上腔静脉和三尖瓣血流评价肺动脉高压时右心室舒张功能的研究

目的　研究上腔静脉和三尖瓣血流频谱评价肺动脉高压患者右心室舒张功能的价值。方法　用多普勒超声心动图检测 17例肺动脉高压患者和 19例正常人的上腔静脉和三尖瓣的血流频谱及右心系统的常规超声心动图参数 ,将结果对比分析。结果　 (1)肺动脉高压组右心系统的常规超声心动图参数均较正常组恶化 (P<0 .0 5 ) ;(2 )三尖瓣血流频谱肺动脉高压组与正常组比较 ,A波峰值 [Ap,(5 8.97± 2 0 .70 ) vs(45 .91± 10 .6 2 ) cm/ s]和流速时间积分 [Ai,(10 .0 8± 3.76 ) vs(7.4 8±2 .73) cm]显著增大 ,E波流速时间积分 [Ei,(10 .6 3± 3.92 ) vs(13.35± 3.4 4 ) cm]和 E波减速时间 [DT- E,(0 .14± 0 .0 6 ) vs(0 .18± 0 .0 4 ) s]明显减小 (P<0 .0 5 ) ,但 E波、 A波峰值流速比值 [Ep/ Ap,(1.4 2± 0 .5 9) vs (1.5 7± 0 .4 1) ]和流速时间积分比值 [Ei/ Ai,(1.38± 0 .99) vs(1.6 1± 1.30 ) ]与正常组比较差异无显著性意义 (P>0 .0 5 ) ;(3)上腔静脉血流频谱肺动脉高压组 S波流速时间积分 [Si,(10 .0 2± 4 .86 ) vs(13.2 4± 3.4 3) cm]变小 ,D波峰值流速 [Dp,(39.5 1± 11.92 ) vs(32 .38±8.37) cm / s]增大 ,S波与 D波流速时间积分比值 [Si/ Di,(1.72± 0 .88) vs (2 .2 2± 0 .5 7) ]减小 ;AR波峰     

原发性高血压患者A型性格分析及护理对策

调查原发性高血压患的A型性格率，结果显示高血压组的A型性格率(336％)与对照组的A型性格率(27．0％)无显差异，而临界高血压组的A型性格率(461％)与对照组有显差异。作认为这与高血压患的平均年龄犬于临界高血压患的平均年龄有关。根据调查分析结果提出的护理对策是：对高血压患在注重药物治疗的同时嘱患保持身心安静，找出可能存在的心理原因，而不应过分强调性格原因；对临界高血压患应把矫正其A型性格作为护理重点之一。     

复方氯沙坦对老年高血压患者肾功能影响的观察

目的　观察复方氯沙坦治疗老年高血压病患者对肾功能的影响。方法　将老年原发性高血压患者 6 0例分为两组 ,治疗组与对照组各 30例 ,分别服用复方氯沙坦和雅施达 12周 ,所有患者检测用药前后血压和血尿素氮 (BUN)、血肌酐 (SCR)、血尿酸 (UA)及血、尿 β2 微球蛋白 (β2 MG)。结果　两组老年高血压患者经 12周治疗后 ,收缩压和舒张压均有下降 ,复方氯沙坦组降压幅度为 42 8/ 17mmHg ,与雅施达组比较 ,舒张压的降低差异有显著意义 (P <0 0 0 1)。复方氯沙坦组治疗前后尿酸、血、尿 β2 MG的降低差异有显著意义 (P <0 0 0 1)。雅施达组患者治疗前后 ,其血、尿 β2 MG差异也有显著意义。结论　两种药均能有效降压 ,在保护肾功能方面有重要作用 ,复方氯沙坦同时有降低血尿酸的作用。     

血管紧张素转换酶和内皮型一氧化氮合酶基因多态性与高血压的相关性

目的探讨血管紧张素转换酶(ACE)基因I/D、内皮型一氧化氮合酶 (eNOS)基因G894T多态性与原发性高血压(EH)的关系.方法采用基因芯片技术检测 224例(124例高血压患者和100例健康人)ACE和eNOS基因多态性.结果 EH组ACE DD基因型携带者频率显著高于对照组 (30.65% vs16.00%,P<0.05 ),eNOS- GT TT基因型频率与对照组相比无显著性差异( 12.90% vs 15.00%,P＞0.0 5).结论 ACE-DD基因多态性可能是高血压病的独立危险因素,eNOS基因G894T多态性可能不是高血压病的独立危险因素.基因芯片技术为研究多种易感基因与高血压病的相关性提供了一项高效、敏感的方法.     

