卡维地洛治疗轻、中度原发性高血压的临床疗效

目的 :观察卡维地洛治疗轻、中度原发性高血压的降压疗效。方法 :60例原发性高血压患者被随机分为卡维地洛组 (卡组 )和阿替洛尔组 (对照组 ) ,各 3 0例 ,分别给予卡维地洛 10～ 40mg/d和阿替洛尔 2 5～ 10 0mg/d ,疗程 8周。治疗前及治疗后 2、4、6、8周末测量坐位血压及心率 ,记录不良反应。结果 :( 1)治疗后两组病人的血压均有明显下降。卡组SBP/DBP降低 2 8.3 / 2 0 .1mmHg( 16.9%/ 19.5 %) ,对照组SBP/DBP降低 2 3 .5 / 16.9mmHg( 14 .3 %/ 16.5 %) ,分别与治疗前比较有显著性差异 (P <0 .0 1) ;两组间差异不显著 (P >0 .0 5 )。 ( 2 )卡组与对照组总有效率分别为 86.7%和 76.7%,总显效率分别为 66.7%和 60 .0 %,两组间差异不显著 (P >0 .0 5 )。 ( 3 ) 8周末 ,两组心率均降低 ,分别与治疗前比较有显著性差异 (P <0 .0 1) ,两组间差异不显著 (P >0 .0 5 )。结论 :卡维地洛治疗轻、中度高血压疗效确切、安全     

卡维地洛对原发性高血压心率变异性的影响

目的　观察卡维地洛对原发性高血压 (EH)患者心率变异性的影响。方法　 4 2例高血压患者每日服卡维地洛 2 0mg,观察 8周。记录用药前后血压、心率及 2 4小时动态心电图 ,分析心率变异 (HRV)时域和频域指标 ,并与 4 2例健康对照组比较。结果　与对照组相比 ,EH患者相邻正常R R间期标准差(SDNN)、正常相邻R R间期差值的方差 (RMSSD)及高频功率 (HF)均明显下降 ,低频功率 /高频功率值 (LF/HF)增加。用卡维地洛后血压从 (15 5 .5± 17.1) / (10 0 .9± 5 .6 )mmHg下降至 (14 7.8± 14 .4 ) / (88.7± 3.6 )mmHg (P <0 .0 1) ,心率从 (79.5± 10 .1)次 /min下降至 (6 6 .1± 7.5 )次 /min(P <0 .0 1) ,同时SDNN、RMSSD、HF增加 ,LF/HF值降低。结论　卡维地洛可提高原发性高血压患者的心率变异性 ,改善自主神经功能。     

缓释维拉帕米和卡维地洛治疗高血压合并不稳定性心绞痛的疗效观察

目的观察缓释维拉帕米和卡维地洛对高血压合并不稳定性心绞痛患者的降压、减少心肌缺血事件及抗室性早搏的效果。方法98例轻、中度高血压合并不稳定性心绞痛患者被随机分成两组,分别服用缓释维拉帕米片(缓释维拉帕米组)和卡维地洛片(卡维地洛组)。比较治疗8周后对心率、坐位血压,24h动态心电图(Holter)中心肌缺血事件及室性早搏的影响。结果服药8周后缓释维拉帕米组和卡维地洛组心率分别下降(8.9±6.1)次/m in和(5.9±4.0)次/m in,坐位血压分别下降(28.0±7.8)/(19.8±7.1)mmHg和(19.5±6.9)/(18.2±5.4)mmHg,24h Holter示缓释维拉帕米组和卡维地洛组缺血事件次数分别减少88.4%和56.5%,缺血时间分别缩短82.7%和41.6%,缺血时间缩短两组间比较P<0.05,抗室性早搏总有效率分别为72.3%和29.4%(P<0.05)。结论缓释维拉帕米和卡维地洛均有较好的降压作用(P>0.05),但缓释维拉帕米减慢心率、减少心肌缺血事件及抗室性早搏的作用优于卡维地洛。     

