美西律对心功能不全的疗效观察

目的：美西律对心功能Ⅲ-Ⅳ级（NYHA分级）并发室性心律失常与心功能正常并发室性心律失常疗效的影响。观察心衰与心律失常及治疗的关系。方法：观察组20例，心功能Ⅲ-Ⅳ级，对照组A组30例，心功能Ⅰ-Ⅲ级，对照B组20例，心功能Ⅲ－Ⅳ级（心功能Ⅲ-Ⅳ级按入院先后分组）。观察组矫正心功能基础上加用美西律300－450mg.d^-1，对照A组在治疗原发性病基础上加用美西律30－450mg.d^-1，对照B组单纯矫正心功能。结果：观察组有效率为25％，与对照A组（73．3％）比较，P＜0．01，与对照B组（20％）比较，P＞0．05，结论：本观察提示，心衰时室性心律失常的发生与心功能有关。     

慢性充血性心力衰竭患者的心率变异性分析

目的：探讨慢性充血性心力衰竭（CHF）患者的心率变异性（HRV）的变化。方法：用24d,时动态心电图分析51例心力衰竭患者、27例心功能代偿的心血管病患者、25例健康人的HRV指标。比较3组HRV指标与心功能NYHA分级和关系。结果：心功能代偿组SDNN、SDANN较对照组显著下降（P〈0.01,P〈0．05）SDNNi、rMSSD和pNN50与对照组差异无显著性（P〉0．05）;CHF组的HRV各指标均显著低于对照组（P〈0．01）。心功能≥Ⅲ级者较Ⅱ级HRV各项指标显著降低（P〈0．01）,各种病因SDNN、SDANN较对照组显著下降（P〈0．01）,但各种病因间差异无显著性（P〉0．05）。结论：CHF患者HRV指标下降的变化与心功能损害程度相关,但原发病之间HRV指标下降无差异。     

小剂量甲状腺素治疗慢性充血性心力衰竭伴低T_3综合征的疗效观察

目的观察小剂量左旋甲状腺素治疗慢性充血性心力衰竭心功能Ⅲ～Ⅳ级伴低T3综合征的临床治疗效果和安全性。方法选择慢性充血性心力衰竭心功能Ⅲ～Ⅳ级伴低B综合征患者40例，随机分为治疗组和对照组，治疗组在常规心衰治疗基础上加口服左旋甲状腺素（L-T4）25～50μg／d治疗，疗程为12周。比较两组治疗前后血清甲状腺激素水平、左室射血分数（LVEF）、左窒舒张术期（LVDD）、E峰从峰比（E／A），心输出量（CO）、心率变化（HR）以及新发心律失常、急性冠脉综合征发生情况。，结果治疗组治疗后甲状腺激素水平较治疗前明显上升（P〈0．05）。两组心功能LVEF、LVDD、CO、E／A治疗后较治疗前有明显改善．差异最著有统计学意义（P〈0．05）；治疗后治疗组心功能LVEF、LVDD、CO、E／A较对照组有明显改善，差异显著有统计学意义（P〈0．05）．．结论存慢性充血性心力衰竭心功能Ⅲ～Ⅳ级伴低T3综合征患者积极补充小剂量左旋甲状腺素可明显改善患者心功能和提高患者生存质量，本研究认为中短期应用小剂量左旋甲状腺素治疗CHF伴低T3综合征是一种安全有效可行的辅助治疗疗法．     

慢性心力衰竭患者血浆N端脑钠素原含量与病情严重程度的关系探讨

目的了解心力衰竭发生发展过程中神经内分泌方面的变化，以探讨心衰早期诊断和治疗的理论依据。方法60例心脏病患者根据纽约心脏病协会（NYHA）分级标准分为心功能Ⅰ级（A组30例）、Ⅱ级（B组14例）、Ⅲ级（C组16例）三组，健康对照组30例。用放射免疫法检测N端脑钠素原（Nt—proBNP）血浆浓度、心脏彩色超声检测其射血分数（EF）。结果B组和C组患者的Nt—proBNP与健康对照组比较有统计学意义（P〈0．05），且与射血分数呈负相关（r=0．512，r=0．548，均P〈0．05）。无症状性心衰患者（EF〈50％但无心衰症状）Nt—proBNP浓度升高也有统计学意义（EF≥50％VSEF〈50％，P〈0．05）。结论慢性心力衰竭患者存在神经内分泌的过度激活，Nt—proBNP血浆浓度升高较为敏感，可作为评价心衰严重程度和早期心功能受损。的指标。     

