuates slightlyThe drug should start with a small amount,He?gradually increase the amountIn order not to sink too fast or too low,Causes adverse consequences such as myocardial infarction.H?Often used clinically:
(1) Sodium nitroprusside: can simultaneously treat small arteries, Expand capillaries and venules,That ven?se reflux blood volume decreases,The left ventricle?re stress is reduced before and after Suitable for patients with left heart failure or acute coronary insufficiency,50 mg to 500 ml of 5% glucosel?intravenous solution?add s,Falling speed 1 ml / min,Measure blood pressure every 2 ～ 3 minutes,Adjust the drip rate and dosage, to keep blood pressure at an appropriate level. This drug quickly lowers and stabilizes blood pressure.No side effects,But the physical and chemical properties are unstable,Must be used within 12 hours of preparation.
(2) glyceryl trinitrate: 25 mg intravenously?s added to 5% glucose 500 ml,Adjust the drip rate to the blood pressure.The antihypertensive effect is rapid,Monitoring is easier than sodium nitroprusside.Less side effects,Some people advocate using it instead of sodium nitroprusside,It is particularly suitable for patients with coronary artery disease, insufficient myocardial blood supply and heart failure.
(3) Reserpine (Reserpine): Can the storage of catecholamines in sympathetic nerve endings be difficult?pep.Widen the blood vessels and decrease the resistance around the blood vessels.1 mg intramuscular?re injection,1.Effective in 5 ～ 3h,If necessary, the injection can be repeated every 6-12 hours.Suitable for maintenance medication after rapid lowering of blood pressure.Side effects are nasal congestion, Dry mouth, Bradycardia, Lethargy and Parkinson’s?Similar manifestations.
(4) captopil: a specific competitive inhibitor, the main one?has an effect on the renin-angiotensin-aldosterone system (RAA system); inhibition of the angiotensin converting enzyme (ACE) of the RAA system,Prevent the conversion of angiotensin-I to angiotensin-II.Inhibition of the secretion of aldosterone,Reduce water and sodium retention.12th5 ～ 25 mg orally,3 times / d,60 ～ 90min is effective.Visible gastrointestinal reactions Insomnia, Dry mouth and neutropenia,Heart failure patients should not use it.
(5) nifedipine (nifedipine,Xintongding) 10 ～ 20 mg taken sublingually or crushed and swallowed or given rectally,3 times / d,It can also be sprayed into the pharynx with aerosol,Every time 0.5 mg,Use 6 times in a row, this medicine is a calcium channel antagonist.Effective in 20 ～ 30min,1.5 ～ 2h lowered the blood pressure significantly,80% of the effects are achieved after one administration,The average arterial pressure can be reduced by 25%.For hypertensive encephalopathy in combination with coronary artery disease Ideal for patients with less severe diseaseIt is a safer and faster antihypertensive drug.
2.About the intracranial pressure and the brain?to lower k?Can you use 20% mannitol 250 ml rapid intravenous?use a drip.
Once every 6-8 hours,Patients with cardiac and renal dysfunction?stakes k?Can be used with caution. You k?Can you use furosemide 40 mg intravenously?ser injection, 10% human albumin 50 ml intravenously?sem drops or dexamethasone 10-20 mg intravenously?sem drop can be combined.
3.At h?early startllen or status epilepticus is diazepam 10 to 20 mg by slow intravenous?given injection.
If it can’t be controlled do you use diazepam 40-50 mg intravenously?s to 500 ml of 10% glucose?sung.Pay attention to your breathing.Phenytoin (phenytoin sodium) can also be usedOften used in combination with diazepam as a maintenance drug or in patients with respiratory depression.The first dose of 500 mg is added to 500 ml of 5% glucose.Intravenous?this drop,300 ～ 500 mg / d maintain the effect.Then k?Adults can use phenobarbital 0.2 g intramuscular?re injection,30 ml enema with 10% chloral hydrate,Alternative application after 6 hours; after checking the start, switch to phenytoin (phenytoin sodium) or carbamazepine orally for 1 to 2 days.Keep for 2 to 3 months, to prevent recurrence.
The disease has a rapid onsetThe symptoms are obviousSeriously ill,If not treated in time,A brain fracture can be due to an aggravation of the brain?dems occur.Can die quickly.According to the statistics,Untreated critically ill high blood pressure,The 6-month mortality rate is> 50%,The 1-year death rate is> 90%.After treating hypertensive encephalopathy, in most of the F?Are the symptoms complete?permanently relieved,The abnormal imaging exam completely disappeared?ndig.The prognosis is good.Hence h?its prognosis depends on early diagnosis and treatment.
Syndrome differentiation and treatment of hypertensive encephalopathy
TCM treatment for hypertensive encephalopathy
1. TCM treatment:
1. Liver wind internal movement
Syndrome: severe headache such as splitting,Vomiting h?ufig,Hand and foottremble,Twitching limbs,Deafness,He was very confusedRed tongue,The pulse train is thin and drawn?holds.Wind-Yang Storm Syndrome
Syndrome: pl?death of severe headache,Dizziness and vomiting,Blurred vision,Restlessness,Numbness, Tremor or kr?fights in the limbs,Or see
Coma,Red-faced,Red tongue,Yellow moss,The pulse rate is strong.
Treatment: Pinggan Xifeng.
Main recipe: Zhengan Xifeng decoction
Addition and subtraction: jerks,Add Gastrodia, Uncaria, Scorpio, Vomit, Add faxia.
2. Liver fire syndrome
Syndrome: severe headache,Dizziness and vomiting,Red-faced,Bitter and dry mouth,Irritable,Constipation of yellow urine,Red tongue,Yellow moss,The number of pulse trains.
Treatment method: clean liver and vent fire.
Main recipe: Longdan Xiegan decoction
Modification: can be yellow, Earthworm, Scorpio, Get high blood pressurehen,Add achyranthes, Stone cassias and raw oysters are added.
3. Wind slime attack syndrome
Syndrome: headache and dizziness,Blurred vision,feeling sick and vomitingSchl?frustration and tiredness,Restless walking,Vomiting and salivation,Greasy moss,The pulse rate is slippery.
Treatment method: expelling wind and phlegm?en, Calm and reduce side effects
Main recipe: Banxia Baizhu Tianma decoction and Xuanfu Daizhe decoction
Addition and subtraction: it is advisable to Ginseng, Remove jujube and ginger; optional stiff silkworm, knowen aconite, add whole scorpion; High blood pressure,Add achyranthes, Stone cassias and raw oysters are added.
Take Zusanli, Quchi, the courtyard, Zulinqi, Taichong, Ganshu, Shenshu, Hegu, Fengchi, Sanyinjiao and other points
,Or just prick the head Wei point,Use diarrhea.Or ten Xuan bloodshed?en.
5. Unilateral prescription:
1) Longdan Xiegan pills,6 g each time3 times t?resembledOrally.
2) Glauber’s salt 250g,Put it in warm rice water,Sheng pen,Give way to your feete a.
3) whole scorpion 3g,Angelica dahurica 15g,3 peppers,Decoction in water,1 dose t?resembled.