高血压患者动态血压变化节律与昼夜血浆内皮素和一氧化氮浓度的相关性研究

目的：探讨高血压患者昼夜24h血浆内皮索（ET）、一氧化氮（NO）浓度变化与动态血压各参数及心率（HR）的关系。方法：对46例高血压患者佩带24h血压、心率动态检测仪自动记录心率、血压等参数，同时采用放免法和比色法测定患者24h内不同时间点血浆ET、NO浓度。结果：高血压患者血浆ET与平均动脉压（MAP）、HR有明显的夜间2：00低谷和晨起8：00高峰的昼夜节律性变化，并且高血压患者ET及MAP24h均明显高于正常对照组，而且呈正相关。同时高血压患者血浆NO明显低于正常对照组，血浆NO与MAP24h两者之间呈负相关。结论：血压的调节明显受ET、NO的影响，ET、NO在高血压的发生发展及血压的昼夜波动中起重要的作用。     

婴儿重症肺炎并急性心力衰竭时血浆内皮素和降钙素基因相关肽及动脉血氧分压的相关研究

目的：探讨婴儿重症肺炎合并急性充血性心力衰竭（婴儿肺炎并心衰）时血浆内皮素（ET）水平变化的影响因素。方法：用放射免疫分析法,同期动态观测了26例肺炎并心衰患儿血浆ET、降钙素基因相关肽（CGRP）及动脉血氧分压（PaO2)变化。结果：心衰急性期（治疗前）血浆ET含量较其自身缓解期（治疗后）、轻型肺炎组及正常对照组均显著增高（P均＜0．01）,而同期测定的血浆CGRP含量及PaO2值则较其自身缓解期及正常对照组均显著降低（P均＜0．01）;心衰缓解期与型肺炎组与轻型肺炎组和正常对照组间血浆ET、CGRP水平及PaO2值变化无统计学差异（P均＞0．05）。心衰急性期血浆ET含量变化与血浆CGRP水平呈显著负相关（P＜0．01）,与PaO2值亦至显著负相关（P＜0．01）。结论：血浆ET水平增高是促进婴儿重症肺炎合并心衰发生发展的重要因素;血浆ET水平增高的原因可能与血浆CGRP含量降低及PaO2下降有关;动态监测血浆ET及CGRP含量变化对判断病情及预后有重要临床意义。     

心电图解读第3讲窦性心律心电图及窦性心律失常

窦性心律是指激动起源于窦房结。并控制整个心脏电活动的主导节律，可分为正常窦性心律和窦性心律失常两大类。正常窦性心律的心电图特征是：①清醒及静息状态下．窦性心律的频率在青少年和成年人为60～100次／分，通常为65～85次／分。婴幼儿和儿童的频率比成年人快。婴儿期心率约为110～150次／分，平均为130次／分。     

食管心脏电生理检查的护理体会

食管心脏电生理检查是经食管送入电极导管，用一定强度的电流通过导管电极，在食管中靠近左心房处施行电刺激以引起心电冲动，从而调节心律和心率的改变来达到诊断和治疗的目的。近一年来，我院心血管内科开展了食管心脏电生理检查，它在诊断和治疗阵发性室上性心动过速（室上速）、了解心脏电生理特性、分析疑难心电图等方面有着重要作用，现将在护理配合方面的体会总结如下。     

食管心脏电生理检查的护理体会

食管心脏电生理检查是经食管送入电极导管，用一定强度的电流通过导管电极，在食管中靠近左心房处施行电刺激以引起心电冲动，从而调节心律和心率的改变来达到诊断和治疗的目的。近一年来，我院心血管内科开展了食管心脏电生理检查，它在诊断和治疗阵发性室上性心动过速（室上速）、了解心脏电生理特性、分析疑难心电图等方面有着重要作用，现将在护理配合方面的体会总结如下。     

