贝那普利和氯沙坦联合用药对慢性肾脏病高血压和肾功能的影响

高血压是慢性肾脏病的常见并发症之一,也是加重肾脏疾病发展和终末肾衰竭的重要因素之一[1].控制血压,延缓肾衰竭的进展,减少心脑血管并发症的发生是治疗该病的关键环节.贝那普利和氯沙坦均有减少蛋白尿、降血压、改善肾功能及延缓肾脏病进展的作用[2],但目前关于两药联合应用治疗慢性肾脏疾病高血压的报道较少.本研究对我院收治的慢性肾脏病高血压患者应用贝那普利联合氯沙坦进行治疗,旨在探讨其降压效果及对肾功能的影响.     

中西医结合防治高血压的切入点及策略探讨

高血压病是一种多病因疾病,中、西医作为两种不同的医学理论体系,对高血压有不同层面的研究和认识,且对高血压病有不同的治疗理念.中、西医治疗高血压,各有其优势及不足,而中西医结合治疗高血压,能起到扬长避短、优势互补的作用.本文针对目前国内中西医联合治疗高血压的切入点、研究思路及防治策略作一浅析.     

去肾交感神经治疗难治性高血压:未到尘埃落定时

正高血压是目前引起全球心血管病高发病率和死亡率的主要危险因素。因此,通过管理高血压,减少上述疾病的发生,改善疾病的预后至关重要。目前治疗高血压的主要方法是生活方式改变加多种药物联合治疗,高血压患者中有8%~18%是所谓的难治性高血压(resistant hypertension,RH),即在改善生活方式的基础上,采用合理可耐受的足量≥3种降压药(包括利尿剂)治疗1月,血压仍未达标[收缩压     

硝苯地平与硫酸镁联合对妊娠期高血压疾病的临床效果分析

目的探讨硝苯地平与硫酸镁联合运用对妊娠期高血压疾病的治疗效果。方法以本院自2012年1月至2013年8月90例妊娠期高血压疾病重度子痫前期患者为研究对象,将患者随机分成两组,分别是观察组和对照组,对照组患者使用硫酸镁注射液治疗妊娠期高血压疾病,观察组患者使用硝苯地平与硫酸镁联合治疗妊娠期高血压疾病,对两组患者的疗效进行对比分析。结果硝苯地平与硫酸镁联合运用治疗妊娠期高血压疾病的疗效明显优于其他两组患者的治疗效果,患者治愈率明显高于单纯使用硫酸镁注射液的患者。结论硝苯地平与硫酸镁联合运用治疗妊娠期高血压疾病效果显著,可在临床上广泛运用。     

减少血压波动性、血压达标是脑卒中预防的关键

在心脑血管疾病发生发展过程中,血压的持续增高是一种最重要的原因。研究显示,收缩压每增加5mmHg（1mmHg=0．133kPa）,脑卒中的风险就升高46％,心肌梗死事件的发生概率则会上升14％。据2002年的营养健康调查发现,高血压已是心血管疾病中发病率最高的疾病,目前我国有1．6亿高血压患者,而血压长期增高对心脑血管疾病的产生及事件发生的不良影响,已极大地损害了高血压患者的健康。因此,高血压的达标治疗受到了广泛的重视。目前国际、国内提倡合理的联合治疗,目的在于较好地达标,降压的获益体现在保护器官及降低心脑血管事件。降压达标对临床器官的保护起到了重要的作用。     

探讨硫酸镁联合硝苯地平治疗妊娠高血压疾病的治疗效果及安全性

目的分析硫酸镁联合硝苯地平治疗妊娠高血压疾病的治疗效果及安全性。方法本文研究对象为妊娠高血压疾病患者,研究例数一共200例,妊娠高血压疾病患者均采取抽签分组方式分为两组,收取时间在2015年2月1日-2016年2月10日之间,分为观察组(100例妊娠高血压疾病患者)、对照组(100例妊娠高血压疾病患者),分别实施硫酸镁联合硝苯地平治疗、常规治疗,将两组治疗效果进行对比。结果观察组妊娠高血压疾病患者的胎儿宫内窘迫率2.00%、早产率3.00%、宫缩乏力率2.00%均低于对照组患者(P0.05);观察组妊娠高血压疾病患者不良反应发生率1.00%(其中发生患者1例、所占比为1.00%;未发生患者99例、所占比为99.00%)低于对照组患者(P0.05);观察组妊娠高血压疾病患者的DBP(77.52±8.21)mmHg、SBP指标(125.12±10.12)mmHg与对照组具有差异(P0.05)。结论通过对妊娠高血压疾病患者实施硫酸镁联合硝苯地平治疗后,具有较高的安全性和治疗效果。     

镇肝息风汤联合拉贝洛尔治疗难治性及恶性高血压疗效观察

目的 通过降压药物疗效差异性对比观察,筛选更好的难治性高血压、恶性高血压及其他高血压急症的最有效药物组合方案.方法 采用随机分组方法,对中药镇肝息风汤联合拉贝洛尔组(治疗组)和硝酸甘油联合硝普钠组(对照组)在降压效果、平稳控制血压时间上进行对比分析.结果 治疗组疗效优于对照组,差异有统计学意义(P＜0.05).结论 中药镇肝息风汤联合拉贝洛尔对难治性高血压、恶性高血压及其他高血压急症治疗在快速降低血压、平稳控制血压的时间和缩短血管活性药物使用时间上有较好作用,是临床治疗该类疾病的有效药物组合方案.     

