维持性血液透析患者贫血与左室舒张功能障碍的关系

目的 观察维持性血液透析(MHD)患者贫血与左室舒张功能障碍(LVDD)的关系. 方法 MHD的患者59例,透析前测定血压、行心脏多普勒检测,按不同舒张早期峰值速度(Ve)与舒张晚期峰值速度(Va)的比值分为二组:左心室舒张功能障碍组(Ve/Va＜1)和左心室舒张功能正常组(Ve/Va≥1).同时检测透析前血常规及肾功能. 结果 左室舒张功能障碍组与左室舒张功能正常组相比,血红蛋白显著性降低( P＜0.01).而年龄、透析时间、超滤量、超滤量/体重、舒张压及Kt/v等无显著性差异. 结论 贫血是引起MHD患者LVDD的重要因素之一.     

血浆脑型钠利尿肽在维持性血液透析患者左室舒张功能障碍诊断中的价值

目的：探讨血浆脑型钠利尿肽（BNP）在维持性血透（MHD）患者左心室舒张功能障碍（LVDD）中的诊断价值。方法：MHD患者59例,透析前行心脏多普勒组织成像检测,按不同舒张早期峰值速度（Ve）与舒张晚期峰值速度（Va）的比值分为LVDD组（Ve／Va〈1）和左心室舒张功能正常组（Ve／Va≥1）两组。同时检测透析前血浆BNP、血常规及生化指标、超敏c反应蛋白（hs—CRP）、甲状旁腺激素（PTH）等。结果：LVDD组与左心室舒张功能正常组相比,BNP、hs—CRP、收缩压显著性升高,血红蛋白（Hb）显著性降低（P〈0．05）。MHD患者的BNP水平与hs-CRP、收缩压、舒张压等显著正相关,与Hb显著负相关。BNP诊断MHD患者LVDD的曲线下面积（AUC）为0．86（95％CI：0．76—0．96）,353．6Pg·ml-1作为界值的灵敏度为80％,特异度为85％。结论：BNP水平升高对MHD患者合并LVDD可能具有重要的诊断价值。     

原发性高血压患者血清脑钠素水平变化及临床意义

目的:探讨原发性高血压(EH)左心室肥厚及左室舒张功能障碍患者血清脑钠素(BNP)水平变化及其意义。方法:采用超声心动图测定左心室质量指数(LVMI),舒张早期血流峰值(E)/舒张晚期血流峰值(A)比值,将68例EH患者分别分为左心室肥厚(LVH)与无左心室肥厚(NLVH)组;左室舒张功能障碍组与无左室舒张功能障碍组。采用酶联免疫吸附法(ELISA)测定血清BNP水平,并与30例正常对照组进行对比分析。结果:EH患者血清BNP水平明显高于正常对照组(P<0.01),伴LVH血清BNP水平较NLVH明显升高(P<0.01);伴左室舒张功能障碍患者血清BNP水平显著高于无舒张功能障碍患者及正常对照组(P<0.01)。结论:原发性高血压患者BNP水平明显升高,检测血清BNP水平将有助于了解高血压病患者左室肥厚及舒张功能改变。     

维持性血液透析患者贫血与左室舒张功能障碍的关系

目的观察维持性血液透析（MHD）患者贫血与左室舒张功能障碍（LVDD）的关系。方法MHD的患者59例,透析前测定血压、行心脏多普勒检测,按不同舒张早期峰值速度（ve）与舒张晚期峰值速度（Va）的比值分为二组：左心室舒张功能障碍组（Ve／Va〈1）和左心室舒张功能正常组（Ve／Va≥1）。同时检测透析前血常规及肾功能。结果左室舒张功能障碍组与左室舒张功能正常组相比,血红蛋白显著性降低（P〈0．01）。而年龄、透析时间、超滤量、超滤量／体重、舒张压及Kt／V等无显著性差异。结论贫血是引起MHD患者LVDD的重要因素之一。     

组织多普勒定量评价高血压与冠心病伴或不伴左室肥厚患者心脏舒缩功能

目的　评价高血压与冠心病伴或不伴左室肥厚患者心脏舒缩功能，以及DTI评价高血压与冠心病左室舒张功能的准确性。方法 对正常人组(n=15例)，高血压组（n=30例，15 例非左心室肥厚（non-LVH）和15例左心室肥厚（LVH）) 及冠心病组（n=33例，15 例非左心室肥厚（non-LVH）和18例左心室肥厚（LVH）)分别测量:① 二尖瓣口舒张早期充盈速度(E) 和舒张晚期充盈速度(A)； ② 二尖瓣环心肌组织等容收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）和舒张晚期峰值速度（Va），以及用猪尾导管直接测量LVEDP。结果　与对照组相比，高血压组和冠心病组Ve/Va、E/A均显著减小（P＜0.05）；冠心病LVH组的Ve/Va、E/A与高血压LVH组的比较无明显差异（P＞0.05），而冠心病non-LVH组的Ve/Va、E/A比高血压non-LVH组的均减小（P＜0.05）。冠心病组的Vs明显低于对照组和高血压组的Vs（P＜0.05），而对照组和高血压组的Vs比较则无明显差异（P＞0.05）。Ve/Va与LVEDP的相关性高于E/A与LVEDP的相关性。结论　高血压和冠心病患者伴或不伴左室肥厚均存在左室舒张功能降低，然而左室收缩功能降低仅见于冠心病患者，DTI是评价左室舒张功能的良好方法。     

高血压病患者血浆中脑利钠肽水平与不同左室构型的相关性

目的: 分析心脏功能代偿期的高血压患者不同心脏构型之间的血浆中脑利钠肽(BNP)水平差异,探讨左室重构可能的机制. 方法: 心脏收缩功能正常的高血压患者166例,血压正常对照组87例,应用彩色多普勒超声诊断仪,按Ganau分类法,将高血压组患者的左心室重构分为正常型、向心性重构型、向心性肥厚型、离心性肥厚型4种构型. 对比血浆BNP水平. 结果: 总体上高血压组BNP水平高于对照组,按心脏重构分组后,以向心性肥厚组BNP水平升高最显著(P<0.01),向心性构型组和离心性肥厚组次之(P<0.01, P<0.05),而正常构型组虽高于对照组,但差别不具有显著差异. 结论: 尽管高血压患者尚未出现心功能失代偿,但BNP水平有升高;在不同左心室构型之间,BNP水平不同,提示BNP可能参与了高血压左心室的重构.     

