卡维地洛治疗扩张型心肌病心力衰竭患者30例

目的探讨卡维地洛对扩张型心肌病心力衰竭的治疗作用。方法60例扩张型心肌病并发慢性心力衰竭患者随机分为治疗组和对照组各30例。对照组应用血管紧张肽转化酶抑制药（ACEI）、利尿药和洋地黄制剂，治疗组在对照组基础上加用卡维地洛，平均剂量为（28.66±12.48） mg·d^-1，共治疗6个月，治疗前后采用超声心电图测定心功能进行疗效评价。结果治疗组治疗后左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）和左心室射血分数(LVEF)分别为（57.40±7.12） mm、（43.77±7.87） mm和(51.26±9.22)%，对照组分别为（63.08±7.03） mm、(52.24±7.85) mm和(42.38±7.45)%(P＜0.01)。结论卡维地洛通过阻带β1，β2 和α1受体，能明显改善心功能。     

曲美他嗪对冠心病心力衰竭患者心功能的影响分析

目的 评价曲美他嗪对冠心病心力衰竭患者心功能的影响。方法 110例冠心病心力衰竭患者作为研究对象,依据入院编号单双数分为对照组和观察组,每组55例。对照组采用常规手段治疗,观察组在对照组基础上采用曲美他嗪进行治疗。比较两组患者的临床治疗效果以及心功能指标(左心室舒张末期内径、左心室收缩末期内径、左心室射血分数)。结果 观察组患者治疗总有效率96.36%高于对照组的83.64%,差异具有统计学意义(P<0.05)。治疗后,观察组患者左心室舒张末期内径(50.89±3.13)mm、左心室收缩末期内径(35.16±2.19)mm均小于对照组的(58.14±2.52)、(40.87±2.48)mm,左心室射血分数(61.77±5.27)%高于对照组的(59.44±4.54)%,差异均具有统计学意义(P<0.05)。结论 曲美他嗪可以有效地提升冠心病心力衰竭的治疗效果,改善患者的心功能水平,临床效果优异,建议临床推荐。     

卡维地洛对心力衰竭患者胰岛素抵抗的影响

目的:评价卡维地洛对心力衰竭患者胰岛素抵抗的影响.方法:45例心力衰竭患者,随机分为治疗组22例和对照组23例,分别给予卡维地洛(39.5±4.2)mg或美托洛尔(64.5±7.2)mg.观察治疗前和治疗后8周,心功能、空腹血糖、空腹胰岛素、胰岛素敏感指数的变化.结果:2组治疗后左室舒张末期内径(LVEDd)均减小(P<0.05),左心室射血分数(LVEF)及心输出量(CO)、短轴缩短率(FS)均有提高(P<0.05,P<0.01),但舒张功能均无改善.对照组对空腹血糖、空腹胰岛素、胰岛素敏感指数无影响,治疗组能降低心力衰竭患者的空腹胰岛素,增加胰岛素敏感指数.结论:卡维地洛不仅能改善患者的心功能,而且能改善心力衰竭患者的胰岛素抵抗.     

卡维地洛治疗糖尿病合并冠心病心力衰竭的疗效观察

目的 观察卡维地洛对2型糖尿病并发冠心病心力衰竭的心功能及血脂、血糖、胰岛素抵抗、C-反应蛋白的影响.方法 选择伴2型糖尿病并心病心力衰竭患者60例,随机分为对照组30例和治疗组30例,治疗前及治疗后1年分别观察左室舒张末期内径(LVEDD)、收缩末期内径(LVESD)、左室射血分数(LVEF)、血脂、血糖(FPG)、C-反应蛋白(CRP)、胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)、6 min步行试验(6MHW)、NYHA分级.结果 治疗组心功能治疗前后比较:分级:X2=3.12,P＜0.05;LVEF:t=2.377,P＜0.05;LVEDD、LVESD:t=2.367,t=2.289,P＜0.05;LVEF(0.50 ±0.08)%高于对照组(0.45±0.06)%(t=2.357,P＜0.05);治疗组治疗后LVEDD、LVESD(50.74±2.05 mm、32.17±2.32 mm)均低于对照组(61.45±3.72 mm、39.32±1.91 mm)(t=2.217,t=2.319,P＜0.05);治疗组治疗后C-反应蛋白(7.56±3.25)mg/L低于治疗前(10.99±4.26)mg/L(t=2.317,P＜0.05).结论 卡维地洛能明显逆转2型糖尿病并心力衰竭的心室重塑、改善心功能和血糖代谢.     