超声心动图评价高血压大鼠左室结构变化与血浆及组织心钠素、内皮素变化关系

目的：应用超声心动图评价高血压大鼠心脏结构、功能动态变化,同步监测血浆及心肌组织中心钠素（atrial natriuretic peptide,ANP)、内皮素（cedothelin,ET)含量变化,分析高血压大鼠心脏结构功能变化与血浆及心肌组织中ANP、ET含量变化关系,从而进一步了解高血压心脏病左室结构、功能变化的生物化学基础。方法：SD大鼠左肾动脉狭窄,即二肾一夹型（2K1C）肾血管性高血压大鼠（RHR）。术后每周监测尾动脉压及心脏超声学参数。用放免法测定血浆及心肌组织中ANP、ET含量。结果：1、高血压早期（术后3周左右）血浆及心肌组织（左心室）中ANP、ET含量明显升高;2、高血压左室向心性肥厚组血浆及心肌组织中ANP、ET升高更为显著;3、左室离心性肥厚期血浆ET较向心性肥厚期组更高,但心肌组织中ET含量与其无显著差别,而血浆及心肌组织中ANP含量均较向心性肥厚期组低;4、相关分析：（1）血浆及心肌组织中ANP含量与室间隔厚度（IVST）、左室后壁厚度（PWT）、相对室壁厚度（RWT）呈正相关;（2）血浆及心肌组织中ET含量与LVM／BW（体重）正相关（r=0.682,r=0.557,P＜0．01）,与射血分数（EF）、左室短轴缩短率（FS）均呈负相关;血浆ET、ANP水平分别与心肌组织中ET、ANP正相关（r=0.726,P＜0．01、r=0.57,P＜0．01）。结论：2K1C型RHR血浆及心肌组织中ANP、ET含量均升高,血浆及心肌组织中ET、ANP在2K1C型高血压大鼠左室几何构型中均起着重要作用。     

病态窦房结综合征患者的动态心电图特征

目的：探讨病态窦房结综合征患者的动态心电图特征。方法：选用经临床心脏电生理检查证实的54例病态窦房结综合征患者进行24h动态心电图检查。并选30例正常人进行对照。结果：患者组心率明显慢于对照组，两者差异具有显著性（P〈0.001）。患者组心律失常检出率明显高于对照组。结论：动态心电图能提供较多的心率和心律变化资料，适用于间歇性心率和心律改变的病态窦房结综合征患者，能明显提高其心律失常的检出率。     

百草枯中毒与内皮素及氧自由基关系的研究

目的：探讨内皮素（ET）及氧自由基（OFR）在急性百草枯中毒（APP）发病中的作用及相互关系。方法：采用放射免疫分析法、硫代巴比妥酸法及黄嘌呤氧化酶法测定68例APP组、及29例正常对照组血浆ET、血清丙二醛（MDA）及超氧化物歧化酶（SOD）的含量。结果：APP患者血浆ET、血清MDA水平均较正常对照组明显升高，且病死组ET及MDA水平明显高于存活组（P〈0．01或P％0．05）；而SOD明显降低（P〈0．01或P〈0．001），病死组与存活组之间亦差异有显著性（P〈0．05）；ET含量与MDA呈正相关，而与SOD呈显著负相关（P〈0．01）。结论：OFR损伤是APP发病的重要因素之一，ET水平增高协同OFR参与发病机制，血浆ET、MDA、SOD水平可作为APP患者病情程度的评估、指导治疗与预后判断的临床指标之一。     

低频电刺激对椎-基底动脉供血不足患者的疗效观察

目的 观察低频电刺激对椎-基底动脉供血不足（VBI）患者的临床疗效，同时探讨其对患者椎-基底动脉血流速度及血浆中内皮素（ET）、心钠素（ANP）、血栓素B2（TXB2）、血管紧张素Ⅱ（AngⅡ）、降钙素基因相关肽（CGRP）及神经元特异性烯醇化酶（NSE）含量的影响。方法 共选取临床确诊的VBI患者120例，将其随机分为电刺激治疗组（治疗组）和常规对照组（对照组）。2组患者均给予常规内科治疗，治疗组患者还同时给予低频电刺激。分别观察2组患者治疗后的临床症状改善率，同时对2组患者治疗前、后椎-基底动脉血流速度及血浆中ET、ANP、TXB2、AngⅡ、CGRP及NSE水平进行比较。结果 经2个疗程治疗后，治疗组患者的症状改善总有效率高达87．93％，显著高于对照组相应水平（P〈0．01）；而且治疗组患者的椎一基底动脉血流速度明显加快，同时其血浆中ET、ANP、TXB2、AngⅡ、NSE水平显著下降，CGRP含量明显升高。结论 低频电刺激对VBI患者症状改善具有显著促进作用，并且在治疗过程中及治疗后均无明显不良反应发生，其治疗作用机制可能与增加脑灌注、减轻脑缺血后神经损伤有关。     