慢性克山病心衰病人血清TNF的检测及意义

应用单克隆抗体ELISA法分别检测30例慢性克山病心衰病人及30例正常人血清肿瘤坏死因子水平，结果发现，慢性克山病心衰病人TNF水平明显高于对照组（P＜0．01）．心功能不同，TNF水平也不同，心功能Ⅳ级组明显高于Ⅲ级组、Ⅱ级组，组间比较有显著性差异（P＜0．01）．提示TNF在漫性克山病心衰的发病机制中起重要作用．     

血清 cTnI、NT-proBNP水平用于心力衰竭患者心室重构评定的临床价值分析

目的：探讨血清肌钙蛋白I（cTnI）、N末端B型利钠肽原（NT-proBNP）水平用于心力衰竭（心衰）患者心室重构评定的临床价值。方法将该院就诊的79例心衰患者为观察组,另选取生理指标全部正常的20例为对照组,基于胶体免疫层析法检测血清cTnI水平,化学发光法检测血清NT-proBNP水平,进行组间比较,将观察组患者进行心功能NYHA分级,比较各等级间血清cTnI、NT-proBNP水平,基于SPSS 20．0分析NYHA分级与二者的相关性。结果血清cTnI、NT-proBNP水平在对照组与观察组间呈明显差异（P＜0．05）,在NYHA分级各级间差异明显（P＜0．05）。且二者水平均与心衰患者NYHA分级呈现明显正相关（P＜0．05）。结论血清cTnI、NT-proBNP水平与心衰患者心功能NYHA分级呈现相关性,二者作为心衰患者心室重构的评定具较高的临床价值。     

慢性心力衰竭患者血尿素氮升高198例临床分析

目的：探讨尿素氮升高在慢性心力衰竭病情评估中的意义。方法选择198例慢性心衰患者作为观察组（根据NYHA心功能分为Ⅱ、Ⅲ、Ⅳ级）,另外选择同期NYHA心功能Ⅰ级患者85例作为对照组。24 h内检测两组血BUN、血肌酐（ Scr ）、B型脑钠肽（ BNP ）、血尿酸（ UA ）及左室射血分数（ LVEF ）并比较。结果观察组Ⅱ、Ⅲ、Ⅳ级BUN分别为（5．5＋1．8） mmol/L、（6．6＋2．6） mmol/L、（8．8＋4．1） mmol/L,均高于对照组的（4．9＋1．0）mmol/L（均P＜0．01）。 BUN、 Scr、UA与LVEF负相关（r＝-0．298、-0．325、-0．379,均P＜0．01）。结论尿素氮升高与慢性心力衰竭病情严重程度相关,可作为评估病情的指标。     

心脏再同步治疗在慢性心力衰竭患者的临床应用

目的评价心脏再同步治疗（cardiac resynchronization therapy,CRT）慢性心力衰竭患者临床应用效果。方法将植入三腔起搏器进行cR王的32名慢性心力衰竭患者根据纽约心脏病学会（New Yor kHeart Association,NYHA）心功能分级分为NYHA心功能Ⅲ级组和。科Y}骆心功能Ⅳ级组。其中NYHA心功能Ⅲ级组14例,NYHA心功能Ⅳ级组18例,并对其进行随访观察治疗,以观察两组患者心功能改善情况,以评价心脏再同步治疗的效果。结果两组在性别构成比、年龄、基础心脏病构成比、左心室射血分数（1础ventricular ejection fraction,LVEF）、术前左室舒张末期内径（1eft ventricular end-diastolic diameter,LVEDD）、植入时心律为窦性心律、术前心电图QRS波时限、术后心电图QRS波时限、左室电极植入靶静脉、植入起搏器类型,及合并糖尿病、高血压病、脑血管疾病史等方面未有统计学差异。术后随访发现,NYHA心功能Ⅳ级组治疗效果明显比例显著低于NYHA心功能Ⅲ级组（5仉O％t】s92．9％,P=0．019）。回顾性分析治疗效果明显与治疗效果不明显两组临床资料,发现治疗效果不明显组NYHA心功能Ⅳ级所占比例明显高于治疗效果明显组（90．O％铘40．9％,P=0．019）,且术前LVEDD明显大于治疗效果明显组[（76．7±10．3）mmvs（68．0±7．6）mm,P=0．012）]。结论NYHA心功能Ⅳ级组CRT后效果不如NYHA心功能Ⅲ级组,较大的术前LVEDD是CRT术后疗效不佳的预测因素。但在药物治疗基础上,CRT仍可改善慢性心力衰竭患者的心功能。     

