心酰胺治疗老年心力衰竭的临床观察

目的 讨论心酰胺在治疗老年心力衰竭的临床疗效.方法 将102例心力衰竭患者随机分为两组.对照组采用常规治疗;治疗组在常规治疗的基础上加用心酰胺120～150 mg加入5%葡萄糖注射液200 ml中静脉输注,1次/d,10～15 d为1个疗程.结果 治疗组治疗后每搏输出量、射血分数、心排指数均较治疗前明显改善(P<0.01);与对照组治疗后比较每搏输出量、射血分数差异有统计学意义(P<0.05).结论 心酰胺能明显增强心力衰竭患者的左室收缩功能和泵血功能.     

When To Hospitalize in Congestive Heart Failure

Mandatory for impending pulmonary edema, hospitalization is also indicated for the minority of patients who no longer respond to the measures that permit most to be treated at home. Hospitalization gives the physician an opportunity to improve his application of the three “D's” of therapy-digitalis, diuretics, and diet-in the particular case, and to determine why the patient has become refractory to treatment.     

乌拉地尔治疗慢性充血性心力衰竭临床观察

目的 观察乌拉地尔治疗慢性充血性心力衰竭临床效果。方法 将76例慢性充血性心力衰竭住院患者随机分为2组，在常规治疗基础上，A组给予乌拉地尔50～100mg加液体持续静脉滴注24～72h后，改为每日1次静脉滴注，连用5～7d；B组给予硝普钠12．5～25．0mg加液体持续静脉滴注，用法同A组。结果A组显效60．5％，有效34．2％，总有效率99．7％；B组显效55．3％，有效36．8％，总有效率92．1％。2组间疗效比较，差异无统计学意义（P〉0．05）。结论乌拉地尔治疗慢性充血性心力衰竭安全，有效，不良反应小，作用缓和平稳，具有临床推广价值。     

小剂量醛固酮拮抗剂治疗慢性充血性心力衰竭的临床疗效观察

目的观察小剂量安体舒通治疗CHF的疗效及安全性。方法选择109例无休克及严重肝肾功能不全及高血钾的CHF患者为对象，将所有病人随机分成治疗组56例、对照组53例．对照组应用常规强心、利尿、ACEI或ARB等基础治疗．治疗组在基础治疗的同时，给予安体舒通20mg／d，24周为1疗程。服药前及服药24周后分别测定心电图（ECG）、动态心电图（Holter）、超声心动图及血生化指标，观察治疗效果、不良反应：结果CHF治疗的总有效率．2组间无统计学意义（P〉0．05），但按心功能分组研究发现，NYHA分级心功能Ⅳ级的2组间疗效比较，治疗组高于对照组（P〈0．05）、治疗组治疗后的室性心律失常明显减少（P〈0．05），左室舒张末内径减少（P〈0．05），左室射血分数增加（P〈0．05），低钾及低镁血症得到纠正．对血生化无不良影响，无严重的不良反应发生．结论小剂量安体舒通治疗CHF安全有效。     

环磷腺苷葡胺治疗妊娠期心力衰竭疗效观察

目的观察环磷腺苷葡胺治疗妊娠期心力衰竭的疗效。方法120例妊娠期心力衰竭心功能Ⅱ~Ⅳ级住院患者,随机为治疗组(60例)和对照组(60例)。治疗组用环磷腺苷葡胺120 mg加入5%葡萄糖注射液250 ml中,对照组用能量合剂250 ml,每日一次静脉滴注,其它治疗两组相同。连续10日为一疗程。结果疗程结束后,总有效率:治疗组96.67%,对照组73.33%(P<0.01)。结论环磷腺苷葡胺能有效的治疗妊娠期心力衰竭。     

硝普钠治疗老年充血性心力衰竭的临床应用

目的观察静脉应用硝普钠治疗老年充血性心力衰竭患者的疗效及安全性。方法对98位老年充血性心力衰竭患者随机分为硝普钠组和硝酸甘油组,均南微量注射泵经静脉泵入,开始剂量分别为6．25μg／min和5μg／min,根据血压及临床表现调整剂量持续静脉泵入。结果硝普钠组总有效率为96％,硝酸甘油组为78．7％,两组比较,硝普钠组明显优于硝酸甘油组（P〈0．01）。结论硝普钠对老年充血性心力：莨竭患者疗效显著,不良反应较少,对常规治疗效果不佳的老年充血性心力衰竭患者,可应用硝普钠治疗。     

