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Том 2 №3 2000 год - Нефрология и диализ

Ремоделирование артерий и артериальное давление у больных с уремией (Лекция)


Жерар Лондон

Аннотация: Артериальная гипертензия (АГ), как следует из проспективных исследований, выполненных в общей популяции, является главным фактором риска ишемической болезни сердца (ИБС), застойной сердечной недостаточности и инсульта. Кроме того, она также повышает вероятность формирования гипертрофии левого желудочка (ЛЖ), которая сама по себе является независимым кардиоваскулярным фактором риска. Наконец, АГ представляет собой фактор риска развития почечной недостаточности. У гемодиализных больных влияние артериального давления (АД) на исход заболевания менее ясно. Результаты проспективных исследований по этому поводу противоречивы. В частности, было показано, что повышение смертности диализных больных ассоциируется с низким АД [1-3]. Одним из объяснений такого противоречия может быть упрощенный подход к пониманию патогенеза различных форм АГ. Роль АД состоит в поддержании адекватного тканевого перфузионного давления, так называемого среднего АД (СрАД). Последнее является производной сердечного выброса (СВ) и общего периферического сопротивления (ОПС) и считается постоянным в течение сердечного цикла. Поэтому в артериях, в которых измеряется АД, СрАД является «виртуальным». Реально оно существует только в прекапиллярных артериолах, где колебания давления в значительной степени сглаживаются [4]. На этом уровне СрАД - это давление, ответственное за стабильное распределение кровотока по тканям и органам. Для данного СВ оно определяется площадью поперечного сечения и числом артериол и мелких артерий, от общего поперечного сечения которых зависит ОПС. ** Редколлегия журнала благодарит автора за предоставленные материалы лекции. ** Перевод Е.В. Захаровой

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Ключевые слова: артериальная гипертония, ремоделирование артерий, демпфирующая и проводящая функции, податливость, атеросклероз, артериосклероз, уремия

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