血浆 NT-proBNP水平与心力衰竭的相关性分析

目的：探讨血浆B型脑钠肽前体（NT-proBNP）水平与心力衰竭（心衰）的相关性。方法选取于该院就诊的心衰患者142例作为研究组,以及同期住院的非心衰患者140例作为对照组。研究组患者入院初即依据临床症状进行NYHA分级。于入院之后采用药物治疗之前,检测所有患者的血浆NT-proBNP水平。比较2组间以及研究组不同NYHA分级间的NT-proBNP水平。结果研究组血浆 NT-proBNP水平高于对照组,差异有统计学意义（P＜0．05）;研究组心功能越差,血浆NT-proBNP水平越高,且各分级之间的NT-proBNP水平差异均有统计学意义（ P＜0．05）。结论血浆NT-proBNP水平可作为临床诊断是否存在心衰的参考指标,同时也可作为心衰诊断的独立敏感指标。     

慢性心力衰竭患者血N端B型脑钠肽、β2微球蛋白临床意义及相关性研究

【摘要】目的观察慢性心力衰竭患者血浆N端B型脑钠肽（NT-proBNP）、β2微球蛋白（β2-MG）的临床意义及其相关性。方法将120例慢性心力衰竭患者按纽约心脏病协会（NYHA）心功能分级方法分为3组：心功能Ⅱ级组、Ⅲ级组、Ⅳ级组,每组40例,测定3组患者血NT-proBNP、β2-MG、尿素氮（BUN）、肌酐（Cr）,并进行统计学分析。结果3组NT-proBNP水平差异有统计学意义（P＜0.01）,且随心力衰竭程度加重而增加;心功能Ⅳ级组β2-MG水平高于心功能Ⅱ、Ⅲ级组（P＜0.01）,心功能Ⅱ、Ⅲ级组β2-MG水平差异无统计学意义（P＞0.05）。NT-proBNP与β2-MG呈高度正相关（r=0.855,P＜0.01）。各组BUN、Cr差异无统计学意义（P＞0.05）。结论NT-proBNP能准确评估心功能,且心衰越重早期肾损害越重     

The effects of reboxetine on autonomic and cognitive functions in healthy volunteers

RATIONALE: Though reboxetine, a selective noradrenaline reuptake inhibitor, causes autonomic and cognitive adverse events there is a paucity of appropriately designed studies on the cognitive and autonomic effects of the drug in the literature. OBJECTIVE: To compare the effects of reboxetine on cognitive and autonomic functions with those of placebo in healthy humans. METHOD: A randomised, double-blind, crossover study of 12 healthy male volunteers aged 25 (21-27; median, range) years. Subjects orally received 4 mg reboxetine and placebo twice daily for periods of 14 days each with at least 14 days in between. Vasoconstrictory response of cutaneous vessels (VR) and skin conductance response (SCR) following sudden deep breath were employed as parameters for autonomic function. Quantitative EEG (qEEG) and psychometric tests served as parameters for cognitive function. RESULTS: Reboxetine decreased SCR and prolonged the dilation phase of VR (P<0.05). It did not affect cognitive functions such as flicker fusion frequency, choice reaction, memory and psychomotor coordination but increased slow beta (beta1) power density in the qEEG. Tiredness (n=12), dry mouth (n=9), delayed urination (n=3) and constipation (n=1) were noted with reboxetine. CONCLUSION: Sustained peripheral and/or central sympathetic activation accounts for the prolongation of VR. The decrease of SCR and typical side effects suggest a relevant antimuscarinic drug action. Chronic administration of reboxetine at therapeutic doses causes autonomic dysfunction and subjective sedation but does not impair cognitive and psychomotor abilities in healthy humans.     

