缬沙坦联合卡维地洛治疗慢性心力衰竭的临床研究

目的:探讨缬沙坦联合卡维地洛对慢性充血性心力衰竭心功能及心室重塑的影响。方法:66例充血性心力衰竭患者随机分为观察组(缬沙坦联合卡维地洛)和对照组(常规治疗)。对照组给强心苷及利尿药常规治疗,观察组在常规治疗基础上加用缬沙坦及卡维地洛。疗程6个月。比较2组治疗前后心率、收缩压、6min步行试验、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF),并进行统计学分析。结果:对照组治疗后心率显著下降、6min步行试验、LVEF等指标均显著改善,与治疗前比较,差异有统计学意义(P<0.05);观察组治疗后心率、收缩压、LVEDD、LVESD均显著下降、6min步行试验及LVEF显著改善(P<0.05),与对照组比较,差异均有统计学意义(均P<0.05)。结论:缬沙坦联合卡维地洛改善慢性充血性心力衰竭心功能并逆转心室重塑。     

培哚普利联合卡维地洛治疗心力衰竭的疗效观察

目的观察培哚普利联合卡维地洛治疗心力衰竭的疗效。方法将56例慢性心力衰竭患者随机分为培哚普利和卡维地洛联合治疗组(28例)与对照组(传统治疗,28例)。3个月为1个疗程。观察治疗后心功能情况,彩色多普勒超声心动图测量左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及左室射血分数(LVEF)、6min步行试(6-MWT)变化及不良反应等。结果治疗组的心功能疗效总有效率71.4%,对照组为53.6%;两组患者用药后LVEDD、LVESD下降,LVEF增加,治疗组改善更明显(P<0.05)。结论培哚普利和卡维地洛联合治疗可提高疗效,明显改善CHF患者的远期预后。     

心率控制对慢性心力衰竭患者心功能的影响

目的观察慢性心力衰竭患者入院后予以积极控制心率后对心功能的影响。方法选择2015年1月至12月在上海市浦东医院心血管内科住院纽约心脏学会(NYHA)心功能分级Ⅱ~Ⅳ级的120例充血性心力衰竭(CHF)患者,随机数字表法分配至治疗组及对照组,所有患者在常规治疗基础上,治疗组予以琥珀酸美托洛尔缓释片积极控制心率,以患者静息心率降至55~60次/min为目标心率指导药物治疗。检测2组治疗前、治疗12个月后静息心率,左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD),左心室射血分数,6min步行试验距离以及血清脑钠肽(BNP)水平,以心力衰竭再入院为终点事件。结果治疗12个月后,治疗组患者静息心率显著低于对照组(P<0.01),治疗组患者LVEDD、LVESD及血浆BNP水平显著低于对照组,6min步行试验距离、LVEF显著高于对照组(P<0.05),心衰再入院率低于对照组(P<0.05)。结论积极控制心率可以改善CHF患者心功能。     

卡维地洛治疗扩张型心肌病心力衰竭临床观察

目的：观察卡维地洛治疗扩张型心肌病心力衰竭的疗效。方法：将80例扩张型心肌病心力衰竭患者随机分配到观察组和对照组,对照组采用常规抗心衰治疗,观察组在常规抗心衰治疗的基础上加用卡维地洛进行干预。比较治疗前后观察组和对照组的左心室收缩末期内径（LVESD）,左心室舒张末期内径（LVEDD）,左心室射血分数（LVEF）等反映左心室功能与结构变化的指标,比较观察组和对照组治疗扩张型心肌病心力衰竭的总有效率。结果：对照组对扩张型心肌病心力衰竭患者治疗的总有效率明显低于观察组,P〈0．05。治疗6个月后。观察组患者LVESD明显低于对照组,P〈0．05,而LVEDD与LVEF明显高于对照组。治疗前后组内比较LVESD、LVEDD与LVEF．P〈0．05。差异有统计学意义。结论：对于扩张型心肌病心力衰竭患者,在常规抗心衰治疗的基础上加用卡维地洛能够显著改善左室舒缩功能与心功能状态．有利于左室重构．提高生活质量。     

