生长激素对烧伤病人影响的研究进展

烧伤感染应激后引起的高分解代谢导致机体蛋白质净生成率下降和负氮平衡,严重影响了患者的免疫防御和创面愈合能力。目前,尽管采用了更为先进的治疗和监测措施,但高代谢后器官功能不全仍是严重烧伤病人常见的死因。许多作者研究了重组人生长激素（ｒｈ ＧＨ）对烧伤后代谢等多方面的影响。作者就此进行综述,以便为用生长激素治疗烧伤提供较系统的理论依据。１对代谢的影响 Ｇｏｒｅ等［１］在一个双盲、随机试验中,将１３例严重烧伤病人分为２组,分别给予安慰剂和ｒｈＧＨ［０．２ｍｇ／（ｋｇ·ｄ）］,结果表明,ｒｈＧＨ能显著减少…     

高压氧对新生儿缺氧缺血性脑病血浆ET、CGRP、6-keto-PGF_(1α)及TXB_2浓度的影响

目的　探讨高压氧（ＨＢＯ）对新生儿缺氧缺血性脑病（ＨＩＥ）患者血浆内皮素（ＥＴ）、降钙素基因相关肽（ＣＧＲＰ）、前列环素（６－ｋｅｔｏ－ＰＧＦ１α）及血栓素Ｂ２ （ＴＸＢ２ ）浓度的影响。方法　ＨＢＯ组２０ 例,给予ＨＢＯ 及常规治疗;对照组２７ 例,只给常规治疗。ＨＢＯ 治疗使用透明单人氧舱,绝对压力为０．１３～０．１５ ＭＰａ,氧浓度为６５％ ～９０％ ,每次１ 小时,每天１ 次,１０ 次为１ 个疗程（一般进行１～２ 个疗程）;于患者出生第３ 天开始ＨＢＯ治疗。治疗前、出生后第５ 天及第９ 天分别取静脉血用放射免疫法测ＥＴ、ＣＧＲＰ、６－ｋｅｔｏ－ＰＧＦ１α及ＴＸＢ２ 浓度。结果　发现ＣＧＲＰ随新生儿出生后日龄增长,血浓度减低;但ＨＢＯ对ＥＴ、ＣＧＲＰ、６－ｋｅｔｏ－ＰＧＦ１α及ＴＸＢ２ 浓度无明显影响。结论　ＣＧＲＰ可能参与ＨＩＥ的病理生理过程,而ＨＢＯ治疗ＨＩＥ主要是通过其它机制发挥作用。     

雌激素替代疗法对绝经后妇女冠心病患者血脂及胰岛素抵抗的近期影响

为探索小剂量雌激素（Ｅ）及Ｅ与孕激素（Ｐ）联合应用对妇女冠心病（ＣＨＤ）的防治机制。将１０８例绝经１年以上的ＣＨＤ患者随机分为３组各３６例，甲组口服ｐｒｅｍａｒｉｎ（倍美力）０．６２５ｍｇ１／ｄ，乙组口服ｌｉｖｉａｌ（利维爱）２．５ｍｇ，１／ｄ，丙组口服安慰剂１片／ｄ，于服药前及服药第３、６个月末检测血浆性激素、血脂谱、糖代谢等各项指标的变化情况。结果显示，ｐｒｅｍａｒｉｎ治疗３个月后可使ＴＣ降低１２．８％，ＴＧ降低１７％，ＬＤＬ－Ｃ降低２９％，ＨＤＬ－Ｃ上升１４．６％，Ｉｎｓ降低３７．８％，１／ＳＧ．Ｉｎｓ上升１倍（Ｐ均＜０．０１），６个月时与３个月治疗效果相同。而ＳＧ治疗前后无显著变化（Ｐ＞０．０５）。ｌｉｖｉａｌ治疗３个月及６个月时ＴＣ降低８．７％，ＴＧ分别降低１５．６４及３３．８％、ＨＤＬ－Ｃ降低１９．７％及２８．３％（Ｐ均＜０．０１），ＬＤＬ－Ｃ、Ｉｎｓ、ＳＧ水平１／ＳＧ．Ｉｎｓ比值治疗前后无显著变化。安慰剂组治疗前后各指标均无显著变化。表明单用小剂量Ｅ可显著改善绝经后妇女ＣＨＤ患者的异常血脂谱、胰岛素抵抗，其作用显著优于Ｅ＋Ｐ联合疗法。     

