高血压病24小时平均脉压与血浆内皮素、一氧化氮关系的探讨

目的　研究 2 4小时平均脉压与血浆内皮素、一氧化氮关系。　方法　对我院住院的原发性高血压病人 70例 ,均在未服药状态下进行动态血压监测。按 2 4小时平均脉压 <6 0mmHg ,6 0mmHg～ 6 9mmHg ,70mmHg～ 79 mmHg,80mmHg～ 89mmHg,90mmHg～ 99mmHg ,>10 0mmHg分成六个组 ,同时测定每个组的血浆内皮素、一氧化氮。　结果　随着 2 4小时平均脉压增加 ,血浆内皮素浓度增加 ,而血浆一氧化氮浓度降低。　结论　高血压患者 2 4小时平均脉压与血浆内皮素成正相关 ,与血浆一氧化氮成负相关     

Akute hämodynamische Effekte

Zusammenfassung Akutstudien zeigten Mitte der 90iger Jahre bei schwerer Herzinsuffizienz und Linksschenkelblock, dass die links- bzw. biventrikuläre Stimulation einen Anstieg der Pulse Pressure, der Kontraktilität und einen Abfall des endsystolischen Volumens bewirken. Die Hämodynamik bei schmalem Kammerkomplex unter 150 ms kann sich dagegen durch Stimulation verschlechtern. In dieser Studie wurden Patienten mit Linksschenkelblock, schwerer Herzinsuffizienz und einer QRS-Breite über 150 ms rechtsventrikulär, biventrikulär und linksventrikulär mit verschiedenen AV-Delays im Katheterlabor stimuliert. Akut-Response war als 10% Pulse-Pressure-Anstieg definiert. 165 von 188 Patienten (88%) im Sinusrhythmus (47 Frauen, mittleres Alter 62,5±10 Jahre, Ejektionsfraktion 23±8%, NYHA-Stadium 3,1±0,3) waren Responder. 10% der 103 mit dilatativer Kardiomyopathie und 16,5% der 79 Patienten mit koronarer Herzkrankheit waren Non-Responder. Das interventrikuläre Delay war bei Respondern mit 114±29 ms gegenüber 91±29 ms bei Non-Respondern signifikant weiter. 29 von 36 Patienten (81%) mit 2 oder mehr posterolateralen Venen waren Akut-Responder. 10 Patienten (33%) waren nur in einer Vene Responder. 54 Patienten hatten atriolinksventrikulär einen höheren Pulse-Pressure-Anstieg im Mittel von 10,7±10,6%, 48 Patienten bei biventrikulärer Stimulation von 9,8±6,4%. Über ein Jahr verbesserte sich die Herzinsuffizienz hochsignifikant (<0,0001) von NYHA 3,1±0,4 auf 2,1±0,7, VO2- peak von 12,7±2,8 auf 15,9±3,6 ml/min/kg und der linksventrikuläre enddiastolische Durchmesser von 80,5±10,5 auf 73,3±13 mm. Die präoperative hämodynamische Testung identifiziert akute Non-Responder und bei den Respondern den besten Stimulationsmodus, den optimalen Stimulationsort und das beste atrioventrikuläre Delay. Im Langzeit-Follow- up erscheint die maßgeschneiderte kardiale Resynchronisation klinisch überlegen.     

老年人脉压指数与颈动脉内膜中层厚度的关系

为了研究脉压指数与颈动脉内膜中层厚度的关系 ,对 334例老年人行颈动脉内膜中层厚度超声检测并进行测压 ,分别以脉压≤ 6 0mmHg、6 1～ 80mmHg、81～ 10 0mmHg及 >10 0mmHg和脉压指数≤ 0 .4 0 0、0 .4 0 1～ 0 .5 0 0、0 .5 0 1～ 0 .6 0 0及 >0 .6 0 0分为四个亚组进行分析。结果发现 ,随着脉压和脉压指数的增加 ,颈动脉内膜中层厚度和收缩压均随之增加 ,脉压指数组舒张压进行性下降 ;Spearman’s相关分析发现 ,颈动脉内膜中层厚度与脉压指数相关性最佳 ;多元逐步回归分析显示 ,颈动脉内膜中层厚度仅与脉压指数、年龄具有显著回归效果 ,脉压指数的标准回归系数远大于年龄。结果提示 ,在老年人中脉压指数评价血管硬化比脉压有一定的优越性     

