紧急还是急诊--关于高血压危象伴严重视网膜病变的报告

M. S. E. Shalihin, Mohd Daud Che Yusof
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摘要

高血压危象是初级保健诊所常见的一种疾病。它可能由未控制的高血压或已知的心血管风险疾病引起,但也可能是未确诊的继发性高血压的首次出现。然而,对于某些非典型表现,尤其是没有急性症状和确切症状持续时间的年轻患者,是否应将其视为高血压急症或急诊,目前还存在分类上的混乱。一些异常体征,如蛋白尿或视网膜病变,可能是潜在慢性疾病进展的征兆,而不是急性高血压危象的表现。尽管如此,如果这些异常体征是在近期出现的,且事先未进行随访,则应将其视为急性高血压危象的征兆。即使没有液体超负荷或衰竭症状,床旁的线索,如同时出现的贫血和蛋白尿,也是终末期肾病(ESRD)导致高血压危象的有效证据。我们报告了一例年轻男性急性高血压危象患者的病例,该患者仅有一个月的视力模糊病史。尽管起初患者进退两难,但由于存在视网膜病变和明显蛋白尿,该病例被作为高血压急症治疗。后来的肾功能检查证实,患者患有 ESRD。这个病例证明,即使是没有长期病史或其他辅助体征的年轻患者,也有可能患上 ESRD。首次就诊时做出的正确决定挽救了患者的生命。
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Urgency or Emergency – A Report on Hypertensive Crisis with Severe Retinopathy
Hypertensive crisis is a common condition encountered in primary care clinics. It may result from uncontrolled hypertension or a known cardiovascular risk disease but may also be the first occurrence of undiagnosed secondary hypertension. However, there is confusion on the classification of whether certain atypical presentations, particularly in young patients without acute symptoms and exact duration of symptoms, are to be considered as hypertensive urgency or emergency. Some abnormal signs, such as proteinuria or retinopathy, could be signs of an existing progression of underlying chronic disease rather than a manifestation of acute hypertensive crisis. Nonetheless, in any situation where the findings have occurred recently without prior follow-up, they should be treated as if they are signs of an acute hypertensive crisis. Bedside clues, such as concomitant anaemia and proteinuria, are valid evidence for the presence of end-stage renal disease (ESRD) causing the hypertensive crisis, even without the features of fluid overload or failure symptoms. We report the case of a young man presented with an acute hypertensive crisis with an isolated one-month history of blurred vision. Despite the initial dilemma, the case was treated as a hypertensive emergency due to the presence of retinopathy and overt proteinuria. The renal profile later confirmed that the patient had ESRD. This case proves that ESRD is still possible even in a young patient without a long medical history or other supporting signs. Making the right decision on the first visit saved the patient’s life.
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