131I-MIBG治疗58例恶性嗜铬细胞瘤的临床疗效与副反应

目的 探讨用＾１３１Ｉ间－碘苄胍（ＭＩＢＧ）治疗５８例恶性嗜铬细胞瘤软组织转移灶的临床价值。方法 第一疗程每月静脉滴注＾１３１Ｉ－ＭＩＢＧ２５９０～３７００ＭＢｑ，共６个月，此后每隔２～３个月继续治疗１－３次，用ＭＩＲＤ法测试肿瘤吸收剂量，结果 （１）５８例患者按肿瘤大小分成３组，第１组肿瘤体积〈８ｃｍ＾３（１１例）第２组８－２０ｃｍ＾３（２１例）第３组〉２０ｃｍ＾３（２６例）第１组１１例肿瘤平均     

重组人碱性成纤维细胞生长因子治疗烧伤及皮肤损伤的临床研究

目的 观察重组人碱性成纤维细胞生长因子（ｒｈ－ｂＦＧＦ,商品名贝复济）对烧伤、供皮区、外伤和慢性创面愈合的影响及不良反应。方法 将１８３例患者按照创面的可分性分为两部分。在常规治疗的基础上,试验组加ｒｈ－ｂＦＧＦ,对照组不加,第１部分１１０例采用随机自身对照法,观察同一创面不同区域或同体对称部位创面的愈合效果。第２部分７３例患者,采用开放试验。分别观察记录创面愈合时间在不同时间内的创面愈合率。结果     

高压氧加激光治疗脑梗塞208例临床观察

我院自１９９４年９月～２０００年１２月对２０８例脑梗塞患者进行了高压氧（ＨＢＯ）加激光及药物治疗,取得较好效果,现报道如下。 一、对象与方法 １．对象选择：所有患者均为本院住院者,病程 １～３０ ｄ,全部患者均符合１９８６年中华医学会第二次全国脑血管病学术会议第三次修定的诊断标准,均经头颅ＣＴ或ＭＫＩ证实．并为首次发病或过去患病后未遗留神经功能缺损者。 ２．分组：按入院日期随机分为 ３个组：（１）ＨＢＯ加激光及常用药物治疗组２０８例（简称ＨＢＯ＋激光组）,男１１２例,女９６例,年龄４７～６７岁,平均６…     

重组人生长激素对烧伤后高代谢的影响

为探讨重组人生长激素（ｒｈＧＨ）对烧伤后高代谢反应的影响,采用实验用小型香猪ＴＢＳＡ３５％Ⅲ度烧伤模型,动态观察了ｒｈＧＨ对静息能量消耗（ＲＥＥ）、血清生长激素、胰岛素样生长因子１（ＩＧＦ－１）、胰岛素、胰高血糖素、皮质醇、白蛋白及体重等代谢相关指标的影响。结果发现,ｒｈＧＨ能明显降低烧伤后ＲＥＥ水平,并使表生长激素、ＩＧＦ－１、白蛋白及体重罗对照组显著升高,但对胰岛素、胰高血糖素和皮质醇等无明显     