洛沙坦对老年高血压病多种血管活性物质的影响

目的：观察多种血管活性物质在轻、中、重度老年高血压病(EH)中浓度变化，及洛沙坦对其影响．方法：用放射免疫法分组测定90例老年EH和30例健康体检血浆内皮素(ET)，心钠素(ANF)，血管紧张索Ⅰ(AngⅡ)及血清醛固酮(ALD)浓度．并对38倒EH患用洛沙坦50～100mg/d治疗8周后，复测上述各值．结果：各期EH随血压水平升高．血浆ET、ANF、AmgⅠ及血清ALD球度均升高．与平均动脉压(MAP)有良好的相关性．洛沙坦治疗8周后．ET、ANF、AngⅠ、ALD均明显降低，P<0．05。结论：提示高血压病的发生、发展与上述血管活性物质水平变化有关。洛抄坦在明星降压的同时，可降低这些血管活性物质的浓度．因而对动脉内皮功能可能有保护作用。     

Effects of a bolus dose of atrial natriuretic factor in young and elderly volunteers

We assessed the haemodynamic and renal effects as well as the effects on plasma cGMP levels of a small i.v. dose (33 micrograms) of human atrial natriuretic factor (99-126; hANF) in two age groups of healthy volunteers. Binding properties of platelet ANF receptors were also measured. The elderly (four males, eight females, mean age 52.3 years) showed increased haemodynamic (decrease in blood pressure) and renal responses (diuresis, natriuresis, calciuresis) as well as greater increases in plasma cGMP levels and urinary cGMP excretion than the young subjects (four males, 12 females, mean age 26 years). Binding capacities and affinities of platelet ANF receptors were identical in both groups. These data indicate that the sensitivity to ANF increases with age and that this increased sensitivity is reflected in the reactivity of plasma cGMP levels but not in the properties of platelet ANF receptors. The data may be important for the therapeutic use of ANF, for the understanding of the physiological regulation of ANF action and may underline the necessity of using age-matched control subjects for clinical studies on the possible therapeutic effectiveness of ANF.     

Exercise and posture-related changes of atrial natriuretic factor and cardiac function in diabetes

To study whether the release of atrial natriuretic factor (ANF) was altered in diabetic cardiac autonomic neuropathy (CAN), we determined plasma ANF concentrations during exercise and changes of posture in three groups of age- and sex-matched subjects (9 healthy subjects, 7 diabetic patients with CAN, and 7 diabetic patients without CAN). During exercise, plasma ANF concentrations rose threefold (P less than .001), and this increase was similar in the three groups. However, heart-rate response to exercise was impaired in the two groups of diabetic patients (P less than .004 vs. healthy subjects) but was more severely impaired in patients with CAN (P less than .03 vs. patients without CAN). In healthy subjects and patients without CAN, the increases of ANF during exercise correlated significantly with those of heart rate, systolic blood pressure, and rate-pressure product (P less than .01). In patients with CAN, the correlation was found exclusively with heart rate (P less than .01). An increase of ventricular ejection fraction occurred in all groups (P less than .001) but without showing statistical differences between groups. After 30 min of standing, a similar postural drop of plasma ANF concentrations (P less than .002) was observed in all subjects, reflecting preserved sympathetic control of vessels. In conclusion, exercise induces an increase of plasma ANF in diabetic patients with CAN. This increase, occurring similarly to healthy subjects, indicates that autonomic activation plays a minor role in ANF release during exercise. Impaired heart-rate response to exercise in patients without CAN suggests early damage of autonomic function, undetected by conventional rest tests.     

Hemodynamic effects of atrial natriuretic factor in young and elderly subjects

Because levels of plasma atrial natriuretic factor (ANF) increase with advancing age, a diminished hemodynamic responsiveness to ANF in the elderly has been hypothesized in the literature. Therefore hemodynamic effects after two infusion rates (0.25 and 2.0 micrograms/min) of atrial natriuretic factor (99-126) were investigated in young (n = 8) and elderly (n = 9) volunteers in a double-blind, randomized, and placebo-controlled protocol. After low-rate infusion, ANF concentrations increased to the upper normal range, and only minor effects were observed. In contrast, high-rate infusion resulted in a decrease in blood pressure and forearm vascular resistance, whereas an increase in heart rate was observed in both groups. Between young and elderly subjects, a significant difference was observed in the ANF-induced decrease in systolic blood pressure (mean +/- SD, -4% +/- 4% versus -12% +/- 7%, p less than 0.05) and mean arterial pressure (-6% +/- 5% versus -11% +/- 4%, p less than 0.05) during the high rate infusion. When compared with the concentrations of the young subjects, the ANF concentrations reached at both ANF dosages were higher in the elderly subjects; this was the result of a diminished ANF clearance in the elderly subjects. After correction of the changes of systolic blood pressure and mean arterial pressure for the higher ANF levels reached within this elderly group, no difference between young and elderly subjects remained. We conclude that a diminished cardiovascular responsiveness to ANF with advancing age could not be demonstrated. In contrast, the high-rate infusion of ANF induced an increased hemodynamic response in the elderly subjects, but this seems to be the result of the higher ANF levels reached within this group.     

