美托洛尔与地尔硫(艹卓)对X综合征患者疗效的对比研究

目的 研究应用美托洛尔与地尔硫(艹卓)对X综合征患者的疗效.方法 收集2005年7月至2006年5月山东省医学科学院附属济宁市第一人民医院诊断的X综合征患者42例,将其随机分为美托洛尔组(20例)和地尔硫(艹卓)组(22例),随访治疗3个月后的临床情况并复查平板运动试验及冠状动脉血流储备(CFR).结果 与用药前相比,用药后2组平板运动试验到达终点时间均明显延长(P＜0.05),CFR均明显升高(P＜0.05).临床胸痛及平板运动试验阳性显著减少(P＜0.01).与地尔硫(艹卓)组相比,美托洛尔组平板运动试验中到达运动终点时间显著延长(P＜0.05),CFR显著升高(P＜0.05).结论 美托洛尔与地尔硫(艹卓)能提高心脏X综合征患者的运动耐量及CFR,美托洛尔较地尔硫(艹卓)更为有效.     

美托洛尔对慢性心力衰竭伴慢性心房颤动患者的作用

目的:探讨地高辛联用美托洛尔对慢性心力衰竭(CHF)伴慢性心房颤动(AF)患者的疗效。方法:选择CHF伴慢性AF患者106例,随机分为地高辛治疗组(54例)和美托洛尔+地高辛组(52例),观察两组1月疗效并随访1年期间因心脏原因的再住院率、死亡率。结果:治疗1月后,与地高辛组相比,美托洛尔+地高辛组静息心室率[(91.6±8.5)次/min比(72.8±9.7)次/min]和运动前后即刻心室率差值显著降低[(23.1±4.2)次/min比(12.3±4.7)次/min],6min步行距离显著增加[(256.4±90.4)m比(299.8±94.1)m],P均<0.05;随访1年,与地高辛组相比,美托洛尔+地高辛组因心力衰竭再住院率(42.6%比19.2%)、死亡率(20.4%比11.5%)明显降低,NYHA分级明显改善、6min步行距离明显增加,左室舒张末容积、左室收缩末容积明显减小,左室射血分数明显提高,生活质量明显改善,P均<0.05。结论:在常规用药的基础上,地高辛联用美托洛尔的1月疗效与1年后疗效都明显优于单用地高辛的治疗。     

静脉滴注地尔硫(艹卓)治疗不稳定心绞痛伴心功能不全患者的临床观察

目的探讨静脉滴注地尔硫(艹卓)治疗伴有心功能不全的不稳定心绞痛(UAP)患者的疗效和安全性.方法68例伴心功能不全NYHA分级Ⅱ～Ⅲ级的UAP患者,其中32例应用地尔硫(艹卓)静脉滴注持续48h,36例同法应用硝酸甘油,对照观察其心绞痛改善程度、心电图变化及对心功能不全的影响.结果临床总有效率地尔硫(艹卓)组高于硝酸甘油组,差异有显著性意义(P＜0.05),而对心功能的影响两组间无明显差别.结论在UAP急性发作期间,对那些伴有轻、中度心功能不全的患者,短期静脉滴注地尔硫(艹卓)不致引起心功能的恶化,临床应用较为安全有效.     

盐酸地尔硫(艹卓)和硝普钠治疗肺源性心脏病的疗效分析

目的观察地尔硫(艹卓)和硝普钠治疗慢性肺源性心脏病急性发作期的疗效和安全性.方法67例病人随机分为地尔硫(艹卓)组34例,硝普钠组33例,对照观察静脉给药前后4h的血压、心率、血气和临床症状、体征变化.结果两组血压下降最大均≥20%,血气分析PaO2,SaO2,PaCOz上升和下降≥10mmHg,两组无显著差异(P≥0.05);心率下降地尔硫(艹卓)组≥20%,硝普钠组≤15%(P＜0.05);地尔硫(艹卓)组临床有效率94%,硝普钠组91%(P＜0.05).地尔硫(艹卓)肺源性心脏病组2例病人有头晕、一过性低血压未处理,硝普钠组8例病人有头晕、恶心、低血压,减慢滴速后缓解,2例停药后恢复.结论地尔硫(艹卓)治疗慢性肺源性心脏病急性期疗效好、安全,可作为首选用药.     

