重组人脑利钠肽治疗顽固性心力衰竭临床疗效观察

目的探讨重组人脑利钠肽(rhBNP)治疗顽固性心力衰竭(RHF)的疗效和安全性。方法将86例RHF患者采用单盲法随机分为常规治疗联合静脉滴注硝酸甘油(NTG)治疗组(NTG组,n=43)和常规治疗联合rhBNP治疗组(rhBNP组,n=43)。NTG组患者NTG初始以5μg/min的速率静脉泵入,然后根据患者的血压、心率,每3～5分钟增加5～10μg,至20μg/min,连用3d;rhBNP组rhBNP首次负荷剂量1.5～2.0μg/kg静脉推注,继而以速率0.007 5～0.010 0μg.kg-1.min-1,连续静脉泵入3d。停用NTG和rhBNP后,继续常规抗心力衰竭治疗,7d后比较两组患者治疗前、后的临床症状、心功能、尿量,以及血浆BNP、肌酐、钠、钾浓度的变化及不良反应的发生率。结果与NTG组比较,rhBNP组患者临床症状(血压、尿量、呼吸困难程度)、心功能及血浆BNP水平都得到明显改善(P<0.05);且rhBNP组患者不良反应发生率与NTG组比较,差异无统计学意义(P>0.05)。结论 rhBNP能明显改善RHF患者的临床症状、心功能及血浆BNP水平,其用于治疗RHF疗效显著,安全性高。     

重组人脑钠肽治疗扩张型心肌病顽固性心力衰竭的临床研究

目的探讨重组人脑钠肽(rhBNP)治疗扩张型心肌病顽固性心力衰竭的临床疗效。方法 50例扩张型心肌病顽固性心力衰竭患者随机分为重组人脑钠肽治疗组和米力农对照组各25例。2组均给予常规抗心力衰竭药物治疗,治疗组给予注射用rh BNP,对照组给予米力农静脉滴注。观察2组治疗后的临床疗效,心率、平均动脉压、尿量、心功能及血浆BNP水平变化。结果治疗后1周,治疗组总有效率为88.0%,明显高于对照组的64.0%,差异有统计学意义(P<0.05)。治疗后24 h,2组心率明显下降(P<0.05),平均动脉压明显降低(P<0.05),尿量明显增加(P<0.01),且治疗组心率下降、尿量增多均优于对照组(P<0.05)。2组治疗后24 h血浆BNP水平较基线值明显降低(P<0.01),治疗后1周治疗组的左心室射血分数(LVEF)较治疗前提高(P<0.05);血浆BNP显著降低,治疗组治疗后LVEF改善和血浆BNP降低均明显好于对照组(P<0.01或P<0.05)。结论 rhBNP治疗扩张型心肌病顽固性心力衰竭患者疗效显著,可明显改善患者的心力衰竭症状。     

不同剂量重组人脑利钠肽治疗难治性心力衰竭的疗效分析

目的评价不同剂量冻干重组人脑利钠肽（recombinant human brain natriuretic peptide,rhBNP）治疗难治性心力衰竭（RHF）的临床疗效。方法四川省仁寿县人民医院将80例经常规抗心力衰竭药物治疗无明显改善的RHF患者随机分为小剂量组（n=36）和大剂量组（n=44）。首次负荷剂量1.5μg/kg静脉推注后,小剂量组以0.0075μg/（kg·min）继续静脉泵入维持治疗48h,大剂量组以0.01μg/（kg·min）维持治疗48h。观察2组患者治疗后心功能改善情况,以及24h尿量、左室射血分数（LVEF）和血浆脑钠肽（BNP）水平。结果 2组心功能改善总有效率分别为80.6%、88.6%,差异无统计学意义。使用不同剂量rhBNP治疗后,2组患者24h尿量较用药前明显增多,LVEF明显增加、血浆BNP水平明显下降,大剂量组改善更为显著,2组差异有统计学意义（P〈0.05）。结论 rhBNP可以明显改善难治性心力衰竭患者近期心功能状态,缓解患者的症状,表现为尿量增多、LVEF升高,且不同剂量rhBNP对上述指标改善不同,但并不影响心功能的改善程度。     

