多普勒组织成像对预激综合征旁道定位的研究

目的：探讨多普革组织成像（DTI）技术对预激综合征（WPW）旁道（AP）定位的可行性和准确性，方法：选择32例体表心电图诊断为WPW患者，行导管射频消融（RFCA）术前，采用DTI的速度，加速度及频谱技术模式初步确定旁道位置即最早心室激动点，并以心内膜靶点准确定位标的速度，结果，DTI技术所确定的心室最早激动亮点出现时限与同步记录的心电图δ汉出现时限完全相同，DTI技术对旁道定位的敏感性，准确性分别为88％，7％，结论：DTI有助于确定旁道位置，评价RFCA的效果，该技术无创，安全，重复性良好，可与心内电生理标测技术相互补以，因此具有一定的临床应用价值。     

美托洛尔与维拉帕米治疗阵发性室上性心动过速的比较

阵发性室上性心动过速患者40例,分为2组。美托洛尔组21例,用酒石酸美托洛尔2.5mg或5mg加入葡萄糖液10mL或20mL,以2mL/min速度静脉注入,间隔5-10min可重复注射,心电图监护下俟转为窦性心律即停药,总量<10mg。维拉帕米组19例,用维拉帕米5mg加葡萄糖液10mL,静注速度、方法、总量同上。有效率分别为81％和74％(P>0.05);平均起效时间分别为16±11min和9±9min(P<0.05)。     

射频消融对室上性心动过速(左侧旁道)患者左室功能的影响

目的 观察射频消融术（RFCA）对房室折返性心动过速（左侧旁道）[AVRT（L）]患者左室功能的影响。方法 利用二维和Doppler超声检查AVRT（L）患者手术前、后三天左室收缩功能及舒张期充盈情况,为提高敏感性,检查时增加了三级等长收缩运动。结果 （1）在各级运动中心率（HR）、收缩压（SBp)、舒张压（DBp)均显著增加,但三者均值分别不超过90bpm、160mmHg、95mmHg,运动后五分钟均恢复。（2）RFCA术前,后同级运动量时左室功能各参数无显著变化。结论 对于AVRT（L）患者,在有经验医师操作下,RFCA术中施放总能量在一定范围内时,对左室功能无影响。     

窦性心律时静注ATP非侵入性诊断隐匿性房室旁路的研究

目的：探讨房室折返性心动过速（AVRT）患者在窦性心律时静注三磷酸腺苷（ATP）非侵入性诊断隐匿性房室旁路（AP）的价值及射频消融（RFCA）的结果。方法：研究组42例系隐匿性AP参与的VRT准备接受RFCA者，对照组37例为RFCA成功的房室结折返性心动过速（AVNRT）者，在窦性心律时静注递增剂量的ATP（10－40mg)，结果；静注ATP后出现隐匿性AP征象研究组35例（85％），对照组2例（6％）（P＜0．001），所有受试者PR间期在出现房室回波（AVRE）前均轻微延长（＜50ms)，体表心电图与心内电图结果一致。23例RFCA成功者术后重复ATP试验，均未出现隐匿性AP征象。结论：窦性心律时静注APT是诊断隐匿 性AP有一定价值的非侵入性床旁试验方法，还可用于判断隐匿性AP消融的结果。     

Oral verapamil and calcium infusion in patients with sick sinus syndrome

Electrophysiologic and circulatory effects of a single oral dose of verapamil (120 mg) were evaluated in 8 patients with symptomatic sick sinus syndrome. Ninety min. after verapamil, calcium gluconate (1375 mg) was infused in an attempt to reverse the depressor actions of the drug. Verapamil significantly increased sinus node recovery time (P less than 0.05) and atrioventricular conduction time (P less than 0.01), and decreased both systolic (P less than 0.01) and diastolic blood pressure (P less than 0.05) and spontaneous heart rate (P less than 0.01). Intravenous calcium significantly reversed blood pressure reduction (P less than 0.001) and further lowered heart rate (P less than 0.05) without affecting sinus node recovery time and atrioventricular conduction significantly. There was no significant correlation between plasma verapamil concentrations and any of the cardiovascular parameters. These data confirm that verapamil is principly contraindicated in patients with sinus node dysfunction and demonstrate that the actual calcium dose, although partly reversing blood pressure reduction, cannot reverse the depressant action of the drug on the sinus and atrioventricular node in such patients.     

