理性的临床检查. 这位病人有低血压症吗?
S McGee1, W B Abernethy, D L Simel
1Department of Medicine, University of Washington, Seattle-Puget Sound VA Health Care System, 98108, USA.
JAMA
|March 23, 1999
概括
在成年人中诊断低血压依赖于显著的姿势脉冲变化或严重的头导致血液损失. 由于其他原因,很少有物理标志是可靠的,需要进行实验室测试以确定.
科学领域:
- 紧急医疗 紧急医疗
- 内部医学 内部医学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 低血压症是一种血液体积下降的状态,在成年人中存在诊断挑战.
- 准确的身体诊断对于及时有效的患者管理至关重要.
研究的目的:
- 系统地审查身体检查结果,以诊断成人患者的低血压症.
- 评估不同低血压症病因中的各种身体症状的诊断效用.
主要方法:
- 对MEDLINE和其他来源进行系统的文献搜索 (1966-1997).
- 包括10项关于体位生命体征和毛细血管补充时间的健康志愿者瘤切除术后的研究.
- 包括4项研究,这些研究涉及疑似低血压患者到急诊室的患者.
主要成果:
- 严重的姿势头或脉增加≥30次/分钟是显著血液损失的关键指标 (97%对大损失的敏感性).
- 即使有大量的血液损失 (33%的灵敏度),也往往没有斜腰低血压和低心率.
- 在非出血性低血压症中,干支支持诊断,而潮湿的粘膜和光滑的舌头则反对.
结论:
- 血液流失导致的低血压的临床诊断需要显著的姿势生命体征变化,在中度病例中可能缺席.
- 对于由于吐,腹或摄入不良的低血症,物理发现的实用性有限.
- 血清电解质,BUN和肌素对于非出血性低血的诊断确定性至关重要.
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