阿托伐他汀钙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(spontaneously hypertensive rats,SHR)为实验模型,观察单纯使用阿托伐他汀钙对SHR血压、左室功能的影响,并探讨其相关机制.方法:10周龄雄性大鼠共30只,其中实验对照组21只,正常对照组9只.按实验和对照的原则分为3组:正常对照组(WKY),实验对照组(SHR),阿托伐他汀钙组[SHR-A,SHR服阿托伐他汀钙50 mg/(kg·d)],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(LVMI),血浆内皮素-1(ET-1),肌浆网Ca2 -ATP酶活性(SERCA).两组间资料的比较采用t检验和方差分析(ANOVA).结果:SHR-A组较SHR组SBP低17.11mmHg;左室等容舒张期室内压下降的时间常数(T)显著降低[(1.02±0.04)ms vs(2.38±0.59)ms,P＜0.05];LVMI有明显下降[(3.08±0.20)mg/g vs(3.31±0.23)mg/g,P＜0.05].ET-1有明显降低[(131.94±26,84)pg/mL vs(196.96±38.87)pg/mL,P＜0.001],SERCA活性稍有升高.结论:阿托伐他汀钙治疗对延缓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.     

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。     

丹参对自发性高血压大鼠左室肥厚及心肌凋亡的影响

目的观察丹参对自发性高血压大鼠左室肥厚的作用及左室心肌组织细胞凋亡的影响,并探讨其作用机制。方法实验用WKY大鼠做阴性对照组,SHR大鼠分为对照组和治疗组。治疗组给予丹参注射液腹腔内注射12周,其余两组分别注射相当容积的蒸馏水。测量大鼠尾动脉收缩压(systolic b lood pressure,SBP)及左心室重量指数(left ventricu larm ass index,LVM I)。应用HE、VG染色、免疫组织化学的方法,结合计算机图像分析技术,检测心肌细胞的直径和面积、心肌组织胶原体积比例(collagen volum e fraction,CVF)、血管周围胶原面积和管腔面积比例(perivasu lar c ircum ferentiall area,PVCA),采用TdT介到的dUTP缺口末端标记技术(TUNEL)检测心肌细胞凋亡。结果与WKY大鼠相比,20周龄SHR大鼠的SBP、LVM I、心肌细胞的直径、面积、CVF、PVCA、心肌凋亡细胞数显著增加,用丹参治疗后,SHR除收缩压外余指标均显著性下降(P<0.05)。结论长期应用丹参治疗可预防和逆转高血压大鼠左室肥厚形成,其机制可能与丹参降低心肌细胞凋亡有关。     

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.     

自发性高血压大鼠左心室肥厚与血压、心肌局部血管紧张素Ⅱ的关系

目的 研究自发性高血压大鼠(SHR)左心室肥厚与血压、心肌局部血管紧张素Ⅱ的关系。方法 取SHR(n=40)及正常对照组WKY(n=41),分为4周龄、8周龄、12周龄、24周龄及36周龄组．测收缩压、体重,左心室重量及用放免法测定心肌局部血管紧张素(AⅡ)含量,并进行两两线性相关分析。结果 通过对5个年龄段的SHR和WKY的收缩压、左心室重与体重比(LVM／BW)及心肌局部AⅡ含量的测定结果发现三者之间存在相关性,其中AⅡ与心肌肥厚有明显相关性。结论 血压与AⅡ在SHR大鼠的左心室肥厚中起着重要作用。     

安体舒通对自发性高血压大鼠心肌中的血管紧张素转换酶表达的影响

目的 观察自发性高血压大鼠(SHR)与Wistar-Kyoto(WKY)大鼠心肌细胞中血管紧张素转换酶(ACE)mRNA及其蛋白的表达差异,以及安体舒通对SHR心肌细胞中ACE mRNA表达的影响.方法 选取15只16周龄雄性SHR,随机分为对照组(n=7)和安体舒通组(n=8),另取10只同龄的正常血压WKY大鼠作为对照,尾袖法测定血压,药物干预4周后称取左心室质量及体质量,计算左室质量指数;采用RT-PCR法检测SHR对照组、安体舒通组、WKY组大鼠心肌中ACE mRNA的表达水平,Western blot法测定上述3组心肌中ACE蛋白表达水平.结果 (1)SHR对照组血压显著高于WKY组,差异有高度统计学意义(P<0.01);安体舒通可小幅度降低SHR血压,与SHR对照组比较,差异有统计学意义(P<0.05);(2)WKY组的左室质量指数显著低于SHR对照组,差异有高度统计学意义(P<0.01);安体舒通组介于其他两组之间,且与SHR对照组的差异亦有高度统计学意义(P<0.01).(3)SHR对照组心肌细胞ACE mRNA及蛋白表达显著高于WKY组,差异有高度统计学意义(P<0.01);安体舒通组介于其他两组之间,高于WKY组,差异有统计学意义(P<0.05).结论 安体舒通可降低自发性高血压大鼠心肌中ACE mRNA及其蛋白的表达,可能为其抑制左室肥厚的一种潜在机制.     

