直流电复律对合并高血压持续性心房颤动患者的血压影响

目的 探讨合并高血压持续性心房颤动（PeAF）直流电复律（DCC）后对血压的影响.方法 入选31例合并高血压PeAF患者,根据是否接受DCC转复窦性心律,分为DCC组（A组,n=13）和对照组（B组,n=18）.记录DCC前既往最高收缩压（pre-SBPmax）、最高舒张压（pre-SBPmax）及DCC前及1d后24h动态血压获取的房颤时平均收缩压（MSBP）与平均舒张压（MDBP）.结果 DCC前：两组临床基线水平、服用药物、pre-SBPmax、pre-DBPmax、MDBP差异均无统计学意义（均P＞0.05）,A组MSBP高于B组（P=0.001）.DCC后：A组MSBP高于B组（P=0.008）、MDBP低于B组（P＜0.01）.DCC前后：1、B组MSBP、B组MDBP差异无统计学意义（P＞0.05）,A组DCC后MDBP较DCC前低（P＜0.01）.结论 合并高血压PeAF患者经DCC后可使MDBP降低,但MSBP变化不明显.     

高血压合并冠心病与24小时脉压的关系

目的　探讨高血压合并冠心病与 2 4h脉压的相关性。方法　将 15 3例住院患者分两组 ,A组为单纯高血压病 110例 ;B组为高血压合并冠心病 4 3例。用动态血压监测仪监测各组患者 2 4h血压及脉压 (PP)。结果　A组的MSBP ,MDBP和PP分别为 (136 72± 13 95 ) ,(79 37± 8 84 )和 (5 7 35± 11 74 )mmHg ,且PP≥ 5 0mmHg百分率 6 8 2 % ;B组的MSBP ,MDBP和PP分别为 (136 38± 12 36 ) ,(76 5 6± 10 13)和 (6 1 83± 8 75 )mmHg ,且PP≥ 5 0mmHg百分率 90 7% ,两组比较 ,MSBP和MDBP差异无显著性 ,但B组PP大于A组 ,且PP≥ 5 0mmHg百分率均高于A组 ,差异有显著性 (P <0 0 5 )。结论　高血压合并冠心病患者PP较单纯高血压患者大 ,冠心病合并症发生与PP相关。     

不同动态血压参数在高血压靶器官损害中的应用价值

目的:探讨不同动态血压参数对评价高血压靶器官损害的临床应用价值.方法:对100例原发性高血压患者进行24 h动态血压监测(Ambulatory blood pressure monitoring,ABPM)及相关靶器官的检查,根据有无靶器官损害分为单纯高血压组(高血压组)和高血压伴靶器官损害组(靶器官损害组).分别对2组间及靶器官损害组内的动态血压参数进行统计学分析.结果:(1)靶器官损害组的夜间平均收缩压、夜间平均脉压、白天收缩压负荷、夜间收缩压负荷均明显高于高血压组(P均<0.05).(2)伴3个靶器官损害组的血压昼夜节律异常概率、24 h平均收缩压、夜间平均收缩压、白天收缩压负荷、夜间收缩压负荷均明显高于伴1个靶器官损害组(P均<0.05);伴3个靶器官损害组的24 h平均舒张压、白天平均舒张压、夜间平均舒张压、夜间收缩压负荷、夜间舒张压负荷均明显高于伴2个靶器官损害组(P均<0.05);伴2个靶器官损害组的24 h平均舒张压、白天平均舒张压均明显低于伴1个靶器官损害组(P均<0.05),但24 h平均脉压却明显高于伴1个靶器官损害组(P均<0.05).结论:ABPM参数中有关收缩压的参数对临床判断高血压靶器官损害及其程度最有价值.     

