阿托伐他汀联合地尔硫卓在预防桡动脉痉挛的对照研究

目的:观察经桡动脉介入治疗时应用阿托伐他汀钙片联合地尔硫卓针预防桡动脉痉挛(RAS)的疗效,及对血压、心率的影响,进一步了解阿托伐他汀钙和地尔硫卓联合应用在预防桡动脉痉挛的安全性和有效性。方法:378例经桡动脉路径行冠脉介入治疗的患者,随机分为阿托伐他汀钙和地尔硫卓(130例),阿托伐他汀钙组(120例)和地尔硫卓组(128例),术前6 h口服阿托伐他汀钙片80 mg,成功置入6F动脉鞘管后以"弹丸式"注入地尔硫卓针,分别记录注入药物前,注入后1、3、5、10及30 min的血压、心率,观察局部及全身情况变化。结果:阿托伐他汀钙和地尔硫卓联合组局部及全身情况与对照组相比均无明显差异,三组对血压、心率的影响比较,差异无统计学意义(均P>0.05)。阿托伐他汀钙联合地尔硫卓组有4例发生桡动脉痉挛,地尔硫卓组有12例,而阿托伐他汀钙组有16例,三组相比,差异有显著统计学意义(χ2值:4.992 6,P值<0.05,χ2值:8.0085,P值<0.01)。结论:经桡动脉介入治疗时,阿托伐他汀钙和地尔硫卓联合应用可以有效预防桡动脉痉挛的发生,且对心率、血压无明显影响。     

瑞舒伐他汀联合地尔硫卓对急性心肌梗死患者直接PCI治疗的心肌保护作用

目的 探讨瑞舒伐他汀联合地尔硫卓对急性心肌梗死患者直接PCI治疗的心肌保护作用。方法 选择急性ST段抬高型心肌梗死并行直接PCI术患者150例,随机分为A组(n=72)和B组(n=78)。A组术前口服瑞舒伐他汀联合持续静脉泵入并术中梗死相关动脉内注射地尔硫卓;B组术前口服瑞舒伐他汀联合单纯术中梗死相关动脉内注射地尔硫卓。术前及术后检测两组生化指标、TIMI血流分级及术后90 min ST段回降率。结果 术后两组反映心肌损伤的生化指标较术前均有下降,但A组优于B组(P<0.05);两组治疗后TIMI血流达3级的比例及90 min ST回降率明显升高,A组更为明显(P<0.05)。结论 瑞舒伐他汀联合持续静脉泵入并术中梗死相关动脉内注射地尔硫卓可明显减轻PCI术中心肌损伤。     

血管内支架置入术治疗症状性颅内动脉狭窄的临床研究

目的 探讨颅内动脉支架置入术治疗症状性颅内动脉狭窄的有效性,安全性,以及近期临床疗效及围手术期并发症的防治.方法 对入选的68例颅内动脉狭窄的患者,于颈内动脉颅内段、大脑中动脉、椎动脉颅内段及基底动脉狭窄处行支架置入治疗,手术前后对患者行经颅脑多普勒超声(TCD)检查,评估颅内血流动力学情况;临床症状体征变化采用美国国立卫生研究院卒中量表评分(NIHSS);血管狭窄采用华法令-阿司匹林症状性颅内动脉病变(WASID)标准计算术前术后狭窄率;对术后所有病例进行短期(3～6个月)随访.结果 68例患者共置入73枚支架,手术成功率为95.59%,其中3例因颅内血管过度迂曲,支架未能达到狭窄部位,余支架置入均一次成功,支架位置准确,膨胀良好,血流通畅.1例术中出现血管痉挛,2例出现新发颅内缺血事件,2例出现颅内出血,余患者均反应良好.结论 血管内支架置入术治疗颅内动脉狭窄安全性高、创伤性小,近期疗效明显,远期疗效有待进一步研究.     

静脉注射地尔硫卓治疗冠脉三支病变心绞痛发作的临床观察

目的探讨静脉注射地尔硫卓治疗冠脉三支病变心绞痛发作的临床疗效。方法对30例冠状动脉三支病变患者,随机分为治疗组(地尔硫卓)与对照组(硝酸甘油),每组15例。治疗组给予合贝爽初始剂量1ug/kg.min静脉泵入。对照组给予硝酸甘油初始剂量0.1ug/kg.min静脉泵入。两组根据胸痛缓解情况及心率、血压变化调整剂量。分别记录30分钟内两组患者心绞痛缓解情况及心电图、心率、血压变化。结果30分钟,地尔硫卓组与硝酸甘油组30分钟内症状缓解,两组对比差异无显著性。心电图改善时间比较,地尔硫卓组明显短于硝酸甘油组,两组对比,差异有统计学意义。结论静脉注射地尔硫卓能迅速、有效控制冠脉三支病变患者心绞痛的发作。     