卡维地洛与比索洛尔治疗慢性心力衰竭的临床效果及安全性对比

目的：研究研究卡维地洛与比索洛尔治疗慢性心力衰竭的临床效果和安全性。方法187例慢性心力衰竭患者随机分为卡维地洛组（ n ＝94）和比索洛尔组（ n ＝93）。2组患者在常规基础治疗上按照各自给药方案进行治疗。所有患者在治疗前后观察血压、心率、6 min步行试验,进行彩色超声心动图检查[左心室射血分数（ LVEF）、左心室舒张末期内径（ LVEDD）、左心室收缩末期内径（ LVESD）],同时观察药物不良反应。结果2组治疗前后的心率、血压、6 min步行试验、LVEF、LVESD、LVEDD进行对比,差异均有统计学意义（ P ＜0．05）,治疗后比索洛尔组心率下降较卡维地洛组明显,而卡维地洛组LVEF改善优于比索洛尔组。2组患者总有效率及不良反应比较差异无统计学意义（ P ＞0．05）。结论卡维地洛与比索洛尔治疗慢性心力衰竭的临床效果相似,可以有效改善心功能,且耐受性较好。     

靶剂量卡维地洛改善充血性心力衰竭患者心功能的临床研究

目的:观察靶剂量卡维地洛(Carvedilol)治疗充血性心力衰竭(CongestiveHeartFailure,CHF)患者的临床疗效。方法:80例NYHA心功能Ⅱ～Ⅳ级CHF患者随机分组:Betaloc组40例,常规治疗(ACEI、利尿剂、血管扩张剂、有或无洋地黄) Betaloc;Carvedilol组40例,常规治疗 Carvedilol。随访1～2年,观察二组治疗前后血流动力学、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、6分钟步行距离(6-MWD)及心功能变化。结果:两组治疗后心率(HR)、收缩压(SBP)、心肌耗氧量(HR*SBP)、LVEDD、LVESD、LVEF、左室短轴缩短分数(LVFS)、NYHA心功能分级均较治疗前显著改善(P<0.01),而carvedilol组在血流动力学及心功能改善上较betaloc组更明显(P<0.05);但治疗后组间HR降低无显著差异(P>0.05)。两组治疗后6-MWD也均较治疗前显著增加(P<0.01),尤其carvedilol组(P<0.05)。Carvedilol组无不良反应出现。结论:联用靶剂量carvedilol治疗CHF安全有效,可在ACEI上进一步延缓心室重塑、改善心功能、显著提高患者的运动耐量。     

卡维地洛治疗慢性心力衰竭患者疗效观察

目的观察卡维地洛治疗慢性心力衰竭的临床疗效。方法慢性心衰患者69例,随机分为常规治疗组34例和卡维地洛治疗组35例。常规治疗组用强心、利尿药和扩血管药物治疗,卡维地洛治疗组在常规治疗药物的基础上加用卡维地洛,疗程8周。观察其临床效果并测定治疗前后左心室射血分数（LVFF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）的变化。结果治疗8周后,卡维地洛治疗组总有效率高于常规治疗组（P〈0．05）,卡维地洛治疗组LVFF、LVEDD、LVESD与常规治疗组比较,差异均有统计学意义（P〈0．01,P〈0．05）。结论卡维地洛治疗慢性心力衰竭疗效可靠,可改善心肌功能。     

血管紧张素Ⅱ受体阻滞剂与转换酶抑制剂治疗慢性心衰

目的:探讨血管紧张素Ⅱ受体阻滞剂(ARB)与血管紧张素转换酶抑制剂(ACEI)联合治疗慢性心力衰竭(CHF)的疗效.方法:对照组治疗包括原发病治疗和心衰常规治疗(包括血管扩张剂、利尿剂、β受体阻滞剂、洋地黄制荆);ACEI组治疗是在对照组治疗基础上加用ACEI;ARB ACEI组治疗是在对照组治疗基础上加用ARB和ACEI联合治疗.治疗时间1年.每组患者治疗前后分别测定左室射血分数(LVEF)、左房内径(LAD)、左室收缩末期内径(LVESD)、左室舒张末期内径(INEDD)、6 min行走距离.结果:ARB ACEI组和ACEI组治疗1年后其心脏结构(LAD、LVESD、LVEDD)、心功能(LVEF、6min行走距离)、因CHF住院次数,均较对照组显著改善(P<0.01,P<0.05);同时ARB ACEI组LVESD、LVEF、6min行走距离又较ACEI组显著改善(P<0.05).结论:ARB与ACEI联合治疗CHF能更好地预防左室重塑,进一步改善患者的心功能,减少CHF患者临床事件的发生,提高生活质量.     