高-低氧全肺照射对小鼠肺纤维化的影响

目的以小鼠肺组织中ＴＧＦβ１含量变化为指标,观测高低氧（ＨＯ＋ＬＯ）照射对肺晚期损伤的生物学效应。方法雄性Ｃ５７ＢＬ小鼠,１３Ｇｙ全肺一次照射,照射同时分别吸入空气、高氧（９５％Ｏ２＋５％ＣＯ２）或高低氧（１０％Ｏ２＋５％ＣＯ２＋８５％Ｎ２）,照射后不同时间取肺组织ＨＥ染色、Ｍａｓｏｎ染色、Ｖ．Ｇ．染色观察肺纤维化形成。ＲＴＰＣＲ方法测定肺组织内ＴＧＦβ１的表达。结果照射后８个月肺组织局部灶性纤维化形成。高氧组肺纤维化面积大于空气组及ＨＯ＋ＬＯ组,两者相比,差异具有显著性;ＨＯ＋ＬＯ组纤维化面积虽略高于空气组,但差异无显著性。照射后３６小时,ＴＧＦβ１表达下降,照射后２个月,ＴＧＦβ１表达升高,至照射后８个月,略呈下降趋势,但仍高于正常对照。结论低氧的加入降低单纯高氧导致的正常组织损伤,ＨＯ＋ＬＯ照射不增加肺的晚期损伤,ＴＧＦβ１的表达在肺纤维化形成过程中起重要作用     

高压氧对重型颅脑损伤患者脑血流动力学的影响

高压氧（ＨＢＯ）疗法已广泛应用于临床,尤其对颅脑损伤的治疗已取得明显疗效,因此ＨＢＯ对脑血流动力学变化的影响及其变化规律更令人关注。我们利用脑导纳图技术测定重型脑损伤患者ＨＢＯ治疗前后脑血流变化,以期为ＨＢＯ治疗重型颅脑损伤提供理论依据。一、临床资料１．一般资料：１９９５年１月至１９９７年１２月ＨＢＯ舱治疗重型颅脑损伤３２例,男２１例,女１１例,年龄１９～５５岁,平均４２岁,ＨＢＯ治疗前格拉斯哥（ＧＣＳ）记分为３～８分。２．ＨＢＯ治疗：采用国内宁波ＨＢＯ舱厂生产的ＨＢＯ单人舱（型号：ＮＧ９０－Ⅱ…     

rhG─CSF对6．5Gy照射小鼠近期及远期造血恢复作用的影响

为了观察重组人粒细胞集落刺激因子（ｒｈＧ－ＣＳＦ）对机体长期造血功能恢复的影响，设计了二次照射小鼠模型，即首次γ线照射后给予不同剂量的ｒｈＧ－ＣＦＳ治疗，待外周血细胞恢复正常后（照后４５ｄ），给予等剂量第二次照射，照后不再接受任何治疗，观察前后两次照射后外周血细胞的恢复和活存率的改变。结果发现首次照射后各治疗组小鼠外周血ＷＢＣ、ＲＢＣ及血小板恢复时间提前，恢复速度加快，ＲＢＣ及血小板谷值升高。第二次照射后尽管各观察组小鼠外周血ＷＢＣ、ＲＢＣ及血小板的恢复均较缓慢，但原ｒｈＧ－ＣＳＦ治疗组小鼠外周血恢复速度仍明显快于对照组，恢复时间也明显提前，其中以２．５及５．０μｇ剂量组效果最佳，１．２５、２．５和５．０μｇ组小鼠３０ｄ活存率分别比对照组提高６％、４０．５％和４４．２％，后两组均明显高于对照组（Ｐ＜０．０５或０．０１）。表明ｒｈＧ－ＣＳＦ不仅能促进受照小鼠近期造血功能的恢复，而且照后早期给药对照射小鼠长期造血功能也有保护作用     

Strength/endurance training versus endurance training in congestive heart failure