维拉帕米与普罗帕酮治疗阵发性室上性心动过速对比研究

目的观察静脉注射维拉帕米与普罗帕酮治疗阵发性室上性心动过速(PSVT)的疗效。方法选择2003年12月至2008年7月在我院急诊科确诊的PSVT患者82例,随机分为维拉帕米组42例,普罗帕酮组40例。维拉帕米组静脉注射维拉帕米,并与静脉注射普罗帕酮组进行对比观察。结果维拉帕米组终止率为88.1%,平均起效时间为(21.78±13.60)min;普罗帕酮组终止率为85.0%,平均起效时间为(39.18±17.89)min。两组在复律时间上差异有统计学意义(t=4.635 2,P<0.01),但终止率差异无统计学意义(χ2=0.169 0,P>0.05)。结论PSVT的治疗应用维拉帕米复律优于普罗帕酮。     

Effect of propranolol on secretin-induced gastrin release and secretin-induced tachycardia in patients with the Zollinger-Ellison syndrome

The mechanism for secretin-induced gastrin release in the Zollinger-Ellison syndrome is uncertain. We evaluated whether the stimulatory effect of intravenous secretin on gastrin release was partly mediated through a beta-adrenergic stimulatory mechanism. Serum gastrin concentrations and heart rate were monitored in six patients with the Zollinger-Ellison syndrome. Secretin (2 clinical units/kg) increased mean serum gastrin concentrations from 1558 pg/ml basally to a peak of 3683 pg/ml (136% above baseline). This increase was not altered by pretreatment with 2 mg of propranolol intravenously, a dose which in previous studies blocked terbutaline-induced gastrin release. Secretin increased heart rate by 14 beats/min (20% above base-line) and this also was not altered by propranolol pretreatment. Thus, the stimulatory effects of secretin on gastrinoma cells and the heart do not appear to be mediated by beta-adrenergic receptors.     

稳心颗粒联合维拉帕米治疗阵发性室上性心动过速的疗效观察

目的 探讨稳心颗粒联合盐酸维拉帕米注射液治疗阵发性室上性心动过速的临床疗效。方法 选取2021年7月—2023年6月在首都医科大学附属北京康复医院就诊的116例阵发性室上性心动过速患者,按随机数字表法分为对照组和治疗组,每组各58例。对照组静脉推注盐酸维拉帕米注射液,将5 mg盐酸维拉帕米注射液加入10 mL生理盐水,3 min内静脉推注,观察20 min,若病情未好转,重复注射直至转复后停止,每日剂量不超过50 mg。治疗组在对照组治疗基础上开水冲服稳心颗粒,1袋/次,3次/d。两组疗程均为4周。比较两组的临床疗效、发作和治疗情况、超声心电图检查和心功能指标。结果 治疗组的总有效率为93.10%,明显高于对照组的总有效率79.31%,差异有统计学意义（P＜0.05）。治疗后,治疗组的发作频次、平均转复时间低于治疗前,30 min内转复率高于治疗前（P＜0.05）;治疗组的发作频次、平均转复时间低于对照组,30 min内转复率高于对照组（P＜0.05）。治疗后,治疗组患者的短阵室速数、室性期前收缩数比治疗前小（P＜0.05）,且比对照组的短阵室速数、室性期前收缩数更小（P＜0.05）。治疗后,治疗组的左心室射血分数（LVEF）比治疗前大,左心室收缩末期容积（LVESV）比治疗前小（P＜0.05）;治疗组患者的LVEF比对照组大,LVESV比对照组小（P＜0.05）。结论 稳心颗粒联合盐酸维拉帕米注射液可提高阵发性室上性心动过速的临床疗效,减轻发作频率,改善心功能。     

118例右侧房室旁道导管射频消融治疗分析

目的 分析右侧房室旁道电生理特性及导管射频消融（RFCA）术操作要点,试图总结实用有效的常规消融方法。方法 利用RFCA技术阻断右侧房室旁道参与的折返性心动过速118例,其中显性旁道71例。隐匿性47例,结果 首次消融成功率89.0%,随访个月-3年,15例（12.7%)复发,经再次RFCA14例成功。最终治愈113例,治愈率95.8%,无严重并发症发生。结论 准确的旁道定位及消融导管与靶组织的稳定接触是成功的关键。     

The effect of propranolol, prindolol, practolol and verapamil versus placebo on exercise induced tachycardia in patients with ventricular preexcitation.

