2004例长期高血压患者服药情况调查

高血压是一种严重危害人类健康的常见病和多发病,而且是心脑血管病主要危险因素之一。已有大量的证据表明,降压治疗可以降低心血管病事件的发生率。我国也制定了相应的包含高血压患者合理用药的高血压防治指南,并不断修订[1,2],旨在通过降压治疗降低患者心血管病的发病和死亡率。首钢医院心脑血管病防治研究所对1974—1995年间经过体检检出的2736例高血压病人根据血压水平的高低进行长期的统一分级管理,该组人群随着管理时间延长,达标率逐渐升高[3]。1995年后由于首钢结构调整及人员退休和离岗而     

降压要达标顾此不失彼

1996年,经行为危险因素监测系统(BRFSS)研究发现,69.6%的高血压患者合并有其他危险因素.原发性高血压患者合并心血管或肾脏疾病时,无论血压水平如何,均为高危患者.高血压合并高危因素(心肌梗死、脑卒中、肾脏病或糖尿病等)时,即使血压为140/90毫米汞柱也要降压.如果血压高于140/85毫米汞柱,心血管病危险增加.对于高血压患者,单纯降压即能使心血管病发生率降低20%～30%.降压本身是保护靶器官的重要措施,有效降压能降低心脑血管事件的危险性.     

全科医疗干预原发性高血压病46例临床观察

高血压是心脑血管病最主要的危险因素,其脑卒中、心肌梗死、心力衰竭及慢性肾脏病等主要并发症,不仅致残、致死率高,而且严重消耗医疗和社会资源.2002年<中国居民营养与健康状况调查报告>指出:我国高血压患者数已经超过1.6亿,与之相对的是普遍的知晓率低,仅为30.2%,并且治疗率低,仅有24.7%,同时,更为严峻的是我国的高血压控制率更低,仅为6.1%.约有1.3亿高血压患者不知道自己患有高血压,在已知患有高血压的人群中,约有3千万没有治疗;在接受降压治疗的患者中,有75%血压没有达到控制水平[1].     

缺血性脑卒中二级预防中高血压防治的现状及其影响因素

目的   调查分析海南省缺血性脑卒中二级预防中高血压的防治现状及影响因素。方法   选择合并高血压的缺血性脑卒中患者586例,调查患者入院时降压治疗的情况,采用单因素及多因素Logistic回归分析,寻找影响患者降压治疗的独立危险因素。结果   患者降压治疗知晓率77.1%,治疗率56.0%,达标率21.3%,受到健康教育的患者血压达标率较未受健康教育的患者高(P＜0.001),多因素Logistic回归分析显示,教育程度、健康教育、医保类型、医生建议服药、高血压病史是影响患者降压治疗的独立危险因素(P＜0.05)。结论   海南省缺血性脑卒中患者二级预防中高血压的降压治疗知晓率、治疗率、达标率低,临床医生需按指南对患者进行健康教育并建议患者服药。     

某舰官兵高血压患病情况及影响因素调查分析

高血压是以动脉血压持续升高为主要表现,常引起重要器官病变并出现相应后果的最常见的心脑血管疾病。高血压是我国人群脑卒中、冠心病发病及死亡的主要危险因素。据中国疾病预防控制中心慢性非传染性疾病预防控制中心发布的＂2010年中国成年人高血压患病情况＂,我国现有33.5%的成年人患有高血压,约有3.3亿成年人为高血压患者。为了解舰艇部队官兵高血压患病情况,笔者对某舰83名体检官兵的血压情况进行了检测和统计,并对血压偏高的官兵进行了认知情况和影响因素等的问卷调查,以期对舰艇部队官兵开展高血压防治工作提供依据。     

动态血压监测在高血压防治中的应用

目前,我国的高血压患者约有1.3亿,而且新增患者人数呈逐年递增趋势。高血压疾病目前仍是心血管疾病主要危险因素之一。有资料显示,中国人群中至少20%的急性冠心病事件、59%的出血性脑卒中和约40%缺血性脑卒中与高血压有密切关系[1]。与高血压疾病严重程度形成鲜明对比的是,我国人群高血压知晓率、治疗率以及控制率偏低,分别为44.7%、28.2%、8.1%[2]。因此,合理有效地降压治疗对于防控高血压十分重要。1动态血压监测(Ambulatory Blood Pressure Moni-toring,ABPM)的基本概念动态血压监测对于高血压诊断治疗有着无可替代的地位,单次手工测…     