PURPOSE: The aim of this study was to compare the effects of endurance training alone (ET) with combined endurance and strength training (CT) on hemodynamic and strength parameters in patients with congestive heart failure (CHF). METHODS: Twenty male patients with CHF were randomized into one of two training regimens consisting of endurance training or a combination of endurance and resistance training. Group ET had 40-min interval cycle ergometer endurance training three times per week. Group CT combined endurance and strength training with the same interval endurance training for 20 min, followed by 20 min of strength training. Left ventricular function was assessed at baseline and after 40 training sessions by echocardiography and radionuclide ventriculography. Work capacity was measured with cardiopulmonary exercise test (CPX) and lactate determination. Strength was measured with an isokinetic dynamometer. RESULTS: After 40 sessions, the ET group improved functional class, work capacity, peak torque, and muscular endurance. However, peak O2 remained unchanged. Left ventricular ejection fraction (LVEF) and fractional shortening (FS) decreased, whereas left ventricular end-diastolic diameter (LVED) increased. The CT group improved NYHA score, working capacity, peak O2, and peak lactate; peak torque and muscular endurance, LVEF, and FS increased, whereas LVED decreased. Compared with ET, CT was significantly (P < 0.05) better in improving LV function.CONCLUSION: Combined endurance/strength training was superior to endurance training alone concerning improvement of LV function, peak VO2, and strength parameters. It appears that for stable CHF patients, a greater benefit can be derived from this training modality.     

促红细胞生长素对充血性心衰患者心功能的影响

目的探讨充血性心衰(CHF)并贫血的患者,在EPO加铁剂治疗后,对心脏结构与功能及B型利钠肽水平的影响。方法32例连续CHF并贫血(80g/L<血红蛋白<120g/L)的患者纳入本研究。以随机方法分为治疗组(A组、16例),皮下注射EPO12000IU/周+每天口服铁剂共4个月。对照组(B组、16例),每天口服铁剂。结果A组患者在随机治疗的4个月中,相对于基础状态血红蛋白增加(P<0.001),左室内径缩小(P<0.001),射血分数增加(P<0.05),心功能分级(P<0.001)与6min步行试验(P<0.05)改善,同时血浆中B型利钠肽水平(P<0.01)下降。B组患者在试验期间射血分数(P<0.05)及6min步行距离(P<0.05)有所下降,其他指标无明显变化。结论CHF并贫血患者,EPO加口服铁剂治疗,能改善患者的心脏结构与功能,降低B型利钠肽水平。     

高血压病合并心力衰竭时使用硝苯地平、氨氯地平治疗的对比观察

目的　观察高血压病合并心衰时使用硝苯地平、氨氯地平治疗时对心脏影响。　方法　 4 7例高血压病合并心衰患者 ,分为硝苯地平治疗组 (30 mg/d,n=2 5 )及氨氯地平 (5 m g/d,n=2 2 )治疗组。观测 2 4 h平均血压、平均心率 ,脉压 ,左室射血分数 (L VEF)、舒张早期减速度 (Dct)、左室等容舒张时间 (IVRT)。　结果　血压、心率、L VEF两组差异不显著 (P>0 .0 5 ) ;平均脉压、IVRT硝苯地平组大于氨氯地平组 (P<0 .0 1) ;硝苯地平组 Dct小于氨氯地平组 (P<0 .0 1)。　结论　高血压合并心衰时使用硝苯地平增大脉压差 ,并影响心脏的舒张功能。     

Improved left ventricular function after growth hormone replacement in patients with hypopituitarism: Assessment with radionuclide angiography

Prolonged growth hormone deficiency (GHD) leads to marked cardiac dysfunction; however, whether reversal of this abnormality may be achieved after specific replacement therapy has not yet been completely clarified. Fourteen patients with childhood-onset GHD (nine men and five women, mean age 27±4 years) and 12 normal control subjects underwent equilibrium radionuclide angiography under control conditions at rest. Patients with GHD were also studied 6 months after recombinant human (rh) GH treatment (0.05 IU/kg per day). Normal control subjects and patients with GHD did not differ with respect to age, gender and heart rate. In contrast, left ventricular ejection fraction (53%±9% vs 66%±6%,P <0.001), stroke volume index (41±11 vs 51±8 ml/m²,P <0.01) and cardiac index (2.8±0.6 vs 3.±0.51/min/m²,P <0.001) were significantly lower in GHD patients than in normal control subjects. None of the GHD patients showed adverse or side-effects during rhGH therapy; thus none required a reduction in GH dose during the treatment period. Heart rate and arterial blood pressure were not significantly modified by rhGH treatment. After 6 months of rhGH therapy a significant improvement in left ventricular ejection fraction (from 53%±9% to 59%±9%,P <0.01), stroke volume index (from 41±11 to 47±13 ml/m²,P <0.05) and cardiac index (from 2.8±0.6 to 3.3±0.8 1/min/m²,P <0.01) was observed in GHD patients. In conclusion, prolonged lack of GH leads to impaired left ventricular function at rest. Reversal of this abnormality may be observed after 6 months of specific replacement therapy in patients with childhood-onset GHD.     

