达格列净治疗糖尿病冠心病合并心功能不全的疗效观察

目的 探讨在常规治疗基础上,达格列净对糖尿病冠心病合并心功能不全患者心脏功能和疗效的影响。方法 选取2018年5月—2021年6月我院收治的糖尿病冠心病合并心功能不全患者134例为研究对象,采用随机数字表通过简单随机的方法将其分为观察组与对照组,每组67例。两组均给予基础降糖治疗、基础心力衰竭治疗以及冠心病治疗,观察组在上述治疗基础上,给予达格列净治疗,两组均连续治疗6个月,比较两组治疗前后心功能指标［ N 末端脑钠素前体（NT-proBNP）、左室射血分数 (LVEF)、左室舒张末期内径 (LVEDD)以及纽约心脏病协会 (NYHA) 分级及 6 min 步行测试］,血糖指标［空腹血糖（FPG）及餐后2 h血糖（2 h FPG）、糖化血红蛋白（HbA1c）］、不良反应情况,随访180 d,比较两组不良心血管事件发生率。结果 治疗后,观察组各项指标均较治疗前有明显改善（P＜0.05）,对照组仅NT-proBNP和6 min 步行距离较治疗前明显改善,且治疗后观察组LVEF、6 min步行距离高于对照组,LVEDD、NT-proBNP低于对照组（P＜0.05）;观察组治疗后FPG、2 h FPG、HbA1c均低于对照组（P＜0.05）,两组不良反应无显著差异（P＞0.05）,对照组1例发生心源性死亡,观察组无死亡病例,观察组严重心律失常发生率低于对照组（P＜0.05）。结论 在常规治疗基础上,达格列净治疗糖尿病冠心病合并心功能不全疗效显著,在降低血糖、改善患者心功能方面效果明显,对于降低不良心血管事件发生率有重要应用价值,可在临床推广运用     

重组人脑利钠肽治疗老年急性失代偿性心力衰竭患者的疗效及安全性观察

目的 探讨重组人脑利钠肽(rhBNP)治疗老年急性失代偿性心力衰竭患者的临床疗效及安全性.方法 82例老年急性失代偿性心力衰竭患者,随机分为治疗组(rhBNP组)及硝普钠对照组.并应用超声心动图及Swan-Ganz导管检测患者心功能、血流动力学参数变化,比较2组患者临床状况、心功能、血浆NT-proBNP及血流动力学参数及不良事件的差异.结果 2组患者呼吸困难减轻,血氧饱和度提高,rhBNP组优于对照组.治疗后2组患者NT-proBNP均降低,rhBNP组降低显著.患者左室射血分数、心指数均有提高,rhBNP组升高更明显.2组患者血流动力学参数(PCWP、PAP)均降低,rhBNP组明显优于对照组,且在用药30分钟时2组即显现出明显差异;治疗24小时时2组PCWP分别降低:12.29mmHg、8.8 mmHg,PAP降低:15.56 mmHg、11.42 mmHg,rhBNP组明显优于对照组; 2组患者治疗前后肝、肾功能无明显差异;rhBNP组的不良事件主要是低血压,但与对照组相比差异无显著性.结论 rhBNP治疗老年急性失代偿性心力衰竭疗效显著,安全性较高,短期效果优于常规硝普钠治疗.     

米力农对老年性顽固性心力衰竭患者心脏功能及N-末端脑钠肽前体水平的影响

目的:探讨米力农对老年性顽固性心力衰竭患者心脏功能及N-末端脑钠肽前体(NT-proBNP)水平的影响。方法:收集在本院接受治疗的老年性顽固性心力衰竭患者90例,随机分为对照组、观察组各45例。对照组接受临床常规治疗,观察组接受常规+米力农治疗。对比两组治疗前后心功能及血清NT-proBNP含量的差异。结果:治疗前,两组超声及血清心功能指标、血清NT-proBNP水平的差异无统计学意义(P>0.05)。治疗后,观察组超声心功能参数LVEDD的水平低于对照组,CI、SV的水平高于对照组患者;血清心功能指标Cys-C、GDF-15、sST2、H-FABP的含量低于对照组患者;血清中NTproBNP的含量低于对照组患者(P<0.05)。结论:老年性顽固性心力衰竭患者接受米力农治疗,可有效优化心脏功能并降低血清NT-proBNP水平。     

