《RN-ISPN学习》2021年05月14日总第774期
★ Vocabulary ★
RAS - Renin–Angiotensin–Aldosterone System -- 肾素-血管紧张素-醛固酮系统
compensatory – a. 代偿的
compensatory mechanism -- 代偿机制
juxtaglomerular – a. 肾小球旁的
juxtaglomerular cells – 球旁细胞
glomerulus – n. 血管小球
angiotensinogen – n. 血管紧张素原
angiotensin – n. 血管紧张素
osmoreceptor – n. 渗透压感受器
propranolol – n. 普萘洛尔
hydrochloride – n. 盐酸华物
quinapril – n. 喹那普利
Accupril – n. 【奥】阿克普利
注：带“【奥】”标记者为奥医临时用名，只为方便学员复习记忆，不得作为临床诊疗依据！
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★ RN/ISPN Review ★
Renin–Angiotensin–Aldosterone System 肾素-血管紧张素-醛固酮系统
Another compensatory system is activated when the BP within the kidneys falls. Because the kidneys require constant perfusion to function properly, they have a compensatory mechanism to help ensure that blood flow is maintained. This mechanism is called the renin–angiotensin–aldosterone system (RAS).
当肾血压下降时，另外一个代偿系统就会激活。因为肾需要不断灌注才能正常发挥功能，肾有一个代偿机制来帮助确保血流的维持，这一机制就称为肾素-血管紧张素-醛固酮系统（RAS）。
Low BP or poor oxygenation of a nephron causes the release of renin from the juxtaglomerular cells, a group of cells that monitor BP and flow into the glomerulus. Renin is released into the bloodstream and arrives in the liver to convert the compound angiotensinogen (produced in the liver) to angiotensin I. Angiotensin I travels in the bloodstream to the lungs, where the metabolic cells of the alveoli use angiotensin-converting enzyme (ACE) to convert angiotensin I to angiotensin II. Angiotensin II reacts with specific angiotensin II receptor sites on blood vessels to cause intense vasoconstriction. This effect raises the total peripheral resistance and raises the BP, restoring blood flow to the kidneys and decreasing the release of renin.
低血压或肾元充氧不足引起球旁细胞肾素释放，--球旁细胞是监测血压和血液进入肾小球的一组细胞。肾素释放进入血流到达肝脏，将复合血管紧张素原（产生于肝）转化为血管紧张素I。血管紧张素I随血流进入肺部，在些，肺泡代谢细胞利用血管紧张素转换酶（ACE）将血管紧张素I转化为血管紧张素II。血管紧张素II与血管特异性血管紧张素II受体部位起反应，引起强烈的血管收缩。这一效应提升外周总阻力，升高血压，使血流回流至肾脏，减少肾素释放。
Angiotensin II, probably after conversion to angiotensin III, also stimulates the adrenal cortex to release aldosterone. Aldosterone acts on the nephrons to cause the retention of sodium and water. This effect increases blood volume, which should also contribute to increasing BP. The sodium-rich blood stimulates the osmoreceptors in the hypothalamus to cause the release of antidiuretic hormone, which in turn causes retention of water in the nephrons, further increasing the blood volume. This increase in blood volume increases the BP, which should increase blood flow to the kidneys. This should lead to a decrease in the release of renin, thus causing the compensatory mechanisms to stop.
血管紧张素II，大概在转化为血管紧张素III后，刺激肾上腺皮质释放醛固酮。醛固酮作用于肾元，引起钠和水保留。这一效应增加血容量，也促进血压升高。富钠血刺激下丘脑渗透压感受器，引起抗利尿激素释放，此举转而引起肾元水保留，进一步增加血容量。血容量的增加又增加了血压，此举使对肾血流增加，从而导致肾素释放下降，因此，引起代偿机制的终止。
★ Video ★
ACE Inhibitors
★ Tests ★
1. When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride:
A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
B. Increases norepinephrine secretion and thus decreases blood pressure and heart rate.
C. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure.
D. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.
2. The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed?
A. "The medication may not work as well if I take any aspirin."
B. "The doctor may order a blood potassium level occasionally."
C. "I will call the doctor if I notice that I have a frequent cough."
D. "I won't worry if I have a little swelling around my lips and face."
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答案 Answers
1.A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
Rationale: Propranolol hydrochloride is a beta-adrenergic blocking agent. Actions of propranolol hydrochloride include reducing heart rate, decreasing myocardial contractility, and slowing conduction.
2. D. "I won't worry if I have a little swelling around my lips and face."
Rationale: Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.
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