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。     

细胞外调节激酶的表达及活化在不同年龄自发性高血压大鼠心肌肥厚中的作用

目的:研究不同年龄的自发性高血压大鼠(spontaneously hypertensive rat,SHR)心室肌组织中细胞外调节激酶(extracellular signal-regulated kinases,ERKs)的表达及活化与心肌肥厚的关系.方法:选择Wistar Kyoto(WKY)大鼠作对照,SHR和WKY大鼠按年龄分为5周、8周、14周和24周各4组,以左心室质量与体重的比值反映心肌肥厚的程度;采用Western blot方法测定大鼠左心室心肌组织中基础表达ERK (basal ERK,b-ERK)和磷酸化ERK(phosphorylated-ERK,p-ERK)的水平.结果:①与相同周龄WKY大鼠比较,SHR自8周龄起血压明显升高(P<0.001),14周后心肌肥厚指数明显增加(P<0.01).②各年龄组SHR与相同周龄WKY大鼠b-ERK水平比较均无明显差异(P>0.05). ③5周龄SHR p-ERK水平与同龄WKY大鼠无差异,8到24周SHR大鼠p-ERK水平明显高于同龄WKY大鼠(P<0.01).④心肌肥厚指数与b-ERK量无明显相关性,与p-ERK量呈正相关. 结论:在SHR大鼠心肌肥厚形成中,心肌组织b-ERK没有增加,p-ERK水平增高,ERK活性增加参与高血压心肌肥厚过程.     

螺内酯和缬沙坦对高血压大鼠心肌肥大信号通路的影响

目的观察血管紧张素Ⅱ受体拮抗剂缬沙坦和盐皮质激素受体拮抗剂螺内酯对自发性高血压大鼠(spontane-ously hypertensive rats,SHR)心肌中活化的丝裂原活化蛋白激酶家族(m itogen-activated protein kinase fam ily,MAPK)(细胞外信号调节激酶[ERK]、c-Jun NH2-末端激酶[JNK]和p38)的影响。方法将18只雄性SHR随机分为3组,每组6只。其中两组分别用缬沙坦30 mg.kg-1.d-1、螺内酯20 mg.kg-1.d-1溶于饮水灌胃,连续治疗13周;对照组给正常饮水,并与W istar-kyoto大鼠(WKY)比较。用W estern-blot方法检测大鼠心肌磷酸化MAPK的表达。结果SHR对照组心肌磷酸化JNK/actin值高于其余3组(P<0.01),缬沙坦组高于螺内酯组和WKY组(P<0.01),螺内酯组与WKY水平接近;SHR对照组心肌磷酸化ERK/actin值高于其余3组(P<0.01),螺内酯和缬沙坦组高于WKY组(P<0.01),两用药组之间无差异;缬沙坦组磷酸化p38/actin值高于WKY组(P<0.01),低于SHR对照组和螺内酯组(P<0.01)。结论醛固酮能促进SHR的心肌肥厚和心肌纤维化,盐皮质激素受体拮抗剂能通过抑制MAPK途径而抑制左室肥厚和心肌纤维化。     

曲美他嗪联合阿托伐他汀对老年扩张型心肌病急性心力衰竭患者心肌功能及相关免疫指标的影响

目的探讨曲美他嗪联合阿托伐他汀对老年扩张型心肌病急性心力衰竭患者心肌功能及相关免疫指标的影响。方法将2013年8月至2015年1月首都医科大学附属北京同仁医院收治的60例老年扩张型心肌病急性心力衰竭患者按照抽签法分为曲美他嗪组、阿托伐他汀组和联合治疗组各20例,分别服用20 mg曲美他嗪(每日3次)、阿托伐他汀20 mg(每日1次)、20 mg曲美他嗪(每日3次)及20 mg阿托伐他汀(每日1次)。记录三组患者心肌功能情况以及肿瘤坏死因子α(TNF-α)、白细胞介素33(IL-33)、转化生长因子β(TGF-β)的变化情况。结果治疗后联合治疗组患者纽约心脏病协会心功能分级显著改善(P<0.05)。治疗后联合治疗组6 min步行试验、左心室射血分数显著高于曲美他嗪组、阿托伐他汀组[(386±19)m比(341±23)m,(343±20)m;(48±9)%比(38±10)%,(39±10)%];左心室舒张末期内径、左心室舒张末期容积、左心室收缩末期容积、左心室短轴缩短率显著低于曲美他嗪组、阿托伐他汀组[(54.4±0.9)mm比(58.1±3.8)mm,(57.9±3.6)mm;(162±36)m L比(179±29)m L,(187±27)m L;(87±15)m L比(126±29)m L,(123±24)m L;(22.6±4.3)%比(25.3±4.6)%,(25.1±5.3)%],差异有统计学意义(P<0.05)。治疗后联合治疗组患者TNF-α、IL-33和TGF-β水平均比治疗前显著降低,且联合治疗组水平显著低于曲美他嗪组和阿托伐他汀组[(23±4)ng/L比(28±8)ng/L,(27±8)ng/L;(10.3±1.3)pg/L比(12.3±2.4)pg/L,(13.2±1.2)pg/L;(135±11)μg/L比(188±13)μg/L,(190±14)μg/L],差异有统计学意义(P<0.05)。结论采用曲美他嗪联合阿托伐他汀对老年扩张型心肌病急性心力衰竭患者进行干预治疗后,患者心肌功能及免疫指标改善程度均显著升高,值得在临床工作中推广应用。     

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.     

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.