地尔硫(艹卓)在经皮冠状动脉介入治疗后的作用

目的探讨静脉应用地尔硫(艹卓)(Diltiazem)在经皮冠状动脉介入治疗(PCI)后的作用。方法 200例急性心肌梗死和不稳定心绞痛择期行PCI患者分为2组,105例PCI术后立即给予持续静脉泵入地尔硫(艹卓)(1-1．5 ug/kg/min)72小时,95例未给予地尔硫(艹卓)泵入。分析两组一般临床特征及术后心血管事件发生率,用药前后心率、血压的变化和不良反应。术后5-7天作超声心动图检查, 对比左心室射血分数(LVEF),左心室舒张末期容积指数(EDVI),左心室收缩末期容积指数(ESVI) 以评价对心功能影响。结果两组在一般临床特征方面差异无显著性意义(P>0．05),应用地尔硫 (艹卓)组术后发生不稳定心绞痛较未应用地尔硫(艹卓)组明显降低(4．70％vs 18．94％,P<0．05),但对心功能无影响。结论 PCI术后静脉泵入地尔硫(艹卓)可安全、有效地减少术后因冠状动脉痉挛引起的胸痛。     

比较钙拮抗剂与利尿剂及β阻滞剂对高血压的心血管病残率、死亡率影响的随机试验:NORDIL研究

钙拮抗剂是治疗高血压的一线药物,资料表明其较利尿剂和(或)β阻滞剂能更有效地逆转左心室肥厚。地尔硫(艹卓)是一个非二氢吡啶类的钙拮抗剂,它在减少心血管病残率和死亡率方面的功效还未十分明了。NORDIL研究通过比较地尔硫(艹卓)与利尿剂及β阻滞剂对高血压患者病残率和死亡率的影响,来了解地尔硫(艹卓)在心血管保护方面的作用。 方法 在瑞典、挪威的1032个医学中心     

静脉应用地尔硫(艹卓)治疗不稳定型冠状动脉疾病的临床观察

目的观察静脉应用地尔硫(艹卓)治疗不稳定型冠状动脉疾病,评价其疗效及其对心脏功能的影响.方法58例冠心病病人,包括不稳定型顽固性心绞痛45例及急性非Q波心肌梗死13例,静脉注射地尔硫(艹卓)0.3mg/kg(5mg/mm),继而静脉点滴10ug·kg-1·min-1(90min内),随后口服地尔硫(艹卓)30mg,每日4次,共计10d为一个疗程,分别在用药前、用药过程中及用药后1、3、5、10、15、20、30、60、90min及第10d监测心率、血压,用药前及用药后90min、10d各做同一切面超声心动图,监测心脏功能指数(每搏心输出量SV、每搏心指数SI、每分心输出量CO、每分心指数CI、射血分数EF、心率HR).结果用药后5min心率开始下降,15min时达高峰,下降幅度为(15±5)bpm(P＜0.05),收缩压(SBP)10min下降(12±4)mmHg(P＜0.05)、舒张压(DBP)下降不明显(6±2)mmHg(P≥0.05);超声心动图显示心脏功能指数变化:SV、CI、EF无明显改变(P≥0.05),而SI、CO、HR明显改善(P＜0.05).结论静脉应用地尔硫(艹卓)治疗不稳定型冠状动脉疾病疗效确切,安全可靠.     

不同类型钙拮抗剂对高血压病患者左心室肥厚的逆转作用

以单盲法观察钙拮抗剂地尔硫(艹卓)(硫氮(艹卓)酮)、硝苯地平(硝苯吡啶)及尼群地平对高血压病患者左心室肥厚的逆转作用。服药8～10个月,三种药物均使患者的平均室间隔、左室后壁厚度及左室重量指教下降。其中地尔硫(艹卓)的作用最强,硝苯地平和尼群地平的作用相似,但不及地尔硫(艹卓)明显。三种药物均不影响左心收缩功能,但均能使舒张功能改善。     

医院外使用地尔硫治疗快速心房颤动

目的 评价医院外静脉注射地尔硫(艹卓)治疗快速心房颤动(房颤)或心房扑动(房扑)的疗效。 方法 采用回顾性对照研究。地尔硫(艹卓)治疗组43例来自1999年全美辅助医疗机构的快速房颤或房扑患者,平均心室率≥150次/分,接受9个月地尔硫(艹卓)治疗,平均剂量19.8mg。对照组27例,从1998年起未用地尔硫(艹卓)治疗。剔除气管插管或电击复律史者。以转为窦性心率、心室率≤100次/分或     

