呋塞米与托拉塞米治疗老年慢性心力衰竭伴利尿剂抵抗短期治疗观察

目的:观察老年慢性心力衰竭(CHF)伴利尿剂抵抗患者短期应用呋塞米、托拉塞米对利尿剂抵抗的临床疗效。方法:随机将老年CHF伴利尿剂抵抗患者分为呋塞米泵入组(A组)32例和托拉塞米组(B组)32例,治疗5d,比较两组疗效,治疗前后血BNP、血电解质变化,尿量、肾功能变化。结果:B组改善心力衰竭总有效率高于A组(P<0.05);两组治疗前后血BNP变化无统计学意义(P>0.05);A组血钾治疗前后出现降低(P<0.05);B组血钾改变不明显(P>0.05);两组治疗前后血钠变化不明显(P>0.05)。两组治疗后患者每日尿量明显增多(P<0.01),B组尿量较A组尿量增加明显(P<0.01)。血肌酐两组治疗前后变化不明显。结论:短期呋塞米泵入和托拉塞米注射法均可以改善老年CHF伴利尿剂抵抗,能够增加尿量,改善心功能,托拉塞米改善心力衰竭总有效率高于呋塞米。     

肺部超声在指导急性左心衰竭患者呋塞米使用中的价值

目的:探讨肺部超声在指导急性左心衰竭患者呋塞米使用中的价值。方法:70例急性左心衰竭的患者随机分为2组。对照组34例经验性使用呋塞米,观察组36例给予肺部超声指导下使用呋塞米。比较2组患者所需利尿剂总量、最大日尿量和治疗后B型尿钠肽下降程度。结果:观察组患者所需呋塞米的总量少于对照组(P<0.01),2组患者最大日尿量和治疗后B型尿钠肽下降程度差异均有统计学意义(P<0.01)。结论:肺部超声能评估急性左心衰竭患者的治疗效果,并可以指导急性左心衰的治疗,降低呋塞米的使用总量。     

肾移植病人围手术期利尿药物的应用

目的 探讨托拉塞米在肾移植病人围手术期中的应用价值。方法 52例肾移植术后病人分为2组。托拉塞米组26例．男性16例，女性10例，年龄（31±10）岁，围手术期应用托拉塞米100mg＋氯化钠注射液500mL，iv，qd；呋塞米组26例，男性15例，女性11例，年龄（29±9）岁，围手术期中应用呋塞米400mg·d-1＋NS500mL，iv，qd。2组均治疗7d为一个疗程。观察手术前和术后每日尿钾、钠及血钾、钠的含量，血压、血肌酐和24h尿量变化情况。监测2组环孢素全血谷值血药浓度。结果 手术后托拉塞米组24h尿钠含量、血钠和血肌酐与呋塞米组比较，差异无显著性（P〉0．05）。托拉塞米组血钾的含量和24h尿量高于呋塞米组，差异非常显著（P〈0．01）。呋塞米组24h尿钾含量高于托拉塞米组，差异非常显著（P〈0．01）。2组血压和环孢素全血谷值血药浓度比较，差异不显著（P〉0．05）。不良反应发生率托拉塞米组为8％（2／26），呋塞米组为69％（18／26），差异非常显著（P〈0．01）。结论 托拉塞米具有排钠又相对保钾的作用，在增加病人尿量的同时不影响环孢素全血谷值血药浓度，减少了肾移植病人不良反应的发生，是一种比呋塞米更加适合肾移植围手术期利尿药物。     