卡维地洛对缺血性心脏病心力衰竭患者心室重塑和心功能的影响

目的　探讨卡维地洛对缺血性心脏病心力衰竭患者心室重塑及心功能的影响。方法　缺血性心脏病心力衰竭患者 80例 ,左室射血分数≤ 4 5 %,心功能 (NYHA)Ⅱ～Ⅳ级 ,常规治疗基础上随机分为治疗组和对照组。治疗 6个月 ,观察卡维地洛对心室重塑和心功能的影响。应用心脏彩色超声仪测定基线值及1、3、6个月左室结构及功能指标变化。结果　卡维地洛平均用量为 (15± 3.75 )mg/d ,经过 6个月治疗卡维地洛组心功能改善 ,与对照组比较左室射血分数上升 [(4 8.1± 2 .5 ) %与 (39.5± 2 .74 ) %,(P =0 .0 0 2 ) ],左室收缩末容积下降 [(16 3.5 0± 4 5 .0 0 )ml与 (181.10± 4 4 .0 0 )ml,(P =0 .0 4 2 ) ];与基线比较左室舒张末容积下降 (P<0 .0 5 ) ;但两组间尚无统计学差异。结论　在利尿、血管紧张素转换酶抑制剂基础上 ,应用卡维地洛能显著改善缺血性心脏病心力衰竭患者的心功能 ,改善心室重塑。     

硝苯地平缓释片和复方利血平氨苯蝶啶片疗效比较

目的比较硝苯地平缓释片和复方利血平氨苯蝶啶片对老年高血压患者的降压疗效。方法将来南京军区杭州疗养院海勤疗养区疗养的60例老年高血压患者随机分为两组,每组30例。分别选用硝苯地平缓释片20mg和复方利血平氨苯蝶啶片1片,1次/d,疗程4周。用药前后进行血压测量,每天定时测血压3次。结果两组药物治疗4周后,硝苯地平缓释片组治疗前后收缩压和舒张压分别下降(21.20±5.49)mmHg(1mmHg=0.133kPa)和(14.20±4.58)mmHg,总有效率为96.67%;复方利血平氨苯蝶啶片组治疗前后收缩压和舒张压分别下降(16.90±7.98)mmHg和(13.00±5.03)mmHg,总有效率为80.00%。两者差异有统计学意义,P0.05。硝苯地平缓释片组副作用发生率为13.33%,复方利血平氨苯蝶啶片组副作用发生率为23.33%。治疗后心电图由供血不足恢复正常。结论硝苯地平缓释片与复方利血平氨苯蝶啶片对老年高血压均有效,尤其硝苯地平缓释片治疗老年人轻、中度高血压疗效好、副作用小,可作为抗高血压一线药物。     

卡维地洛治疗肾性高血压的剂量效应关系及安全性的观察

目的　观察卡维地洛治疗肾性高血压的量效关系和安全性。方法　 5 6例血肌酐≥ 178μmol/L的肾性高血压患者给予卡维地洛治疗 8周。起始剂量为 10mg/d ,无效者每隔 2周增加剂量 10mg/d ,直至血压有效控制或剂量达 4 0mg/d ,观察不同剂量卡维地洛对血压、心率和肾功能的影响以及控制血压的有效率和不良反应的发生率。结果　卡维地洛 10～ 4 0mg/d治疗后 ,血压由基础水平 (174 1± 11 2 / 10 5 3± 7 7)mmHg分别降至 (16 9 9± 12 7/ 10 2 8± 8 7)、(15 7 5± 11 4 / 94 1±9 9)、(15 2 4± 13 3/ 90 9± 10 1)、(15 0 9± 12 0 / 91 5± 8 3)mmHg ;有效率分别为 2 3 2 %、6 2 5 %、71 4 %、75 0 %。心率、血肌酐和尿素氮水平在治疗前后无明显变化。 2例在卡维地洛剂量达 4 0mg/d时出现头晕、胸闷、气短而退出试验 ,不良反应的发生率为 3 6 %。结论　卡维地洛治疗肾性高血压安全、有效 ,且疗效与剂量呈正相关 ,最适宜剂量为 2 0～ 30mg/d。     

卡维地洛治疗心力衰竭28例疗效观察

目的 :探讨卡维地洛治疗心力衰竭的临床疗效。方法 :将 5 6例心力衰竭患者随机分为卡维地洛组 (A组 ) 2 8例和常规治疗组 (B组 ) 2 8例。B组采用洋地黄、利尿剂和包括ACEI在内的血管扩张剂等治疗 ;A组在B组治疗及临床情况稳定的基础上加用卡维地洛治疗。对比两组治疗前后心功能分级情况及左室射血分数 (LVEF)。结果 :两组治疗后 ,心功能NYHA分级 :A组为 (2 .0 7± 0 .90 )级 ,B组为 (2 .5 4± 0 .88)级 ,两组比较 ,有显著性差异 (P <0 .0 5 ) ;LVEF :A组为 (39± 4 ) % ,B组为 (36± 4 ) % ,两组比较 ,有显著性差异 (P <0 .0 5 )。结论 :卡维地洛治疗心力衰竭的疗效优于常规治疗 ,并能更显著改善心功能。     