普伐他汀短期治疗充血性心衰对炎症因子的影响

目的观察短期普伐他汀治疗对慢性心衰患者血浆肿瘤坏死因子（TNF—d）,高敏C反应蛋白（hs-CRP）和白介素-6（IL-6）的影响,并分离外周血单个核细胞（PBMC）,观察普伐他汀对单核细胞分泌IL-6的影响,探讨普伐他汀在慢性心力衰竭中的作用。方法32名慢性心衰患者被随机分为A、B组。A组接受常规治疗（对照组,n=14）。B组在常规治疗的基础上加用普伐他汀20mg／d治疗2周（普伐他汀治疗组,n=18）。在治疗前后分别检测左室舒张末期内径（LVED）和射血分数（LVEF）,血浆TNF-α、hs—CRP和IL-6的浓度,同时分离外周血单个核细胞,检测培养上清液IL-6的浓度。心功能测定是应用彩色超声诊断仪进行左室功能的测定,LVEF应用Simpson法在四腔心切面测定。血浆TNF—α．血浆IL-6和上清液IL-6的浓度,均采用夹心酶联免疫吸附测定法（enzyme—linkedim munosorbent assay,ELISA）测定。结果经治疗2周后．对照组的血脂水平无显著性变化。与治疗前相比,普伐他汀治疗组对慢性心衰患者的TC和LDL明显下降,均达到显著性差异（P〈0．05）。与治疗前比较,对照组和普伐他汀组LvEF均未达到显著性差异。经治疗2周后,与治疗前比较,对照组和普伐他汀治疗组血浆hs—CRP水平,血浆TNF—α浓度,血浆IL-6浓度均显著降低（P〈0．01）。与对照组相比,普伐他汀组血浆hs—CRP水平、血浆TNF—α浓度以及血浆IL-6浓度下降更为明显（P〈0．05）与治疗前比较,对照组和普伐他汀治疗组外周血单个核细胞分泌的IL-6浓度均显著下降（P〈0．01）。与对照组相比,外周血单个核细胞分泌的IL-6浓度下降更为明显（P〈0．05）。结论普伐他汀短期治疗充血性心力衰竭能够降低血浆hs—CRP、TNF—α、IL-6,并可抑制外周血单个核细胞分泌IL-6,但不影响患者的心功能。提示普伐他汀在慢性心力衰竭中具有抗炎作用,可能与抑制单核细胞的活性有关。     

Diuretics in the Management of Congestive Heart Failure

The various classes of diuretic agents have distinct and very often complementary sites and modes of action within the nephron. By defining these differences, investigators have provided the clinician with rational bases for designing diuretic regimens that not only assure maximum benefits for the patient but also point to logical solutions for such problems as refractoriness and hypokalemia if these occur.     

Severe Congestive Heart Failure With Progressive Dyspnea

Earlier this summer, the VIII International Conference on AIDS was held in Amsterdam, in conjunction with the Third World Congress on Sexually Transmitted Diseases. Hospital Practice Senior Editor Nancy Berezin attended the meeting and whatjollows is her report on some salient developments. Ms. Berezin also prepared a more impressionistic presentation of the International Conference that appears as the editorial in this issue.

The Amsterdam meeting report also serves to introduce two articles on the current status of HN chemotherapy and of chemotherapy for the opportunistic diseases associated with HN injection. These articles are, in fact, revisions of articles previously published in Hospital Practice in 1991, revisions necessitated by the considerable progress made in therapy during the past year.     

充血性心力衰竭治疗的新认识与进展

充血性心力衰竭是大多数心血管疾病的最终归宿,也是最主要的死亡原因。近年来,随着人们对心力衰竭发病机理和病理生理改变认识的深入,心力衰竭治疗方法上有了很大改变,已经不再是单纯的强心,利尿,扩血管治疗。如今,ACEI,β受体阻滞剂,螺内酯为核心的"神经内分泌拮抗"药物以及"药物电机械综合治疗"等方法的研究都为心力衰竭的治疗提供了新的思路,延长了患者的生命。     

充血性心力衰竭治疗的新认识与进展

充血性心力衰竭是大多数心血管疾病的最终归宿,也是最主要的死亡原因.近年来,随着人们对心力衰竭发病机理和病理生理改变认识的深入,心力衰竭治疗方法上有了很大改变,已经不再是单纯的强心,利尿,扩血管治疗.如今,ACEI,β-受体阻滞剂,螺内酯为核心的"神经内分泌拮抗"药物以及"药物-电机械综合治疗"等方法的研究都为心力衰竭的治疗提供了新的思路,延长了患者的生命.     

参附汤加味在充血性心衰治疗中的应用体会

目的中西药联合治疗提高充血性心力衰竭的临床疗效。方法将充血性心力衰竭患者随机分为治疗组和对照组。2组常规给予血管扩张剂、强心利尿剂,转换酶抑制剂,配合吸氧对症治疗,治疗组同时给予参附汤加味,观察治疗结果。结果治疗组和对照组患者临床症状均有不同程度好转,治疗前后对比,治疗组较对照组心胸比率有明显缩小,其他检查指标较对照组有明显改善。结论参附汤加味与西药联合应用治疗充血性心力衰竭,疗效优于单纯西药治疗,且降低了西药的用药量及毒副作用,相对安全。     

参麦注射液治疗老年心力衰竭96例疗效观察

目的：探讨参麦注射液滴注治疗老年心力衰竭的临床疗效。方法：将本院2010年2月-2012年1月收治的96例老年心力衰竭患者随机分为治疗组和对照组各48例,两组均给予常规治疗,治疗组在常规治疗的同时加用参麦注射液。结果：治疗组总有效率95.83%,明显优于对照组的83.33%,差异有统计学意义（P〈0.05）。结论：参麦注射液治疗老年心力衰竭疗效佳,值得临床推广应用。     