卡维地洛治疗慢性心力衰竭的临床观察

目的:探讨卡维地洛对慢性心力衰竭患者心功能的疗效和安全性。方法:将51例慢性心力衰竭患者随机分为两组,卡维地洛组26例,对照组25例。两组患者基础临床特征相似,应用彩色超声心动图测量患者治疗前、后6个月射血分数(LVEF)及左心室腔径变化,并观察患者的NYHA心功能分级、血压、心率(律)的变化。结果:6个月后,卡维地洛组的LVEF比对照组明显升高[LVEF:(46.52±6.24)%比(39.62±5.63)%],P<0.05,左室舒张末径(LVDd)和收缩末径(LVDs)均比对照组明显下降[LVDd:(52.24±6.12)mm比(58.34±6.31)mm;LVSd:(39.35±5.31)mm比(43.71±5.64)mm],P<0.05。治疗6个月后卡维地洛组患者的NYHA心功能分级改善优于对照组。结论:卡维地洛对慢性心力衰竭的治疗是有效和安全的。     

老年心力衰竭应用厄贝沙坦氢氯噻嗪联合美托洛尔早期治疗的效果分析

目的 研究厄贝沙坦氢氯噻嗪联合美托洛尔早期治疗老年心力衰竭的临床效果。方法 64例早期入院治疗的老年心力衰竭患者,随机分为观察组和对照组,各32例。观察组采用厄贝沙坦氢氯噻嗪联合美托洛尔治疗,对照组单纯采用厄贝沙坦氢氯噻嗪治疗。比较两组患者的临床疗效及治疗前后心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]。结果 观察组治疗总有效率93.75%明显高于对照组的71.88%,差异有统计学意义(P<0.05)。治疗前,两组LVEF、LVESD、LVEDD比较差异无统计学意义(P>0.05);治疗后,观察组LVEF(53.56±5.02)%大于对照组的(45.52±5.31)%, LVESD(34.31±7.02)mm、LVEDD(52.02±4.44)mm小于对照组的(37.56±5.24)、(58.59±4.61)mm,差异有统计学意义(P<0.05)。结论 厄贝沙坦氢氯噻嗪联合美托洛尔早期治疗老年心力衰竭可以有效提升治疗效果,改善心功能,值得推荐。     

美托洛尔联合依那普利治疗慢性心力衰竭的疗效

目的分析慢性心力衰竭患者予以美托洛尔联合依那普利治疗的临床效果及对血压、心功能的影响。方法 90例慢性心力衰竭患者,采用随机数字表法分为对照组和观察组,每组45例。对照组采用常规治疗,观察组在对照组基础上采用美托洛尔联合依那普利治疗。比较两组患者的治疗效果及治疗前后收缩压、舒张压、左心室射血分数、左室舒张末期内径、左室收缩末期内径。结果观察组患者治疗总有效率为93.33%(42/45),高于对照组的73.33%(33/45),差异具有统计学意义(χ²=6.4800,P=0.0109<0.05)。治疗后,两组患者收缩压、舒张压均低于本组治疗前,且观察组收缩压(124.06±4.70)mm Hg(1 mm Hg=0.133 kPa)、舒张压(75.57±2.65)mm Hg均低于对照组的(141.24±6.05)、(88.23±3.31)mm Hg,差异具有统计学意义(P<0.05)。治疗后,两组患者左心室射血分数均高于本组治疗前,左室舒张末期内径、左室收缩末期内径均短于本组治疗前,且观察组患者左心室射血分数高于对照组,左室舒张末期内径、左室收缩末期内径均短于对照组,差异具有统计学意义(P<0.05)。结论慢性心力衰竭患者予以美托洛尔联合依那普利治疗的效果确切,可有效降低血压水平,改善患者的心功能。     

