辽宁省阜新农村地区高血压患者中心动脉压研究

目的通过在基于社区样本的高血压人群中进行横断面调查,研究中心动脉压(cSBP)指标在高血压人群中的分布特点。方法对辽宁阜新农村地区321例2周内没有服用过降压药的原发性高血压患者用平面压力法测量cSBP。结果高血压患者在基线水平相同的条件下,女性cSBP显著高于男性cSBP[(163±25)mm Hg与(154±25)mm Hg,P<0.01];在依据年龄进行分组后,60岁以下女性cSBP高于男性(P<0.01);而在60岁以上人群中,男女性间差异无统计学意义(P>0.05)。相关分析显示年龄与cSBP呈正相关(男性r=0.350,P<0.01;女性r=0.122,P=0.048)。SBP和cSBP呈正相关(男性r=0.239,P=0.006;女性r=0.229,P=0.002)。结论在辽宁农村高血压人群中,女性cSBP显著高于男性,年龄与cSBP呈正相关。SBP与cSBP呈相关,大部分高血压患者的cSBP要高于SBP。     

中心动脉压研究进展和应用

一般所说的血压即主动脉压,代表心脏后负荷大小,是心血管结构损伤、病变和临床预后的强预测因子。临床上通常以袖套法测定肱动脉压代表主动脉压,用以评判降压治疗疗效,以及评估患者临床预后,这是建立在假设肱动脉血压能够准确地反映中心动脉血压（Central Arterial Blood Pressure,CABP）的基础之上。然而,有研究已经表明不同的降压药物降低肢体动脉血压的幅度即使相似或相同,对中心动脉压的影响也会有所不同。周围动脉压并不能完全替代中心动脉压或更不能等同于中心动脉压用以评价高血压药物治疗效果。本文就中心动脉压研究进展及其与周围动脉压的关系和临床应用进行综述。     

中心动脉压测定及对不同药物反应的临床观察

目的观察不同方法测得的中心动脉压和外周动脉压的差别，比较美托洛尔和培哚普利对中心动脉压的作用。方法通过桡动脉应用导管法测量中心动脉压和外周动脉压（桡动脉血压），同时测量肱动脉无创血压，比较高血压病患者应用关托洛尔和培哚普利后中心动脉压和外周动脉压的差别。结果非高血压病患者中心动脉收缩压和桡动脉收缩压明显高于肱动脉无创收缩压，桡动脉有创收缩压明显高于中心动脉收缩压，中心动脉舒张压明显高于桡动脉舒张压和肱动脉无创舒张压，桡动脉舒张压和肱动脉无创舒张压无统计学意义。结论不同测量方法测得中心动脉压和外周血压值不同，培哚普利比较关托洛尔降低中心动脉收缩压效果更为明显。     

血浆同型半胱氨酸水平与冠心病患者中心动脉压及颈动脉狭窄程度的相关性研究

目的 探讨血浆同型半胱氨酸(Hcy)水平与冠心病患者的中心动脉压以及颈动脉狭窄程度之间的相关性.方法 收集2013年9月-2015年9月于石家庄市第三医院诊治的疑似冠心病患者272例,均行冠状动脉造影,依据造影结果分为冠心病组160例及非冠心病组112例,依据血浆Hcy水平的不同分为正常、轻度、中度以及重度升高,根据颈动脉狭窄程度分为正常、轻度、中度、重度狭窄,同时行彩色多普勒超声检查颈动脉内膜厚度,有无斑块、狭窄,利用直径法计算狭窄率.记录两组年龄、性别、相关疾病病史、吸烟史、体重指数、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、尿酸、血浆Hcy水平以及中心动脉压.结果 冠心病组血浆Hcy水平以及中心动脉压均高于非冠心病组(P＜0.05).冠心病组血浆Hcy水平与颈动脉狭窄程度、中心动脉收缩压、中心动脉脉压、中心动脉舒张压以及肱动脉收缩压呈明显正相关性(P＜0.05、P＜0.01),但是与肱动脉舒张压以及肱动脉脉压无明显相关性(P＜0.05).结论 血浆Hcy水平较高的冠心病患者颈动脉狭窄程度较严重,中心动脉压较高,血浆Hey水平是冠心病患者独立危险因素.     