原发性高血压患者动态脉压与心脏损害的关系

目的 使用超声心动脉图技术探讨高血压患者动态脉压与心脏损害的关系.方法 对108例高血压患者分别进行24 h动态脉压(ABPM)监测和超声心动图检查,根据24 h动态脉压(24 h pp)分为高血压A组(24 h pp＜60 mm Hg)49例和高血压B组(24 h pp≥60 mm Hg)59例,同时选取45例健康者为对照组.先用超声心动图测定心脏室壁厚度及腔室大小,再用多普勒组织成像(DTI)技术记录二尖瓣环侧壁、间隔、前壁和下壁的舒张早期及晚期的峰值运动速度及其比值,计算上述4个位点的均值,分别以Em、Am、Em/Am表示.分析24 h pp与心脏结构及功能各参数的关系.结果 高血压A、B组左房内径(LAD)均较对照组增大(P＜0.01),DTI各参数与对照组比较差异均有统计学意义(P＜0.01).高血压B组LAD、室间隔厚度(IVST)、左室后壁厚度(LVPWT)和左室质量指数均明显高于高血压A组(P＜0.05).同时DTI参数明显低于高血压A组(P＜0.05).3组间左室射血分数(EF)差异无统计学意义(P＞0.05).结论 24 h pp的增加是高血压患者心脏损害的重要危险因素.     

老年高血压患者动态脉压指数与靶器官损害的关系

目的探讨老年高血压患者动态脉压指数与靶器官损害的关系。方法选择60岁以上原发性高血压患者146例,按动态脉压指数水平分为3组：脉压指数≤0.40组（44例）,脉压指数0.41～0.50组（56例）,脉压指数≥0.51组（46例）。3组患者均化验血清肌酐,行动态血压、超声心动图、颈动脉超声、颅脑CT和（或）MRI检查;计算内生肌酐清除率（Ccr）、24h平均收缩压（24hMSBP）、24h平均舒张压（24hMDBP）、24h平均脉压（24hMPP）、脉压指数、左室重量指数（LVMI）、左室射血分数（LVEF）、左室舒张早期充盈峰值流速（E峰）及舒张晚期左房收缩期充盈峰值流速（A峰）比值（E/A）、颈动脉内膜-中层厚度（IMT）。结果3组患者左室肥厚、脑损害、肾功能损害及颈动脉斑块的患病率间差异均有统计学意义（P〈0.05）,脉压指数0.41～0.50组及脉压指数≥0.51组以上指标患病率与脉压指数≤0.40组比较,差异均有统计学意义（P〈0.05）,脉压指数≥0.51组以上指标患病率与脉压指数0.41～0.50组比较,差异均有统计学意义（P〈0.05）。脉压指数≥0.51组LVEF〈50%患病率与其他两组比较,差异均有统计学意义（P〈0.05）,E/A〈1的患病率与脉压指数≤0.40组比较,差异有统计学意义（P〈0.05,）。Spearman相关分析显示,动态脉压指数与心脑肾及颈动脉损害有相关性（均P〈0.05）。结论老年高血压患者动态脉压指数增大与靶器官结构和功能的损害程度密切相关;动态脉压指数可以作为老年高血压患者靶器官损害的预测因子。     

老年原发性高血压患者血管结构及功能与靶器官损害的关系研究

  目的  探讨老年原发性高血压患者动脉弹性功能与靶器官损害的关系。  方法  回顾性选取老年原发性高血压住院患者155例为高血压组〔包括24 h血压水平≥130/80 mmHg(1 mmHg=0.133 kPa)者68h血压水平＜130/80 mmHg者87例〕,同期住院的老年非高血压患者61例作为对照组。收集患者体质量指数(body mass index,BMI)、尿白蛋白肌酐比值(urine albumin-creatinine ratio,UACR)及血生化指标,记录24 h动态血压监测参数、颈动脉内膜中层厚度(intima-media thickness,IMT)及超声心动图测值,计算动态动脉硬化指数(ambulatory arterial stiffness index,AASI)和左心室质量指数(left ventricular mass index,LVMI)。比较高血压患者与非高血压患者动脉弹性功能指标(AASI、24 h PP)及靶器官损害指标(UACR、IMT、LVMI)的差异;Pearson相关分析AASI与24 h动态脉压(24 h pulse pressure,24 h PP)的关联性;多元线性回归分析靶器官损害的影响因素。  结果  与对照组相比,高血压组患者AASI、24 h PP、UACR、LVMI均较高(P＜0.05),估算的肾小球滤过率降低(P＜0.01)。高血压亚组分析发现,24 h血压水平≥130/80 mmHg的患者24 h收缩压、AASI、24 h PP、UACR均高于24 h血压水平＜130/80 mmHg者(P＜0.05)。Pearson相关分析证实AASI与24 h PP呈正相关(r=0.36,P＜0.01)。多元线性回归分析发现,UACR随着24 h收缩压的增加而增大(P＜0.05);LVMI和IMT亦随着AASI的增加而增加(P＜0.05);男性高血压患者发生左心室肥厚的风险较女性患者高(P＜0.05)。  结论  老年原发性高血压患者AASI增加与靶器官损害相关。     