高血压与脑卒中21年随访研究

目的探讨21年间高血压患病率、脑卒中患病率及二者之间相关性的变化情况,以脑卒中为终点指标评价降压治疗的效果。方法参照我国高血压抽样调查的有关标准,对1983年普查的1187名职工于2004年进行了第二次高血压和脑卒中的随访调查,并将资料进行对比研究。结果①随年龄增长,该人群血压均值和高血压患病率均显著升高,男女之间无差别;②高血压知晓率74.26%,服药率48.3%,控制率6.38%,均较1998年第一次随访时提高。③脑卒中患病率21年升高8.8倍,高血压者脑卒中患病率为18.33%,正常血压者为3.50%,差异显著;④高血压控制达标者与未达标者脑卒中患病率差异显著;⑤脑卒中发病率在50~65岁呈现高峰,平均发病年龄56岁。结论该人群21年的高血压发病率逐年增高,高血压控制率低,脑卒中患病率高,高血压与脑卒中发病密切相关。应进一步重视高血压与脑卒中的预防,积极开展有关知识的宣传,加强基层企业职工的医疗保健,以降低其发病率。     

承德市高校教职工高血压患病及相关危险因素认知情况调查

高血压是最常见的心脑血管疾病,是全球范围内的重大公共卫生问题[1].高血压严重威胁人群的身心健康,是冠心病、脑卒中确定的危险因素.我国分别于1959、1979和1991年做了高血压抽样调查,患病率呈上升趋势,1991年的统计结果显示高血压的患病率为11.26%.随着未来社会的老龄化和疾病谱的改变,高血压的发病的发病率仍会继续上升.     

内蒙古通辽市出血性和缺血性脑卒中入院血压的差异比较

目的调查研究内蒙古通辽市脑卒中不同亚型患者入院血压的差异。方法从内蒙古通辽市所属的6家医院病案室,抽取神经内科2003年至2005年所有符合纳入标准的病历,对病历资料进行回顾性调查,用病例-病例研究的方法来分析血压对脑卒中不同亚型作用的差异。结果出血性脑卒中收缩压和舒张压比缺血性脑卒中平均高20.19mmHg和11.96mmHg。在缺血性脑卒中组中,血压正常者占22.5%,其余各级高血压所占比例均衡;而出血性脑卒中组各级高血压的构成比随着血压等级增高而增大,血压正常者占9.9%,3级高血压占54.1%。调整基线不均衡危险因素后,1级、2级和3级高血压导致出血性脑卒中的发病危险性是缺血性脑卒中的1.84倍、2.87倍和7.04倍,并且血压等级越高,相对于缺血性脑卒中,出血性脑卒中的发病危险就越大（线性趋势检验P=0.000）。结论脑卒中患者入院血压在不同亚型之间存在差异,高血压对出血性脑卒中的危险度高于缺血性脑卒中,且随血压级别增高而增强。     

北京回龙观社区脑卒中高危人群筛查方法与防治分析

目的 探讨社区脑卒中高危人群的筛查方法 与防治.方法针对回龙社区脑卒中高危人群,采取随访管理、脑卒中危险因素预防、社区人群健康教育以及脑卒中的转诊服务等措施.结果 高血压、高血糖及血脂异常是脑卒中的主要诱发因素,2015年随访6139人次,筛查出高危人数355人,随访人数308人;其中血压在140/90 mm Hg以上者随访前后血压改善率为74.1%;血脂改善率为79.9%;戒烟率为59.8%;实施规范管理以来年均脑卒中发病率下降7.49%.讨论脑卒中作为可预防的严重危害人民身体健康的疾病,需要全社会的重视和共同防御,特别是社区医院任重道远.基于脑卒中的发病原因,建立高效的社区随访制度,可以有效防治脑卒中.     

活血解毒方对银屑病小鼠血管增殖以及炎症因子的干预作用

目的观察活血解毒方对咪喹莫特诱导的银屑病样小鼠模型皮损的干预作用,明确解毒类中药在银屑病治疗中的重要性。方法 BALB/c雄性小鼠55只,随机分为正常对照组、模型组、活血解毒方组、活血方组和甲氨蝶呤组,每组11只,采用外涂咪喹莫特诱导皮肤银屑病样模型。甲氨蝶呤(1 mg/kg)、活血解毒方组(35.1 g/kg)及活血方组(26.9 g/kg)分别予以药物灌胃,正常对照组和模型组予以等量纯净水灌胃。于第7天观察小鼠皮损变化情况后进行处死,取皮肤组织进行检测。HE染色光镜下观察皮损组织形态学变化、表皮层厚度;免疫组织化学法检测皮损中增殖细胞核抗原(PCNA)和T淋巴细胞表面标志CD3的表达以及微血管阳性标记物CD31的表达并检测微血管密度(MVD);采用实时PCR技术检测皮损白细胞介素-17(IL-17)和白细胞介素-23(IL-23)mRNA的表达。结果 HE染色结果显示活血解毒方组皮损表皮增生较模型组少,角化不全的细胞明显减少;表皮厚度降低,P<0.001;活血解毒方组PCNA、CD3阳性表达远低于模型组,P<0.001;活血解毒方MVD明显低于模型组,P<0.05;活血解毒方组IL-17、IL-23的mRNA表达水平均低于模型组,P<0.05。结论活血解毒方的活血润肤作用是通过抑制血管增殖,而清热解毒作用则通过调节IL-23/IL-17轴减少Th17相关因子的表达、表皮层角质细胞的增生、真皮层免疫细胞浸润以改善咪喹莫特诱导的小鼠银屑病样皮损改变。     