Evaluation of a novel automated non-invasive pulse pressure variation algorithm

In mechanically ventilated patients, Pulse Pressure Variation (PPV) has been shown to be a useful parameter to guide fluid management. We evaluated a real-time automated PPV-algorithm by comparing it to manually calculated PPV-values. In 10 critically ill patients, blood pressure was measured invasively (IBP) and non-invasively (CNAP^® Monitor, CNSystems Medizintechnik, Austria). PPV was determined manually and compared to automated PPV values: PPV_manIBP vs. PPV_autoIBP was ?0.19±1.65% (mean bias±standard deviation), PPV_manCNAP vs. PPV_autoCNAP was ?1.02±2.03% and PPV_autoCNAP vs. PPV_manIBP was ?2.10±3.14%, suggesting that the automated CNAP^® PPV-algorithm works well on both blood pressure waveforms but needs further clinical evaluation.     

Effects of modifying the electrode placement and pulse width on cognitive side effects with unilateral ECT: A pilot randomised controlled study with computational modelling

BackgroundThe electrode placement and pulse width for electroconvulsive therapy (ECT) are important treatment parameters associated with ECT related retrograde memory side-effects. Modification of these parameters with right unilateral (RUL) ECT may have utility for further reducing these side-effects.ObjectiveThis study explored use of the frontoparietal (FP) placement for reducing retrograde memory side effects with ECT. We hypothesised that superior retrograde memory outcomes would occur with FP compared to temporoparietal (TP) placement and with ultrabrief (UB: 0.3 ms) compared to brief pulse (BP: 1.0 ms) width ECT.MethodsIn this randomised cross-over, double-blinded study, participants received a single treatment of BP TP, BP FP, UB TP and UB FP ECT. Neuropsychological testing was conducted prior to and immediately following each treatment. Computational modelling was conducted to explore associations between E-fields in regions-of-interest associated with memory.ResultsNine participants completed the study. The FP placement was not superior to TP for retrograde memory outcomes. For both electrode placements UB pulse width was associated with significantly better visual retrograde memory compared to BP (p < .05). With TP ECT, higher E-fields in regions-of-interest were significantly associated with greater visual retrograde memory side-effects (hippocampi: r = −0.77, p = .04; inferior frontal gyri: r = −0.92, p < .01; middle frontal gyri: r = −0.84, p = .02).ConclusionsModification of pulse-width had greater effects than electrode placement for reducing retrograde memory side-effects with RUL ECT. Preliminary findings suggested that higher E-fields may be associated with greater cognitive side-effects with ECT.     

亚甲基四氢叶酸还原酶基因C677T多态性与原发性高血压患者动脉顺应性的关系

目的研究亚甲基四氢叶酸还原酶基因C677T多态性与原发性高血压及动脉顺应性的关系。方法对695例原发性高血压患者和509例年龄匹配的正常对照者采用聚合酶链反应和限制片长多态性分析方法进行基因多态性分析,电泳判断基因型及测序,并测定颈动脉—桡动脉脉搏波速度和颈动脉—股动脉脉搏波速度。结果高血压组TT基因型频率和T等位基因频率显著高于正常对照组(26.5%比20.6%及48.7%比42.4%,P=0.015和0.002)。T等位基因携带者的颈动脉—股动脉脉搏波速度显著高于CC基因型者(P<0.05),高血压组颈动脉—桡动脉脉搏波速度在T等位基因携带者也显著高于CC基因型者(P=0.001)。携带T等位基因的高血压患者颈动脉—股动脉脉搏波速度及非单纯收缩期高血压患者颈动脉—桡动脉脉搏波速度均显著高于CC基因型者(P<0.05)。结论亚甲基四氢叶酸还原酶基因C677T多态性可能与原发性高血压发病危险性增加有关,并且677T等位基因可能是高血压动脉硬化的遗传因素。     