美托洛尔治疗老年性慢性心力衰竭42例疗效分析

目的观察β受体阻滞剂美托洛尔治疗老年慢性心力衰竭（CHF）的安全性及临床疗效。方法将84例CHF患者随机分为观察组和对照组各42例,对照组患者给予常规抗心力衰竭治疗（应用利尿剂,ACEI和地高辛）,观察组患者在同对照组常规治疗基础上加用β受体阻滞剂美托洛尔,观察治疗前后两组患者血压、心率、左心室舒张末期内径和左心室收缩末期内径以及左心室射血分数的变化。结果观察组临床疗效优于对照组（U=2.331,P=0.020）;治疗后两组患者血压、心率及心功能指标均较治疗前明显改善（P〈0.05或P〈0.01）,观察组与对照组比较,改善更为明显（P〈0.05或P〈0.01）。结论目标剂量的β受体阻滞剂治疗老年性慢性心力衰竭安全有效。     

Treatment of chronic hepatitis C in patients with chronic kidney disease with Sofosbuvir-basead regimes

BackgroundTo analyze the effectiveness and the safety of Sofosbuvir-based regimens to treat patients with chronic hepatitis C virus (HCV) infection and chronic kidney disease (CKD).MethodsA retrospective, observational study in patients with chronic HCV infection and CKD treated with Sofosbuvir-based regimens was performed. Liver fibrosis, comorbidities, HCV genotype and sustained virological resposnse (SVR) at 12th week post-treatment were evaluated. Kidney function was accessed by serum creatinine and glomerular filtration rate (GFR). The assumed level of significance was 5 %.ResultsThirty-five patients were treated. The mean age was 52.1 ± 10.9 years, 19 (54.3 %) were women, 32 (91.4 %) were already kidney transplanted and 3 (8.6 %) were on hemodialysis. The SVR by intention to treat was 88.6 %. The mean GFR was 65.8 ± 28.6 and 63.7 ± 28.3 ml/min pre- and post-treatment respectively (p > 0.05). Treatment was interrupted in 1 (2.85 %) patient due to anemia and in 2 (5.7 %) due to loss of kidney function.ConclusionSofosbuvir-based regimens are effective to treat HCV in patients with CKD. In patients with mild CKD this type of therapy seems to be safe.     

慢性腹泻与肿瘤

腹泻是肿瘤的一种常见临床症状 ,据报道 10 %进展期癌的病人有发生急、慢性腹泻[1] 。严重腹泻影响病人完成全程治疗 ,增加医疗费用 ,降低生活质量 ,甚至危及生命。肿瘤相关性腹泻多为伴随症状 ,但也有以腹泻为首发或突出表现。由于引起腹泻的肿瘤甚多 ,因此全面了解肿瘤相关性腹泻的疾病谱和临床特征 ,对于减少常见肿瘤的误诊 ,提高少见肿瘤的诊断率 ,以及选择正确治疗措施 ,具有重要意义。肿瘤相关性慢性腹泻主要见于消化系肿瘤及某些具有神经内分泌特征的肿瘤 ,少数消化系以外脏器的肿瘤亦可引起慢性腹泻。此外 ,恶性肿瘤的手术治疗和放…     

Post-necrotic cirrhosis with chronic cholestasis

Features of biliary obstruction were seen in 57 of 300 cases of post-necrotic cirrhosis but gave rise to real diagnostic difficulty in only 11 cases. The paper deals with the recognition and possible pathogenesis of this syndrome.     

Successfully living with chronic arthritis

The treatment and care of patients with rheumatoid arthritis (RA) is complex and various health professionals with different areas of expertise may be involved. The objective of this article is to review the treatments and their efficacy as provided by health care professionals in RA care. The requirements for further research in this area are formulated. To achieve better effects of treatment it is necessary to improve the coordination of services as provided by the different specialists. The important roles of the patients themselves in the care and management of the disease are emphasized, as well as the roles of the informal caregivers such as a spouse or other family members and friends and the role of patient societies. The possible role of the International Classification of Functioning, Disability and Health (ICF) to improve the communication and facilitate the coordination among health professionals and between patients and health professionals is mentioned. The topics presented in this article may encourage further discussion and research, particularly concerning the effects of the treatments as provided by allied health professionals. Health professionals play an important role in the life of patients with rheumatic disorders, in all the domains of the ICF: body functions and structure, activities (action by an individual) and participation (involvement in a life situation). Health professionals in rheumatology can make the difference in the lives of RA patients and their families.