普伐他汀对高血压患者脉压和动脉弹性的影响

目的:评价普伐他汀对高血压患者脉压和动脉弹性的影响。方法:选择54例正在规律服用降压药物治疗并且脉压≥60mmHg的高血压患者,随机分成治疗组和对照组,每组各27例,治疗组在原降压药物的基础上加服普伐他汀(20mg/d),对照组则继续服用原降压药物不变,在治疗前及治疗16周以后分别检测患者的血压、大动脉和小动脉弹性指数(C1和C2)。结果:普伐他汀组治疗后的收缩压(SBP)、脉压(PP)和C2较对照组有明显改善(P<0.05),C1则无显著改变(P>0.05)。结论:普伐他汀能明显改善高血压患者的小动脉弹性,从而起到降低脉压的作用。     

短期服用氢氯噻嗪对中心动脉压影响的研究

<正>近年来有研究表明一些新的降压药,如血管紧张素转换酶抑制剂和钙通道阻滞剂,降低心血管危险可能优于利尿剂[1,2],原因之一可能系血管紧张素转换酶抑制剂(ACEI)和钙通道阻滞剂降低中心动脉压及大动脉僵硬度优于利尿剂[3]。小剂量利尿剂短期使用对中心动脉压影响     

冠心病患者动脉压分量的临床价值研究

目的 探讨冠状动脉粥样硬化性心脏病（CHD）患者动脉压分量的临床价值。方法 回顾性分析2020年5—10月就诊于郑州大学第二附属医院心内科门诊及住院患者181例,根据冠状动脉造影结果分为CHD组（97例）与非CHD组（84例）,比较两组一般资料及动脉压各分量的差异性,根据差异有统计学意义的指标进行多因素logistic回归分析。结果 与非CHD组的相比,CHD组年龄大、心率慢,肱动脉收缩压（BSP）、外周脉压（PP）、中心收缩压（CSP）、中心脉压（CPP）、前向波高度（Pf）、第一前向波高度（P1）、反射波高度（Pb）、反射波指数（RM）均升高,差异有统计学意义（P <0.05）。多因素logistic回归分析显示,年龄是CHD的独立危险因素[OR(95%CI)=1.063(1.027,1.100),P <0.05]。进一步矫正年龄因素,将患者分为老年亚组与非老年亚组。仅非老年亚组中,CHD组患者BSP、PP、CSP、CPP、P1、Pb及RM均高于非CHD组,差异有统计学意义（P <0.05）。结论 CHD患者动脉压分量有临床研究价值,尤其在非老年患者中。     

高血压患者脉压对肾功能的影响

目的研究高血压患者脉压（PP）与早期肾损害的关系,为早期防治提供临床依据。方法将157例高血压患者根据PP不同分为三组：A组PP〈60mm Hg;B组60mm Hg≤PP〈100mmHg;C组PP≥100mmHg。进行血清尿素氮（BUN）、肌酐（Cr）、尿酸（UA）、尿液微量白蛋白（UmAlb）、内生肌酐清除率（Ccr）等测定。结果各组间UmAlb及UA与PP呈显著正相关（P〈0．01和0．05）。而BUN、Cr、Ccr与PP相关性不显著（P〉0．05）。结论PP与早期肾脏损害有关,对防止早期肾脏损害有着重要的临床意义。     

脉压对老年高血压病患者靶器官的影响

目的探讨脉压对老年高血压患者靶器官的影响。方法将80例老年高血压病患者分入两组,Ⅰ组24hPP<60mmHg,Ⅱ组24hPP≥60mmHg。结果Ⅰ组心功能、颈动脉粥样硬化及肾脏改变显著优于Ⅱ组(P<0.05)。结论脉压升高是老年高血压靶器官损害的重要原因。     

不同型号穿刺针穿刺测压对桡动脉影响的分析

目的 比较使用不同型号穿刺针穿刺测压对桡动脉的影响.方法 连续选取行桡动脉穿刺测压的患者68例,随机分为两组(n=34):F组、T组,分别用20 G或22 G动脉穿刺针穿刺测压,记录一次穿刺成功率,测量穿刺前,穿刺后即刻,穿刺后10、30、60 min及拔管后30 min桡动脉直径,计算动脉闭塞发生率.结果 F组一次穿刺成功率(82.35％)优于T组(55.88％)(F=5.58,P=0.03);在穿刺后即刻,T组桡动脉内径明显小于F组,其动脉痉挛发生率亦明显高于F组(x2 =4.12,P=0.08);10 min后绝大部分桡动脉痉挛自行解除,且两组患者桡动脉内径在其后各时点差异均无统计学意义(P＞0.05).两组均未发现桡动脉闭塞病例.结论 20 G穿刺针穿刺后动脉痉挛发生率高于使用22 G针者,但10 min后绝大部分桡动脉痉挛可自行解除.     