高血压联合用药治疗方法评价

原发性高血压是最常见的心血管疾病,也是脑卒中、心肌梗死、心力衰竭及慢性肾脏病的重要危险因素。世界高血压联盟颁布的高血压指南认为,血压水平与其有关的心血管疾病危险性之问存在着连续的相关关系,将血压控制至目标值极为重要。高血压是一种多因素疾病,涉及多种发病机理,单一用药治疗的有效率仅为50％-60％,如何才能尽早的控制血压并达标,降压药物联合治疗才是根本。国内外高血压防治指南中均提出了联合治疗的需要和价值,联合用药已成为血压控制达标的重要原则和基本策略。     

氨氯地平联合二甲双胍治疗肥胖型高血压的效果观察

目的对应用二甲双胍与氨氯地平联合对患有肥胖型高血压疾病的患者实施治疗的临床效果进行研究。方法选择在我院就诊的患有肥胖型高血压疾病的患者86例,随机分为对照组和治疗组,平均每组43例。单纯应用氨氯地平对对照组患者实施治疗;采用二甲双胍与氨氯地平联合对治疗组患者实施治疗。结果治疗组患者高血压疾病用药前后的血脂水平的改善幅度明显大于对照组;高血压症状消失时间和药物治疗总时间明显短于对照组;肥胖型高血压疾病药物治疗效果明显优于对照组;药物不良反应明显少于对照组。结论应用二甲双胍与氨氯地平联合对患有肥胖型高血压疾病的患者实施治疗的临床效果非常明显。     

高血压病人服药依从性探讨

高血压是心脑血管疾病的重要危险因素,对高血压的防治是降低心脑血管疾病发病率的关键.但是目前我国高血压的服药率及控制率依然相当低.在高血压控制不尽人意的众多因素中,药物治疗依从性差是一个重要原因.     

Combination Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Diabetic Kidney Disease

Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) have played a major role in slowing the progression of diabetic kidney disease, since they lower urine protein levels, lower blood pressure, and slow progression. Studies have suggested that the combination of ACE-I and ARB offered greater benefits for patients with diabetic kidney disease. In 2008, the large ONTARGET study reported no benefit with combination therapy, as compared with monotherapy. This study has changed practice patterns, but few patients in this study had diabetic kidney disease. In this review, the data in favor of the combination use of these agents in patients with diabetic kidney disease and data against the combination are reviewed. At this time, there is little support for using the combination in diabetic patients with no kidney disease or early stage diabetic kidney disease. But there are patients who may benefit from combination use.     

New aspects of adjuvant therapy in endometrial cancer: current standards and future directions

Endometrial cancer is one of the most common gynaecological cancers in western countries. Most women are diagnosed at an early stage of the disease and can be cured by surgery alone. In patients with poor prognostic factors or an advanced disease, the chance of progression-free survival and overall survival is greatly diminished. Adjuvant chemotherapy is effective for patients with advanced disease. The combination of doxorubicin and cisplatin achieves overall response rates ranging from 34 to 60%, and the addition of paclitaxel seems to improve the outcome of patients with advanced disease, but it induces a significantly higher toxicity. A Gynecologic Oncology Study Group phase-III study is currently exploring the triplet paclitaxel+doxorubicin+cisplatin plus G-CSF vs. the less toxic combination of paclitaxel+carboplatin. Ongoing and planned phase-III trials are evaluating newer combination chemotherapy regimens, a combination of irradiation and chemotherapy and the implementation of targeted therapies with the goal of improving the tumour control rate and quality of life.     

冠心病合并抑郁症的诊治进展

冠状动脉性心脏病是临床常见的心血管疾病,抑郁症是一种与情绪障碍有关的精神性疾病,与冠状动脉性心脏病的关系近些年来越来越受到人们的关注与重视。冠状动脉性心脏病合并抑郁症的发病率远高于普通人群,抑郁症也是冠状动脉性心脏病发生、发展及预后的重要独立危险因素之一。现就近年冠状动脉性心脏病合并抑郁症的发病机制、诊治进展综述如下。     

Multifactorial Prevention of Cardiovascular Disease in Patients with Hypertension: the Cardiovascular Polypill

Hypertension is a major, if not the most important, contributor to the disease burden and premature death globally which is largely related to cardiovascular disease. In both the primary and the secondary preventions of cardiovascular disease, blood pressure (BP) targets are often not achieved which is similar to achievement of cholesterol goals. Combining aspirin, cholesterol and blood pressure-lowering agents into a fixed-dose combination pill called the cardiovascular polypill has been proposed as complementary care in the prevention of cardiovascular diseases in both the primary and secondary preventions of cardiovascular disease. This review article focuses on the potential role of fixed-dose combination therapy in the treatment of hypertension, outlines the pros and cons of combination therapy and emphasizes the rationale for trialling their use. Current and planned future cardiovascular polypill trials are summarized, and the prerequisites for implementation of the polypill strategy are described.     