国产北京降压0号长期疗效和安全性观察

目的观察北京降压0号长期治疗的疗效和评价长期使用的安全性。方法高血压门诊就诊的60例病人随机分成两组,观察组用北京降压0号半片/d开始,依据血压情况调整至1片/d,最大剂量2片/d。对照组用氨氯地平,开始用5mg/d,后调整至10mg/d,最大剂量20mg/d。观察2月、6月、1年、2年。结果2月末两组患者坐位平均收缩压和舒张压均较治疗前有显著下降,观察组收缩压/舒张压下降幅度21.1±6.6/18.9±5.5mmHg,对照组收缩压/舒张压下降幅度20.8±6.4/17.5±4.7 mmHg,P>0.05。2年末两组的降压总有效率分别为90.0%和86.7%,P>0.05。副作用发生率分别为6.7%和10.0%,P>0.05。结论国产北京降压0号长期治疗疗效与氨氯地平疗效相似,未见明显毒副作用,不失为价廉、安全、有效的降压药。     

氨氯地平治疗高血压的临床效果评价

取2016年1月1日~2017年5月30日间本院收治的高血压60例患者进行研究,按患者用药类型将患者分为国产组和进口组各30例,国产组患者采取口服门冬氨酸氨氯地平片(5mg/次,1次/d)治疗,进口组患者采取口服苯磺酸氨氯地平片(5mg/次,1次/d)治疗,统计分析两组患者治疗4周后临床疗效及治疗安全性。结果进口组和国产组患者治疗舒张压(101.8±3.4)vs(101.6±3.8)mm Hg、收缩压(178.6±10.1)vs(178.2±10.5)mm Hg对比无明显差异(P0.05)。国产组与进口组患者治疗后舒张压(80.2±3.5)vs(79.7±3.7)mm Hg、收缩压(122.5±8.4)vs(121.6±7.9)mm Hg相比无明显差异(P0.05)。国产组患者血压控制总有效率83.5%与进口组84.8%相比无明显差异(P0.05)。国产组患者治疗后用药不良反应发生率7.7%与进口组5.1%相比无明显差异(P0.05)。高血压患者实施国产氨氯地平治疗临床效果与进口氨氯地平相似。     

动态血压比较洛汀新与络活喜降压疗效

目的比较洛汀新与络活喜对轻中度原发性高血压的疗效.方法分别选取38例与31例原发性高血压(essentialhypertension,以下简称EH)患者,以洛汀新10mg或络活喜5mg每天晨服一次,治疗4周,比较两药治疗前后的动态血压检测(ambulatory blood Pressure monitoring,以下简称ABPM)结果.结果两药治疗后24小时平均血压分别由SBP 143.75±13.66,147.63±14.37(mmHg)降至125.13±14.85,126.63±11.92(mmHg),DBP 98.87±9.14,94.13±8.53(mmHg)降至76.75±9.94,80.25±11.45(mmHg);白昼平均血压分别由SBP 147.38±10.86,151.63±15.30(mmHg)降至127.25±12.10,130.63±12.84(mmHg),DBP 90.25±9.29,97.5±8 37降至76.25±13.63,83.13±9.45(mmHg);夜间平均血压分别由SBP131.25±11.93,133.25±12.37(mmHg)降至115.88±7.30,117.13±8.82(mmHg),DBP 88.75±8.07,91.75±8.07(mmHg)降至73.25±8.07,74.75±10.55(mmHg);两药降压幅度无显著差异(P＞0.05);两药降压谷峰比值分别为SPB 68.51%,DBP 74.10%和 SBP 70.36%,DBP 76.29%;洛汀新治疗前后心率无明显变化(P＞0.05),络活喜治疗后心率有所增加(P＜0.05);两药不良反应均较少(分别为21.05%和19.35%),耐受性良好.结论洛汀新与络活喜均能持续稳定地控制轻中度EH,值得在临床广泛应用.     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

糖尿病视网膜病变筛查与防治中存在的问题及对策

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者筛查和防治中存在的问题及对策。方法以76例糖尿病DR患者为对象,调查未能早期接受眼科诊治的原因。结果存在问题主要是患者对DR防治知识不了解、血糖控制不理想、内科医生未建议进行专科检查等。结论眼科医护人员应密切与糖尿病专科的联系,尽早对DM患者进行DR健康教育,并开展社区DR防治工作。