氯沙坦对老年高血压病患者颈动脉结构及内皮功能的影响

为观察氯沙坦(Losartan)对老年高血压病患者颈动脉的内径、内中膜复合体以及血流介导的血管内皮舒张功能的影响.对15例老年高血压病患者服用Losartan 50 mg/d3个月,治疗前后监测24 h动态血压,并采用高分辨超声技术和肱动脉充血反应法,检测患者颈动脉的内径、内中膜复合体厚度和充血前后肱动脉内径变化率.发现Losartan使患者24 h收缩压从(143.13±2.95)mmHg(1 kPa=7.5 mmHg)降至(134.87±1.64)mmHg,下降(8.62±0.80)mmHg(P<o.001).24 h舒张压均值从(92.47±2.59)mmHg降至(86.27±2.40)mmHg,下降(6.20±o.53)mmHg(P<0.001).颈动脉内径由(6.63±0.98)mm减为(6.23±1.03)mm,减少(0.39±0.04)mm;内中膜复合体从(0.95±0.19)mm降至(0.81±0.21)mm,减少(0.13±0.02)mm(P<0.001)、肱动脉内径变化率由(4.71±3.18)%增至(10.61±3.03)%,增加(5.92±0.26)%(P<0.001).结果表明Losartan在控制老年高血压病患者血压的同时,还能逆转颈动脉壁的早期异常,修复血管内皮功能.     

吲达帕胺降压及逆转左室肥厚的效果观察

目的观察吲达帕胺治疗轻、中度原发性高血压(EH)的降压疗效及对左心室肥厚(LVH)的逆转作用.方法选择32例轻、中度伴LVH的EH患者,每日1次服用吲达帕胺2.5mg,疗程12周,治疗前后进行测血压及超声心动图检测室间隔厚(IVST)和左室后壁厚度(LVPWT).结果吲达帕胺能显著降低血压(P＜0.01),平均收缩压由(169±9)mmHg降至(131±6)mmHg,平均舒张压由(101±6)mmHg降至(82±7)mmHg;吲达帕胺能显著改善LVH(P＜0.01),IVST由(13.8±1.2)mm减至(12.8±1.4)mm,LVPWT由(13.2±1.5)mm减至(12.1±1.1)mm.结论吲达帕胺能有效降低轻、中度EH患者的血压及逆转LVH,降低靶器官损害的危险性.     

经皮穿刺球囊导管二尖瓣成形术的临床应用（附45例报告）

应用经皮穿刺球囊导管二尖瓣成形术(PBMV)治疗45例风湿性心脏病二尖瓣狭窄(MS)患者,均获成功。其二尖瓣瓣口面积从术前的1.05±0.31cm~2增至术后的2.10±0.51cm~2(P<0.001),二尖瓣跨瓣膜压力阶差从术前的2.6±0.7kPa(19.4±5.2mmHg)降至术后的1.1±0.2kPa(8.0±1.8mmHg)(P<0.001),左心房平均压从术前的3.0±0.9kPa(22.5±7.1mmHg)降至术后的1.4±0.5kPa(10.6±3.4mmHg)(P<0.001),左心房内径72h 内从术前的46.6±5.7mm 降至术后的38.9±5.1mm(P<0.001);患者心功能均明显改善,心前区舒张期杂音消失或明显减弱,且无任何严重并发症,提示该技术系一项非开胸治愈 MS 的可靠方法。     

保留尿道内括约肌腔内前列腺切除压力-流率的临床研究

目的应用尿动力学检查指标对保留尿道内括约肌腔内前列腺切除术后的尿动力学改变进行研究。方法240例BPH患者采用电汽化或等离子汽化治疗,术前、术后的国际症状评分和尿动力学检查。结果最大尿流率(Qmax)由术前(8.02±4.02)mL/s增加至术后的(17.83±4.78)mL/s,最大尿流量术前的(143.33±57.63)mL增加至术后的(245.56±68.73)mL,术前残余尿(PVR)为(87.92±73.47)mL减少至术后的(9.31±8.49)mL,IPSS评分由术前23.44分降至10.73分,剩余分数(RF)由术前的(0.54±0.22)降至术后的(0.03±0.05),最大尿流率时膀胱逼尿肌压由术前的78.41cmH2O下降至术后的38.68cmH2O,膀胱颈压由术前的36.35cmH2O下降至术后的8.26cmH2O,膀胱顺应性由术前的22.76mL/cmH2O上升至术后的41.22mL/cmH2O。RF与Qmax呈显著负相关(r=-0.253,P<0.01),PRV与Qmax呈显著负相关(r=-0.220,P<0.05)。RF与PRV呈正相关(r=0.2870,P<0.05)。A一D组间差异无显著性(P>0.05)。结论该研究以客观的指标证实保留尿道内括约肌腔内前列腺切除可切实地解除由BPH所致的膀胱流出道梗阻改善膀胱功能。     