脉压与心脑血管病的关系:一个大样本的随访研究

目的研究脉压(PP)是否与死亡有关,尤其是否与心、脑血管病有关。方法选择了1992-1993年,在韩国医疗保险公司投保年龄在40岁及以上的投保人,共有698796人,随访7年。随访开始时对每个观察对象进行健康检查并调查相关问题,随访期每2年进行1次查体。结果PP与全因死亡、心、脑血管病死亡有正相关关系。无论性别、年龄以及是否患有高血压,均得到相同结果,即随着PP升高,死亡危险性升高。但年龄越大,脉压的影响力度越弱。结论PP与全因死亡率、心脑血管病死亡率呈相关关系,在预测心脑血管病危险性时,PP可以作为一个独立的预测指标。     

单纯收缩期高血压患者脉搏波传导速度与心率变异性

目的研究单纯收缩期高血压患者主动脉脉搏波传导速度与心率变异性特别是低频部分(LF)的关系,评估这两个指标与心血管危险度的相关性。方法选取单纯收缩期高血压(ISH,n=89)患者及双期高血压(DH,n=98)患者,应用 SUN-8800动脉硬化检测仪检测颈股动脉脉搏波传导速度(cfPWV)及颈桡动脉脉搏波传导速度(crPWV),采用5 min 短程频域分析法分析其心率变异性(HRV)指数。89例 ISH 根据危险程度分为低危(n=3)、中危(n=17)、高危(n=35)以及极高危(n=34)4组,观察不同危险程度组间 cfPWV、crPWV 及 HRV 指数与心血管危险程度的相关性。结果 ISH 的 cfPWV 明最高于 DH[ISH:(399.6±48.2)cm/s 比 DH:(374.3±39.7)cm/s,P<0.01],而两组 crPWV 无明显差异[ISH:(371.5±37.5)比 DH:(363.5±31.5)cm/s,P>0.05];ISH 的心率变异指数、LF 以及 LF/HF 明显高于 DH[ISH:(3.28±0.86)log ms~2比 DH:(2.93±0.59)log ms~2,P<...     

Determinants of Brachial-Ankle Pulse Wave Velocity and Carotid-Femoral Pulse Wave Velocity in Healthy Koreans

The aim of this study was to determine the normal value of brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV) according to age group, gender, and the presence of cardiovascular risk factors in healthy Koreans, and to investigate the association between PWV and risk factors such as prehypertension, dyslipidemia, smoking, and obesity. We measured an arterial stiffness in 110 normal subjects who were 20 to 69 yr-old with no evidence of cardiovascular disease, cerebrovascular accident or diabetes mellitus. The mean values of baPWV and cfPWV were 12.6 (±2.27) m/sec (13.1±1.85 in men, 12.1±2.51 in women; P=0.019) and 8.70 (±1.99) m/sec (9.34±2.13 in men, 8.15±1.69 in women; P=0.001), respectively. The distribution of baPWV (P<0.001) and cfPWV (P=0.006) by age group and gender showed an increase in the mean value with age. Men had higher baPWV and cfPWV than women (P<0.001). There was a difference in baPWV and cfPWV by age group on prehypertension, dyslipidemia, current smoking, or obesity (P<0.001). In multiple linear regression, age and prehypertension were highly associated with baPWV and cfPWV after adjustment for confounding factors (P<0.001). The present study showed that baPWV and cfPWV are associated with age, gender, and prehypertension in healthy Koreans.

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增强型体外反搏治疗代谢综合征的临床疗效及对患者动脉血管的影响

目的 探讨增强型体外反搏治疗代谢综合征的临床疗效,观察增强体外反搏治疗对患者血液生化指标及动脉弹性的影响.方法 选取本院2012年1～12月收治的80例代谢综合征患者,其中50例近期未用药患者为A组,30例规律用药患者为B组,均给予增强型体外反搏治疗,并于治疗前后检测患者各项血液生化指标.同时选取30名健康受试者作为对照组,检测相同指标,并将检测结果与代谢综合征患者进行比较.结果 两组代谢综合征患者的血压、血糖、甘油三酯、胆固醇、ABI及baPWV水平均比对照组高,且差异有统计学意义（P＜0.05）.治疗后两组代谢综合征患者的血压、血液生化指标、ABI及baPWV均显著改善,与治疗前比较差异有统计学意义（P＜0.05）.结论 对代谢综合征患者开展增强型体外反搏治疗可显著缓解各项临床危险指标,并且能够促进动脉血管功能的改善.