血浆脑钠肽浓度与高血压患者左室肥厚及心功能的关系

目的观察高血压患者左室肥厚与血浆脑钠肽(BNP)浓度的关系,分析氯沙坦钾片治疗前后左室肥厚及左室舒张功能不全的变化情况,探讨血浆BNP浓度可否作为判断左心室肥厚的逆转及左室舒张功能改变的临床指标。方法高血压患者63例,平均年龄(57.2±6.4)岁,其中伴左心室肥厚组患者34例,不伴左心室肥厚组患者29例,健康对照组30例。予以高血压病患者氯沙坦钾片50~100mg/d,治疗40周,所有对象行超声心动图测定左心室重量指数(LVMI)、E/A比值;采用美国博适Triage及其试剂盒快速测定血浆BNP水平,对BNP与LVMI、E/A比值作相关分析。结果高血压左心室肥厚患者组的血浆BNP水平明显高于高血压病不伴左心室肥厚患者组和健康对照组(P<0.01),经氯沙坦钾片治疗后高血压病左心室肥厚患者组血浆BNP水平明显下降,差异有统计学意义(P<0.05),且与LVMI呈显著正相关,与E/A比值呈显著负相关。结论血浆BNP浓度能较好地反映高血压患者左心室肥厚及左室舒张功能状态。     

多普勒组织成像技术对高血压患者左室功能的评价

目的:了解采用多普勒组织成像技术(TDI)检测二尖瓣环运动速度对评价高血压患者左室功能的临床价值。方法:根据左室质量指数(LVMI)将78例高血压患者分为左室肥厚组(n=32)和左室非肥厚组(n=46),另设正常对照组(n=31),分别行常规超声心动图检查测量左室射血分数(EF),二尖瓣口舒张早期与舒张晚期血流峰值之比(E/A)。在TDI模式下获得二尖瓣环运动频谱,测量收缩期峰值速度(Vs)舒张早期峰值速度(Ve),舒张晚期峰值速度(Va),并计算Ve/Va比值。结果:(1)高血压组与正常对照组EF值均正常,高血压病左室肥厚组(LVH)Vs低于左室非肥厚组(NLVH)及对照组,高血压组E/A、Ve、Ve/Va均低于对照组,且肥厚组低于非肥厚组,高血压组E/A低于对照组、Va高于对照组,P均<0.05;(2)二尖瓣环Ve/Va、Ve、Va与二尖瓣口血流E/A比值有关,其中以Ve/Va与E/A的相关性最好。结论:TDI技术测定二尖瓣环运动速度能客观反映左室功能,结合多普勒超声可提高综合分析高血压病左室舒缩功能的准确性。     

老年轻中度高血压患者血清脑利钠肽水平与左室重构的关系

目的观察老年轻中度高血压患者血清BNP水平与左室重构之间的关系。方法 175例高血压患者根据超声心动图检查结果分为4个亚组:正常构型组35例,向心性重构型组50例,向心性肥厚型组50例,离心性肥厚型组40例;另将50例无高血压的健康人设为健康对照组。用ELISA法测定血清BNP浓度。结果 (1)高血压病组的BNP水平显著高于健康对照组(P<0.05):向心性肥厚组与离心性肥厚组的BNP水平均明显升高,且显著高于其他2组(P<0.05),但2个肥厚组间差异无统计学意义(P>0.05);高血压正常构型与向心性重构组的BNP水平虽高于健康对照组,但差异无统计学意义(P>0.05)。(2)血浆BNP与左室质量指数、左心室室壁相对厚度、室间隔厚度和左室后壁舒张末期厚度呈显著正相关(P<0.05),与左室射血分数(LVEF)呈负相关(P<0.05)。结论有左室重构的高血压患者血清BNP水平明显升高,血清BNP水平与左室重量指数和平均室壁厚度有相关性。血清BNP水平能反映高血压患者左室重构的存在及其程度;检测血清BNP浓度可能有助于发现高血压左室结构的异常。     

厄贝沙坦与福辛普利合用对原发性高血压患者左室肥厚及舒张功能的影响

目的:研究合用厄贝沙坦片(Irbesartan)福辛普利(Fusinopril)逆转原发性高血压左心室肥厚(LVH)及改善左室舒张功能的作用.方法:将100例原发性高血压左心室肥厚(LVH)患者随机分为A组(口服厄贝沙坦片,n=50)和B组(同时口服福辛普利、厄贝沙坦片,n=50),于服药前及服药6个月后分别测定室间隔厚度(IVST)、左心室后壁厚度(PWT)、左心室舒张末期直径(LVD)、左心室重量指数(LVMI)A/E峰值.结果:两组患者经治疗后IVST、PWT、LVD、LVMI、A/E峰值显著降低,并且B组降低更加显著(P<0.05).结论:厄贝沙坦、福辛普利合用能更加明显逆转左心室月巴厚和改善左心室舒张功能.     

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…     

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.     

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.