乌拉地尔治疗高血压急症的疗效观察

目的观察静脉注射剂乌拉地尔对高血压急症的疗效.方法选择89例高血压急症女性患者,静脉使用乌拉地尔治疗,并记录用药后5min、0.5h、1h、2h、4h、6h、12h及24h血压及心率.结果89例患者在用药后5min内血压明显下降,收缩压由(218.2±14.7)mmHg降至(201±13.3)mmHg(1mmHg=0.133kPa),P＜0.01,舒张压由(119.3±6.7)mmHg降至(109.7±5.4)mmHg,P＜0.01.显效率100%.仅有2例出现头晕,但可耐受.结论静脉使用乌拉地尔降低血压起效迅速、疗效肯定、使用安全、简单、副作用轻微,可作为高血压急症的首选药.     

硝苯吡啶对无并发症的高血压病患者疗效观察

10例无并发症的高血压病患者于口服国产硝苯吡啶10 mg 3次/d 后第3 d 及1周检测血压及应用超声心动图检测左心功能。血压由21.5±3.4/12.4±1.4 kPa(161.4±25.9/92.8±10.8 mmHg)分别降至18.7±1.6/11.3±1.2 kPa(139.8±11.8/84.6±9.4 mmHg)、17.9±1.7/11.3±1.2 kPa(134.2±12.7/84.6±8.7 mmHg)(P 均<0.01);平均动脉压由15.2±0.9 kPa(114.2±7.7 mmHg)分别降至13.9±0.9 kPa(104.2±7.3 mmHg)、13.6±0.8 kPa(102.0±6.3 mmHg)(P 均<0.01),总外周阻力由1741.0±392.5 dyn·s/cm~5分别降至1514.0±175.5(P>0.05)及1263.1±237.6 dyn·s/cm~5(P<0.01)。舒张早期流速积分由7.2±1.3分别增至8.4±2.6及8.7±2.1((P 均<0.05),舒张早期及心房收缩期峰值流速、心指数等指标亦有所改善。提示国产硝苯吡啶能有效持久降压并改善左心功能。     

鼻塞持续气道正压在早产儿动脉导管未闭合并呼吸暂停的应用

目的探讨鼻塞持续气道正压对早产儿PDA合并AOP的治疗机理 ,评价疗效。方法选择监护病房入院临床资料完整 ,平均日龄 3.6± 1.8天 ,平均胎龄 33.2± 3.2周的 2 5例早产患儿 ,同时符合早产儿PDA诊断标准、早产儿呼吸暂停诊断标准的2 5例患儿 ,分别观察记录应用NCPAP治疗前 6小时 ,治疗后 6小时、12小时的临床症状、体征、心电监护参数、动脉血气及超声心动图左心室射血功能变化 ,进行自身前瞻性对比分析。结果与应用NCPAP治疗前比较 ,患儿一般状况显著改善 ,喂养困难 ,青紫、气促、呻吟、吸气性三凹征逐渐减轻至消失。 (1)呼吸暂停发作明显减轻。发作频率由治疗前 (11± 2 )次 /小时分别降至 (7± 3)把小时和 (3± 2 )次 /小时 (P均 <0 .0 1) ;呼吸暂停发作时SpO2 下降程度由 (6 0± 8) %分别升至 (74± 10 ) %和 (87± 5 ) %(P均 <0 .0 1)。 (2 )呼吸衰竭得以改善。呼吸频率由 (85± 7)次 /min分别降至 (74± 12 )次 /min和 (6 0± 5 )次 /min(P均 <0 .0 0 1) ;血气分析PH值由 (7 2 2 5± 0 0 17)分别升至 (7 2 83± 0 0 4 7)和 (7 377± 0 0 5 3) (P <0 0 1) ,PsO2 由 (44 3± 4 6 )mmHg分别升至(49 8± 6 9)mmHg和 (5 8 6± 4 7)mmHg(P =0 0 1) ,PaCO2 由 (6 0 7± 3 9)mmHg分别降至 (5 2 6     

