心钠素对充血性心衰患者血液动力学及肾脏效应的进一步观察—附六例报告

研究小量α-HANP对6例充血性心衰患者的血液动力学及肾脏效应。给药后,患者心排血量及排血指数明显上升;心腔压力、体及肺循环阻力大多下降;血压、心率及呼吸轻微下降;尿量及尿钠排出增加;心衰情况明显改善;室性早搏显著减少。未见明显副作用。着重指出与动物及正常人中应用α-HANP后的结果有所不同。     

Detecting residual ischemia and identifying coronary artery disease after myoc ardial infarction using dobutamine technetium-99m-MIBI SPECT

Objective To evaluate dobutamine technetium-99m methoxy isobutyl nitrile (sestamibi) single-photon emission computed tomography (Dobu-ECT) in detecting residual ischemia and identifying coronary vessel disease after myocardial infarction.Methods Sixty-two patients with confirmed myocardial infarction were studied with Dobu-ECT at the time of coronary artery angiography. Dobutamine was administered intravenously in incremental rates from 5 to 40 μg· kg(-1)·min (-1) at 3-minute intervals. At the highest infusion rate, 7.4×10[8] Bq (99m) Tc-MIBI was injected intravenously, and tomographic imaging was performed after one hour. Resting images were taken after 24 hours, with a second dose of (99m)Tc-MIBI.Results The sensitivity of Dobu-ECT in detecting residual ischemia of myocardial infarction was 76%, which was higher than dobutamine electrocardiography (Dobu-ECG). Regardless of the single-, double- or triple-vessel diseases, Dobu-ECT was superior to Dobu-ECG in identifying residual ischemia (56% vs 4%, 86% vs 27%, 100% vs 47%, P<0.01, respectively). The incidence of residual ischemia in patients receiving thrombolytic therapy was 67%, lower than patients without thrombolysis (72%) or those with an old myocardial infarction (94%).But the differences were not statistically significant. Dobu-ECT detected only 56% of ischemias in non-infarct related myocardium. Eighty-two percent of all significantly stenosed vessels were detected with Dobu-ECT, and 84% of patients with multivessel disease could be accurately identified. The sensitivity of Dobu-ECT was significantly greater for detecting severe stenosis over moderate stenosis. The sensitivity for detecting stenosis in the right coronary artery was greater than left anterior descending or left circumflex, but its specificity was lower.Conclusion Dobu-ECT can identify residual ischemia, as well as its location and extent after myocardial infarction. Dobu-ECT can also accurately detect significantly stenosed vessels.     

直接经皮冠状动脉腔内成形术与溶栓治疗对限制急性心肌梗死面积的影响

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慢性心衰的药物治疗

心衰内科治疗近10年有重大进展。轻中度心衰2级OPT治疗(Optimal Medical Therapy)应用ACE抑制剂与β受体阻滞剂可降低死亡率40％以上，如果再加CRT-D治疗可进一步降低死亡率超出60％。     

心电图P波异常对急性心肌梗死的影响

目的：探讨心电图P波异常对急性心肌梗死的影响。方法：选择129例急性心肌梗死患者,根据心电图P波的异常（新出现的）与否分为：P波异组95例,P波正常组34例,所有患者均行超声心动图,核素心血池、冠状动脉造影等检查,观察12个月再梗死及死亡率。结果,心电图P波异常组三支病变多见,P＜0．01;左室射血分数＜40％者多见,P＜0．01;12个月个时再发心肌梗死率为7．4％,死亡率为4．2％,而P波正常组无再发心肌梗死及死亡病例,结论：心电图P波异常可能为影响心肌梗死预后的重要因素。     

小剂量重组组织型纤溶酶原激活剂对心肌梗死后不同时间溶栓效果的影响

目的评价小剂量重组组织型纤溶酶原激活剂(rt-PA)对急性心肌梗死后不同时间溶栓的疗效。方法100例急性心肌梗死患者,根据发病后不同时间溶栓分成≤3h,＞3～6h,＞6～12h3组,于发病30min至12h,在90min内给予rt-PA,总量50mg,比较3组之间血管再通率及4周病死率。结果总的血管再通率为82％,开始溶栓距发病时间≤3h,＞3～6h,＞6～12h血管再通率分别为92．5％、81．8％、66．7％(后者与前两者比较,P＜0．05);4周病死率分别为0、6．1％、14．8％(后者与前两者比较,P<0．05);脑出血1例,2d后死亡。其余5例,死于心源性休克2例,心脏破裂1例,室颤2例。结论小剂量rt-PA对治疗急性心肌梗死有较高血管再通率,且发病时间越短,再通率越高,4周病死率越低。     

乐卡地平治疗轻中度高血压患者的长期降压疗效和耐受性

目的:评价新型钙通道阻滞剂乐卡地平在中国轻中度高血压患者中的降压疗效和耐受性。方法:本研究为多中心、随机、氨氯地平对照临床试验,由二阶段组成,前8周为双盲阶段,后16周为开放试验。240例导入期末坐位舒张压在12～14.67kPa的高血压患者随机分入乐卡地平组或氨氯地平组接受治疗。双盲8周治疗末坐位舒张压≤11.33kPa者继续按原治疗药物和剂量维持治疗至24周末。结果:乐卡地平组有52例、氨氯地平组有60例患者实际完成24周治疗。在治疗末,乐卡地平组和氨氯地平组患者均获得显著而且相似的血压下降幅度,分别为2.77/2.11kPa和2.79/2.17kPa(P>0.05),各组均与8周末获得的血压下降幅度相似(2.50/1.99kPa和2.40/2.04kPa)。8周治疗有效的患者中,乐卡地平组有42.3％、氨氯地平组有41.3％的患者出现不良事件,具体表现为头晕、心悸和水肿,均为轻度。结论:乐卡地平与氨氯地平相似,在我国轻中度高血压患者中长期应用降压疗效稳定,耐受性好。     

海捷亚和科素亚双盲、随机、对照降压疗效临床研究

目的本研究旨在对比评价氯沙坦钾/氢氯噻嗪(海捷亚组)和氯沙坦钾(科素亚)治疗原发性高血压病的疗效、安全性和耐受性。方法179例原发性高血压门诊患者（舒张压95mmHg～115mmHg）参加了双盲、随机对照的临床治疗研究。经过2周安慰剂洗脱期后,患者被随机分入海捷亚组(氯沙坦钾加氢氯噻嗪),或科素亚组(氯沙坦钾50mg～100mg),每日服药一次。168例患者完成了8周治疗研究。疗效判定标准为4,8周DBP血压下降到正常或下降10～19mmHg以上为有效。结果两组血压均较药前显著下降。海捷亚有效率81.9%(4周),88.0%(8周)较单纯科素亚组的41.2%和50.6%组高。两组间心率和不良反应为15%～19%,两组无明显差异。结论氯沙坦钾片和氢氯噻嗪联合使用治疗原发性高血压疗效比单用氯沙坦钾片好。海捷亚的安全性和耐受性同科素亚。     

多巴酚丁胺99mTC-MIBI心肌断层显像在冠心病中的应用价值

近年来我国冠心病的患病率和死亡率逐年增加,早期对冠心病的诊断和功能评价是临床研究的重要内容。目前确诊冠心病的“金标准”是冠状动脉造影术,因是有创检查方法,设备要求较高,费用相对较贵,病人也不易接受,不可能在全国大规模推广。现阶段国内大多数医院诊断冠心病的方法主要是运动负荷试验。然而,有20％～30％的病人