面向国家重大科技专项的信息服务探索与实践

根据中国医学科学院医学信息研究所/图书馆开展面向国家重大科技专项的信息服务实践,总结了为国家重大科技专项提供信息服务的工作经验和存在的问题,提出了专业图书馆面向重大科技专项信息服务的对策和建议.     

Predictive Values of Body Mass Index and Waist Circumference for Rish Factors of Certain Related Diseases in Chinese Adults—Study on Optimal Cut—off Points of Body Mass Index and Waist Circumference

For prevention of obesity in Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of BMI and waist circumference for Chinese adults. The Working Group on Obesity in China under the support of International Life Sciences Institute Focal point in China organized a meta-analysis on the relation between BMI, waist circumference and risk factors of related chronic diseases (e. g.,high diabetes, diabetes mellitus, and lipoprotein disorders). Methods 13 population studies in all met the criteria for enrollment, with data of 239 972 adults (20-70 year) surveyed in the 1990s. Data on waist circumference was available for 111411 persons and data on serum lipids and glucose were available for more than 80 000. The study populations located in 21provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study provided data according to a common protocol and uniform format. The Center for data management in Department of Epidemiology, Fu Wai Hospital was responsible for statistical analysis. Results and conclusion The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. BMI at 24 with best sensitivity and specificity for identification of the risk factors, was recommended as the cut-off point for overweight, BMI at 28 which may identify the risk factors with specificity around 90 % was recommended as the cut-off point for obesity. Waist circumference beyond 85 cm for men and beyond 80 cm for women were recommended as the cut-off points for central obesity.Analysis of population attributable risk percent illustrated that reducing BMI to normal range (＜24) could prevent 45%-50% clustering of risk factors. Treatment of obese persons (BMI ≥ 28)with drugs could prevent 15%-17% clustering of risk factors. The waist circumference controlled under 85 cm for men and under 80 cm for women, could prevent 47%-58% clustering of risk factors. According to these, a classification of overweight and obesity for Chinese adults is recommended.     

Acupuncture at otoacupoint heart for treatment of vascular hypertension.

The immediate, short-term and long-term depressor effects, the immediate effects on cardiac functions in grade II and grade III vascular hypertension, and the effects on angiotensin II in grade III vascular hypertension by acupuncture at otoacupoint Heart were studied in 30 cases of vascular hypertensive patients. The immediate depressor effect of acupuncture at otoacupoint Stomach was also recorded for comparison. It was found that acupuncture at otoacupoint Heart produced marked immediate depressor effect, and the short-term effective rate was 100%, the long-term effective rate was 63.3%, as well as evident immediate effects on cardiac functional activities in grade II and grade III hypertension and marked effects on angiotensin II in grade III hypertension. Acupuncture at otoacupoint Stomach produced no depressor effect on vascular hypertension.     

H型高血压与缺血性脑卒中血管狭窄的相关性研究

目的:探讨H型高血压与缺血性脑卒中血管狭窄的相关性。方法:选取郑州大学第一附属医院神经内科收治的365例缺血性脑卒中血管狭窄患者作为研究对象,根据血管狭窄程度将其分为轻度狭窄、中度狭窄、重度狭窄3组,同时测定血压、血清同型半胱氨酸水平,并进行相关性分析。结果:高血压和缺血性脑卒中血管狭窄程度有关联,差异有统计学意义(r=0.498,P<0.05)。不同血管狭窄程度间同型半胱氨酸水平进行比较,差异有统计学意义(P<0.05)。高血压及高同型半胱氨酸血症之间存在正相加的交互作用(S=1.83>1)。H型高血压与血管狭窄部位无明显相关性(P>0.05)。结论:高血压、同型半胱氨酸均为引起血管狭窄的独立危险因素,且随着血压及同型半胱氨酸的增高,血管狭窄程度也逐渐增高,高血压和高同型半胱氨酸血症具有协同作用。H型高血压与缺血性脑卒中患者血管狭窄部位无明显关系。     