卡维地洛治疗慢性心力衰竭的疗效观察

目的观察卡维地洛治疗慢性心力衰竭的临床疗效。方法选择不同病因的慢性心力衰竭患者80例,随机分为2组,每组40例,对照组应用洋地黄、利尿剂、血管紧张素转换酶抑制剂等常规治疗,治疗组在常规治疗的基础上加用卡维地洛,疗程6个月,观察2组治疗前后临床疗效、NYHA分级、左心室射血分数（LVEF）、左心室输张末期内径（LVEDD）、血清B型尿钠肽（BNP）、6min步行距离。结果治疗组的总有效率显著高于对照组（90．0％V870．0％,P〈0．05）。LVEDD及BNP较治疗前及对照组减少（P〈0．05）。LVEF、6min步行距离较治疗前及对照组增加（P〈0．05）。结论卡维地洛可改善慢性心力衰竭的心功能．     

厄贝沙坦联合卡维地洛治疗慢性充血性心力衰竭的疗效研究

目的：观察厄贝沙坦联合卡维地洛治疗慢性充血性心力衰竭(CHF)的效果。方法以2011年1月-2013年12月我院心内科收治的78例CHF患者为研究对象,随机分为研究组和对照组,各39例。在基础治疗上,两组均采用厄贝沙坦治疗,研究组则另加卡维地洛,比较两组治疗前后的左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)的变化及疗效。结果治疗前两组LVEDD、LVESD、LVEF无显著差异,治疗后研究组LVEDD和LVESD均低于对照组,LVEF高于对照组(P<0.05);研究组总有效率为82.05％,对照组为56.41％,研究组总有效率高于对照组,差异有统计学意义(P<0.05)。结论在基础治疗上,联合应用卡维地洛与厄贝沙坦治疗CHF,能够显著改善及逆转心室重构,从而改善患者症状体征和心功能指标,提高临床疗效。     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

HACCP在学校集体食堂卫生管理中的应用研究

目的 通过HACCP在学校集体食堂管理中的应用,提高食品卫生水平,保障学生的身体健康。方法 HACCP原则。结果 食品卫生达到较高水平,极大地减少了食物中毒的发生。结论 提示HACCP原则可在学校集体食堂的卫生管理中发挥有效作用。     

半导体激光治疗老年人压疮疗效观察

目的探讨半导体激光局部照射治疗老年人压疮疗效.方法:收集2012年1月-2015年6月48例压疮患者,分为半导体组和常规组各24例.常规组采用常规治疗,半导体组采用半导体激光加常规治疗,10 d为1个疗程,不超过3个疗程.疗程结束后比较两组疗效.结果:半导体组压疮愈显率为83.33％,创面愈合时间为(12.75±5.51)d,常规组分别为54.17％和(19.63±8.65)d,组间差异有统计学意义(P＜0.05),两组均未见不良反应.结论:半导体激光加常规治疗压疮效果肯定,无明显不良反应,且操作简便.     

脑卒中恢复期患者社区综合康复的疗效观察

目的：探讨社区开展康复活动对于脑卒中患者肢体功能康复的影响。方法：选取2014年4至10月参与社区“陈睿健康工作室”康复活动的脑卒中恢复期患者50例作为观察组,选取同期延吉社区卫生服务中心门诊的50例脑卒中恢复期患者作为对照组（进行门诊随访、服药、自我康复）。采用知识、信念、行为（KAP）量表对观察组患者进行问卷调查。采用简化Fugl-Meyer肢体运动功能评分表（Fugl-Meyer assessment of motor function,FAM）比较两组患者入组时和入组6个月时的肢体功能恢复情况及对家庭医生（门诊医师）的满意度。结果：入组6个月时,两组患者的FAM均有所改善,观察组FAM得分[上肢（50.92±7.05）分,下肢（33.01±1.37）分]较对照组[上肢（34.85±6.55）分,下肢（25.20±4.88）分]更高,差异有统计学意义（t上肢=11.8215,t下肢=10.8595,P均＜0.01）。观察组患者的满意率为92%（46/50）,明显高于对照组的30%（15/50,P＜0.05）。结论：在社区开展康复活动可以促进脑卒中患者肢体功能的康复,提高患者的满意度。     

Evaluation of the safety of enalapril in the treatment of heart failure in the very old

