巯甲丙脯酸治疗高血压病探讨

本文报告16例原发性高血压病人,用一般降压药物治疗2年以上,因血压控制不满意改用血管紧张素转换酶抑制剂巯甲丙脯酸。剂量从12.5mg/d开始,逐渐增加,维持量25～75mg/d,治疗13个月复查血压有所下降。平均收缩压从22.9±2.5kPa降至19.5±2.7kPa;(p<0.05)。平均舒张压从15.2±1.1kPa降至11.3±1.1kPa(p<0.01)。治疗前后进行了尿蛋白定性、白细胞、血离子(钾、钠、氯、钙)、肝肾功、空腹血糖、胆固醇、甘油三脂、血尿酸、糖耐量与胰岛素释放试验等检查,二者比较差异无显著性(p>0.05)。治疗2年后复查心功能及左室质量,与治疗前比较差异无显著性(p>0.05)。本组病人在巯甲丙脯酸治疗期间未观察到明显副作用,耐受良好,分析可能与用药剂量较小,血压下降缓慢有关。根据本组研究认为,巯甲丙脯酸是一个副作用较小、相对安全、又不影响生活质量而有效的降压药物。     

依那普利与厄贝沙坦对系膜增生性肾炎的疗效观察

目的观察依那普利和厄贝沙坦对治疗系膜增生性肾炎患者蛋白尿、血尿的有效性和安全性。方法诊断系膜增生性肾炎共40例,其中,选自2001~2003年20例,男11例,女9例。年龄10~44岁。未使用ACEI(血管紧张素转换酶抑制剂)、ARB(血管紧张素转换酶受体拮抗剂)为对照组。选自2004-06~2005-01 20例,男12例,女8例。年龄13~48岁。使用依那普利2.5~10 mg,2次/d+厄贝沙坦150 mg/d。治疗过程中检测24 h尿蛋白定量、尿沉渣红细胞计数,血肌酐、血钾2、4 h尿量,并记录血压及不良反应。结果用依那普利+厄贝沙坦组24 h尿蛋白治疗0、4、6、8周分别为(2.14±0.78)g/d、(0.76±0.43)g/d,(0.49±0.30)g/d,(0.51±0.31)g/d;对照组分别为(2.01±0.67)g/d,(1.43±0.76)g/d,(0.78±0.58)g/d,(0.72±0.56)g/d,用依那普利+厄贝沙坦组尿沉渣红细胞计数0、4、6、8周分别为(454±189)万/mL,(85±57)万/mL,(26±14)万/mL,(23±11)万/mL,对照组分别为(370±175)万/mL,(136±53)万/mL,(49±22)万/mL,(35±23)万/mL。2例服用依那普利出现干咳,无低血压、高血钾、尿量减少、肾功能恶化发生。结论依那普利+厄贝沙坦减少尿蛋白、血尿快于对照组,疗效好,对血压影响不大,副作用轻,安全性好。     

用血清药理学方法观察眼血散对NIH/3T3成纤维细胞的抑制作用

目的运用血清药理学方法,体外观察中药复方眼血散对NIH/3T3成纤维细胞生长的影响。方法给正常兔连续灌服眼血散煎剂浓缩液3d,制备含药血清。将3种浓度的眼血散煎剂浓缩液及含药血清作用于成纤维细胞,用MTT(噻唑蓝)比色法,观察细胞抑制率。结果3种浓度的眼血散及含药血清均能抑制NIH/3T3细胞的生长,6.25mg/ml、12.5mg/ml、25mg/ml眼血散煎剂浓缩液抑制率分别是30.00±2.90、51.35±2.01、59.95±1.34;5%、10%、20%含药血清抑制率分别是4.03±3.15、31.75±31.38、51.11±1.73。结论眼血散可抑制NIH/3T3细胞生长,可能是其防治增殖性玻璃体视网膜病变的作用机理之一。     

硝苯吡啶对无并发症的高血压病患者疗效观察

10例无并发症的高血压病患者于口服国产硝苯吡啶10 mg 3次/d 后第3 d 及1周检测血压及应用超声心动图检测左心功能。血压由21.5±3.4/12.4±1.4 kPa(161.4±25.9/92.8±10.8 mmHg)分别降至18.7±1.6/11.3±1.2 kPa(139.8±11.8/84.6±9.4 mmHg)、17.9±1.7/11.3±1.2 kPa(134.2±12.7/84.6±8.7 mmHg)(P 均<0.01);平均动脉压由15.2±0.9 kPa(114.2±7.7 mmHg)分别降至13.9±0.9 kPa(104.2±7.3 mmHg)、13.6±0.8 kPa(102.0±6.3 mmHg)(P 均<0.01),总外周阻力由1741.0±392.5 dyn·s/cm~5分别降至1514.0±175.5(P>0.05)及1263.1±237.6 dyn·s/cm~5(P<0.01)。舒张早期流速积分由7.2±1.3分别增至8.4±2.6及8.7±2.1((P 均<0.05),舒张早期及心房收缩期峰值流速、心指数等指标亦有所改善。提示国产硝苯吡啶能有效持久降压并改善左心功能。     