充血性心力衰竭患者血浆一氧化氮和内皮素含量及其临床意义

目的：探讨血浆一氧化氮（ＮＯ）和内皮素（ＥＴ）的改变在充血性心力衰竭（ＣＨＦ）病程中的临床意义。方法：检测３５例ＣＨＦ患者外周静脉血和肺动脉血中ＮＯ、ＥＴ、血管紧张素转换酶（ＡＣＥ）的含量。以２０例健康体检者作为对照组。结果：ＣＨＦ患者外周静脉和肺动脉血浆中ＮＯ、ＥＴ含量显著高于健康对照组（Ｐ均＜０．０５）;血浆ＡＣＥ水平呈现相同的变化;血浆ＥＴ增加的幅度大于ＮＯ,因此,ＣＨＦ患者ＮＯ／ＥＴ比值降低（Ｐ＜０．０５）。这些变化在患者的肺动脉中比外周静脉中更明显（Ｐ均＜０．０５）,与心力衰竭的严重程度有关。结论：血浆ＮＯ水平增高,ＮＯ／ＥＴ比值降低是ＣＨＦ的病理生理特征之一,反映了心力衰竭时血管内皮细胞的功能紊乱     

Influence of blood pressure, heart rate, age, and sex on concentrations of atrial natriuretic factor and cyclic GMP in 124 volunteers

The significance of increased atrial natriuretic factor (ANF) in relation to blood pressure and age is still controversial. We investigated the influence of blood pressure, age, and some other variables on ANF and its putative second messenger, cGMP. Samples for ANF and cGMP detection were taken from 124 ostensibly healthy individuals who were donating blood. Samples were also collected from 27 volunteers before and after blood donation, to study the influence of bleeding. During blood donation, ANF increased from 78.9 to 87.4 ng/L (P = 0.0035), whereas cGMP remained unchanged. ANF concentrations in 124 healthy individuals, corrected for the influence of bleeding, were 61.5 (SD 26.1) ng/L, with a 95% confidence interval of 10.0 to 112.1 ng/L. Mean cGMP concentrations in plasma were 2.9 (SD 1.45) nmol/L, with a 95% confidence interval of 0.4 to 5.75 nmol/L. Multivariance analysis revealed no significant influence of blood pressure, age, heart rate, or sex on concentrations of either ANF or cGMP in plasma.     

Significance of adrenoceptor-mediated atrial natriuretic factor release in normal humans.

To assess the potential role of adrenoceptor-stimulated atrial natriuretic factor (ANF) release in healthy humans, 18 volunteers, divided into groups of six, underwent experiments with infusion of incremental doses of salbutamol with and without beta-blockade with propranolol, propranolol alone, and bolus injections of clonidine before and after alpha-blockade with phentolamine, and phentolamine alone. Since changes in right atrial pressure have been shown to influence ANF release, central venous pressure (CVP) was continuously measured 30 min before, during the 120 min duration of drug infusions, and for 30 min after the bolus injections of the drugs. ANF was serially determined in central venous plasma during all drug infusions, and plasma catecholamines were measured to determine any possible influence of endogenous sympathetic activation on ANF levels. Plasma ANF was unaffected by all individual drugs and drug combinations, despite significant reductions in CVP in the salbutamol, phentolamine and phentolamine + clonidine groups, and a doubling of heart rate during salbutamol administration (p less than 0.01 for all). The results do not suggest a major role for adrenoceptor-mediated ANF release in normal humans, and do not indicate that plasma ANF levels are determined by tonic inhibition or facilitation of the sympathetic nervous system.     

充血性心衰患者血浆内皮素、肿瘤坏死因子含量变化

目的　探讨充血性心力衰竭（ＣＨＦ） 患者血浆ＥＴ 和ＴＮＦ 含量变化及其意义。方法　检测７０ 例充血性心力衰竭患者血浆ＥＴ 和ＴＮＦ 含量,选３０ 例健康体检者作为正常对照组。结果　ＣＨＦ 患者ＥＴ 和ＴＮＦ 水平明显高于正常对照组（ Ｐ＜ ０ ．０１） ,且心衰程度越重,血浆ＥＴ 和ＴＮＦ 水平越高,ＣＨＦ 患者血浆ＥＴ 与ＴＮＦ 含量呈正相关（ ｒ ＝ ０ ．７２４６ ,Ｐ＜ ０ ．００１） 。结论　血浆ＥＴ 和ＴＮＦ 的测定有助于诊断心力衰竭和判断心力衰竭的程度。     