Colonic carcinoma after chemotherapy of Hodgkin's disease

We describe a 28-year-old man with stage IV-B Hodgkin's disease who developed an adenocarcinoma of the colon after treatment with combination chemotherapy. To the best of our knowledge, this patient is the youngest, and only the fourth person in the English-language literature to develop colonic carcinoma after combination chemotherapy of Hodgkin's disease without radiation.     

Colon cancer: medical therapy

Fluorouracil is the major chemotherapy agent currently available for colon cancer. It is utilized alone or in combination in a variety of schedules, though the optimal schedule has not yet been identified. In addition to the use for metastatic disease, fluorouracil also is useful for adjuvant treatment or in combination with radiation therapy for treatment of locoregional disease.     

A report on efficacy and safety of azathioprine in a group of inflammatory bowel disease patients in northwest Greece

BACKGROUND/AIMS: Inflammatory bowel disease has a variable severity and in a group of patients a second-line treatment with immunosuppressive agents, such as azathioprine is required. The aim of the present study was to determine the efficacy and safety of long-term azathioprine treatment in inflammatory bowel disease patients unresponsive to steroids. METHODOLOGY: We investigated the efficacy of azathioprine in controlling the disease relapse (in combination with other drugs) in 29 patients with inflammatory bowel disease (16 with ulcerative colitis and 13 with Crohn's disease). Patients, who were started on azathioprine in combination with steroids, were those who were resistant to steroids. After controlling the acute phase, steroids were discontinued or reduced in very low doses (up to 4 mg methylprednisone per day) and azathioprine was administered in combination with mesalamine for a period of 12-48 months. RESULTS: Azathioprine (in combination with 5-ASA products and steroids) succeeded in controlling the acute relapse in 24 of 29 patients [82.75%, 15/16 (93.7%) with ulcerative colitis and 9/13 (69.2%) with Crohn's disease]. Of the patients who achieved remission, this was maintained for 1 year at least. Only one case of pancreatitis and one with vomiting and diarrhea were noted a few months after the initiation of therapy and azathioprine was discontinued. CONCLUSIONS: Azathioprine is an effective agent which controls acute relapse of inflammatory bowel disease in many cases in combination with other drugs. Long-term remission can be achieved. Side effects are uncommon.     

Study of Coronary Artery Disease in Single Aortic Valvular Disease

Objectives To analyze the results of coronary angiographies (CAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p < 0.01 ). Conclusions Angina pe     

原发性肺动脉肉瘤的诊治进展

原发性肺动脉肉瘤是一种起源于肺动脉并主要累及肺循环的罕见肿瘤,其临床表现多样且无特异性,易复发和转移.本病与慢性肺血栓栓塞疾病在临床和影像学表现方面存在相似性而容易混淆,不同影像学诊断方法联合有助于提高术前诊断率.治疗以手术为主,联合化疗和放疗可延长生存期.本病总体预后差,与肿瘤切除程度、病理类型等相关.     

Combination antithrombotic therapy with antiplatelet agents and anticoagulants for patients with atherosclerotic heart disease

We reviewed the efficacy and safety of combination antithrombotic therapy with aspirin plus warfarin versus aspirin alone in patients with atherosclerotic heart disease. We performed a comprehensive MEDLINE search of English-language reports published between 1966 and 2002 and search of references and relevant papers. Only clinical research studies on primary or secondary prevention of cardiovascular events in patients at high risk for coronary artery disease or patients experiencing unstable angina or myocardial infarction were included. Despite daily aspirin treatment, many patients break through aspirin treatment and experience cardiovascular events. Individuals at high risk for coronary disease or with established disease benefit from combination therapy with aspirin plus warfarin, if compliance with warfarin is greater than 70% and the target international normalized ratio (INR) of 2.0-2.5 is achieved. Combination therapy within these parameters leads to a 29-45% reduction in the risk of death, reinfarction and/or ischemic stroke. There is a significant increase in the rate of minor and a slight increase in the rate of major bleeding with combination therapy. Other potential indications for combination therapy include myocardial infarction associated with acute left ventricular aneurysm or significant left ventricular systolic dysfunction. In spite of reluctance to use oral anticoagulants, several large, randomized clinical trials support combination therapy with aspirin plus warfarin (INR, 2.0-2.5) in high-risk patients with atherosclerotic heart disease. Combination therapy increases the risk of minor and major bleeding, but not intracranial bleeding.