重组人脑利钠肽与硝普钠对急性失代偿性心力衰竭的疗效观察

目的比较重组人脑利钠肽(rhBNP)和硝普钠对急性失代偿性心力衰竭的临床疗效。方法本院60例急性失代偿性心力衰竭住院患者随机分为硝普钠(SNP)组和rhBNP组,分别记录两组患者给药前及用药24 h后液体的出入量变化,给药后48 h的心功能改善情况,给药前及用药72 h后血流动力学参数和神经内分泌激素变化。结果用药24 h后rhBNP组的尿量(1503.6±194.3mL)明显多于硝普钠组(1319.4±195.9mL)(P=0.001);静脉给药48 h后,rhBNP组患者显效率和总效率分别为93.3%和96.7%(P值分别为0.010和0.012),均显著优于硝普钠组,用药72 h时rhBNP组患者射血分数的增加以及中心静脉压的降低均明显多于硝普钠组(P值分别为0.000和0.000),用药72 h后rhBNP组血清B型脑钠肽下降水平较硝普钠组相比明显降低(P=0.000)。结论 rhBNP是改善急性心力衰竭的安全有效的药物。     

重组人脑利钠肽联合硝普钠治疗急性失代偿性心力衰竭的疗效评价

目的观察国产重组人脑利钠肽(rh-BNP)联合硝普钠治疗急性失代偿性心力衰竭(ADHF)的疗效及安全性。方法选择ADHF住院患者200例,心功能(NYHA)Ⅲ~Ⅳ级,随机分为试验组(rh-BNP+硝普钠治疗)100例,对照组(硝普钠治疗)100例,分别静脉滴注48h。观察给药前后血流动力学改变、临床症状、心脏超声变化,记录不良事件。结果与对照组比较,试验组给药1h后平均肺毛细血管楔压[MPCWP,(19.09±3.33)mm Hg(1mm Hg=0.133kPa)vs(24.62±5.15)mm Hg,P<0.05]、平均肺动脉压[(26.71±2.92)mm Hg vs(35.67±4.22)mm Hg,P<0.05]、心输出量[(3.57±0.53)L/min vs(3.15±0.40)L/min,P<0.05]有显著差异。2组MPCWP和心输出量的差异持续至给药4h(P<0.05);试验组与对照组第1天(24h)总尿量比较有统计学差异[(2410.00±826.88)ml vs(2110.00±768.64)ml,P<0.05];试验组全身临床症状变化比例在给药1h高于对照组(99.0%vs 82.0%,P<0.05),试验组较对照组LVEF明显升高(P<0.05)。结论rh-BNP和硝普钠联合治疗ADHF能更快更显著改善患者的血流动力学指标,增加尿量,改善临床症状,提高LVEF,耐受性和安全性良好。     

急性失代偿性心力衰竭治疗中使用重组人脑利钠肽和硝酸异山梨酯的效果对比

目的分析急性失代偿性心力衰竭治疗中使用重组人脑利钠肽和硝酸异山梨酯的重组人脑利钠肽和硝酸异山梨酯的效果。方法 2013年5月—2016年12月,于青海省西宁市第一人民医院收治的急性失代偿性心力衰竭患者中选取100例,随机分为两组,各50例。两组均采用常规疗法进行治疗,在此基础上,给予对照组患者硝酸异山梨酯治疗,给予观察组患者重组人脑利钠肽治疗,比较两组临床疗效。结果观察组临床治疗总有效率为98%,相较于对照组的64%更低(P0.05);相较于治疗前,两组患者治疗后的生活质量评分均有所降低,24h尿量均有所增加,且观察组改善幅度优于对照组(P0.05)。结论急性失代偿性心力衰竭治疗中使用重组人脑利钠肽的效果较硝酸异山梨酯更加显著,值得推广。     

