抗焦虑药物对地震灾区难治性高血压的临床观察

Clinical observation of antianxietic for refractory hypertension CRH in earthquake stricken area

目的观察汶川大地震灾区高血压患者中的难治性高血压人群,通过加用抗焦虑和抑郁障碍药物调节情绪后对血压的影响。方法按照2005年中国高血压防治指南中难治性高血压定义,选择门诊及住院的难治性原发性高血压病人72例。在常规抗高血压基础上,既给予口服依那普利10 mg,2次/d,氢氯塞嗪25 mg,1次/d,美托洛尔25 mg,2次/d;在上述基础上加服阿普唑伦0.4 mg,2次/d或帕罗西丁20 mg,1次/d。连服12周。结果治疗后显效56例(77.78%),有效14例(19.44%),无效2例(2.78%),总有效率97.22%。有3例出现轻度嗜睡、头昏、乏力,未见其他不良反应。治疗前后血糖、血脂、肝肾功能、心电图无明显变化。结论地震发生后灾区灾民由于紧张、压抑、焦虑和睡眠障碍、过度劳累处于高度应激状,在应激状态下,肾上腺素分泌增加,使收缩压及舒张压增高使得血压用常规抗高血压药物难以控制,针对焦虑、抑郁障碍给予治疗。以打断患者的紧张,焦虑等心理因素的影响,能有效控制血压,保护靶器官。

Objective To observe the patients with refracoty hypertension（RH） in Wenchuan,to whom antianxietic was added to adjust their moods.Method Select 72 patients with RH in the hospital,administer 10 mg enalapril 2tid,25 mg hydrochlorothiazide 1tid,and 25 mg metoprolol tartrate 2tid;based on the conventional medical treatment,add 0.4 mg 2tid or 20 mg paroxetine hydrochloride for 12 weeks in a row.Results After treatment,14 cases（77.78%） had marked efficiency,14 cases（19.44%） were improved to some degree,2 cases（2.78%） had no effect,and the average efficiency got to 97.22%.3 cases were mildly drowy,dizzy and weak without other adverse reaction.Before and after treatment,there were no obvious changes in blood sugar,blood fat,hepatic/renal function,and cardiogram.Conclusion After the earthquake,the patients were under high stress because of tension,depression,anxiety and sleep-disorder.Under these circumstances,increased aldosterone followed by increased systolic and diastolic pressure would cause conventional medicine difficult to control hypertension.The treatment aiming at anxiety and depressive disorder,antianxietic can effectively control blood pressure and protect the target oran.