血脂康对自发性高血压大鼠血压及左室功能的影响

目的以原发性高血压大鼠(SHR)为实验模型,观察单纯使用血脂康对SHR血压、左室功能的影响,并探讨其相关机制。方法10周龄雄性SHR和WKY按试验和对照的原则分为三组:正常对照组(WKY),实验对照组(SHR),血脂康组(SHR-X,SHR服血脂康2400mg.kg-1.d-1),饲养16周后观察鼠尾收缩压(SBP),有创心功能,左心室心肌肥厚指数(LVM I),血浆内皮素-1(ET-1),肌浆网Ca2 -ATP酶活性(SERCA)。心肌细胞横径(TDM),心肌胶原含量及分布情况。结果SHR-X组较SHR组SBP低17.02mm Hg;左心室等容舒张期室内压下降的时间常数(T)显著降低[(1.01±0.09)m s,(2.38±0.59)m s,P<0.05];LVM I有明显下降[(3.07±0.25)mg/g,(3.31±0.23)mg/g,P<0.05]。ET-1有明显降低[(138±26pg/m l,(197±39)pg/m l,P<0.01),SERCA活性稍有升高。结论血脂康对延缓SHR血压的上升产生一定影响,有助于改善SHR左心室舒张功能,有助于抑制SHR左室肥厚。血脂康对心脏重构逆转的作用机制可能涉及血清ET-1水平下降,提高心肌细胞SERCA活性,抑制SHR心肌细胞内[Ca2 ]i超载等环节。     

福辛普利和左旋氨氯地平对高盐饮食下自发性高血压大鼠SBP、左心室肥厚、NO及ET-1水平的影响

目的 观察福辛普利和左旋氨氯地平对高盐饮食下自发性高血压大鼠(SHR)收缩压(SBP)、左心室肥厚(LVH)、一氧化氮(NO)及内皮素-1(ET-1)水平的影响.方法 将40只8周龄SHR随机分为5组(n=8),即对照组、高盐对照组、福辛普利组、左旋氨氯地平组及联合治疗组.除对照组给予含0.9%氯化钠饲料喂养外,其余4组大鼠均给予含4%氯化钠饲料喂养8周.在第5周起各组按照0.01 mL·g-1等体积0.9%氯化钠灌胃4周.福辛普利组:按剂量4 mg·kg-1·d-1;左旋氨氯地平组:按剂量1 mg·kg-1·d-1;联合治疗组:福辛普利4 mg·kg-1·d-1,左旋氨氯地平1 mg·kg-1·d-1.每周测量SBP、体质量、心率1次,8周后通过放血处死全部SHR,计算左心室质量指数(LVMI),放免法测定血清及心肌ET-1含量,化学法检测血清及心肌NO水平.结果 与高盐对照组比较,左旋氨氯地平组能明显降低高盐饮食下SHR的SBP,增加血清NO的含量,减少心肌组织ET-1含量和LVMI(均P<0.01);福辛普利组能明显降低高盐饮食下SHR心肌组织ET-1含量和LVMI(P＜0.05或P<0.01),但无明显降低SBP作用;联合治疗组能更明显降低SBP和LVMI(均P<0.01).结论 左旋氨氯地平与福辛普利均能降低高盐饮食下SHR SBP作用,机制可能与血清NO含量的升高有关;抑制LVH的作用机制可能与心肌组织ET-1含量降低有关.     

活血潜阳方对高血压大鼠血压和左室心肌间质重构的影响

目的:观察活血潜阳方对自发性高血压大鼠(SHR)血压和左室心肌间质重构的影响。方法:72只SHR随机分SHR对照组、活血潜阳方组、缬沙坦组及两药合用组。20只京都Wistar大鼠(WKY)作为正常对照组。治疗前测大鼠尾动脉收缩压(SBP)、舒张压(DBP);分别于治疗7周及14周后测定SBP、DBP和左心室重量指数(LVMI),光镜观察并计算胶原容积分数(CVF)。结果:SHR的SBP、DBP、LVMI和CVF均高于同龄WKY大鼠(P<0.05或P<0.01)。活血潜阳方治疗14周可抑制SHR的SBP、DBP增高(P<0.05或P<0.01),可降低SHR的LVMI和CVF(P<0.05或P<0.01),较7W效果更明显;活血潜阳方与缬沙坦合用治疗14周可进一步降低SHR的CVF(P<0.01)。结论:长疗程(14W)的活血潜阳方治疗具有缓和的降压作用,并改善心肌间质重构,可能是其逆转高血压左室肥厚的机制。     