随机双盲观察国产坎地沙坦酯/依那普利动态降压疗效

目的研究国产坎地沙坦酯片/依那普利治疗原发性高血压的降压疗效和安全性。方法经过2周的洗脱期后,患者随机接受国产坎地沙坦酯片8mg或依那普利10mg,每日1次,治疗4周后,若坐位舒张压(SeDBP)≥90mmHg者,剂量加倍;SeDBP<90mmHg者维持原剂量,继续治疗4周。结果①药后24小时、白天和夜间DBP/收缩压(SBP)坎地沙坦酯组较用药前下降分别为(3.51±2.71)/(5.74±3.53)mm、(3.80±2.62)/(6.46±3.55)mmHg、(2.92±2.98)/(4.29±3.22)mmHg,依那普利组为(2.13±3.05)/(5.78±3.81)mmHg、(1.48±3.28)/(5.38±3.88)mmHg、(3.42±2.16)/(6.58±3.79)mmHg;②谷/峰比:坎地沙坦酯组DBP70.11%,SBP 64.27%,依那普利组DBP16.43%,SBP 18.61%;③不良反应发生率坎地沙坦酯组18.18%,依那普利组30.43%。结论坎地沙坦酯与依那普利均可安全、有效降压。坎地沙坦酯每日1次口服能24小时平稳降压。     

缬沙坦对早期糖尿病肾病的疗效观察

80例2型糖尿病(DM)患者,尿白蛋白排泄量(Alb)在30～300mg/d,不伴高血压.维持原DM治疗不变.分缬沙坦组(80mg/d)、依那普利组(10mg/d)和维生素B6组(20mg/d).比较治疗12周前后平均动脉压(MAP)、Alb、糖化血红蛋白(HbA1c)、内生肌肝清除率(Ccr)、尿酸(UA)和空腹血糖(FPG)的变化.结果,对照组各项指标均无明显变化(P＞0.05);缬沙坦组～b由117±55(62～172)mg/d降至68±35(33～103)mg/d(P＜0.01);依那普利组Alb由114±56(58～170)降至76±36(40～112)mg/d(P＜0.05).二者疗效相似,与血压变化不相关.结果表明,缬沙坦可降低早期糖尿病肾病的蛋白尿,对糖尿病肾病有良好的保护作用.     

观察依那普利对急性前壁心肌梗死QRS积分的影响

目的观察依那普利对急性前壁心肌梗死QRS积分的影响。方法32例急性前壁心肌梗死患者随机分成依那普利组(20例)与对照组(12例),治疗组给予依那普利10mg/日,并对每例患者住院即刻、24h、7d、21d做常规心电图,采用Wagner提出的QRS积分方法记录每份ECG分值。结果依那普利组第21日QRS分值(5.53±2.42)显著低于对照组(6.54±1.88),P<0.05。结论依那普利可明显降低急性前壁心肌梗死患者QRS的分值。     

硝苯吡啶对无并发症的高血压病患者疗效观察

10例无并发症的高血压病患者于口服国产硝苯吡啶10mg 3次/d后第3d及1周检测血压及应用超声心动图检测左心功能。血压由21.5±3.4/12.4±1.4kPa(161.4±25.9/92.8±10.8mmHg)分别降至18.7±1.6/11.3±1.2kPa(139.8±11.8/84.6±9.4mmHg)、17.9±1.7/11.3±1.2kPa(134.2±12.7/84.6±8.7mmHg)(P均<0.01);平均动脉压由15.2±0.9kPa(114.2±7.7mmHg)分别降至13.9±0.9kPa(104.2±7.3mmHg)、13.6±0.8kPa(102.0±6.3mmHg)(P均<0.01),总外周阻力由1741.0±392.5dyn·s/cm⁵分别降至1514.0±175.5(P>0.05)及1263.1±237.6dyn·s/cm⁵(P<0.01)。舒张早期流速积分由7.2±1.3分别增至8.4±2.6及8.7±2.1((P均<0.05),舒张早期及心房收缩期峰值流速、心指数等指标亦有所改善。提示国产硝苯吡啶能有效持久降压并改善左心功能。     

福辛普利与依那普利对急性心肌梗死患者QT及QTc离散度的影响

目的 :探讨福辛普利与依那普利对急性心肌梗死 (AMI)患者QT离散度 (QTd)及QTc离散度 (QTcd)的影响。方法 :AMI患者分为 3组 :基础治疗组 2 3例 ,基础治疗 +福辛普利 10mg/d治疗组 (福辛普利组 2 8例 )和基础治疗 +依那普利 10mg/d(依那普利组 32例 ) ,并对治疗前和治疗第 8周的QTd、QTcd进行对比分析。结果 :基础治疗组发病后即刻QTd、QTcd与治疗 8周后相比变化无显著性。依那普利组治疗前后QTd分别为 (80 .7± 36 .8)和(5 9.7± 2 9.1) ,QTcd分别为 (89.6± 38.8)和 (6 9.1± 35 .0 ) ,治疗前后比较P均 <0 .0 5。福辛普利组治疗前后QTd分别为 (78.3± 2 9.5 )和 (6 1.4± 35 .6 ) ,QTcd分别为 (92 .5± 4 1.2 )和 (71.3± 2 8.1) ,治疗前后比较P均 <0 .0 5。结论 :福辛普利与依那普利均能显著降低AMI患者QTd、QTcd。但 2组间对比差异无显著性     

评价莫索尼定在原发性高血压患者中的降压疗效

目的 评价莫索尼定在原发性高血压患者中的降压疗效及耐受性。 方法 40名高血压患者随机分为莫索尼定组(0.2mg/d)与依那普利组(5mg/d) ;于安慰剂期末及治疗2、4、6、8周作双盲治疗 ,测诊室血压(OBP)、心率并记录症状、体征及不良反应。结果 治疗8周降压总有效率 :莫索尼定组为88.2 % ,依那普利组为90.0 %。莫索尼定组坐位收缩压下降(12.6±15.4)mmHg,坐位舒张压下降(14.8±7.3)mmHg;依那普利组坐位收缩压下降(16.9±11.1)mmHg,坐位舒张压下降(13.7±6.0)mmHg ,两组收缩压和舒张压下降幅度比较差别无显著性意义(均P>0.05)。结论 莫索尼定对原发性轻、中度高血压患者有良好的降压作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.