医生在行医时应注意测量儿童血压
2012-05-19 12:11:20   来源： 丁香园   作者：  评论：0 点击：

有迹象表明，在某些人群中肥胖症的流行已经减缓，但是对大多数美国人来说，它仍然占有支配地位。目前有三分之一的儿童和青少年超重或者肥胖。研究者们预测，到2030年我国（指美国）将会有多达一半的人口可能肥胖——不是“超重”而是“肥胖”。

肥胖症常常伴随有许多与健康有关的问题：糖尿病、高血压、心脏病、甚至某些癌症。也许最令人担忧的是，儿科医生报告称已经看到这些疾病的端倪——以前认为这些问题只在成年人中存在——而现在在3岁大的孩子中也发现了。

这就是为什么美国儿科学会和联邦卫生官员建议医生经常对儿童进行例行高血压检查。 但在儿童中诊断高血压是比成年人更复杂。

“在成年人中，血压超过140或者低于90被认为是不正常的，” 密歇根大学医学院的家庭医生Margaret Riley说。然是对于孩子们而言并非如此。

儿童和青少年正常的血压值都基于各自的年龄、性别和身高。这意味着医生不仅需要测量儿童的血压，而且还要将其和基于年龄、性别和身高标准化图表相比较。

“一个15岁男孩与一个8岁的女孩的正常血压不同，” Riley说。

她最近在《美国家庭医生》杂志上发表了一篇回顾性文章来提醒医生，孩子们的血压不仅要测量，还要和标准化图表相比较。

早期数据显示医生在日常诊察中经常忽略测量孩子的血压。在最终诊断为高血压孩子们中，只有26%的人在他们的医疗记录中有测量记录。

“通 常医生们在理论上都知道血压的价值，但他们还不够重视，因为他们没有意识到对于具体的孩子一个不正常血压值的重要性，” Riley补充道，“我认为临床医师已经习惯看到一个超过60比如说像100这样的血压值，这乍看之下不错，但如果你对于一个特定的孩子的年龄，身高，实 际观察后，这个值对于他们而言可能就高了。”

早期没有诊断高血压可以引发一系列危险的连锁反应，落基山儿童医院儿科心血管医生Reginald Washington如是说。

“问题是机体不能容忍这些问题；因此，作为一个孩子，如果你有高血压和高胆固醇，你就是在把自己推向过早产生问题的不良状态，” Washington还补充说, 如果他们有高血压而未经处理，在20岁或者30岁就有可能发生脑中风。

据 估计,大约有2000名儿童和青少年每年由于高血压而中风。但好消息是, Washington接着说，此年龄组通常不需要药物。简单的改变生活方式就能奏效。减少高脂食物和高糖饮料，积极外出活动，会让他们有很大的不同。而且 因为孩子们有较高的新陈代谢，他们比成人更容易减肥。

Washington补充说，当他们孩子的健康处于危险中时，家庭往往更有动力。Riley也表示，父母应该通过经常锻炼, 尽可能少吃加工食品，树立健康的生活方式。
There have been hints that the obesity epidemic's rise has slowed a bit among certain populations, but for the most part, it continues to dominate American health. One third of children and teenagers are now overweight or obese. And researchers forecast as many as half of our nation's population could be obese — not overweight but obese — by 2030.

With obesity comes a host of health-related problems: diabetes, high blood pressure, heart disease and even certain cancers. Perhaps most worrisome of all, pediatricians report seeing the beginning of these diseases — previously considered problems among adults only — in children as young as 3.

And this is why the American Academy of Pediatrics and federal health officials recommend that doctors routinely screen children for high blood pressure. But diagnosing hypertension in children is more complicated than it is among adults.

"In adults, anything over 140 over 90 is considered abnormal," says family physician Dr. Margaret Riley with the University of Michigan Medical School. Not so for kids.

Normal blood pressure values for children and adolescents are based on age, sex and height. This means doctors need to not only measure a child's blood pressure but also compare it to standardized charts that indicate what's normal for children based on age, sex and height.

"A normal blood pressure for [a 15-year-old boy] is different from that of an 8-year-old girl," Riley says.

She recently published a review of available data in the journal American Family Physician to remind doctors about the importance of not only taking children's blood pressure but also comparing it to standardized tables.

Earlier data show doctors often overlook taking a child's blood pressure during routine visits. Among children eventually diagnosed with high blood pressure, only 26 percent of them had it written in their medical records.

"A physician often will put the blood pressure value in their notes, but they won't address it as high because they won't have recognized it as an abnormal value for that specific child," Riley says, adding, "I think clinicians are used to seeing a number like 100 over 60, and that looks good at first glance, but if you actually look at that for a specific child's age and height, then it may be high for them."

Dr. Reginald Washington, a pediatric cardiologist at Rocky Mountain Hospital for Children, says not diagnosing high blood pressure early can set off a dangerous chain reaction.

"The problem is the body doesn't forgive this; so, if you have high blood pressure or cholesterol as a child, you're setting yourself up for premature problems," says Washington, adding that patients can have strokes in their 20s or 30s if they have high blood pressure that's untreated.

According to one estimate, about 2,000 children and teens suffer strokes every year as a result of hypertension. But the good news, says Washington, is that medication is generally not needed for this age group. Simple lifestyle changes can do the trick. Cutting down on high-fat foods and high-sugar drinks, along with active family outings, can make a big difference, he says. And, because they have higher metabolism, kids have an easier time shedding pounds than adults.

Washington adds that families are often more motivated when their child's health is at stake. Parents should model healthy lifestyles, too, says Riley, by exercising regularly and eating as few processed foods as possible.