Summary We have introduced enalapril, in doses equal to or less than the 2.5 mg currently recommended, as an adjuvant to digoxin and diuretics in 17 patients of mean (SD) age 83 (5) years with severe heart failure. Only eleven patients tolerated its introduction. Unlike those reported in younger patients, all but one of the adverse drug reactions occurred 8 h or more after the first dose. Aged patients started on ACE inhibitors should be observed in hospital until stabilized on a maintenance dose. Three patients had an adverse reaction which differed in nature from those previously reported: acute confusional state, ataxia and mesenteric ischaemia.Ten patients were discharged on 5 mg or 10 mg maintenance doses of enalapril. In nine of them improvement on triple therapy was sustained for a minimum of three months. ACE inhibition was lost in the other patient when her compliance with enalapril therapy fell to around 75%: monitoring compliance is essential when ACE inhibitors are used in low dosages.Enalapril was withdrawn during follow up in three patients because of symptoms of mesenteric ischaemia and in four because of dramatic deterioration of renal function. One of the latter was found subsequently to have severe bilateral atheromatous renal artery stenosis. When isosorbide dinitrate was substituted for enalapril, symptoms of mesenteric ischaemia resolved and renal function returned to baseline. Continuing surveillance for adverse effects is essential in patients of this age group with severe heart failure, and the risk of occult renal artery stenosis requires regular biochemical screening during follow up.The benefit to cost ratio of ACE inhibitors might be improved in aged patients by their use at an earlier stage in the natural history of heart failure, when perfusion of essential organs is not grossly impaired, but carefully monitored trials would be necessary to establish this.     

替普瑞酮治疗老年慢性浅表性胃炎的疗效分析

目的分析替普瑞酮治疗老年慢性浅表性胃炎的疗效。方法100例老年慢性浅表性胃炎患者,通过计算机随机表数字法分为对照组和实验组,每组50例。对照组患者选择西咪替丁作为本次治疗药物,实验组患者选择替普瑞酮作为本次治疗药物。比较两组患者临床疗效、不良反应发生情况以及生活质量。结果实验组治疗总有效率92.00%高于对照组的76.00%,差异具有统计学意义(P<0.05)。实验组不良反应发生率6.00%低于对照组的20.00%,差异具有统计学意义(χ^2=4.332,P=0.037<0.05)。实验组患者治疗后的生活质量评分(68.68±4.11)分高于对照组的(57.73±3.48)分,差异具有统计学意义(t=14.377,P=0.000<0.05)。结论对于老年慢性浅表性胃炎疾病患者,选择替普瑞酮进行治疗不仅疗效更为理想,而且还不易增加患者的用药不良反应,有利于提高患者的生活质量,建议进一步推广。     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

Interactions among the cannabinoids in the antagonism of the abdominal constriction response in the mouse

The ability of ⁹-tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD), 11-OH THC and 8,11-diOH THC to antagonise the abdominal constriction response in the mouse induced by formic acid, phenylquinone, 5-hydroxytryptamine, prostaglandin E₁ (PGE₁) and bradykinin was tested. THC was an effective antagonist against all nociceptive agents with an ED₅₀ in all cases between 1.0 and 2.6 mg/kg. CBN, while also effective against all nociceptive agents, was less potent than THC, with an ED₅₀ range between 46.2 and 112.5 mg/kg. CBD in doses as high as 200 mg/kg was without effect. Using PGE₁ as the nociceptive agent, 11-OH THC was equipotent to THC while 8,11-diOH THC was inactive. Naloxone, while able to antagonise the antinociceptive effect of morphine against formic acid-induced writhing, did not reverse the antinociceptive effects of THC. There were no pharmacological interactions between THC, CBD and CBN.     

Problems in the evaluation of hypnosis in the treatment of alcoholism

Although hypnotherapy has been applied to alcoholism for over a century and is accepted by the AMA as a medically valid technique, the effectiveness of hypnosis in treating alcoholics remains controversial. Systematic evaluation has been hampered by the unique role of hypnosis as a cultural artifact, by problems in defining and verifying hypnotic intervention, by individual and situational variation in hypnotizability, and by difficulty in separating hypnosis from the therapies to which it is applied. Clinicians using hypnosis are likely to continue to base their claims for its effectiveness on intuition, especially since no study has demonstrated that hypnotherapy is contraindicated for patients requesting its use.