高龄老年高血压患者脉压特征的分析

目的：探讨高龄老年高血压患者脉压变化的特点。方法将346例老年高血压患者按年龄分为两组：老年高血压组（A组）186例,年龄60～79岁;高龄老年高血压组（B组）160例,年龄80～99岁。分析两组患者动态血压参数。结果24 h平均舒张压（24 h DBP）B组低于A组（P＜0．01）。A组和B组24 h动态脉压（24 h APP）分别为（62．06±11．79）、（66．73±11．45） mm Hg。日间平均压（dABP）A组高于B组（P＜0．01）。24 h APP A组低于B组（P＜0．01）。结论老年高血压患者随着年龄的增加,24 h DBP呈现降低趋势,24 h APP呈现增高趋势。     

老年高血压病患者24h动态脉压对左室结构及心功能的影响

目的研究老年高血压病患者24h动态脉压(24hPP)与左室结构及心功能的关系.方法对130例老年高血压病患者进行动态血压(ABP)和超声心动图等检查,分别测量ABP和超声心动图的各种参数.将24h PP≥60 mmHg的患者62例列为甲组,24 h PP＜80 mmHg的患者68例列为乙组.结果甲、乙两组LVH的发生率差异有显著性(P＜0.01),左心室重量指数(LVMI)与24h Pp、24h平均收缩压(24h SBP)呈密切正相关(r分别为0.49、0.44,P＜0.01),与脉压(PP)呈弱相关(r分别为0.27、0.21,均P＜0.05).结论老年高血压病患者24 h动态脉压对左室结构及心功能密切相关,可作为评价抗高血压药物能否更好地减少高血压靶器官损害的重要指标之一.     

高血压患者靶器官损害与动态血压参数研究

目的 探讨高血压患者动态血压参数与其靶器官损害的关系.方法 收集符合纳入标准高血压患者动态血压监测等资料,分为单纯高血压组（n=18）和高血压伴靶器官损害组（n=79）,比较2组间及靶器官损害组内的动态血压参数.结果 靶器官损害组的年龄及病程大于单纯高血压组（P＜0.05）;伴3个靶器官损害组病程、24h SBP、24h DBPV大于伴1个靶器官损害组（P＜0.05）.多因素分析显示,病程、24h SBP及24h DBPV与高血压患者靶器官受损量有相关关系.结论 病程、24h SBP、24h DBPV是高血压患者靶器官损害及程度重要判断指标.     

脉压与左室功能的相关分析

目的 探讨中老年人高血压病患者动态脉压与左室收缩及舒张功能的关系.方法 将149例高血压患者按照24 h脉压分为三组:A组23例,24 h动态脉压≤40 mmHg;B组51例,24 h动态脉压≤70 mmHg;C组75例,24 h动态脉压>70 mmHg.比较不同组别的超声心动图结果,分析24 h脉压与左室收缩、舒张功能各参数的关系.结果 随着24 h脉压增大,左室舒张功能减低,表现为E峰降低,A峰升高,E/A减低,在脉压较小的A、B组,收缩功能各指标比较差异无统计学意义(P＞0.05);在脉压较高的C组,各指标与A、B组比较差异有统计学意义(P＜0.05).结论 24 h脉压增大是左室舒张功能减退的一个重要因素,脉压较大时左室收缩功能减低.     

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…