Propranolol, prindolol, practolol and verapamil have been given orally in a fixed dose to subjects with preexcitation syndrome in a cross over study. The effect on exercise induced tachycardia, prevention of tachyarrhythmias and normalization of heart rate after exercise was investigated. Propranolol, practolol and prindolol significantly (p less than 0.01-0.05) reduced the heart rate at rest and during exercise and favourably influenced the normalization of the heart rate after exercise. The effect on effort tolerance (work done till the submaximal heart rate was reached) was significantly better after propranolol (versus prindolol and verapamil) and practolol (versus verapamil) only. Verapamil showed a consistent effect only given intravenously in paroxysmal tachycardia while in the majority of patients there was no difference between oral verapamil and placebo.     

普罗帕酮、维拉帕米治疗阵发性室上性心动过速的疗效观察

目的:观察普罗帕酮、维拉帕米治疗阵发性室上性心动过速(PSVT)患者的疗效及安全性。方法:将87例阵发室上性心动过速患者随机分为普罗帕酮组、维拉帕米组。对比2组患者:转复率、恢复正常窦性心律的时间和治疗过程中的不良反应发生率。结果:阵发室上性心动过速转复率:普罗帕酮组为98%,维拉帕米组为88%。恢复正常窦性心律的时间:普罗帕酮组平均为5.8分钟,维拉帕米组平均为7.5分钟。不良反应发生率:普罗帕酮组为8%,维拉帕米组为16%。结论:普罗帕酮转复率较维拉帕米高,复律时间较维拉帕米快,不良反应较维拉帕米低。     

Pharmacokinetics of verapamil in patients with hypertension

Summary Twelve hypertensive patients (WHO Stage I-II) were given oral verapamil (Isoptin) b.d. or t.d.s. as long-term treatment. The pharmacokinetics of verapamil and norverapamil were studied both after single and b.d. and t.d.s. doses of verapamil 240, 360 or 480 mg daily adjusted according to the blood pressure response. The apparent oral clearance of verapamil was decreased after both the twice and thrice daily dosage regimens (1.38 and 1.841/min, respectively) as compared to the single dose (4.39 l/min). The plasma half-life of verapamil was increased from 3.34 h (single dose) to 4.65 h (b.i.d.). Decreased elimination of norverapamil was also found after multiple doses of verapamil, as shown by an increase in the adjusted AUC of norverapamil (adjusted to a verapamil dose of 80 mg), namely from 574.9 h·ng·ml^–1 (single dose) to 1172 h·ng·ml^–1 (b.d.) and to 841 h·ng·ml^–1 (t.d.s.). The plasma half-life of norverapamil increase from 5.68 h to 7.34 h during twice daily dosing. During thrice daily verapamil, no increase in plasma half-life was found either for verapamil or norverapamil, probably due to the relatively short sampling time (6 h). The plasma concentration of verapamil and the reduction in supine systolic and diastolic blood pressure were correlated. The mean decrease in supine systolic blood pressure was 5.8 mm Hg per 100 ng verapamil/ml plasma, and for diastolic pressure 2.9 mm Hg per 100 ng verapamil/ml plasma. The mean steadystate plasma concentrations of verapamil were similar after twice and thrice daily dosing regimens, which agrees with the clinical observation that blood pressure control in hypertensive patients is as good after verapamil b.d. and t.d.s.     