血管性帕金森综合征与帕金森病对比研究

目的探讨血管性帕金森综合征(VP)的临床及影像特点以及与帕金森病(PD)的区别。方法对50例VP及118例PD住院或长期门诊随访患者临床及影像学检查,进行归纳分析和统计学处理。结果VP发病年龄大于PD;多以肌僵直-少动起病;临床上以对称性铅管样肌僵直-少动为主,静止性震颤少见;可伴锥体束损害表现和智能障碍、尿失禁。VP影像学主要表现为基底节、脑室周围多发腔隙性梗死;而单纯PD无脑梗死改变。结论VP发病可能与长期高血压、腔隙性脑梗死有关;VP临床表现与PD存在不同;脑MRI或CT检查对两者鉴别具有重要意义。     

Comparison of Local Measurement of Cerebral Metabolism and to Cerebral PvO2 during Alterations in Intracranial Pressure, PaCO2 and Arterial Pressure – An Experimental Study in Goat

Objective.to assess the changes in local brain PO₂, PCO₂, pH (PO₂br, PCO₂br, pHbr) measured by a intraparenchymal probe (Neurotrend^TM, Codeman) and compare them to simultaneous recording of cerebral PvO₂ and blood flow (CBF). Methods.Arterial, venous longitudinal sinus blood samples and CBF were analyzed in 8 adult anesthetized, ventilated goats. Three step increase of intracranial pressure (ICP) (16, 22, 29 mm Hg) were performed by inflation of an epidural balloon. At each ICP level, similar changes in MAP and in PaCO₂ were performed. Results.At constant PaCO₂ and MAP, balloon inflation induced a fast response: a decrease of PO₂br, PCO₂br and pHbr (starting 14 ± 12 sec, 45 ± 23 sec and 55 ± 19 sec after the peak ICP, respectively). Since the second inflation level, PO₂br decreased (p< 0.05) despite an ICP returning at 22 mm Hg and a cerebral perfusion pressure (CPP) larger than 90 mmHg. During changes in PaCO₂, PO₂br paralleled CBF and PvO₂ before the second balloon inflation but diverged at higher ICP. In the same time pH-pHbr gradient rose. Hypotension did not induce sizeable changes. Conclusions.The direct metabolic monitoring of cerebral tissue locally compressed show fast response. At steady state, it shows alterations which are not detected by the measurement of the oxygen saturation in the longitudinal sinus or that of CBF. It confirms that the threshold for ICP which may require therapy in presence of focal brain compression is around 20 mm Hg even in the presence of a CPP > 90 mm Hg.     

Urine Dipstick as a Screening Test for Serum Creatinine Elevation in Emergency Department Patients with Severe Hypertension

OBJECTIVE: Patients presenting to the emergency department (ED) with severe hypertension require assessment for acute end-organ damage. Serum creatinine (SCr) measurement is routinely recommended to detect renal dysfunction. The authors assessed the utility of the urine dipstick test in screening for acute SCr elevation in this population. METHODS: The authors performed a prospective study of adult ED patients with diastolic blood pressures > or = 115 mm Hg that persisted for > or = 30 minutes or necessitated emergent treatment. Excluded were menstruating and pregnant women and patients with urinary infection, trauma, or dialysis dependence. Patients reporting a history of renal disease were excluded if the SCr was abnormal and no baseline value was available. Each subject had an SCr and urine dipstick test. The authors examined the performance of the dipstick in identifying an elevated SCr, defined as SCr > 1.2 mg/dL or > 25% above baseline. RESULTS: Of 143 patients, 42 had SCr > 1.2 mg/dL. Eighteen reported prior renal disease but had an SCr that was normal or < or = 25% above baseline. The remaining 24 subjects comprised the elevated SCr group. The presence of either proteinuria or hematuria on dipstick identified these patients with 100% sensitivity and 29.7% specificity. Specificity rose to 42.4% without loss of sensitivity when an abnormal dipstick was defined as hematuria or > or = 1+ proteinuria. CONCLUSIONS: The urine dipstick may be an effective screening test for SCr elevation in patients with severe hypertension. A restrictive definition of an abnormal dipstick would identify all patients with elevated SCr and substantially reduce the number of SCr assays necessary.