中医数学模型

中医五行学说数学模型是完全以中医理论为基础,以《黄帝内经》等古代医学文献为主要的参考资料进行归纳和整理的一种处理中医问题的有效方法。必要的数学假设,精练的数学语言对中医五行学说理论加以描述,并且初步建立起中医数学模型。同时为其他中医理论的数学建模提供了参考依据,从而逐步实现中医与现代科学接轨。     

扇贝裙边糖胺聚糖抗肿瘤作用和对荷瘤小鼠免疫功能的影响

目的：研究扇贝裙边糖胺聚糖（SS-GAG）的抗癌作用及对荷瘤小鼠免疫功能的影响。方法：建立小鼠移植性S180实体瘤模型，观察SS-GAG的抑瘤率以及对荷瘤小鼠的体质量、肝质量、白细胞计数、脾指数、胸腺指数的影响，同时观察SS-GAG对荷瘤小鼠细胞免疫活性的影响。结果：SS-GAG可明显抑制S180实体瘤的生长，SS-GAG与环磷酰胺联用可使化疗药物的抗癌作用增强并能有效提升减少的白细胞；能显著增强荷瘤小鼠腹腔巨噬细胞的吞噬能力和杀伤活性，增强荷瘤小鼠脾淋巴细胞的转化增殖和NK细胞活性。结论：SS-GAG可显著抑制肿瘤生长，与环磷酰胺联用时有减毒增效作用；并能增强荷瘤小鼠的免疫功能。     

颅骨修补对患者神经及认知功能的影响

目的 探讨颅骨修补对患者神经和认知功能的影响.方法 应用NIHSS卒中量表(美国国立卫生研究院卒中量表)对患者手术前后的神经功能进行评价,认知功能的评价采用MMSE量表(简明智能量表),结果进行t检验统计学分析.结果 NIHSS术前为(2.72±3.82),术后为(2.38±3.27),t检验P＜0.01.MMSE术前为(53.09±34.2),术后为(46.84±31.88),t检验P＜0.01.结论 颅骨修补可改善患者的神经功能障碍,提高患者的认知能力.除对开放性、污染伤口去除颅骨后需要延期修补外,对其他颅骨缺损的患者,一旦脑水肿消失,局部组织压力降低后就要考虑颅骨修补手术,以利于患者神经功能和认知能力的恢复.     

Effects of sertraline on autonomic and cognitive functions in healthy volunteers

Rationale Though sertraline, a selective serotonin reuptake inhibitor (SSRI), causes autonomic and cognitive adverse events such as dry mouth and somnolence, there is a paucity of appropriately designed studies on the cognitive and autonomic effects of the drug in the literature. Objective To compare the effects of sertraline on cognitive and autonomic functions with those of placebo in healthy humans. Method A randomized, double blind, cross over study of 12 healthy male volunteers aged 24 (21– 32; median; range) years. Subjects orally received 50 mg sertraline and placebo once daily for periods of 14 days each with at least 14 days in between. Heart rate variability (HRV), skin conductance level (SCL) and skin conductance response (SCR) following sudden deep respiration were employed as parameters for autonomic function. Quantitative EEG (qEEG) and psychometric tests served as parameters for cognitive function. Measurements were performed repeatedly before the start of drug administration and on the last treatment day. Results Sertraline caused a significant reduction of heart rate and SCL (P<0.05), whereas HRV and SCR were not changed. Cognitive functions such as flicker fusion frequency, memory, choice reaction time and psychomotor performance were not influenced by sertraline but slow and fast beta power density in the qEEG was increased. Conclusion Cognitive and psychomotor performance are not altered in healthy humans receiving multiple dosing with sertraline. The observed decreases in heart rate and SCL may be due to a sympatho-inhibitory effect of sertraline.     