重组人脑利钠肽联合参附注射液治疗急性心肌梗死伴急性心力衰竭的临床治疗及疗效评价

目的 探讨重组人脑利钠肽(rhBNP)与参附注射液联合治疗急性心肌梗死(AMI)伴急性心力衰竭(AHF)患者的临床效果与评价.方法 入选患者随机分为rhBNP治疗组和rhBNP联合参附注射液治疗组,各31例.rhBNP组先静脉内推注rhBNP;负荷剂量,1.5μg/kg在90 s内推注完,续以0.0075μg/(kg·min)持续静脉泵入48 h.在保证SBP 130~90 mmHg及DBP 80~60 mmHg的情况下,维持剂量可滴定至0.015~0.030μg/(kg·min).rhBNP联合参附注射液治疗组rhBNP使用方法相同,同时联合应用参附注射液治疗7天,参附注射液;用量:5%葡萄糖注射液250 mL+参附注射液40 mL静脉滴注,每天1次.结果 与rhBNP联合参附注射液治疗组比较,rhBNP组用药后24hSBP(P<0.01)、DBP(P<0.05)较治疗前下降的幅度更明显,之后2组血压不再有明显的变化.2组心率下降均在用药后第2天最明显(P<0.05).与治疗前比较,2组治疗后血K+、Na+均无明显变化.联合治疗组治疗期间每24h的尿量明显多于rhBNP组(P<0.05).结论 参附注射液联合rhBNP治疗AMI伴AHF更安全有效.     

重组人脑利钠肽治疗急性心肌梗死伴心力衰竭的疗效评价

目的:研究静脉注射重组人脑利钠肽(rhBNP.)治疗急性心肌梗死伴心力衰竭患者的疗效.方法:2006年8月-2008年8月住院的急性心肌梗死伴心力衰竭患者81例,随机分为常规治疗组(n=43)和rhBNP治疗组(n=38),常规治疗组:予病因、强心、利尿、扩血管治疗,rhBNP治疗组:常规治疗基础上加静脉注射rhBNP[90 s 匀速静脉注射冲击量1.5μg/kg,0.0075μg/(kg·min)维持静脉注射48 h].应用USCOM无创血流动力学监测系统监测各组治疗前、治疗后30 min、1、3、6、12、24和48 h的血流动力学参数和48 h的尿量、血肌酐、血钾、血钠.结果:rhBNP静脉注射后外周血管阻力(SVR)较治疗前下降(P<0.05),每搏输出量(SV)、心脏指数(CI)、总尿量(UR)较治疗前升高(P<0.05),血肌酐(CR)较治疗前下降(P<0.05),较之常规治疗组的变化更明显.结论:急性心肌梗死伴心力衰竭患者静脉注射rhBNP较之单纯常规治疗有着更好的血流动力学效应和临床效果.     

重组人脑利钠肽治疗急性心力衰竭32例临床观察

目的探讨冻干重组人脑利钠肽(rhBNP)治疗急性心力衰竭的疗效和安全性。方法32例急性心力衰竭患者随机分为两组,rhBNP组(n=15):先以rhBNP 1.5μg/kg静脉冲击后,再以0.007 5μg.kg-1.min-1连续静脉滴注;对照组(n=17)静脉持续泵注硝普钠。记录两组治疗前后呼吸困难程度、全身情况、左室射血分数(EF)和E/A指数等。rhBNP的安全性评估采用治疗药前后定期测量血压、心率,复查血电解质及肾功能,并对所有不良事件进行记录。结果治疗72h后rhBNP组呼吸闲难和临床状况好转率优于对照组(P<0.05);rhBNP组治疗后左室收缩舒张功能指数较对照组明显改善(P<0.05),rhBNP组未发生药物相关的不良事件。结论rhBNP能改善急性心力衰竭患者的呼吸困难程度和临床状况,心脏超声提示心脏收缩舒张功能明显改善,治疗安全可靠。     

重组人脑利钠肽改善急性失代偿性心力衰竭患者早期心功能

目的探讨冻干重组人脑利钠肽(rhBNP)治疗急性失代偿性心力衰竭的早期疗效和安全性。方法40例急性失代偿性心力衰竭患者随机分为两组,rhBNP组(n=20):先以rhBNP 1.5μg/kg静脉冲击后,再以0.0075μg.kg-1.min-1连续静脉滴注;对照组(n=20)静脉持续滴注异舒吉(硝酸异山梨酯)或硝普钠。记录治疗前后呼吸困难程度、全身情况、左室射血分数(EF)和Tei指数。rhBNP的安全性评估采用治疗药前后定期测量血压、心率、复查血电解质及肾功能,并对所有不良事件进行记录。结果治疗72 h后rhBNP组呼吸困难和临床状况好转率优于对照组(P<0.05);rhBNP组治疗后左室Tei指数较对照组明显缩短(P<0.05),而两组治疗后EF无显著差异(P>0.05)。rhBNP组未发生药物相关的不良事件。结论rhBNP能改善急性失代偿性心力衰竭患者的呼吸困难程度和临床状况,较硝酸异山梨酯或硝普钠缩短Tei指数,提高早期心脏舒张功能,安全性可靠。     