143例经皮球囊二尖瓣成形术疗效的评价

目的 :评价经皮球囊二尖瓣成形术 (PBMV)治疗后的疗效。方法 :采用改良Inoue方法 ,自 1 993年 5月至 2 0 0 1年 1 2月对 1 4 3例风湿性二尖瓣狭窄患者行PBMV治疗 ,并进行超声心动图和临床心功能评价。结果 :1 4 0患者成功地完成了PBMV ,3例失败 ,手术成功率为 97.9%。二尖瓣口面积 (MVA)由 1 .0 3± 0 .55cm2 增至 2 .0 3± 0 .37cm2 (P <0 .0 0 1 ) ,二尖瓣跨瓣压差 (MVG)由 1 8.1± 4 .8mmHg降至 4 .1± 2 .3mmHg(P <0 .0 0 1 ) ,左心房平均压 (MLAP)由 2 3 .1± 1 0 .1mmHg降至 1 0 .8± 9.2mmHg(P <0 .0 0 1 ) ,左心房内径 (LAD)由 4 .67± 1 .1 0cm减小至 4 .1 3± 0 .59cm(P <0 .0 0 1 ) ,左心室内径 (LVD)由 4 .54± 0 .32cm到 4 .58± 0 .2 8cm (P >0 .0 5) ,心功能级(NYHA)由 2 .69± 0 .74级改善至 1 .2 1± 0 .41级 (P <0 .0 0 1 )。结论 :PBMV术后临床疗效良好 ,是可以替代二尖瓣闭式分离的方法。     

机械通气抢救急性左心衰竭合并呼吸衰竭的临床疗效观察

目的:探讨机械通气抢救急性左心衰竭合并呼吸衰竭的疗效及临床应用价值。方法:26例重症急性左心衰竭伴呼吸衰竭患者在传统常规治疗的基础上加用机械通气治疗。观察通气前后心率、呼吸频率、平均动脉压、动脉血气分析(pH、Pa02、Sa02、PaC02)的变化及临床症状的改善情况。结果:机械通气治疗后,26例患者中23例病情好转,3例死亡。通气后患者的呼吸困难明显改善,肺部罗音明显减少。通气1小时后呼吸频率由(33.2±6.3)次/min降至(21.2±3.3)次/min(P<0.05),心率由(116.5±14.3)次/min降至(86.7±11.6)次/min(P<0.05),平均动脉压由(96.8±7.2)mmHg降至(83.5±4.2)mmHg(P<0.05)。通气前及通气后1小时查血气,Sa02由(75.3±7.9)%升高至(95.8±3.6)%(P<0.01),Pa02由(49.5±8.4)mmHg升高至(84.4±5.1)mmHg(P<0.01),PH、PaC02变化无显著差异。结论:对各种不同原因引起的急性左心衰竭合并呼吸衰竭患者,机械通气治疗能有效的改善患者的临床症状及低氧血症,是抢救急性左心衰竭合并呼吸衰竭的有效辅助措施。     

扩张型心肌病心电图随病程进展的变化

目的探讨扩张型心肌病心电图随病程进展的变化.方法采用回顾分析的方法,选取具有2年以上病史资料并未采取规范治疗的扩张型心肌病病人,统计其临床表现、治疗方法、实验室检查、心电图及超声心动图资料的变化,共两次,间隔2年以上.结果共分析35例病例,其中缺血性14例,原发性21例.男性20例,女性15例,平均年龄(62.7±9.4)岁.从出现充血性心力衰竭临床症状至第一次检查的平均时间是(5.6±14.9)年,从第一次检查至第二次检查平均间隔时间是(3.5±2.1)年.两次检查心功能(NYHA分级)分别为(2.7±0.9)和(2.5±0.7)(P＞0.05),左室射血分数由(0.45±0.21)降低至(0.37±0.34)(P=0.24),左房内径(cm)由(4.12±0.78)增加至(4.79±0.87)(P=0.0012),左室舒张末内径(cm)由(6.77±1.29)增加至(7.65±1.5)(P=0.0105),左室收缩末内径(cm)由(5.05±1.45)增加至(5.97±1.33)(P=0.0073).心电图PR间期(ms)由(166±52)增加至(198±51)(P=0.0115),分别有7/35例(20.0%)和9/35例(25.7%)超过200 ms,QRS间期(ms)由(110±44)增加至(159±49)(P＜0.0001).35例病人中23例出现双峰P波,两次检查P波宽度(ms)分别为(128±46)和(141±59)(P=0.27),随访前后心电图V1～V6导联QRS高度(mm)分别(162±93)和(152±79)(P=0.65),均明显高于正常范围,QT间期及心律失常发生比例没有明显变化.结论随着扩张型心肌病心脏的扩大,可出现严重的传导障碍,不同程度地累及心房、房室传导系统和左心室.心电图表现为PR间期延长、QRS间期加宽,可出现双峰P波及P波增宽.这些变化可造成左心电和机械的不同步而影响心脏收缩功能.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.