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

目的本文研究重组人脑利钠肽应用于急性心梗后失代偿性心力衰竭的疗效。方法选取我院2013年03月~2015年03月收治的急性心梗后失代偿性心力衰竭患者120例作为研究对象,将其平均划分为观察组(n=60例)与对照组(n=60例),分别予以重组人脑利钠肽、多巴酚丁胺治疗。对比2组患者治疗后的血脑钠肽水平(BNP)、左室射血分数(EF)。结果观察组经重组人脑利钠肽治疗后的血脑钠肽水平明显低于对照组(P0.05);观察组的左室射血分数则高于对照组(P0.05)。结论将重组人脑利钠肽药物应用于急性心梗后失代偿性心力衰竭患者中可降低血脑钠肽水平,改善患者的心功能。     

左西孟旦与重组人脑利钠肽治疗AMI急诊PCI术后患者短期临床疗效的对比

目的:探讨静脉应用左西孟旦与重组人脑利钠肽治疗急性前壁心肌梗死急诊经皮冠状动脉介入治疗(PCI)术后患者的短期临床疗效。方法:94例急性前壁心肌梗死急诊PCI术后的患者,随机分为左西孟旦组(51例)和重组人脑利钠肽组(43例),观察两组治疗7d前后脑利钠肽(BNP)、左室射血分数(LVEF)、肌酐水平和治疗前后24h、48h、72h尿量变化情况及低血压、室性心动过速(室速)、心脏破裂发生情况。结果:两组治疗后7d的血浆BNP水平较同组治疗前显著降低(P0.01),重组人脑利钠肽组BNP值显著低于左西孟旦组(P0.01);两组治疗后7d的LVEF较同组治疗前显著升高(P0.05),左西孟旦组LVEF值显著高于重组人脑利钠肽组(P0.01);两组治疗后7d的血清肌酐水平较同组治疗前显著降低(P0.01),重组人脑利钠肽组与左西孟旦组的差异无统计学意义(P0.05);两组治疗后24、48、72h的24h尿量均较同组治疗前显著增多(P0.01);治疗后48、72h的24h尿量,重组人脑利钠肽组显著高于左西孟旦组(P0.01),但治疗后24h尿量无统计学差异(P0.05)。重组人脑利钠肽组低血压发生率高于左西孟旦组(P0.05);左西孟旦组室速的发生率高于重组人脑利钠肽组(P0.05);重组人脑利钠肽组与左西孟旦组心脏破裂发生率差异无统计学意义(P0.05)。结论:左西孟旦较重组人脑利钠肽能更好地提高LVEF,改善左心室收缩功能。左西孟旦和重组人脑利钠肽均具有肾脏保护作用,重组人脑利钠肽利尿效果及降低BNP值均优于左西孟旦。     

重组人脑利钠肽治疗难治性心力衰竭患者34例临床观察

目的探讨重组人脑利钠肽(新活素)治疗难治性心力衰竭的临床疗效。方法选取34例难治性心力衰竭患者给予冻干重组人脑利钠肽治疗,观察治疗前后患者呼吸困难症状、24小时尿量(UV)、心室率(HR)、左室射血分数(LVEF)及氨基末端B型利钠肽(NT-proBNP)水平的变化情况。结果重组人脑利钠肽给药结束24小时患者呼吸困难改善总有效率为82.35%。重组人脑利钠肽给药结束5天后患者NT-proBNP较治疗前明显下降(P<0.05),LVEF值较治疗前升高(P<0.05),UV较治疗前显著增加(P<0.05)。结论重组人脑利钠肽能明显改善难治性心力衰竭患者症状及心功能,有较好的临床疗效。     

新活素与硝普钠治疗顽固性心衰的临床观察

目的观察新活素（重组人脑利钠肽,rhBNP）与硝普钠治疗顽固性心力衰竭的疗效与安全性。方法将62例顽固性心力衰竭患者随机分为治疗组32例,对照组30例,在常规抗心衰治疗基础上分别给予新活素和硝普钠,连续用药3d后观察疗效。结果两组治疗后临床症状好转率比较差异有统计学意义,治疗组显著优于对照组（P〈0．05）,左室射血分数、每搏输出量、心输出量、心指数及尿量改善治疗组均优于对照组。结论新活素能明显改善顽固性心力衰竭患者的血流动力学,其疗效优于硝普钠,安全性与硝普钠类似。     

