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\u8840\u58d3\u5750\u904e\u5c71\u8eca \u8aa4\u7576\u7126\u616e\u75c7 <\/p>\n

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\u5716\uff1a\u5289\u710c\u9676<\/p>\n

\u7de8\u8f2f\uff1a\u738b\u7fe0\u9e97<\/p>\n

\nhttps:\/\/video3.mingpao.com\/201702\/HET20170216_01.mp4\u7e7c\u767c\u6027\u9ad8\u8840\u58d3 \u67e5\u627e\u75c5\u56e0;https:\/\/video3.mingpao.com\/201702\/HET20170216_02.mp4\u670d\u4e09\u7a2e\u964d\u58d3\u85e5\u8840\u58d3\u4ecd\u5931\u63a7;https:\/\/video3.mingpao.com\/201702\/HET20170216_03.mp4\u8f38\u5165\u5169\u516c\u5347\u9e7d\u6c34\u6aa2\u67e5\u8377\u723e\u8499;https:\/\/video3.mingpao.com\/201702\/HET20170216_04.mp4\u5207\u9664\u816b\u7624\u6839\u6cbb\u9ad8\u8840\u58d3;https:\/\/video3.mingpao.com\/201702\/HET20170216_05.mp4\u55dc\u927b\u7d30\u80de\u7624\u4e00\u6210\u5c6c\u60e1\u6027;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170313\/news\/_13ya101.jpg\uff08\u5716\uff1a\u5289\u710c\u9676\uff09;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】高血壓是常見都市病，一旦確診，先乖乖減鹽加運動，有需要再配合降血壓藥治療。因為太常見，大家反而容易忽略查找患病背後的原因。<\/p>\n

腎上腺內分泌失調引發的繼發性高血壓，若誤當原發性高血壓，單靠降血壓藥治療，未能有效控制病情。有繼發性高血壓病人更誤以為自己是頸椎受創、產後肥胖，甚至被誤診為焦慮症近10年。<\/p>\n

35歲或以下發病應注意<\/p>\n

高血壓主要分為原發性及繼發性兩種，內分泌及糖尿科專科醫生楊俊業指出，一般年齡在36歲或以上，身體肥胖，有家族遺傳史而出現的高血壓，大部分屬原發性，佔總體高血壓病人九成或以上。至於餘下大約8至10%，屬於繼發性高血壓，尤其是35歲或以下的病人，同時服用多種降血壓藥亦未能有效控制病情，就要注意。<\/p>\n

無論是原發性或繼發性高血壓，由於徵狀不明顯，病人往往患病而不自知；或即使診斷出患有高血壓，一般都沒有覺察其嚴重性。楊俊業曾經遇上一名女病人，年約三十，身材瘦削，患高血壓兩至三年，有看家庭醫生接受藥物治療，卻沒有特別檢查身體以找出病因。「有一次，這位病人旅行後，身體完全無法動彈，誤以為頸部受創，入院看骨科，但在抽血檢查之後，發現血鉀水平偏低，只得1mEq\/L多一點，正常值是3.5至5mEq\/L。血鉀偏低引致肌肉無力而出現癱瘓，情况嚴重更會令心律失常，相當危險。」<\/p>\n

血鉀低可危及生命，於是第一時間為她補充鉀質，直至病情穩定後，再做詳細檢查。「檢查後發現由於病人腎上腺腫瘤分泌過多醛固酮，而醛固酮最主要作用是控制血壓及排走鉀質，過多便會出現高血壓及四肢乏力。」於是安排微創手術將腫瘤切除，之後便完全根治高血壓及鉀質偏低的問題。楊解釋，以這位病人為例，年齡較輕的高血壓病人，如能及早診斷出病因，發現腫瘤及進行手術，就可以減低血鉀過低帶來的風險。<\/p>\n

內分泌作怪 發胖變樣<\/p>\n

除了醛固酮偏高引發高血壓，腎上腺另一種荷爾蒙皮質醇，分泌過高亦會引起高血壓。「有一位女病人在懷孕期間，體重不停上升，同時血壓偏高，最初以為是因為懷孕期間，過分進補所致。但在分娩之後，體重不單沒有下降，相比未懷孕前重了四五十磅，血壓亦繼續上升，甚至連樣貌亦因肥胖而改變。檢查後發現腎上腺腫瘤引致皮質醇分泌偏高，令身體出現上述變化。」<\/p>\n

皮質醇過高會形響外貌，較容易被發現，不過楊俊業表示，在治療上較為複雜，「因為病因可以是由於腎上腺腫瘤，或腦下垂體腫瘤所引致，必須檢查清楚，以分辨是下方還是上方的腫瘤，如果是腎上腺腫瘤，只需切除腎上腺，體型及血壓便會回復正常」。<\/p>\n

血壓坐過山車 誤當焦慮症 <\/p>\n

除了醛固酮和皮質醇，兒茶酚胺亦是腎上腺荷爾蒙，分泌過高會令血壓間歇性飈升，有病人因而被誤診為情緒病，「這些病人每一至兩星期內，有兩至三次血壓突然飈升，上壓最高可達到近200mmHg，但轉眼間又跌回一百多水平。嚴重者甚至每日都出現，同時出現精神緊張、心跳加速、頭痛等徵狀。求診時，醫生可能診斷為焦慮症或驚恐症，處方精神科藥物」。<\/p>\n

「有一位病人因而誤診為焦慮症近10年，血壓時高時低，直至一次身體檢查，發現在腎上腺上出現一個直徑10cm的腫瘤。」楊指出，這位病人的腫瘤很大，釋放大量荷爾蒙，這些荷爾蒙會在手術期間流入身體，令血壓飈升或暴跌，所以手術前，必須用藥將荷爾蒙對身體影響降低，減少手術中血壓的波動。<\/p>\n

分泌過多兒茶酚胺的腎上腺腫瘤，稱為嗜鉻細胞瘤，有一成屬於惡性。楊俊業說，由於嗜鉻細胞瘤難以被察覺，曾有病人因血壓過高，出現爆血管致死。<\/p>\n

文：勞耀全、鄭寶華<\/p>\n

圖：劉焌陶<\/p>\n

編輯：王翠麗<\/p>\n

■有片睇<\/p>\n

想現場直擊家庭醫生睇醫生，可登入 www.mingpaohealth.com\/doc.htm<\/a><\/p>\n

https:\/\/video3.mingpao.com\/201702\/HET20170216_01.mp4繼發性高血壓 查找病因;https:\/\/video3.mingpao.com\/201702\/HET20170216_02.mp4服三種降壓藥血壓仍失控;https:\/\/video3.mingpao.com\/201702\/HET20170216_03.mp4輸入兩公升鹽水檢查荷爾蒙;https:\/\/video3.mingpao.com\/201702\/HET20170216_04.mp4切除腫瘤根治高血壓;https:\/\/video3.mingpao.com\/201702\/HET20170216_05.mp4嗜鉻細胞瘤一成屬惡性;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170313\/news\/_13ya101.jpg（圖：劉焌陶）;<\/inline><\/p>\n","protected":false},"author":2,"featured_media":4860,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[3],"tags":[1476,1163,889,691,338],"class_list":["post-4861","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-3","tag-video","tag-1163","tag-889","tag-691","tag-338"],"publishpress_future_action":{"enabled":false,"date":"2026-11-22 21:46:49","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts\/4861"}],"collection":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/comments?post=4861"}],"version-history":[{"count":0,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts\/4861\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/media\/4860"}],"wp:attachment":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/media?parent=4861"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/categories?post=4861"},{"taxonomy":"post_tag","embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/tags?post=4861"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}