小剂量螺内酯联合常规治疗对慢性充血性心力衰竭的效果

目的观察小剂量螺内酯联合常规治疗对慢性充血性心力衰竭的效果。方法选取我院2014年4月至2016年5月收治的200例慢性充血性心力衰竭患者,随机分为对照组和观察组,各100例。对照组行常规治疗,观察组在此基础上加用小剂量螺内酯。比较两组患者的心功能指标、治疗效果、BNP和ET水平。结果治疗后,观察组的总有效率为95.0%,明显高于对照组的85.0%(P<0.05)。入院时两组患者的心功能指标、BNP和ET水平比较差异无统计学意义(P>0.05)。治疗后,观察组的心功能指标、BNP和ET水平均优于对照组(P<0.05)。结论对慢性充血性心力衰竭采用小剂量螺内酯联合常规治疗,治疗效果较好,能够明显改善心功能。     

Specialist Nurse-Led Intervention in Outpatients with Congestive Heart Failure

Congestive heart failure (CHF) encompasses a spectrum of clinical syndromes and presentations. It affects 1–2% of the population in the UK and is associated with significant mortality which is comparable to most cancers. It accounts for more than 5% of adult medical admissions in the UK, with significant annual re-admission rates. Improved understanding of the pathophysiology of CHF has resulted in significant advancements in CHF management. Current pharmacologic agents, such as ACE inhibitors, β-adrenoceptor antagonists and spironolactone, influence symptoms and improve mortality. Despite this, many patients still require hospitalization. Multiple, potentially reversible factors are involved which, if addressed effectively, may result in significant reductions in re-admission rates. Patients with CHF often have other conditions, such as respiratory disease, resulting in prolonged lengths of stay. Suboptimal care and failure to adhere to management guidelines is also a preventable cause for re-admission. There has been an increasing need to develop adjunctive, non-pharmacologic strategies for managing CHF, which are designed to improve the patient’s functional status and quality of life. Key elements include systematic follow-up care and patient education. The concept of intensive outpatient or home-based CHF intervention has been developed and extensively evaluated in several randomized controlled trials. Early studies were inconclusive but provided an indication that discharge planning and home-based education are valuable strategies. Recently, an increasing number of studies utilizing the CHF nurse practitioner have provided positive results for non-pharmacologic intervention and demonstrate the potential of these interventions to reduce admissions to hospital by up to 50%. These studies had specific inclusion criteria and could not be generalized to the CHF population as a whole. The Study to Evaluate the effectiveness of Nurse-led Intervention in the management of outpatients with heart Failure (SENIF) explored whether a similar approach to CHF management was beneficial in a typical outpatient population of patients with CHF. Over 12 months, fewer intervention group patients required admission, resulting in 69% fewer hospital days. Cost effectiveness of nurse-led intervention has been suggested in several studies including SENIF, resulting from reduced hospitalizations and re-admissions, which vastly outweighed the modest increase in expenditure required to run the programs. Hospitalizations because of CHF impact greatly on limited healthcare resources. Specialist nurse-led intervention in CHF is a cost-effective, non-pharmacological strategy to help optimize CHF management.     

Introduction: Modern Aspects of Congestive Heart Failure

Abstract

Background: Atherothrombosis is a systemic disease that may manifest as acute ischemic events in multiple vascular beds. Patients who have experienced an atherothrombosis-related ischemic event in 1 vascular bed are at risk for developing ischemic events in other vascular beds. Antiplatelet therapy demands an understanding of the balance between arterial thrombosis benefit and adverse event risk. Clinical trials indicate that dual antiplatelet therapy with aspirin and the newer thienopyridines increases the risk of bleeding in patients with acute coronary syndromes (ACS) with prior cerebrovascular events. Informed clinical decision making requires a better understanding of the real-world prevalence of cerebrovascular events. Objective and Purpose: To estimate the prevalence of stroke and/or transient ischemic attack (TIA) among patients with ACS within US health plan populations. Methods: A retrospective, observational cohort study was conducted of patients with ACS in 5 health care claims databases. The index event was defined as the first documented inpatient health care claim for myocardial infarction or unstable angina. Patients with ≥ 12 months of pre-index medical care encounter information were included. Stroke/TIA was identified by the first health care claim for these conditions any time prior to or within 90 days following the index ACS event. Results: Across all databases, between 3.8% and 15.7% of patients with ACS had prior stroke/TIA and between 3.4% and 11.7% of patients with ACS with no history of cerebrovascular events had documented stroke/TIA following the index ACS hospitalization. Conclusion: Despite important differences between the various database populations, there is a high prevalence of documented stroke/TIA in patients with ACS both prior to and following the ACS event. These real-world findings, set within the context of the increased bleeding risk observed with the newer thienopyridines, are important considerations when selecting antiplatelet therapy for patients with ACS.