重组人脑利钠肽和硝普钠治疗中重度心力衰竭的疗效对比研究

目的对重组人脑利钠肽与硝普钠治疗中重度心力衰竭的疗效进行对比研究。方法选取我院中重度心力衰竭患者100例,将其随机分为观察组与对照组,各50例。观察组患者采用重组人脑利钠肽,对照组采用硝普钠药物进行治疗,观察两组治疗效果。结果观察组总有效率为96%,对照组总有效率为80%,两组疗效比较,差异有统计学意义(P<0.05)。治疗后两组患者去甲肾上腺素、脑利钠肽(BNP)比较,差异有统计学意义(P<0.05);两组抗利尿激素和内皮素比较,差异均无统计学意义(P>0.05)。结论利用重组人脑利钠肽对心力衰竭患者进行治疗,能够明显地改善患者的心力衰竭,改变其舒缩功能,进一步提高患者心排血量,延缓心室重构,是治疗中重度心力衰竭的一种有效药物。     

重组人脑利钠肽治疗顽固性心力衰竭的疗效观察

目的探讨重组人脑利钠肽(rtBNP)治疗顽固性心力衰竭的疗效。方法将60例顽固性心力衰竭患者按治疗方案分为脑利钠肽组(30例)和硝普钠组(30例),硝普钠组在常规治疗基础上使用硝普钠治疗,脑利钠肽组在常规治疗基础上使用脑利钠肽治疗,比较两组患者的临床疗效及对心功能的影响。结果脑利钠肽组临床疗效总有效率达83.3%,优于硝普钠组的56.7%(P0.05);治疗后左室射血分数(LVEF)较治疗前有明显改善,且脑利钠肽组治疗后LVEF较硝普钠组有明显改善,差异有统计学意义(P0.05)。结论 rtBNP治疗顽固性心力衰竭疗效确切。     

硝普钠和多巴胺联合冻干重组人脑利钠肽对难治性心力衰竭患者的影响

目的探讨硝普钠和多巴胺联合冻干重组人脑利钠肽对难治性心力衰竭(RHF)患者的影响。方法选取2014年6月—2016年6月张家口市第一医院心内三科收治的RHF患者120例,采用随机数字表法分为A组、B组、C组、D组,每组30例。在常规抗心力衰竭治疗基础上,A组患者给予硝普钠联合多巴胺治疗,B组患者给予硝普钠联合冻干重组人脑利钠肽治疗,C组患者给予多巴胺联合冻干重组人脑利钠肽治疗,D组患者给予硝普钠和多巴胺联合冻干重组人脑利钠肽治疗;4组患者均连续治疗7 d。比较4组患者临床疗效,治疗前后B型利钠肽差值(ΔBNP)、左心室射血分数差值(ΔLVEF)、左心室舒张末期内径差值(ΔLVEDD),观察4组患者治疗期间不良反应发生情况。结果 4组患者临床疗效比较,差异无统计学意义(P0.05)。D组患者ΔBNP高于A组、B组、C组(P0.05),而4组患者ΔLVEF、ΔLVEDD比较,差异无统计学意义(P0.05)。治疗期间B组患者出现血压偏低2例。结论与硝普钠联合多巴胺、硝普钠联合冻干重组人脑利钠肽、多巴胺联合冻干重组人脑利钠肽相比,在常规抗心力衰竭治疗基础上加用硝普钠和多巴胺联合冻干重组人脑利钠肽可更有效地降低RHF患者血清BNP水平,且安全性较高。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.     

Severe hepatotoxicity with jaundice associated with paroxetine

Hepatotoxicity due to paroxetine, a selective serotonin reuptake inhibitor, is very rare, and to the best of our knowledge, only five cases of liver injury in association with paroxetine have previously been reported in the medical literature. We describe the clinical, biochemical, and pathological findings in a patient with paroxetine hepatotoxicity, which was reversed after withdrawal of the drug. The present case and the others previously reported suggest that hepatotoxicity should be taken into account as a rare complication, sometimes severe, that may occur with paroxetine.