美托洛尔治疗慢性心力衰竭耐受性的探讨

目的:探讨美托洛尔治疗慢性心力衰竭的疗效和对目标剂量的耐受性。方法:对慢性心力衰竭患者60例,在常规治疗心衰的基础上加用美托洛尔,逐渐加至目标剂量。目标分别为:①心率目标:休息静息心率达55~65次/min,不低于55次/min;②心衰目标:加量后,患者心功能恶化1级或1级以上者;③血压目标:患者休息时,收缩压不低于90mmHg(1mmHg=0.133kPa)。结果:美托洛尔平均维持量为12.5~150mg/d(64.7±35.2mg/d),其中5例达心衰目标,2例达血压目标,53例达心率目标,所有病人在治疗3~4个月后,心功能明显改善。随访期间发生不良反应有乏力14例,头晕5例,心衰加重5例,心动过缓9例,低血压2例,所有不良反应经调整治疗后可继续维持治疗。平均随访(12.6±5.6)个月。结论:美托洛尔治疗Ⅱ~Ⅲ级(NYHA分级)病人疗效显著,有较好的安全性和耐受性,其主要对心率影响大,而对血压影响小,其心率减慢是达到推荐靶剂量的最大障碍。     

慢性心力衰竭治疗中美托洛尔目标剂量及维持用药情况观察

目的　探索美托洛尔治疗慢性心力衰竭 (心衰 )目标剂量及维持用药情况。方法　 47例心衰患者于常规心衰治疗上应用美托洛尔 ,逐渐加量至目标剂量。要求 :静息心率 5 5～ 65次 /min ;收缩压 90～ 110mmHg ;追加剂量后无 1级或以上心功能下降。结果　 2 8例 ( 5 9 6% )达心率目标 ,18例 ( 3 8 3 % )达心衰目标 ,1例 ( 2 1% )达血压目标。美托洛尔平均维持量 12 .5～ 15 0mg/d[( 67.5± 2 9.3 )mg/d]。达标后持续目标剂量用药者 2 1例 ( 4 4 7% )。结论　心衰患者对合适个体剂量的美托洛尔耐受性较好 ,心率下降是影响用药的主要因素。     

美托洛尔治疗慢性充血性心力衰竭目标剂量研究

目的研究美托洛尔在慢性充血性心力衰竭治疗中的剂量及耐受性。方法对82例心力衰竭伴窦性心律患者在常规心衰治疗基础上加用美托洛尔,逐渐加量至目标剂量,目标分别为：心率下降至50-60次/min、稍加剂量心功能下降Ⅰ级及收缩压不低于90mmHg。结果美托洛尔平均维持量为（72.5±36.1）mg/d。其中53例（64.6%）达心率目标;29例（35.4%）达心衰目标,无一例达血压目标。结论在治疗期间内,心力衰竭（NYHAⅡ级-Ⅳ级）患者对合适剂量的美托洛尔耐受性较好。     

美托洛尔治疗慢性心力衰竭目标剂量探讨

目的：探讨美托洛尔在慢性充血性心力衰竭（心衰）治疗中的剂量及耐受性。方法：对206例心力衰竭伴窦性心律患者在常规心衰治疗基础上加用美托洛尔,逐渐加量至目标剂量。目标分别为：a．心率下降到50—65次／分;b．稍加剂量心功能下降Ⅰ级;c．收缩压不低于90mmHg。结果：美托洛尔平均维持量12．5～175mg／日（72．7±36．1mg／日）。其中136例（66．0％）达心率目标,70例（34．0％）达心衰目标,无1例达血压目标。随访患者多因认识不足和不适当治疗而减量或停用美托洛尔。结论：在治疗期内,心力衰竭（NYHAⅡ-Ⅳ级）患者对合适剂量的美托洛尔耐受性较好。     

美托洛尔治疗慢性心力衰竭剂量探讨

目的探讨β受体阻滞剂美托洛尔治疗慢性心力衰竭目标剂量及耐受性。方法在96例本病患者在常规抗心力衰竭治疗上加美托洛尔,从小剂量开始逐渐加量,至耐受量,观察其收缩压不低于90mmHg,心率不低于50次/min,心功能下降一级的目标剂量,耐受量。结果96例中平均剂量为(70.0±35.6)mg/d,心率达到50次58例,心功能下降一级32例,血压达90mmHg以下6例。结论慢性心衰患者心功能NYHAⅡ级～Ⅳ级用合适剂量美托洛尔治疗,耐受量较好,是安全的。     