重组人脑利钠肽治疗高龄老年人急性非ST抬高心肌梗死合并心力衰竭的疗效及安全性

目的 观察重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)在治疗合并心力衰竭的急性非ST抬高心肌梗死的老年患者的临床疗效.方法 选择2013年6月至2014年3月在宣武医院综合科和心内科确诊为急性非ST抬高心肌梗死合并心力衰竭住院的高龄老年患者86例,男47例,女39例,平均年龄(79.63±4.41)岁.随机分为rhBNP治疗组(41例)及硝酸甘油对照组(45例),2组均给予常规治疗,治疗组在此基础上加用rhBNP,先给予1.5μg/kg负荷量,继之以0.01 μ g/(kg·min)静脉持续泵入72h.对照组在常规治疗基础上加用硝酸甘油10-15μg/min静脉持续泵入72h.2组均总治疗7d.分别对2组治疗前及治疗后48h、72h、7d收缩压、舒张压、心率、N末端B型利钠肽原(N terminal B type natriuretic peptide,NT-proBNP)、左室射血分数(Left ventricular ejection fraction,LVEF)、左室舒张末期内径(Left ventricular end diastolic dimensio,LVEDD)、左室收缩末期内径(Left ventricular endsystolic volume,LVSDD)、每搏输出量(Stroke volume,SV)、心排血量(Cardiac output,CO)等指标进行检测.观察记录患者住院期间及出院后1个月6min步行试验(6 minutes walking test,6MWT),随访1个月内发生的不良心血管事件(Major adverse cardiacevents,MACE),包括恶性心律失常、再次心肌梗死以及死亡发生情况.结果 治疗7d后rhBNP组收缩压、心率和NT-proBNP与对照组比较明显下降(P＜0.05).rhBNP组治疗后左室射血分数(LVEF)、每搏输出量(SV)、心排血量(CO)均优于对照组(P＜0.05),左室舒张末期内径(LVEDD)和左室收缩末期内径(LVSDD)较对照组显著降低(P＜0.05).rhBNP组患者6MWT大于对照组(P＜0.05).rhBNP组住院及出院后1个月内MACE明显低于对照组(P＜0.05).结论 对老年急性非ST抬高心肌梗死并发心力衰竭患者常规治疗基础上加用rhBNP治疗,可进一步改善心功能,减少MACE.     

参附注射液对心气阳虚型老年慢性心力衰竭的临床疗效

目的 研究参附注射液对心气阳虚型老年慢性心力衰竭(CHF)患者的临床疗效。方法 60例心气阳虚型老年CHF患者随机分为对照组和参附组,所有患者均接受常规西医治疗,参附组在此基础上加用参附注射液50ml静脉泵推,1次/天,疗程2周。治疗结束后,比较两组患者NYHA心功能分级、中医证候积分、6min步行距离、左室射血分数(LVEF)和血浆N末端脑钠肽前体(NTproBNP)。结果 治疗前两组NYHA心功能分级、中医证候积分、6min步行距离、血浆NT-proBNP和LVEF均无显著性差异(P>0.05),治疗后参附组NYHA心功能分级、中医证候积分总有效率显著高于对照组(P<0.05);治疗后两组6min步行距离、LVEF均较治疗前显著提高(P<0.01),血浆NT-proBNP较治疗前显著下降(P<0.05),参附组较对照组更显著增加6min步行距离、LVEF,降低血浆NT-proBNP (P<0.05)。结论 参附注射液对心气阳虚型老年CHF患者具有良好疗效。     

静脉注射脑利钠肽对急性冠脉综合征神经内分泌激素的影响

目的:观察静脉滴注rhBNP对ACS患者神经内分泌的影响。方法:选ACS患者,随机分为rhBNP组25例静脉注射rhBNP;对照组25例硝酸甘油治疗。测两组治疗前后BNP水平、肾素、血管紧张素Ⅱ、醛固酮水平。结果:治疗后48h、5d、7d两组BNP较治疗前均降,rhBNP组降大于对照组,rhBNP组峰值显著低于对照组(P<0.05);治疗后36h rhBNP组血浆肾素、血管紧张素Ⅱ、醛固酮较治疗前降程度显著大于对照组(P<0.05),对照组治疗前后差异无统计学意义(P>0.05)。结论:ACS早期静脉注射rhBNP可降低肾素、血管紧张素Ⅱ、醛固酮、BNP水平,抑制神经内分泌系统的激活。     

卡维地洛联合曲美他嗪治疗高龄慢性心力衰竭的疗效及对左室功能的影响

目的:观察卡维地洛联合曲美他嗪在高龄慢性心力衰竭治疗中的疗效、安全性及对左室功能的影响。方法:100例符合慢性心力衰竭(CHF)诊断标准的患者,随机分为两组各50例,对照组采用常规治疗,治疗组在常规治疗基础上加用卡维地洛与曲美他嗪口服,观察两组治疗前及治疗后6个月的心功能分级,6分钟步行距离,心脏超声指标和血浆N端脑钠肽前体(NT-proBNP)水平变化,评估其有效性及安全性。结果:治疗组较常规组能显著改善患者的左室功能并延长6分钟步行距离(P<0.05),显著降低血浆NT-proBNP水平,增加左心室射血分数(P<0.05)。结论:维地洛联合曲美他嗪,可明显改善老年心力衰竭患者的心脏功能,提高运动耐量及生活质量,改善心室重构。不良反应少。     