Telmisartan, ramipril and their combination improve endothelial function in different tissues in a murine model of cholesterol-induced atherosclerosis

BACKGROUND AND PURPOSE

Erectile dysfunction correlates with cardiovascular disease and its common risk factors due to the development of endothelial dysfunction. Positive effects on endothelial and erectile function have been described for substances inhibiting the renin-angiotensin-system. Here, we investigated in an atherosclerosis model, whether telmisartan (angiotensin receptor blocker) and ramipril (angiotensin converting enzyme inhibitor) are equivalent or the combination of both is superior in improving endothelial function in the aorta and the corpus cavernosum and in reducing atherosclerosis.

EXPERIMENTAL APPROACH

Wild-type (WT, C57/B6) and apolipoprotein-E-deficient (ApoE^−/−) mice were treated with a cholesterol-rich diet for 8 weeks. ApoE^−/− mice were supplemented with either telmisartan (20 mg·kg⁻¹·day⁻¹), ramipril (2.5 mg·kg⁻¹·day⁻¹) or the combination thereof.

KEY RESULTS

Systolic blood pressure significantly decreased in treatment groups (P < 0.001), with significantly smaller reduction under ramipril monotherapy (P < 0.05). Endothelial function (assessed by pharmacological stimulation of aortic rings and corpus cavernosum in organ bath chambers) was impaired in ApoE^−/− mice compared to WT animals, which was improved by all three treatments to a comparable extent (P < 0.05). Atherosclerotic lesion size in the ascending aorta and aortic sinus (P < 0.001), the amount of lipid peroxides in cavernosal and aortic tissue (P < 0.05) and free radical load (dihydroethidium-stain) (P < 0.05) were enhanced in untreated ApoE^−/− mice in comparison to WT animals and were significantly reduced by either treatment. In penile tissue, expression of eNOS could be restored by renin-angiotensin-aldosterone system blockade.

CONCLUSIONS AND IMPLICATIONS

Telmisartan and ramipril significantly improved endothelial function of aortic and cavernosal tissues in ApoE^−/− via reduction of oxidative stress. Combination of both agents does not enhance beneficial effects significantly.     

ACEI治疗中老年高血压的疗效观察与分析

目的探讨血管紧张素转换酶抑制剂（ACEI）类药物治疗中老年高血压的临床特点及疗效。方法将确诊为原发性高血压患者118例，观察患者使用ACEI类药物治疗前后的血压、肾脏功能、心功能、代谢功能变化情况。结果ACEI治疗后，患者收缩压和舒张压（P〈0．01），24小时尿蛋白定量（P〈0．05），左室舒张末容积和左室收缩末容积（P〈0．05和P〈0．01）明显降低，左室射血分数和心输出量明显增加（P〈0．05），差异有统计学意义。治疗前后患者的血钾、血肌酐、血糖、血脂无明显变化。结论ACEI在有效降血压的同时，保护心脏、肾脏功能，对糖、脂代谢无影响，是临床理想的降压药物。     

妇科术后辅助中药灌肠的临床效果观察

目的探讨中药灌肠对妇科术后肠功能恢复的临床研究。方法将妇科手术后24 h不能自行排气,明显腹胀排除机械性肠梗阻患者,给予中药低压保留灌肠。结果低压保留灌肠60例患者,30例用药6 h内,肛门排气,腹胀消失;29例用药24 h内肛门排气,腹胀消失;1例用药24 h仍未排气。结论采用中药低压保留灌肠:1增加肠蠕动,促进排气,解除腹胀,起到预防肠粘连的作用。2可使药液直接渗入病变部位,更有利于发挥药物的作用,达到加速炎症消除,渗出液的吸收,从而使肠壁水肿逐渐减轻,肠功能恢复。     

应用动态心电图分析心脏起搏器功能的价值

目的通过动态心电图（DCG）分析,了解起搏器起搏、感知及特殊功能,评价应用DCG检查在分析起搏器功能中的价值。方法回顾性分析180例次安装永久型心脏起搏器患者DCG检查结果。结果①检出起搏器起搏功能异常5例次,占2.8%。②检出起搏器感知功能异常60例次,占33.3%。③检出起搏器具有特殊功能65例次,占36.1%。④检出与起搏器有关心律失常52例次,占28.9%。结论 DCG检查能了解起搏器起搏、感知功能及起搏器特殊功能,判断与起搏器有关的各种心律失常,为通过体外程控仪调整起搏器技术参数提供参考依据。