结扎大鼠经脉对脏器形态与系数影响的初步观察

目的探索结扎法堵塞循经低流阻通道,制造经脉不通大鼠模型的方法,对大鼠的脏器形态与系数的影响。方法将31只雄性SD大鼠随机分为空白对照组10只,胃经结扎组10只和肾经结扎组11只。使用线结扎法阻断大鼠的胃经和肾经低流阻通道,制造经脉不通模型,观察造模后第7周大鼠脏器系数及脏器剖检情况。结果与对照组比较,胃经结扎组心脏系数、肾脏系数显著升高(P<0.05);肾经结扎组肾上腺系数显著升高(P<0.01),附睾系数显著降低(P<0.01)和前列腺系数显著降低(P<0.05)。解剖肉眼观察发现,胃经结扎组心脏、肾脏、睾丸明显形态大小异常,腹部异常血肿物;肾经结扎组精囊、附睾和盲肠出现异常,1例胸腹腔脏器结构异常。结论结扎法制备经脉不通病理模型可对大鼠相关脏器产生影响,结扎不同经脉出现不同的脏器异常,部分验证了经脉与脏腑之间的关系。     

SUN Yan(孙燕)--A Prominent Oncologist of Internal Medicine

Professor SUN Yan, a famous medical oncologist, was graduated from Yenching University with a B. S.degree in 1951, and from Peking Union Medical College with a M.D. degree in 1956.He studied traditional Chinese medicine from 1960 to 1961, and worked, between 1979 and 1980, as a visiting professor in M. D. Anderson Cancer Center, USA. Since 1959, he has been working in the Department of Medical Oncology in Cancer Hospital of Chinese Academy of Medical Sciences (CAMS), holding the post of professor & director of Department of Medical Oncology during 1986-1994. He was honored as the "Outstanding Physician" by CAMS and Peking Union Medical College (PUMC) in 1993, designated as an "Advanced Worker" in national health care system by the Ministry of Human Affairs in 1994, and elected an academician of Chinese Academy of Engineering in 1999. Since 1991, he has been enjoying the governmental special stipend.     

北京市40岁以上医务人员脑卒中相关风险现况调查

目的调查北京地区40岁以上医务人员脑卒中相关风险的分布。方法采用分层整群随机抽样方法,从北京市38所医院4278例医务人员中抽取1426例,调查其脑卒中相关风险。结果入选人群中各危险因素所占比例由高到低依次为,高脂血症（468例,32.8%）、伏案工作〉6h（464例,32.5%）、高血压（323例,22.7%）、每日活动〈30min（285例,20.0%）。男性危险因素前3位为,高脂血症（35.94%）、高血压（27.46%）、吸烟（18.53%）;女性危险因素前3位为,高脂血症（31.39%）、高血压（20.45%）、睡眠障碍（17.28%）。其中,高血压、高脂血症、吸烟等危险因素在男性中的比例高于女性,女性肥胖的比例高于男性。结论一日三餐没有规律,不注意营养搭配;劳动强度大,伏案工作时间过长,缺乏体力活动,睡眠不足;精神处于高度紧张状态等状况可能是目前导致医务人员脑卒中危险因素发生的主要原因。     

Prevalence of hypertension among Chinese elderly and its relationship to behavioural and nutritional factors

A cross-sectional study was carried out to determine the prevalence of hypertension in the Chinese elderly and to examine its relationship with various behavioural and nutritional risk factors. This study involved 243 Chinese aged 55 years and older in 2 randomly selected Chinese Villages in Seberang Prai Tengah, Penang. The study included an interview, anthropometric assessment and blood pressure measurement. The prevalence of hypertension was 48.1% and out of this, 65 (55.6%) were on anti-hypertensive treatment. There was a significant rise in the prevalence with age. Hypertension was found to be inversely related to per capita income and physical activity (p < 0.05). Hypertension was significantly more common in smokers than non-smokers. Alcohol intake in the elderly was low and not related to hypertension. Obesity was significantly associated with hypertension only among the elderly aged 55-64 years. The dietary intake of sodium, potassium and calcium did not differ significantly between the hypertensive and normotensive elderly.     

Predictive Values of Body Mass Index and Waist Circumference for Risk Factors of Certain Related Diseases in Chinese Adults - Study on Optimal Cut-off Points of Body Mass Index and Waist Circumference in Chinese Adults

The body mass index of Chinese population is lower than that of the Westerncountries, however, the trends of mean body mass index and prevalence of overweight inadults have increased significantly in recent 15 years[1]. Overweight and obesity areclosely r…