血清尿酸及NT-proBNP在评估老年原发性高血压患者左室肥厚中的意义

目的:探讨血清尿酸及N末端B型钠尿肽原(NT-proBNP)在评估老年原发性高血压(EH)患者左室肥厚中的意义。方法:将152例老年EH患者按照心脏超声中左室质量指数(LVMI)分为左室肥厚组(LVH组,n=69例)和非左室肥厚组(非LVH组,n=83例);检测两组患者入院时的血清尿酸及NT-proBNP,比较两组的差异,并应用Logistic回归分析探讨血清尿酸及NT-proBNP与左室肥厚的关系。结果:LVH组患者血清尿酸[(375.31±75.89)μmol/L]高于非LVH组[(337.50±83.93)μmol/L](t=12.432,P<0.05),LVH组NT-proBNP[(365.29±110.45)pg/ml]高于非LVH组[(179.56±59.60)pg/ml](t=17.541,P<0.05),LVH组患者LVMI[(137.78±25.98)g/m2]高于非LVH组[(102.55±20.45)g/m2](t=11.744,P<0.05),二分类Logistic回归分析提示:血清尿酸(Or=1.243,P<0.05),NT-proBNP(Or=2.024,P<0.05)与左室肥厚呈正相关。结论 :血清尿酸、NT-proBNP与老年高血压患者左室肥厚具有正相关性,可能是其发生的独立危险因素。     

培多普利对高血压大鼠左心室肥厚的影响

目的:探讨培多普利对原发性高血压大鼠左心室肥厚重构及进程中血管紧张素II(Ang-II)和肌浆网钙ATP酶的影响。方法:原发性高血压大鼠分成模型组、培多普利治疗组[SHR-t1mg/(kg)·d],WKY大鼠为正常对照组(WKY)。电镜观察左心室肥厚的超微结构,并分别测定心肌指数(左室重/体质量,LV/WT),血、心肌Ang-II水平和肌浆网钙ATP酶的活性变化。结果:SHR-t组的血AngII水平无明显改变,SHR组的血压、LV/WT(3.98±0.32)mg/g、Ang-II(16.72±5.24)pg/mg水平显著升高(P<0.01),电镜下可见心肌相对缺氧及代偿性细胞功能活跃表现。SHR-t组血压、LV/WT(3.38±0.31)mg/g、Ang-II(12.94±1.63)pg/mg明显下降(P<0.05),且未见上述心肌超微结构改变;但SHR-t组的LV/BW与WKY组(2.29±0.49)mg/g相比仍有显著差异(P<0.01);SHR组肌浆网钙ATP酶活性明显下调[0.52±0.11μmol/(g·min),P<0.05],治疗后恢复[0.82±0.11μmol/(g·min),P<0.05],但仍未达正常。结论:ACE-I主要通过抑制局部肾素-血管紧张素系统通路,对高血压大鼠左心室肥厚重构起了很好的逆转作用,但不可能完全阻断左心室肥厚的进程。     

针刺太冲穴对自发性高血压大鼠收缩压、血浆ET-1和血清NO的影响

摘要： 目的:观察针刺太冲穴对自发性高血压大鼠（SHR）收缩压、血浆内皮素（ET-1）及血清NO含量的影响,以对其降压机制作初步探讨。方法：选用9周龄SHR28只,随机分为模型组、针刺太冲、针刺冲阳和针刺非经穴组（均n=7）,并以同体重正常血压SD大鼠（n=7）作为正常组。经过连续针刺治疗7天后,测量收缩压,并测定血浆ET-1和血清NO的水平。结果：（1）模型组血压显著高于正常组（P＜0.01）。经针刺治疗7天后,针刺太冲组大鼠收缩压显著低于模型组[(140.81±4.47)mmHg vs (166.58±9.05)mmHg,P＜0.01],但仍高于正常组[(140.81±4.47)mmHg vs (99.17±9.24)mmHg,P＜0.01]。（2）针刺太冲组大鼠针刺第7天收缩压显著低于第1天[(140.81±4.47)mmHg vs (154. 56±10.59)mmHg,P＜0.01]。（3）针刺太冲能显著降低SHR血浆ET-1水平[(93.19±4.39) pg/mL vs (105.82±6.82)pg/mL,P＜0.05]和升高血清NO的水平[(45.01±8.1)umol/L vs (28.28±4.86)umol/L,P＜0.01]。结论 针刺太冲穴能降低SHR收缩压,但未能使其收缩压恢复至正常水平,其降压机制可能与降低SHR血浆ET-1和升高血清NO的含量有关。     