脑钠肽与老年心力衰竭患者左室射血分数、心功能分级及预后的关系研究

目的:探讨脑钠肽与老年心力衰竭患者左室射血分数、心功能分级、6 min 步行距离以及出院后心脏不良事件的关系.方法:选择124例老年心力衰竭患者为研究对象,根据患者血浆脑钠肽水平,分为A(22例)、B(35例)、C(30例)、D(27例)组.患者入院前,测定脑钠肽、左室射血分数、6 min步行距离,并进行心功能分级.经常规治疗后,出院随访2月,记录患者心脏不良事件发生情况.采用 Pearson相关性分析评价脑钠肽与左室射血分数、心功能分级、6 min 步行距离以及出院后心脏不良事件的相关性.结果:A、B、C和D组脑钠肽水平逐步升高,6 min 步行距离逐步减少,心功能分级严重程度逐步提升,出院后心脏不良事件发生率逐步增大(P<0.05).A、B组左室射血分数差异比较无统计学意义(P>0.05),但是均高于C、D组(P<0.05).经Pearson相关性分析,脑钠肽水平与老年心力衰竭患者左室射血分数、6 min步行距离呈负相关(r=-0.877、-0.925,P<0.05),与心功能分级和出院后心脏不良事件发生率呈正相关(r=0.956、0.910,P<0.05).结论:脑钠肽与老年心力衰竭患者左室射血分数、心功能分级、6 min步行距离以及出院后心脏不良事件发生有密切的关系,可以作为老年心力衰竭诊断和预后判断的参考指标.     

重组人脑利钠肽对急性前壁心肌梗死合并心力衰竭患者左心功能及远期左室重构的影响

【目的】研究静脉应用重组人脑利钠肽(rhBNP)对经皮冠状动脉介入治疗(PCI)的急性心肌梗死合并心力衰竭患者左心功能和远期左室重构的影响。【方法】将60例首发急性前壁ST段抬高心肌梗死合并急性心力衰竭患者随机分为重组人脑利钠钛(rhBNP)治疗组和对照组,每组各30例患者。比较两组患者治疗24小时的心功能改善情况、呼吸困难程度、整体临床状况、尿量的变化。监测两组治疗前及治疗后24 h、48 h血浆NT-proBNP水平,以及治疗前及治疗后肾素、血管紧张素II、醛固酮水平。观察两组患者治疗后24 h、出院时及出院后6个月时心功能及左室重构变化。【结果】用药后24 h rhBNP组患者呼吸困难程度、尿量、尿量与入量的差值、EF值、Tei指数与对照组比较,差异有统计学意义(P<0.05);与对照组相比,治疗48h时,rhBNP组的血浆rhBNP、肾素、血管紧张素II及醛固酮水平下降更明显(P<0.05);两组患者好转出院时,左心室舒张末期容积(LVEDV)差异无显著性意义(P>0.05),而rhBNP组EF值及Tei指数较对照组明显升高(P<0.05);出院后6个月时,rhBNP组Tei指数、EF值较对照组仍明显升高(P<0.05),而rhBNP组LVEDV及△LVEDV%较对照组降低(P<0.05)。【结论】rhBNP能有效改善急性心肌梗死后心力衰竭患者的呼吸困难和临床状况,并且可以延缓远期心室重构,改善远期心功能。     

红花黄色素对老年慢性心力衰竭患者心功能及血浆胱抑素C、超敏C反应蛋白水平的影响

目的 观察红花黄色素对老年慢性心力衰竭(CHF)患者心功能及血浆胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)水平的影响.方法 选择老年CHF患者90例,分为对照组和治疗组各45例,对照组给予常规抗心力衰竭治疗,治疗组在对照组基础上加用红花黄色素静脉滴注.于治疗前及治疗后4周,两组患者均行超声心动图检测左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF);两组患者行6min步行距离测试,检测两组患者血浆N-末端脑钠肽前体(NT-proBNP)、CysC及hs-CRP的水平变化.结果 治疗组总有效率(82.2％)高于对照组(60.0％)(P＜0.05).治疗4周后,两组患者6min步行距离较治疗前显著增加(P＜0.05),治疗组6min步行距离长于对照组(P＜0.05);治疗后两组患者LVEDD、LVESD及LVEF水平较治疗前改善,但差异无统计学意义(P＞0.05);治疗后两组患者血浆NT-proBNP、CysC 及hs-CRP水平较治疗前显著降低(P＜0.05),治疗组低于对照组(P＜0.05).结论 红花黄色素治疗老年CHF患者临床疗效显著,可有效改善患者的心功能,降低其血浆NT-proBNP、CysC及hs-CRP水平.     

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…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

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.