依那普利联合卡维地洛治疗老年慢性心衰的临床观察

目的探讨依那普利联合卡维地洛在老年慢性心力衰竭患者治疗中的疗效、耐受性和安全性。方法选择老年充血性心力衰竭（CHF）患者130例,随机分为常规治疗组（对照组,28例）、依那普利与卡维地洛联合治疗组（观察组,42例）、依那普利治疗组31例和卡维地洛治疗组29例。4组治疗前和治疗6个月后,均使用超声心动图分别测定左心室舒张末期内径（LVEDD）、心输出量（CO）和左心室射血分数（LVEF）,进行疗效观察。结果治疗后4组LVEDD较治疗前显著减少（P〈0.05）,LVEF和CO较治疗前显著增高（P〈0.05）;治疗后观察组、LVEDD低于对照组（P〈0.05）,LVEF和CO较对照组显著增高（P〈0.05）。结论在常规治疗老年CHF患者的基础上,加用目标剂量的依那普利联合卡维地洛,对CHF患者安全有效,能明显改善心功能,提高左室射血分数。     

卡维地洛与美托洛尔对充血性心力衰竭的疗效和二者的成本─效果分析

目的:观察卡维地洛与美托洛尔治疗充血性心力衰竭(CHF)的远期疗效及二者的成本─效果分析.方法:选择CHF患者114例,随机分3组.A组为对照组,予以血管扩张剂、利尿剂、地高辛、血管紧张素转换酶抑制荆等常规治疗;B组为卡维地洛组,在上述常规治疗的基础上给予卡维地洛.C组在常规治疗基础上给予美托洛尔,随访6个月.用药前后分别观察左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、心衰症状等指标变化情况.结果:6个月后B组和C组LVEDD、LVESD缩小,LVEF明显提高,心衰症状明显好转.但卡维地洛组LVEF改善优于美托洛尔组:卡维地洛组的成本─效果分析低于美托洛尔组.结论:美托洛尔、卡维地洛均可逆转心室重塑,改善心脏功能.卡维地洛疗效略优于美托洛尔.     

卡维地洛对心力衰竭患者的抗氧化作用

 目的探讨卡维地洛治疗充血性心力衰竭(CHF)的临床疗效及抗氧化作用.方法将35例充血性心力衰竭患者双盲随机分为卡维地洛组和安慰组,两组患者基础临床特征相似,于治疗前后检测血浆中谷光甘肽(GSH)、超氧化物歧化酶(SOD)及丙二醛(MDA)浓度,左室射血分数(LVEF)及左室腔径变化,15例健康人为对照组.结果CHF患者MDA浓度较对照组上升(P＜0.01),GSH、SOD浓度较对照组下降(P＜0.01),卡维地洛组与安慰组相比MDA浓度下降(P＜0.05),GSH、SOD水平上升(P＜0.01);LVEF升高(P＜0.01),左室舒张末期径(LVDd)和左室收缩末期径(LVDs)均缩短(P＜0.01),左室收缩末期容量(ESV)减小(P＜0.01).结论卡维地洛具有抗脂质过氧化物作用,改善CHF患者左心功能,长期使用可使扩大的心室缩小.     

Addition of valsartan to an angiotensin-converting enzyme inhibitor improves cardiac sympathetic nerve activity and left ventricular function in patients with congestive heart failure.