不同剂量美托洛尔治疗老年性慢性心力衰竭临床研究

目的研究美托洛尔在老年性慢性心力衰竭治疗中的剂量及耐受性。方法对NYHA分级心功能Ⅱ~Ⅳ级129例老年患者在常规心衰治疗基础上加用美托洛尔,从极小剂量开始,逐渐增加剂量,目标分别为:①心率下降到55~60次/min(不低于50次/min);②稍加剂量心功能下降1级以上;③收缩压不低于12.00kPa。结果美托洛尔维持量为(80.7±34.1)mg/d。其中85例(65.89%)达心率目标,44例(34.11%)达心衰目标,血压无显著变化。结论在治疗期间内,心力衰竭(NYHAⅡ级~Ⅳ级)患者对美托洛尔耐受性较好。     

美托洛尔治疗慢性心力衰竭的耐受剂量及安全性

目的:评估美托洛尔治疗慢性心力衰竭的临床耐受剂量范围及安全性.方法:65例符合慢性心衰标准的患者在常规治疗后,病情基本稳定的基础上,加用美托洛尔.美托洛尔初始剂量为6.25 mg/d逐渐加量至目标剂量100～150 mg/d或最大耐受剂量,治疗前后分别对心功能,6 min步行距离,LVEF(左室射血分数),LVEDD(左室舒张末径),LVESD(左室收缩末径)等心功能指标以及血压,心率等体征及实验室(血常规,血糖,肝肾功能及心电图)进行检测,评价其疗效、耐受性及安全性.结果:用美托洛尔治疗心功能明显改善,提高生活质量,改善预后,同时不良反应少,安全性好,61.54%的患者可以达到推荐的靶剂量.结论:美托洛尔治疗慢性心力衰竭耐受性和安全性好.     

美托洛尔在慢性充血性心力衰竭治疗中的临床观察

目的 探讨美托洛尔在慢性充血性心力衰竭(CHF)患者治疗中的疗效、耐受性和安全性.方法 选择CHF患者125例,随机分为对照组(61例)和美托洛尔联合治疗组(64例),后者在常规抗心衰治疗基础上加用美托洛尔,对两组患者治疗前、治疗后1个月和治疗后6个月进行疗效观察.结果 治疗6个月后治疗组疗效优于对照组,差异有统计学意义(P<0.05).治疗6个月后,与治疗1个月相比较,对照组仅在LVEF的差异有统计学意义(P<0.05);治疗组与对照组相比,在LVEDD、LVESD、LADD和LVEF均有明显改善,差异有统计学意义(P<0.05).结论 在常规治疗CHF患者的基础上加用目标剂量的美托洛尔,对CHF患者是安全有效,能明显改善心功能,提高左室射血分数.     

美托洛尔治疗扩张型心肌病心力衰竭62例疗效观察

目的：探讨美托洛尔对扩张型心肌病心力衰竭的治疗效果。方法对我院心血管内科62例扩张型心肌病心力衰竭患者，在常规治疗的基础上加用美托洛尔片进行辅助治疗。结果对治疗前后临床指标进行评价有效率达96.78%，心功能指标显著改善，心率明显减慢（P<0.01），无不良反应发生。结论美托洛尔能够改善扩张型心肌病的临床症状、减慢心率、改善心功能指标，从而提高患者的生活质量，值得临床推广应用。     

美托洛尔在治疗慢性肺心病心力衰竭中的应用

目的 研究与分析选择β受体阻滞剂美托洛尔对慢性肺心病心力衰竭患者的病死率、住院率及耐受性方面的疗效.方法 80例重度慢性肺心病心衰患者随机分成两组:对照组20例,给予常规治疗加维生素B15-60mg/d;治疗组60例,给与常规治疗加美托洛尔6.25-100mg/d,随访1年.结果 随访1年时,在治疗组与对照组相比,在所有预设的病死率研究终点上均明显降低,总死亡数为10例;因心衰恶化死亡数为7例对8例.另外,与对照组相比,美托洛尔治疗组心衰恶化患者住院率下降28%(P<0.01),患者的心功能分级(NYHA)改善更明显,不良反应轻微.结论 美托洛尔治疗重度慢性肺心病心衰患者,可降低住院率,改善心功能状态而具有良好的耐受性.     

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…