卡维地洛联合依那普利治疗风湿性心脏病合并慢性心力衰竭的临床疗效观察

目的:探讨卡维地洛联合依那普利治疗风湿性心脏病合并慢性心力衰竭的临床疗效。方法:选择2015年1月~2016年6月在某院就诊的82例风湿性心脏病合并慢性心力衰竭患者,随机分为观察组和对照组,每组各41例。对照组患者给予服用依那普利进行治疗,观察组患者在此基础上增加服用卡维地洛,比较两组患者的临床治疗效果。结果:治疗结束后,观察组患者与对照组比较,左心房内径(LAD)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)及血浆脑钠肽(BNP)水平显著下降,左心室射血分数(LVEF)及6min步行距离(6MWD)显著上升,且治疗总有效率也显著高于对照组(P<0.05)。结论:卡维地洛联合依那普利可以显著改善风湿性心脏病合并慢性心力衰竭患者的心功能,抑制心室重构,临床效果良好,值得临床推广使用。     

麝香保心丸联合磷酸肌酸钠对慢性心力衰竭患者心功能及血管内皮因子的影响探讨

目的探究麝香保心丸联合磷酸肌酸钠对慢性心力衰竭患者血管内皮因子及心功能的影响。方法84例慢性心力衰竭患者,采取随机数字排列表法分成研究组和对照组,各42例。研究组患者给予麝香保心丸联合磷酸肌酸钠治疗,对照组患者仅给予磷酸肌酸钠治疗。比较两组患者用药前后内皮素、血管紧张素Ⅱ、血浆一氧化氮水平以及心功能、心室重构情况(左心室射血分数、左心室收缩末期内径、左心室舒张末期内径、室间隔厚度、左心室后壁厚度)。结果用药后,研究组内皮素(45.37±10.21)pg/ml、血管紧张素Ⅱ(55.27±8.09)pg/ml均低于对照组的(77.59±12.34)、(70.09±8.12)pg/ml,血浆一氧化氮(122.34±15.27)mmol/L高于对照组的(76.01±16.51)mmol/L,差异均具有统计学意义(P<0.05)。研究组左心室收缩末期内径、左心室舒张末期内径、室间隔厚度以及左心室后壁厚度分别为(30.28±3.90)、(50.03±6.01)、(8.03±2.06)、(8.64±1.15)mm,均低于研究组的(35.29±3.83)、(53.97±6.03)、(10.97±2.22)、(10.91±1.19)mm,左心室射血分数(46.98±6.15)%高于对照组的(41.10±6.13)%,差异均具有统计学意义(P<0.05)。结论慢性心力衰竭患者采用麝香保心丸联合磷酸肌酸钠治疗可有效改善患者血管内皮功能,提升其心功能,改变心室重构,具有一定的临床应用价值。     

比索洛尔联合沙库巴曲缬沙坦钠提高心力衰竭患者心功能的效果评价

目的研究比索洛尔联合沙库巴曲缬沙坦钠应用于心力衰竭患者治疗中的作用与效果。方法 116例心力衰竭患者,根据治疗方式不同分为观察组与对照组,各58例。对照组用比索洛尔治疗,观察组用比索洛尔联合沙库巴曲缬沙坦钠治疗。比较两组治疗前后各项心功能指标及疗效。结果治疗后,观察组左心室射血分数(LVEF)(47.83±0.79)%高于对照组的(43.32±0.97)%,左心室收缩末期内径(LVESD)(43.83±0.28)mm、左心室舒张末期内径(LVEDD)(45.37±0.60)mm小于对照组的(47.42±0.57)、(52.49±0.83)mm,差异有统计学意义(P<0.05)。观察组治疗总有效率98.28%高于对照组的81.03%,差异有统计学意义(P<0.05)。结论心力衰竭治疗工作中应用比索洛尔联合沙库巴曲缬沙坦钠能够改善患者各项心功能指标,并获得更为良好的治疗效果,能够给临床中心脏类疾病的治疗更多的参照,可应用与推广。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.