Effects of central acting drugs on the mirror staircase test

A mirror-covered staircase was erected to study screening methods, and several basic experiments were carried out using it. The staircase consisted of 5 steps each measuring 15 cm long by 20 cm wide by 6 cm high, fabricated in a wooden device measuring 95 cm by 20 cm by 30 cm high. The inner surfaces were all mirrored, including steps, floors and walls. At the foot of the stairs, a rat weighing about 200 g was placed quietly with the back toward the stairs. The frequencies of rearing and climbing on the stairs were recorded for the subsequent 3 and 10 min. The recordings were also performed using 2 rats placed simultaneously and in a non-mirrored device of the same structure. When mirrored, the frequencies of rearing and climbing were much higher, and the average duration lasted also longer than when non-mirrored. To compare the results among the following 3 qualifications: i) a rat in the mirrored device, ii) 2 rats in the mirrored device, and iii) 2 rats in the non-mirrored device, the highest frequency of rearing for the first 3 min was observed in i). Effects of nitrazepam, phenobarbital and morphine were compared between mirrored and non-mirrored qualifications. No significant differences between them were observed in the drug-induced changes in the behaviors. Although the mirrored-staircase test as a screening method was almost identical to the non-mirrored test, it was superior in the point of continuation of augmented frequencies. As a fact arousing interest, the subject received more potent stimulation from its self image exposed on the mirrors than the image of another individual of the same species (within the same device).     

不同降压药物联合治疗对老年高血压患者血压变异性的影响

摘要： 目的 比较缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的治疗作用。方法 80 例老年高血压患者随机分为 2 组, 分别给予缬沙坦联合氨氯地平 （氨氯地平组） 或缬沙坦联合氢氯噻嗪 （氢氯噻嗪组） 降压治疗, 监测 2 组 24 h 动态血压, 观察治疗前、 治疗第 6 周和第 12 周, 2 组血压及血压变异性的变化。同时观察 2 组 6 周末血压达标率。记录治疗过程中的不良反应情况。结果 2 组治疗 6 周和 12 周的 24 h 平均收缩压 （SBP）、白昼 SBP、 夜间 SBP、 晨峰 SBP、 24 h 收缩压变异性 （SBPV） 均较治疗前降低 （P < 0.05）。24 h SBP、 白昼 SBP、 夜间 SBP、 24 h SBPV 及白昼 SBPV 分组因素与时间因素存在交互作用 （P < 0.05）。治疗第 6 周和第 12 周, 氨氯地平组 24 h SBP、 白昼 SBP、 夜间 SBP 及白昼 SBPV 较氢氯噻嗪组降低 （P < 0.05）, 治疗第 12 周, 氨氯地平组 24 h SBPV 低于氢氯噻嗪组 （P < 0.01）。2 组血压达标率和不良反应发生率差异均无统计学意义。结论 缬沙坦联合氨氯地平或氢氯噻嗪均能有效控制老年高血压患者血压变异性, 而缬沙坦联合氨氯地平在降低血压和血压变异性方面作用更强。     

不同种类降压药对血压变异性的影响

目的通过比较6种不同种类降压药(吲达帕胺、依那普利、缬沙坦、氨氯地平、美托洛尔、特拉唑嗪)对患者血压的影响,总结不同种类降压药对血压变异性的影响。方法对85例18⁶5岁确诊为原发性高血压(EH)的患者,分4个阶段服用常见6大类降压药:吲达帕胺(利尿剂)、依那普利(ACEI)、缬沙坦(ARB)、氨氯地平(钙离子拮抗药)、美托洛尔(β1受体阻断药)、盐酸特拉唑嗪(α阻滞剂)。采用无创性便携式动态血压监测仪,24小时动态血压测量及分析系统(简称:ABPM测量装置)对患者血压进行监测,调节血压(6∶0065岁确诊为原发性高血压(EH)的患者,分4个阶段服用常见6大类降压药:吲达帕胺(利尿剂)、依那普利(ACEI)、缬沙坦(ARB)、氨氯地平(钙离子拮抗药)、美托洛尔(β1受体阻断药)、盐酸特拉唑嗪(α阻滞剂)。采用无创性便携式动态血压监测仪,24小时动态血压测量及分析系统(简称:ABPM测量装置)对患者血压进行监测,调节血压(6∶00²2∶00)每20分钟测量1次,晚上每30分钟测量1次的对比试验,根据实验数据分析这6种药物对于实验对象的影响及不同药物对血压BPV的影响。结果吲达帕胺、缬沙坦和氨氯地平有降低24 h血压BPV的作用;依那普利、特拉唑嗪和美托洛尔有升高24 h血压BPV的作用。缬沙坦组用药后,使24 h收缩压BPV降低了(1.72±4.43)mmHg,24 h舒张压BPV降低了(0.68±1.29)mmHg,其降低的幅度远远大于其他药物组。吲达帕胺组用药后使24 h收缩BPV降低了(1.63±2.79)mmHg、24 h舒张压BPV降低了(0.24±1.80)mmHg,其降低幅度比缬沙坦组略小。氨氯地平降低24 h舒张压,其降低值为(-1.3±0.23)mmHg,其降低幅度要比缬沙坦和吲达帕胺小。依那普利组、特拉唑嗪和美托洛尔组的24 h血压BPV有一定程度的升高。结论 6种降压药对血压变异性的影响存在差异性。     