Physiological effects of synthetic atrial natriuretic factor in normal conscious dogs

The objective of this study was to examine the integrative physiologic effects of atrial natriuretic factor (ANF). Synthetic 99-126 ANF was administered to 6 normal conscious dogs as two consecutive infusions (0.02 and 0.1 microgram/kg/min respectively) each over 30 min: each infusion was preceded by a priming dose of 1 microgram/kg. With the first infusion, mean arterial pressure declined from 113 +/- 2 to 103 +/- 4 mmHg, pulmonary capillary wedge pressure declined from 9.6 +/- 0.5 to 7.2 +/- 0.7 mmHg and right atrial pressure declined from 9.8 +/- 0.4 to 8.0 +/- 0.7 mmHg (all p less than 0.05). No change in heart rate was seen. Despite very high plasma ANF concentrations, no further decline in arterial or central filling pressures were seen in the second infusion. In contrast, cardiac output declined progressively from 3.8 +/- 0.2 to 2.8 +/- 0.21/min (p less than 0.01) by the end of second infusion. Plasma renin activity declined from 2.2 +/- 0.7 to 0.9 +/- 0.3 ng/ml/hr (p less than 0.05) while plasma norepinephrine remained unchanged. Urine output and sodium excretion increased in a dose dependent manner. The diverse time course of the hemodynamic, renal and neuroendocrine effects suggests these effects of ANF are mediated by different mechanisms. Furthermore, the failure of heart rate and plasma norepinephrine to increase despite a significant decline in blood pressure and cardiac output suggests ANF may have a depressant effect on the sympathetic nervous system.     

显微镜下多血管炎肾损害患者内皮素水平的变化及泼尼松与环磷酰胺冲击治疗对其影响

目的 探讨显微镜下多血管炎肾损害患者血浆内皮素（ET）的变化及泼尼松与环磷酰胺冲击治疗对其影响。方法 采用特异性放射免疫法检测8例健康人（正常对照组）及8例稳定期显微镜下多血管炎肾损害患者（稳定期组）和6例活动期显微镜下多血管炎肾损害患者（活动期组）泼尼松与环磷酰胺冲击治疗前后血浆ET水平。结果 稳定期组血浆ET-1与正常对照组比较无显著性差异（P〉0．05），而活动期组血浆ET-1水平显著高于稳定期组与正常对照组（P〈0．01），且血浆ET-1与抗髓过氧化物酶抗体、血沉、24h尿蛋白定量、尿素氮、血肌酐呈正相关（19〈0．01或19〈0．05）。与补体C3、C4及内生肌酐清除率呈显著负相关（19〈0．01或19〈0．05），轻度肾功能不全组显微镜下多血管炎肾损害患者血浆ET-1水平显著高于肾功能正常组（P〈0．01）。泼尼松加环磷酰胺冲击治疗能显著降低患者血浆ET-1水平（19〈0．01）。结论 ET参与了显微镜下多血管炎肾损害的发病过程，动态观测血浆ET-1水平有助于判断显微镜下多血管炎肾损害的活动性、肾脏损害程度和治疗效果。     

高机械指数联合高剂量造影剂行心肌声学造影的安全性研究

目的探讨高机械指数（MI）超声辐照联合高剂量国产超声造影剂心肌声学造影,对大鼠血流动力学及组织器官损伤情况的影响。方法20只正常SD大鼠,经颈静脉注射全氟丙烷人血白蛋白微球注射剂（1ml／kg）,在造影模式下调节MI至最大（MI=1．9）,采用R波触发,每6个心动周期一次。造影前后分别监测心率、心电图、血压、肌钙蛋白T,结束后取大鼠心、肝、肾进行病理检查。结果大鼠心率、血压、肌钙蛋白T测值在造影前后无明显变化（P〉0．05）;造影后心脏病理检查见轻微损伤（心肌纤维稍变粗,胞浆呈细颗粒状;间质血管扩张充血）,肝、肾未见异常结构改变;一只大鼠在注射造影剂的过程中出现室性期前收缩,注射结束5min后恢复正常。结论在常规超声条件下高MI及高剂量造影剂心肌声学造影对正常实验大鼠血流动力学无明显影响,肌钙蛋白T升高不明显,病理示心肌轻微损伤,偶致短暂室性早搏,但短时间内可恢复正常。本实验证实,高MI联合高剂量国产声学造影剂行心肌声学造影对于正常大鼠是安全的。