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題名 | Carvedilol Aggravates Orthostatic Hypotension in a Diabetic Patient with Chronic Renal Failure=Carvedilol加重糖尿病合併慢性腎衰竭病患之姿態性低血壓 |
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作者 | 尤鑽石; 曾金鳳; 楊麗瓊; 盧國城; 劉傳捷; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷期 | 20:2 民95.06 |
頁次 | 頁120-125+154 |
分類號 | 415.668 |
關鍵詞 | 姿態性低血壓; 糖尿病; 腎衰竭; 自主性神經病變; Orthostatic hypotension; Carvedilol; Diabetes; Renal failure; Autonomic neuropathy; |
語文 | 英文(English) |
中文摘要 | 一位六十四歲男性,因漸進性氣促、兩側下肢水腫、尿量減少,嘔吐及解黑便而住院。患者於一年前因冠心病接受冠狀動脈繞道手術,他同時還有高血壓、糖尿病,並合併有視網膜病變及腎病變和腎衰竭。入院時因血壓過低及貧血,因而停止使用降血壓藥。第二天經過輸血後血壓回升,又再處方降血壓藥物。入院第十天,病患主訴嚴重頭暈,尤其在變換姿勢時更容易發生,且會引起步態不穩與失調之症狀。至此懷疑病患為糖尿病併腎衰竭產生之自主性神經病變導致的直立性低血壓。神經傳導檢查結果顯示為嚴重之感覺運動性之多發性神經病變。並且為病患再做交感神經性皮膚反應及R-R間隔檢查後,更進一步確認為自主性神經病變。連續兩天測量患者臥、坐、站之心跳及血壓。結果發現因姿勢改變使得血壓的變化達到20mmHg以上,但心跳卻無明顯變化。審視患者之用藥後,懷疑Carvedilol最有可能造成病患產生姿態性低血壓。在停藥兩天後,病患自覺症狀改善。經再度測量不同體位之血壓,其間差距只有10mmHg,且心跳之速率亦明顯增加。我們希望藉此個案提醒大家,糖尿病合併腎衰竭產生之自主性神經病變,可能導致姿態性低血壓的發生。臨床上經常使用的乙型合併甲型阻斷劑之類的降血壓藥,使用於此類患者身上必需格外小心,以避免造成或加重姿態性低血壓的發生。 |
英文摘要 | A 64-year-old male was admitted because of progressive dyspnea, bipedal edema and reduced urine output. His medical history included coronary artery disease with coronary artery bypass graft, hypertension and type 2 diabetes mellitus with chronic renal failure and retinopathy. During admission, he developed severe postural dizziness. Positional blood pressure and heart rate measurements revealed fluctuations in systolic blood pressure greater than 20 mmHg but no significant heart rate change. Two days after stopping carvedilol, systolic blood pressure declined by only 10 mmHg and heart rate increased significantly with positional changes. Orthostatic hypotension due to autonomic neuropathy was suspected. Nerve conduction velocity study showed severe sensorimotor polyneuropathy. Sympathetic skin response and RR interval variability tests indicated autonomic dysfunction. Combinations of alpha- and beta-blockers should always be administered with caution in diabetics, who are likely to have autonomic nervous system dysfunction and in whom the use of such medications may increase the risk of orthostatic hypotension. |
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