We determined whether the addition of the angiotensin-receptor blocker valsartan to an angiotensin-converting enzyme (ACE) inhibitor improves cardiac sympathetic nerve activity and left ventricular function in patients with congestive heart failure (CHF). METHODS: Thirty-two patients with CHF (left ventricular ejection fraction [LVEF] < 40%; mean, 33% +/- 6%) were treated with an ACE inhibitor and a loop diuretic. Sixteen patients (group A) were randomized to additionally receive valsartan (40-80 mg/d), and the remaining 16 patients (group B) continued their current regimen. Patients were studied before and 6 mo after treatment. The delayed heart-to-mediastinum count ratio (H/M ratio), delayed total defect score (TDS), and washout rate (WR) were determined from (123)I-metaiodobenzylguanidine images. The left ventricular end-diastolic volume (LVEDV) and LVEF were determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated. RESULTS: Before treatment, TDS, H/M ratio, WR, LVEDV, LVEF, and NYHA functional class were similar in both groups. After treatment in group A, TDS decreased from 37 +/- 8 to 31 +/- 9 (P < 0.001), H/M ratio increased from 1.66 +/- 0.23 to 1.81 +/- 0.23 (P < 0.001), and WR decreased from 47% +/- 9% to 39% +/- 10% (P < 0.01). In addition, the LVEDV decreased from 193 +/- 36 mL to 169 +/- 51 mL (P < 0.005), and LVEF increased from 32% +/- 7% to 41% +/- 13% (P = 0.0005). In group B, these parameters did not change significantly. NYHA functional class improved in both groups (in group A, from 3.3 +/- 0.5 to 1.7 +/- 0.6 [P < 0.0005]; in group B, from 3.3 +/- 0.5 to 2.4 +/- 0.6; [P < 0.005]). The improvement was significantly greater in group A than in group B (P < 0.05). CONCLUSION: The addition of valsartan to an ACE inhibitor improves cardiac sympathetic nerve activity, left ventricular function, and symptoms in patients with CHF.     

应用cTnT和NT-proBNP水平综合评价左西孟旦治疗老年慢性心力衰竭的疗效

目的：采用心肌钙蛋白T（cardiac troponin T,cTnT）和N-末端B型利尿钠肽前体（N-terminal pro-B-type natriuretic peptide,NT-proBNP）水平结合超声心动图指标,评价经常规抗心力衰竭药物治疗效果欠佳的患者应用左西孟旦注射液的疗效及其安全性。方法选取2012年6月—2014年10月开封市第二人民医院心内科的慢性心力衰竭住院患者96例,随机分为常规组和左西孟旦组各48例,2组患者的心功能为Ⅲ～Ⅳ级,基线资料均衡。常规组患者采用β受体拮抗药、利尿药、洋地黄类药物和血管紧张素转换酶抑制药等药物治疗,左西孟旦组在常规组基础上加用左西孟旦。观察用药前和用药后24 h,2组患者血清标志物NT-proBNP、cTnT及左心室射血分数（left ventricular ejection fraction,LVEF）、每搏输出量（stroke volume,SV）和左心室舒张末期内径（left ventricular end diastolic,LVED）的变化情况。结果2组用药前NT-proBNP、cTnT水平比较差异无统计学意义（P＞0.05）,用药后左西孟旦组NT-proBNP和cTnT水平较治疗前显著降低, LVEF、SV较治疗前显著增高,差异均有统计学意义（P＜0.05）,LVED在用药前后差异无统计学意义（P＞0.05）。而常规治疗组用药前后NT-proBNP、cTnT水平及LVEF、SV、LVED比较差异均无统计学意义（P＞0.05）。左西孟旦组患者用药后的有效率为39.6%（19/48）,常规组为20.8%（10/48）,2组比较差异有统计学意义（P＜0.05）。结论应用cTnT和NT-proBNP水平评价左西孟旦注射液治疗老年慢性心力衰竭效果具有一定的临床价值。