重视降压达标的临床意义

高血压是心血管疾病的独立危险因素，常与糖尿病、脂代谢异常、体质量超重等代谢问题合并存在，与冠心病、脑卒中、猝死等心脑血管事件密切相关，从而直接威胁患的生命。目前，高血压患病率呈逐年上升趋势，对其进行有效的人群防治已成为全世界共同关注的公共卫生问题。据2004年发布的《中国居民营养与健康现状》的调查结果显示，目前我国高血压的患病率约为18．8％，患病总人数达1．6亿以上。虽然通过医务工作和全社会的多年努力，人们对高血压危害的认识水平已明显提高，但是从目前对高血压知晓率（30．2％）、治疗率（24．7％）和控制率（6．1％）的数据上看，仍然任重而道远。     

重症高血压脑出血并发上消化道出血的早期营养

目的：观察早期营养对防治重症高血压脑出血并发上消化道出血的作用。方法：重症高血压脑出血并发上消化道出血病人80例，分2组，治疗组42例，对照组38例。80例病人均给予相应的脑出血治疗措施，给予止血药物，止血芳酸0．4，立止血2．0kU，每12小时1次静脉注射，给抑酸药；西米替丁0．81次滴注。同时下胃管、药管内注凝血酶2000－4000U，每2小时1次，洛赛克40mg日1次鼻饲。治疗组不禁食，按时经鼻管鼻饲牛奶及豆粉，同时给予静脉营养：脂肪乳500ml，复合氨基酸250ml和25％葡萄糖（血糖较高除外）静脉滴注）。对照组暂禁食，且未予静脉营养。结果：治疗组42例中有30例出血停止，治疗有效率71．4％，出血停止时间为3－5天，平均为3．4天。对照组：38例有18例出血停止，治疗有效率47．5％，出血时间为5－7天，平均5．6天，经比较有显差异。结论：早期营养对重症高血压脑出血并发上消化道出血防治有重要意义。     

老年高血压的管理

高血压是多种心脑血管疾病,特别是冠状动脉粥样硬化性心脏病、卒中的重要危险因素,也是造成肾脏损害、心力衰竭及死亡的常见病因,严重危害人类的健康[1]。流行病学资料显示,高血压患病率随年龄增长呈累积性增加,在我国老年人群中,年龄≥60岁的高血压患病率为整体人群的2.5倍,而在≥80岁的老年人群中,高血压的患病率可高达90%[2]。根据《中国老龄事业发展报告（2013）》,今年我国老龄化人口将突破2亿,老龄化水平将达14.8%。老年高血压患者呈持续增加趋势,而老年高血压的治疗率及控制率仅为32.2%和7.6%[3]。老年高血压已经成为重要的社会公共卫生问题,老年高血压的防治工作亟待加强。老年高血压患者的治疗遵循降压治疗的一般原则,但其病理生理以及临床特点决定了其防治有其特殊的规律。     

高血压脑出血术后高血压危象血管活性多肽的测定

高血压脑出血术后高血压危象血管活性多肽的测定栾文忠王智梁冶矢高血压脑出血术后血压突然增高，继之出现高血压危象在临床工作中并不少见，其发病率约为１４．２９％（１）。脑内血肿清除术后颅内压下降，血压应随之有所下降。但这部分病人血压为什么反而突然升高？为解...     

常规开颅手术与脑室镜辅助治疗高血压性脑出血疗效比较

目的 比较脑室镜辅助手术与常规开颅手术治疗高血压性脑出血的效果。方法 高血压性脑出血患者40例中，应用脑室镜辅助手术治疗18例，常规开颅手术治疗22例。术后6个月以病人的日常生活能力（ADL）评定疗效。结果 常规开颅组22例．其中ADLI级2例，Ⅱ级5例，Ⅲ级2例，Ⅳ级3例，死亡10例（45．5％）。脑室镜组18例，其中ADL Ⅰ级6例，Ⅱ级7例．Ⅲ级2例，Ⅳ级1例，死亡2例（11．1％）。两组死亡率相差显著（P〈0．05）。结论 脑室镜辅助手术与常规开颅手术治疗高血压性脑出血均有一定的疗效。脑室镜辅助手术创伤小，提示可降低高血压脑出血患者的死亡率，但对出血量较大者，仍以开颅清除血肿为宜。     

社区高血压的预防与综合防治策略

目的探讨社区高血压的防治措施,控制社区人群的血压水平,降低高血压的发病率,加强对高血压患者的控制和提高高血压的治疗率,降低高血压并发症的发病率,总结有效防治社区高血压的策略。方法对我区2009-2010年全人群范围的健康教育和防治干预高血压人群的干预效果进行回顾性分析。结果城市社区和乡镇社区的高血压人群在干预之后的血压水平均发生了平行下移的现象,其中前者下移情况更为明显,干预社区的高危人群患原发性高血压的几率小于对照社区,高危人群的行为和态度等均有改善,社区综合防治高血压有利于提高社区人群的生活质量,符合经济学的效益原则。结论社区高血压的防治措施干预效果明显,有很大的应用价值,为高血压的综合防治提供了实践依据。     

经CT定位微创穿刺术治疗高血压脑出血

我院自1999年7月至2003年5月应用CT引导，定向微创穿刺术治疗高血压脑出血27例，取得较好疗效。1临床资料 1．1 一般资料本组27例中，男15例，女12例，年龄38～73岁，平均58.3岁。其中22例有高血压病史，入院时血压均明显高于正常范围。     

无框架立体定向机器人治疗高血压脑出血

目的探讨无框架立体定向机器人治疗高血压脑出血的疗效。方法2012年1月至2013年6月采用无框架立体定向机器人治疗39例高血压脑出血患者的临床资料。结果恢复良好率（以术后6个月ADL工、Ⅱ级为良好）为69．2％，致残率25．6％，死亡率5．1％。结论运用无框架立体定向机器人治疗高血压脑出血，具有操作简单，微侵袭，手术定位准确、治疗效果确切、安全有效。     

高血压脑出血的外科治疗

目的 探讨高血压脑出血病人外科治疗手段,提高此类病人的生存率和改善生存质量。方法根据病人高血压脑出血的部位、血肿量及血肿形态,采取不同的手术方法。围手术期的血压管理,并加强静脉营养。结果本组治疗127例不同类型的高血压脑出血病人,良好15例（11．8％）,中残44例（34．6％）,重残36例（28．3％）,植物生存9例（7．1％）,死亡23例（18．1％）。结论依据病人情况,治疗以清除血肿、减轻手术副损伤,内减压或内外减压,严格适度地控制血压．加强并发症的防治,高血压脑出血的外科治疗效果是令人满意的。     

高血压性脑出血继续出血162例分析

目的 探讨高血压性脑出血患继续出血的发生率，发生时间及相关因素。方法 回顾性分析了162例高血压性脑出血患的动态头颅C检查结果，对首次CT检查的时间，血肿量，血肿部位及病程中的血压变化，癫痫和发病前是否有饮酒病史进行对比研究。结果 继续出血的发生率为37％，其中58％的病例发生于发病后6h以内，25％发生于6－24h,11.7%发生于24－168h，5％发生于168h以后；血肿量21－30ml，继续出血的发生率最高，为53．2％。脑叶血肿及血肿破入脑室易继续出血；病程中有持续性高血压，癫当作及发病前有饮酒病史继续出血的发生率较高。结论 高血压性脑出血患有近2／5病人有继续出血，首次CT检查的时间位于24h，尤其是6h以内，血肿量为21－30ml继续出血的发一率较高，病程中有持续性高血压，癫痫发作及发病前有饮酒病史与继续出血密切相关。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.