颅内动脉支架置入术治疗脑缺血的应用研究

目的探讨通过颅内动脉支架置入术（CAS）治疗脑缺血,在预防与延迟致死性中风的发生、发展中的作用,及安全性、近期临床疗效。方法对入选的20例颅内动脉狭窄的患者,于颈内动脉、椎基底动脉及大脑中动脉狭窄处行支架置入治疗。结果 20例患者所有23枚支架置入均一次成功,术后造影显示,支架位置准确,膨胀良好,支架内及远端血管血流通畅。置入后随访,均未出现TIA及其他临床症状。结论颅内动脉支架置入术治疗缺血性脑血管病安全、创伤性小,近期疗效明显,远期疗效还需进一步随访观察。     

静脉泵入地尔硫卓治疗高血压危象30例疗效观察

目的 评价静脉泵入地尔硫卓治疗高血压危象的降压效果及其安全性.方法 对30例高血压危象患者给予静脉使用地尔硫卓,观察用药前后血压、心率变化.结果 患者血压在用药后10min即开始下降,60min时血压明显下降,并保持稳定水平,总显效率为93%.心率也于用药后有较明显下降,但均在安全范围内.结论 静脉泵入地尔硫卓治疗高血压危象起效快,降压疗效显著、平稳,不良反应少,使用方便,可作为高血压危象选择药物之一.     

尼莫同联合3H疗法治疗蛛网膜下腔出血后脑血管痉挛的临床研究

目的探讨尼莫同联合3H疗法（高血压、高血容量、血液高稀释度）在防治蛛网膜下腔出血（Subarachnoid hemorrhage，SAH）后脑血管痉挛的疗效是否优于单纯应用尼莫同。方法78例SAH的患者为研究对象，40例以尼莫同10mg＋500ml生理盐水日一次静脉泵入10d，10d后改口服尼莫同片30mg，日4次，持续l0d；入院后同时给予提升血压到基础血压上10mmHg，入液量4000ml（晶体3500ml，胶体500m1）每天。38例给予单纯尼莫同治疗。对比两者在治疗脑血管痉挛的差异性，用经颅多普勒检测脑血流，并进行统计学分析。结果尼莫同联合3H疗法组的脑血管痉挛发生率明显低于单纯应用尼莫同组（P〈0．05）；尼莫同联合3H疗法组的大脑前动脉、大脑中动脉、大脑后动脉的脑血管收缩峰流速低于单纯应用尼莫同组（P〈0.05）。结论尼莫同＋3H疗法在防治SAH后脑血管痉挛优于单纯应用尼莫同。     

尼莫通预防和治疗珠网膜下腔出血后脑血管痉挛60例的临床观察

目的：探讨尼莫通预防和治疗蛛网膜下腔出血（SAH）后脑血管痉挛（CVS）引起的缺血性神经功能障碍的价值。方法：对照组30例,入院后给预6－氨基已酸等抗溶药降低颅内压力及一般对症治疗,治疗组60例,加用尼莫通每日10mg,用微量静脉输液泵,静脉序贯给药5－10天,后口服至21天的治疗方法,结果：2周内临床症状体征缓解消失率尼莫通组高于对照组,P＜0．05,1月后致残,致死率对照组高于尼莫通组,P＜0．01。结论：尼莫通能降低SAH病人延迟性缺血性神经功能障碍的发生和病死率,尼莫通治疗SAH有明显效果。     

尼莫通治疗视网膜中央动脉阻塞的护理

目的 探讨尼莫通治疗视网膜中央动脉阻塞的疗效及安全性.方法 静脉滴注尼莫通注射液过程中严格控制速度、密切观察血压、心率变化及局部皮肤情况.结果 所有患者在静脉滴注尼莫通治疗过程中均未出现严重并发症.结论 在滴注尼莫通过程中只要认真观察病情变化及药物副作用,能使治疗安全、有效、减少并发症.     

地尔硫卓在原发性高血压患者腹腔镜手术中的应用

目的 探讨地尔硫卓用于原发性高血压患者腹腔镜手术时血流动力学的变化.方法 行腹腔镜手术原发性高血压患者80例,随机分为地尔硫卓组和对照组各40例,地尔硫卓组在麻醉诱导前15 min 静脉持续泵入地尔硫卓5～15 μg/(Kg·min),对照组在同一时间静脉泵入生理盐水.观察患者麻醉诱导前(T1)、插管即刻(T2)、手术开始即刻(T3)、气腹时(T4)、手术开始15 min 后(T5)、放气腹时(T6)、手术结束时(T7)、拔管即刻(T8)的无创血压(SBP),平均动脉压(MAP)和心率(HR).结果 在维持血压不低于基础血压30%的情况下地尔硫卓组的SBP、MAP、HR在T2～T8时间段均明显低于对照组(P<0.05).结论 地尔硫卓静脉持续泵入在原发性高血压患者腹腔镜手术中能有效的保持患者血流动力学的相对平稳,使患者安全平稳的度过麻醉手术期.     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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…     

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.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.