托拉塞米与呋塞米治疗老年慢性心力衰竭伴利尿剂抵抗的短期疗效观察

目的：观察老年慢性心力衰竭伴利尿剂抵抗患者短期应用托拉塞米、呋塞米对利尿剂抵抗的临床疗效。方法：随机将60例老年慢性心力衰竭伴利尿剂抵抗患者分为呋塞米泵入组（A组,30例）和托拉塞米静推组（B组,30例）,治疗5天,比较2组治疗前后血pro-BNP（Pro-BrainNatriureticPeptide,pro-BNP）、6分钟步行试验、NYHA心功能分级、血电解质变化、尿量、肾功能等指标。结果：2组治疗后心功能均得到改善,尿量均明显增多,托拉塞米组疗效优于呋塞米组,差异有统计学意义（P〈0．05）;托拉塞米组（B组）6分钟步行试验较呋塞米组（A组）显著增加,pro-BNP则显著降低,差异均有统计学意义（P〈0．05）;A组治疗后血钾较治疗前降低,差异有统计学意义（P〈0．05）,B组血钾无明显改变（P〉0．05）,2组治疗前后血钠、血肌酐均无明显变化（P〉0．05）。结论：短期泵入呋塞米和静推托拉塞米均可改善老年慢性心力衰竭伴利尿剂抵抗患者的临床症状,增加尿量,改善心功能,托拉塞米改善心功能总有效率高于呋塞米。     

呋塞米与托拉塞米对慢性心力衰竭治疗效果的比较

目的 对比分析呋塞米和托拉塞米对慢性心力衰竭患者电解质、尿量度心功能的影响.方法 将194例中、重度慢性心力衰竭患者分为治疗组和对照组,均予常规抗心力衰竭治疗(ACEI、ARB、β受体阻滞剂、地高辛),治疗组予托拉塞米10mg静推、对照组予呋塞米40mg静推,均1次/日,连续7天;比较两组患者治疗前后尿量、电解质及心功能分级改善情况.结果 治疗后24 h两组尿量变化无统计学差异,血钾均降低,而对照组血钾明显低于治疗组,血钠差异无统计学意义;治疗7天后治疗组心功能分级改善明显好于对照组,差异有统计学意义(P＜0.05).结论 托拉塞米与呋塞米的利尿、排钠作用相近,呋塞米排钾作用明显强于托拉塞米,托拉塞米对心功能的改善优于呋塞米.     

利尿剂呋塞米联合多巴胺治疗难治性肝腹水的临床分析

目的：观察利尿剂呋塞米联合多巴胺治疗难治性肝腹水的临床治疗效果。方法选取2009年2月～2013年2月在河南省登封市人民医院住院治疗难治性肝腹水患者50例,随机均分成对照组和观察组（n=25）。对照组采取常规疗法,观察组腹腔注射利尿剂呋塞米60 mg和多巴胺40 mg,3 d给药1次,疗程30 d,比较2组治疗效果。结果观察组22例患者显示为有效（88%）,明显高于对照组的19例（76%）（P＜0.05）;观察组的尿量增加量（622±48）mL多于对照组（374±34）mL（P＜0.05）。结论利尿剂呋塞米联合多巴胺治疗难治性肝腹水,可显著提高疗效。     

低分子右旋糖酐加呋塞米治疗小儿肾病综合征重度水肿临床效果观察

目的:观察低分子右旋糖酐加呋塞米治疗小儿肾病综合征重度水肿的临床效果.方法:选择我院收治的36例肾病综合征重度水肿患儿(入院时间2014.01.30~2017.01.30),采用随机分组方式,分为2组/18例,对照组接受呋塞米治疗,实验组接受多低分子右旋糖酐联合呋塞米治疗,比较2组肾病综合征重度水肿患儿的水肿消退时间、24h尿量、24h尿钾、24h尿钠.结果:实验组肾病综合征重度水肿患儿的水肿消退时间、24h尿量、24h尿钾、24h尿钠相较对照组均更具优势(P<0.05).结论:低分子右旋糖酐加呋塞米治疗小儿肾病综合征重度水肿效果显著,无明显副作用,具有较高的临床应用价值.     