Effects of central depressant drugs upon acetylcholine release

Several central depressant and other drugs have been examined for their effects upon acetylcholine release from the stimulated, perfused cat superior cervical ganglion and rat isolated phrenic nerve-diaphragm preparations. The acetylcholine released was assayed biologically. Amylobarbitone sodium, chloral hydrate, trichloroethanol, methylpentynol, methylpentynol carbamate, paraldehyde, procaine hydrochloride and troxidone reduced the presynaptic release of acetylcholine from the ganglion. They also exhibited a postsynaptic blocking action, this component of depressant activity being particularly prominent with paraldehyde and troxidone. Closely analogous findings were obtained at the neuromuscular junction with methylpentynol and its carbamate, paraldehyde, procaine hydrochloride, trichloroethanol and troxidone. At both sites the drug-induced depression, both of transmission and of acetylcholine output, was reversible. Whereas hexamethonium regularly blocked ganglionic transmission with no effect upon acetylcholine release, tetraethylammonium not only completely blocked ganglionic transmission but concomitantly augmented acetylcholine output. These results are discussed in relation to the electrophysiological and metabolic events associated with neuro-effector transmission.     

Interaction of histaminergic drugs with adrenergic neurotransmission in rabbit ear central artery

The interaction of histamine and other histaminergic agents with adrenergic neurotransmission in blood vessels was studied in vitro. The experiments were carried out on ear central arteries isolated from male Chinchilla rabbits. The proximal segment of the artery was perfused with Krebs-Henseleit solution at a rate of 3.0 ml/min and was allowed a 120-min adaptation before the experiments. Contractions of the arterial smooth muscle were evoked either by noradrenaline (NA) or by low-frequency electrical stimulation (LFES). The effects of histamine and the other histaminergic agents on the arterial tone and on the NA- or LFES-induced contractions were studied. When applied extralumenally in concentrations higher than 1 x 10(-12) M histamine and 2-(2-aminoethyl) thiazole (2-AET) enhanced the LFES-induced smooth-muscle contractions. Dimaprit (DMP) did not markedly change the LFES-contractile effects. Diphenhydramine (DPH) and mepyramine (MEP) in higher concentrations potentiated the contractions in response to LFES. Ranitidine (RAN) moderately potentiated and cimetidine (CIM) did not affect the LFES-evoked contractions of the artery. None of the drugs tested significantly changed the NA-induced contractions. The results only partly confirm the assumption that histamine exerts its modulatory effects on adrenergic neurotransmission via postsynaptic excitatory H1-receptors and presynaptic inhibitory H2-receptors.     

Effects of topically instilled drugs on intraocular pressure in rabbits.

The effect of the ocular instillation of some drugs on the intraocular pressure of non-anaesthetized rabbits was studied, using the Schi?tz tonometer. The risk of systemic absorption of drugs follwoing ocular instillation was evaluated by 1. measuring the spreading of effects from the treated eye to the contralateral one and 2. studying the effects on blood pressure or on blood pressure responses to noradrenaline. The results showed that trazodone, epinephrine and acetazolamide produced hypotension on the treated eye; there was no spreading of effects to the contralateral one. These data could suggest that the primary site of action of these drugs is the eye. Naphazoline reduced the intraocular pressure both on the treated eye and, with a constant delay, on the contralateral one. This was interpreted as a combination of a local action and systemic absorption. The effects of chlorpromazien were more complex. This drug produced hypertension and a strong irritation on the treated eye as well as a hypotensive effect on the contralateral one. The rise in intraocular pressure was probably caused by irritation; the hypotensive effect by systemic absorption. The following drugs were inactive: amphetamine, chlorothiazide and pilocarpine.