氯沙坦联合吲达帕胺对高血压患者左心室肥厚的影响

目的 评价氯沙坦联合吲达帕胺对高血压并左心室肥厚(LVH)患者的降压疗效及对左心室肥厚的影响.方法 120例原发性高血压并左室肥厚患者随机分为联合组和对照组各60例,分别采用氯沙坦联合吲达帕胺治疗和单一氯沙坦治疗6个月,观察治疗前后血压(SBP、DBP)、心率、左室收缩末期内径(LVESD)、舒张末期室间隔厚度(ⅣSTd)、左室后壁舒张末期厚度(LVPWTd),左室射血分数(LVEF)、左室质量(LVM)和左室质量指数(LVMI)变化.结果 治疗后2组患者的SBP、DBP、ⅣSTd、LVPWTd、LVMI均较治疗前降低(P均＜0.05),联合组ⅣSTd、LVPWTd和LVMI低于对照组(P均＜0.05).结论 与单独使用氯沙坦相比,氯沙坦和吲达帕胺联合治疗能很好地控制高血压并LVH患者的血压,同时逆转LVH.     

缬沙坦单纯和联合用药治疗高血压左心肥厚的临床疗效

目的 观察缬沙坦单纯用药和缬沙坦联合氨氯地平治疗高血压左心肥厚的临床效果.方法 174例高血压左心肥厚患者,随机分成87例缬沙坦联合氨氯地平治疗的治疗组.87例缬沙坦单纯用药的对照组.监测定两组患者治疗前后收缩压(SBP)、舒张压(DBP)、心率(HR)、舒张期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、舒张期左室内径(LVDd)、左室重量指数(LVMI)的变化情况.结果 治疗组SBP、DBP、HR、IVST、LVPWT、LVDd、LVMI治疗前后有非常显著的差异(P＜0.05,P＜0.01,P＜0.001).对照组SBP、DBP、IVST、LVPWT、LVDd、LVMI治疗前后也有显著差异(P＜0.05,P＜0.01,P＜0.001),但治疗组SBP、HR、IVST、LVPWT的改善情况优于对照组(P＜0.05,P＜0.01).讨论我们的研究表明,缬沙坦联合氨氯地平治疗高血压左心室肥厚的疗效、安全性及耐受性均好,不良反应小,对原发性高血压合并左心室肥厚患者是一种较为理想的治疗方案,但单纯采用缬沙坦治疗高血压左心室肥厚也是一种比较好的方法.     

缬沙坦单纯和联合用药治疗高血压左心肥厚的临床疗效

目的 观察缬沙坦单纯用药和缬沙坦联合氨氯地平治疗高血压左心肥厚的临床效果.方法 174例高血压左心肥厚患者,随机分成87例缬沙坦联合氨氯地平治疗的治疗组.87例缬沙坦单纯用药的对照组.监测定两组患者治疗前后收缩压(SBP)、舒张压(DBP)、心率(HR)、舒张期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、舒张期左室内径(LVDd)、左室重量指数(LVMI)的变化情况.结果 治疗组SBP、DBP、HR、IVST、LVPWT、LVDd、LVMI治疗前后有非常显著的差异(P＜0.05,P＜0.01,P＜0.001).对照组SBP、DBP、IVST、LVPWT、LVDd、LVMI治疗前后也有显著差异(P＜0.05,P＜0.01,P＜0.001),但治疗组SBP、HR、IVST、LVPWT的改善情况优于对照组(P＜0.05,P＜0.01).讨论我们的研究表明,缬沙坦联合氨氯地平治疗高血压左心室肥厚的疗效、安全性及耐受性均好,不良反应小,对原发性高血压合并左心室肥厚患者是一种较为理想的治疗方案,但单纯采用缬沙坦治疗高血压左心室肥厚也是一种比较好的方法.     

血浆脑钠肽浓度与高血压患者左室肥厚及心功能的关系

目的观察高血压患者左室肥厚与血浆脑钠肽(BNP)浓度的关系,分析氯沙坦钾片治疗前后左室肥厚及左室舒张功能不全的变化情况,探讨血浆BNP浓度可否作为判断左心室肥厚的逆转及左室舒张功能改变的临床指标。方法高血压患者63例,平均年龄(57.2±6.4)岁,其中伴左心室肥厚组患者34例,不伴左心室肥厚组患者29例,健康对照组30例。予以高血压病患者氯沙坦钾片50~100mg/d,治疗40周,所有对象行超声心动图测定左心室重量指数(LVMI)、E/A比值;采用美国博适Triage及其试剂盒快速测定血浆BNP水平,对BNP与LVMI、E/A比值作相关分析。结果高血压左心室肥厚患者组的血浆BNP水平明显高于高血压病不伴左心室肥厚患者组和健康对照组(P<0.01),经氯沙坦钾片治疗后高血压病左心室肥厚患者组血浆BNP水平明显下降,差异有统计学意义(P<0.05),且与LVMI呈显著正相关,与E/A比值呈显著负相关。结论血浆BNP浓度能较好地反映高血压患者左心室肥厚及左室舒张功能状态。     

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…     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…