早期应用小剂量多巴胺联合呋塞米治疗心功能Ⅲ~Ⅳ级心力衰竭70例疗效观察

目的：观察早期应用小剂量多巴胺联合呋塞米治疗Ⅲ~Ⅳ级心力衰竭（CHF）的疗效。方法将138例CHF患者随机分为观察组（70例,采用小剂量多巴胺联合呋塞米治疗）和对照组（68例,采用呋塞米治疗）。比较两组治疗后心功能改善情况、住院治疗时间、利尿剂抵抗情况、肾功能恶化及死亡病例数及治疗后血钾、血钠、B型脑钠肽等。结果观察组心功能改善总有效率高于对照组,其差异有统计学意义（P＜0.05）。观察组住院治疗时间、利尿剂抵抗及肾功能恶化比例均低于对照组,其差异均有统计学意义（P＜0.05）;两组死亡率比较差异无统计学意义（P＞0.05）。两组血钠、血钾水平比较差异无统计学意义（P＞0.05）;观察组B型脑钠肽含量低于对照组,且差异有统计学意义（P＜0.05）。结论早期小剂量多巴胺联合利尿剂呋塞米治疗Ⅲ~Ⅳ级心力衰竭患者疗效安全可靠,能够明显减少利尿剂抵抗,可有效改善患者的预后,具有重要的临床应用价值。     

用托拉塞米与呋塞米治疗急性心力衰竭对患者尿量及电解质水平的影响分析

目的 :探究用托拉塞米与呋塞米治疗急性心力衰竭对患者尿量及电解质水平的影响。方法 :对我院收治的149例急性心衰患者的临床资料进行回顾性分析,将其分为托拉塞米组、呋塞米组、托拉塞米+螺内酯组及呋塞米+螺内酯组,分别为其应用托拉塞米、呋塞米、托拉塞米+螺内酯、呋塞米+螺内酯进行治疗,并对比分析4组患者在用药前后血钠、血钾及尿量的变化情况。结果 :与其他各组患者相比,托拉塞米+螺内酯组患者在用药前后血钠浓度的变化幅度较大,差异显著(P<0.01),有统计学意义。与其他各组患者相比,呋塞米组患者血钾浓度变化的幅度最大,托拉塞米+螺内酯组患者血钾浓度变化的幅度最小,差异显著(P<0.01),有统计学意义。4组患者在进行用药治疗前后的排尿量相比较,差异不显著(P>0.05),无统计学意义,具有可比性。结论 :托拉塞米的排钠、利尿作用与呋塞米近似,呋塞米的排钾能力明显强于托拉塞米,在治疗急性心力衰竭时交替使用这两种药物可取得更优的临床疗效。     

早期应用小剂量多巴胺联合呋塞米对合并体液潴留心力衰竭的治疗价值

目的 观察早期应用小剂量多巴胺联合呋塞米治疗心力衰竭的疗效.方法 入选255例纽约心脏病学会(NYHA)心功能分级Ⅲ～Ⅳ级的患者,随机分为联合治疗组(128例)和呋塞米组(127例).联合治疗组予静脉泵持续泵入小剂量多巴胺(2～3μg·kg-1·min-1)联合呋塞米(20～40 mg/d)静脉注射.呋塞米组仅静脉注射呋塞米(20～40 mg/d).观察两组患者的冠状动脉性心脏病监护病房(CCU)住院天数(即心力衰竭改善所需时间)以及出现利尿剂抵抗、需要超滤或血液透析治疗、肾功能恶化和死亡患者的构成.结果 联合治疗组的CCU住院天数平均为(3.75±1.20)d,显著短于呋塞米组的(4.13±1.54)d(P=0.030).联合治疗组出现利尿剂抵抗和肾功能恶化的患者构成比(2.3%和8.6%例)均显著低于呋塞米组(21.3%和26.8%例,P值均=0.000).联合治疗组有1例患者需要超滤或血液透析治疗,呋塞米组为6例(P>0.05).联合治疗组无死亡患者,呋塞米组死亡4例(P>0.05).结论 早期应用小剂量多巴胺联合呋塞米可加强心力衰竭患者对呋塞米的治疗反应,及时有效改善体液潴留和心力衰竭症状,保护脏器功能.     

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…     

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     

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.     

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.     

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.