重组人脑利钠肽治疗急性心梗后失代偿性心力衰竭的疗效观察

目的:观察重组人脑利钠肽(rhBNP)治疗急性心肌梗死后失代偿性心力衰竭的临床疗效和安全性.方法:选择急性心肌梗死合并失代偿性心力衰竭、心功能Killip Ⅲ级的患者63例,随机分为rhBNP组(32例)和多巴酚丁胺组(31例),在标准抗缺血治疗和静脉用呋塞米针剂抗心衰治疗的基础上,分别加用rhBNP(1.5 μg·kg-1静脉推注后,以0.007 5～0.01 μg·kg-1·min-1,静脉微泵注射72 h)和多巴酚丁胺(2.5～10 μg·kg-1·min-1,静脉微泵注射72 h).在用药前及用药72 h后测定两组患者血脑钠肽(BNP)、左室射血分数(EF)值,重新评价患者心功能Killip分级,观察患者72 h治疗过程中利尿剂用量及血压的变化,并观察30 d内的病死率.结果:两组血BNP均下降,rhBNP组更加明显(P<0.01);与多巴酚丁胺组比较,rhBNP组EF及心功能Killip分级均改善(P<0.01),利尿剂用量减少(P<0.01);两组患者30 d病死率无明显差异(P>0.05).结论:与多巴酚丁胺比较,rhBNP能更好地改善急性心肌梗死后失代偿性心力衰竭患者的临床症状,但对预后的改善未见明显差异.     

硝酸甘油和重组人脑利钠肽对急性失代偿性心力衰竭的疗效比较

目的 比较重组人脑利钠肽(rhBNP)和硝酸甘油对失代偿性心力衰竭的临床疗效.方法 我院50例失代偿性心力衰竭住院患者随机分为硝酸甘油组和rhBNP组,分别记录两组患者给药前及给药后30 min、6 h及24 h的呼吸困难程度以及整体临床情况.以及用药24 h后液体的出入量和血流动力学参数.其中硝酸甘油组使用硝酸甘油开始剂量为5?g/min.每3～5分钟增加5?g/min,根据个体的血流动力学参数来调整用量;rhBNP组使用rhBNP,首先以1.5 ?g/kg弹丸式静脉冲击,随后以0.0075 ?g穔g-1穖in-1连续静脉滴注72 h.结果 rhBNP组患者静脉给药后30 min和6h的呼吸困难好转程度(P值分别为0.042和0.019)和整体临床状况好转程度(P值分别是0.018和0.044)均显著优于硝酸甘油组,24h后两组未有明显差异(P值分别是0.192和0.179);用药24 h后的尿量rhBNP组(1513.8±242.9)ml明显多于硝酸甘油组(1341.2±239.7)ml(P=0.015);用药24h时rhBNP组患者射血分数的增加以及肺动脉压和收缩压的降低均明显多于硝酸甘油组(P值分别是0.001、0.000及0.002),用药72 h后rhBNP组室性期前收缩、成对期前收缩和阵发性室性心动过速等室性心律失常发作的次数明显减少(P值分别是0.000、0.001和0.002).结论 rhBNP通过促进尿量的排泄、降低肺动脉压及增加左室射血分数等途径明显改善失代偿性心力衰竭患者呼吸困难和整体临床状况,以及明显减少室性心律失常的发作.     

重组人脑利钠肽改善急性失代偿性心力衰竭患者早期心功能

目的 探讨冻干重组人脑利钠肽(rhBNP)治疗急性失代偿性心力衰竭的早期疗效和安全性.方法 40例急性失代偿性心力衰竭患者随机分为两组,rhBNP组(n=20):先以rhBNP 1.5 μg/kg静脉冲击后,再以0.0075 μg·kg-1·min-1连续静脉滴注;对照组(n=20)静脉持续滴注异舒吉(硝酸异山梨酯)或硝普钠.记录治疗前后呼吸困难程度、全身情况、左室射血分数(EF)和Tei指数.rhBNP的安全性评估采用治疗药前后定期测量血压、心率、复查血电解质及肾功能,并对所有不良事件进行记录.结果 治疗72 h后rhBNP组呼吸困难和临床状况好转率优于对照组(P＜0.05);rhBNP组治疗后左室Tei指数较对照组明显缩短(P＜0.05),而两组治疗后EF无显著差异(P＞0.05).rhBNP组未发生药物相关的不良事件.结论 rhBNP能改善急性失代偿性心力衰竭患者的呼吸困难程度和临床状况,较硝酸异山梨酯或硝普钠缩短Tei指数,提高早期心脏舒张功能,安全性可靠.     

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.