伊贝沙坦和缓释维拉帕米对高血压患者交感活性的影响

目的 用握力试验激活交感神经系统,评价服用伊贝沙坦和缓释维拉帕米8周后交感活性的变化。方法 48名轻中度高血压患者经2周安慰剂期后,随机分入伊贝沙坦组(n=24,150mg,每日1次)和缓释维拉帕米组(n=24,240mg,每日1次)。于安慰剂期末和药物治疗8周末各进行1次握力试验,并记录静息和负荷状态下的血压和心率。结果 伊贝沙坦组服药后静息收缩压和舒张压显著降低(P<0.01),下降幅度与缓释维拉帕米组无显著性差异(P>0.05)。握力试验中,服用伊贝沙坦后可使血压上升幅度从30.6±8.69/20.0±4.51mmHg降至15.2±5.90/14.3±4.26mmHg,疗效与缓释维拉帕米组相似。结论 服用伊贝沙坦不仅可降低静息血压,而且可降低负荷状态下的血压,其作用与缓释维拉帕米相似。     

参松养心胶囊联合维拉帕米治疗室性心动过速的疗效观察

目的研究参松养心胶囊联合盐酸维拉帕米缓释片治疗室性心动过速的临床疗效。方法选取2016年8月—2017年7月荆州市第二人民医院接收的120例室性心动过速患者作为研究对象,将所有患者随机分为对照组和治疗组,每组各60例。对照组患者清晨口服盐酸维拉帕米缓释片,1片/次,1次/d。治疗组在对照组的基础上口服参松养心胶囊,3粒/次,3次/d。两组均持续治疗4周。观察两组患者的临床疗效,比较两组治疗前后的心率、PR间期、QT间期、复律时间和左心室功能。结果治疗后,对照组和治疗组的总有效率分别为88.33%、93.33%,两组比较差异具有统计学意义(P0.05)。治疗后,两组心率、QT间期、PR间期和复律时间均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组各指标均显著低于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组左心室射血分数(LVEF)明显升高,左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组左心室功能明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论参松养心胶囊联合盐酸维拉帕米缓释片治疗室性心动过速具有较好的疗效,能够显著改善患者心率和心功能,安全性较好,值得临床推广应用。     

Pharmacokinetics of verapamil in patients with renal failure

Summary The pharmacokinetics of verapamil was studied in patients with end-stage chronic renal failure and in normal subjects after i.v. injection of 3 mg and a single oral dose of 80 mg. Plasma levels of verapamil and its active metabolite norverapamil were measured by HPLC. After i.v. injection, the terminal phase half-life and total plasma clearance of verapamil in both groups were similar. Haemodialysis did not change the time course of plasma verapamil levels after i.v. administration. After a single oral dose, the plasma levels of verapamil and norverapamil in both groups of subjects were similar. Subsequently, normal volunteers and patients with renal failure were treated for 5 days with oral verapamil 80 mg t.d.s. There was no difference between the 2 groups of subjects in the trough and peak levels of verapamil or of norverapamil. Intravenous and oral administration of the calcium channel blocking agent had similar effects on blood pressure, heart rate and the PR-interval in the electrocardiogram in both groups. The study demonstrated that the disposition of verapamil was similar in normal subjects and in patients with renal failure.Some of the results were presented at the Joint Spring Meeting of the German Pharmacological and Physiological Societies in Mainz, 1983 (Schols et al. 1983)     

Effects of captopril on blood pressure and respiratory function compared to verapamil in patients with hypertension and asthma.

Seventeen adult patients with moderate and stable bronchial asthma and established essential hypertension (WHO I or II) were evaluated in a randomized, double-blind, crossover study of the effects of captopril (50-100 mg/day) and verapamil (160-240 mg/day) on blood pressure, orthostatic reactions, respiratory function, and asthmatic symptoms. The effect of both drugs on blood pressure was significant. Blood pressure (mean of 161/98 mm Hg initially) decreased to a mean of 147/90 and 160/91 mm Hg on captopril and verapamil, respectively, with normal orthostatic changes. There were no significant differences in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximal expiratory flow at 50% of FVC (MEF50), or peak expiratory flow (PEF) measurements at the end of each treatment period. The subjective severity of asthma did not change significantly during the trial. No significant cough symptoms were reported on captopril.     

胺碘酮治疗老年人快速型室上性心动过速的临床疗效

目的探讨胺碘酮治疗老年人快速型室上性心动过速的疗效与安全性。方法98例患者随机分为两组,胺碘酮组50例,西地兰组48例。分别给予胺碘酮,西地兰静脉注射治疗,同时观察心率、血压、起效时间及不良反应。结果胺碘酮组有效率及平均起效时间均优于西地兰组(P<0.05),两组均未出现明显的不良反应。结论应用胺碘酮治疗老年人快速型室上性心动过速是安全有效的。     

Effects of verapamil on the pharmacokinetics of puerarin in rats

Abstract

1. The oral bioavailability of puerarin is poor which hindered its clinical performance.

2. This study investigates the effects of verapamil on the pharmacokinetics of puerarin in rats.

3. The pharmacokinetics of orally administered puerarin (50?mg/kg) with or without verapamil pretreatment (10?mg/kg/day for 7?days) were investigated. The plasma concentration of puerarin was determined using LC-MS/MS method, and the pharmacokinetics profiles were calculated and compared. Caco-2 cell transwell model was also used to investigate the effects of verapamil on the transport pf puerarin.

4. The results showed that when the rats were pretreated with verapamil, the maximum concentration (C_max) of puerarin increased from 683.7?±?51.2 to 933.5?±?75.8?ng/mL (p?<?0.05), and the area under the concentration-time curve from zero to infinity (AUC_0-inf) also increased from 3687.3?±?444.6 to 5006.1?±?658.6?μg·h/L (p?<?0.05). The Caco-2 cell transwell experiments indicated that verapamil could decrease the efflux ratio of puerarin from 1.90 to 1.19 through inhibiting the activity of P-gp.

5. In conclusion, these results indicated that verapamil could affect the pharmacokinetics of puerarin, possibly by increasing the systemic exposure of puerarin by inhibiting the activity of P-gp.

     

Effects of canrenone in patients with metabolic syndrome

Background: Metabolic syndrome is becoming a common disease due to a rise in obesity rates among adults.

Objectives: The aim was to evaluate the effects of canrenone compared to placebo on metabolic and inflammatory parameters in patients affected by metabolic syndrome.

A total of 145 patients were treated with placebo or canrenone, 50 mg/day, for 3 months and then 50 mg b.i.d. till the end of the study.

Blood pressure, body weight, body mass index, fasting plasma glucose (FPG), fasting plasma insulin, HOMA-IR, lipid profile, plasma aldosterone, brain natriuretic peptide, high-sensitivity C-reactive protein (Hs-CRP), tumor necrosis factor-α (TNF-α) and M value were evaluated.

Results: A decrease of blood pressure was observed in canrenone group compared to baseline; moreover, systolic blood pressure value recorded after 6 months of canrenone therapy was lower than the one recorded with placebo. Canrenone gave a significant decrease of FPI and HOMA index, and an increase of M value both compared to baseline and to placebo. Canrenone also decreased triglycerides and FPG was not observed with placebo. Canrenone also decreased plasma aldosterone, Hs-CRP and TNF-α compared to baseline and to placebo.

Conclusion: Canrenone seems to be effective in reducing some factors involved in metabolic syndrome and in improving insulin-resistance and the inflammatory state observed in these patients.     

探索临床路径和常规护理在肾病综合征患者护理中的效果对比

目的：比较临床路径和常规护理在肾病综合征患者护理中的效果差异。方法选取本院收治的62例肾病综合征患者,随机均分为对照组和观察组,对照组给予常规护理,观察组给予临床路径护理,比较两组患者住院时间、住院费用、健康教育达标率、护理满意度和复发率的差异。结果观察组住院时间和住院费用均显著少于对照组（P〈0.05）;观察组健康教育达标率和护理满意度分别为100%和96.8%,均显著高于对照组的61.3%和80.6%（P〈0.05）;观察组复发率显著低于对照组（P〈0.05）。结论临床护理路径应用于肾病综合征患者效果确切,高效经济,显著提高了健康宣教效果及护理满意度。