厄贝沙坦/氢氯噻嗪与福辛普利钠联合应用治疗扩张型心肌病的观察

目的 探讨厄贝沙坦/氢氯噻嗪与福辛普利钠联合应用对扩张型心肌病的疗效.方法 100例扩张型心肌病患者在应用洋地黄、螺内酯、β2受体阻滞剂的基础上,随机分为两组:观察组50例口服厄贝沙坦/氢氯噻嗪75～150 mg/d,福辛普利钠5～10 mg/d;对照组50例口服福辛普利5～10 mg/d,治疗前、后分别行血清电解质、肝肾动能和超声心动图检查.结果 治疗3个月后,左室功能和左室结构均有显著改善(P<0.05),观察组较对照组改善更显著(P<0.05),治疗前、后两组血清电解质与肝肾功能差异无统计学意义(P>0.05).结论 厄贝沙坦/氢氯噻嗪与福辛普利钠联合应用治疗扩张型心肌病的疗效优于单用福辛普利钠.     

缬沙坦与雷米普利联合治疗充血性心力衰竭的疗效

目的评价缬沙坦(valsartan)与雷米普利(ramipril)联合治疗充血性心力衰竭(CHF)的疗效.方法 150例CHF患者在应用洋地黄、利尿剂、β受体阻断剂治疗的基础上,随机分为A组(n=75)口服缬沙坦80 mg/d,雷米普利1.25～10 mg/d;B组(n＝75)口服雷米普利1.25～10 mg/d.治疗前、后分别进行心功能(NYHA 分级)评估,行血生化、肝、肾功能、心电图、超声心动图检查.结果治疗8周后两组左房内径(LA)、左室舒张末期容量(LVEDV)、左室收缩末期容量(LVESV)、左心室射血分数(EF)、短轴缩短率(FS)、心输出量(CO)、心排血指数(CI)均有显著改善(P均<0.05).LVEDV、LVESV、EF、FS及心功能改善总有效率A组与B组比较改善更为显著(P<0.05).两组治疗前、后血生化、肝、肾功能均无显著变化,不良反应发生率相仿(P>0.05).结论缬沙坦与雷米普利联合治疗CHF优于单用雷米普利.     

氯沙坦与卡托普利治疗原发性扩张型心肌病的疗效比较

目的对比氯沙坦与卡托普利治疗原发性扩张型心肌病的疗效.方法 65例原发性扩张型心肌病病人在应用洋地黄、利尿剂、β受体阻滞剂治疗的基础上,随机分为A组(33例):口服氯沙坦每天(25～50)mg;B组(32例):口服卡托普利每天(18.75～75.00)mg.治疗8周后进行心功能(NYHA分级)评估,并随访两组病人首次入院后半年、1年的终点事件发生率(再入院率、病死率),行血常规、血生化、肝肾功能检查.结果治疗8周后两组心功能均有明显改善(P<0.05),但对1年内终点事件发生率无统计学意义(P>0.05).两组治疗前后血常规、血生化、肝肾功能均无显著变化,不良反应发生率相仿(P>0.05).结论氯沙坦与卡托普利治疗原发性扩张型心肌病远期疗效相当.     

缬沙坦联合卡托普利治疗心力衰竭的疗效观察

目的 探讨缬沙坦联合卡托普利治疗心力衰竭的临床效果.方法 将我院收治的60例心力衰竭患者,随机分为对照组和观察组,两组患者给予持续强心、噻嗪类利尿剂及其他常规基础治疗.对照组在基础治疗上给予卡托普利治疗,观察组在对照组的基础上加用缬沙坦治疗,比较两组治疗效果及不良反应发生情况.结果 对照组总有效率66.7%,观察组总有效率90%.两组总有效率经统计学分析,差异有统计学意义(P＜0.05).观察组治疗前与对照组治疗前相比差异无统计学意义(P＞0.05),观察组治疗后左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左心室射血分数(LVEF)优于对照组,差异有统计学意义(P＜0.05).两组治疗过程中均未见明显不良反应发生.结论 缬沙坦联合卡托普利治疗心力衰竭疗效显著,使用方便,安全可靠,值得临床推广应用.     

培哚普利 比索洛尔治疗扩张型心肌病并充血性心力衰竭疗效观察及预后评价

目的观察培哚普利、比索洛尔治疗扩张型心肌病并充血性心力衰竭的疗效和对其预后进行综合评估。方法通过对已经确诊扩张型心肌病合并心力衰竭患者58例,根据患者意愿和经济情况分成治疗组A(38例)和对照组B(20例)。在治疗充血性心力衰竭基础上治疗组予以培哚普利10mg每日1次加比索洛尔5～10mg每日1次,对照组予以卡托普利25mg每日3次,倍他乐克25～50mg每日2次,定期门诊随访、复查心脏彩超、心脏三位片、心电图并综合评价其疗效、预后情况及临床心功能改善状况。结果治疗组A患者,心室率控制良好、心功能明显改善、劳动强度和生活质量提高,复查心电图及心脏彩超、心室率控制在60～100/min,左室舒张末期内径较治疗前缩小、左室收缩未内径较治疗前缩小,心肌收缩力增强,左室射血分数增高,再住院率及病死率(5年)明显下降,生活质量提高。结论长期口服培垛普利、比索洛尔治疗扩张型心肌病可明显改善心功能不全临床症状。降低再住院率、病死率,提高生活质量,改观预后。因此培垛普利、比索洛尔可作为扩张型心肌病、充血性心力衰竭患者常规有效治疗。     

盐酸法舒地尔对扩张型心肌病患者心功能的影响

目的研究盐酸法舒地尔对扩张型心肌病患者心功能的影响。方法将扩张型心肌病患者50例随机分为两组:对照组24例,进行常规治疗;治疗组26例,在常规治疗基础上加用盐酸法舒地尔60mg/d。两组均治疗1个月,观察治疗前后患者超声心动图、血清cTnI变化情况。结果治疗组显效率为76.92%,对照组显效率为58.33%,两组比较差异有统计学意义(P0.05);两组患者治疗后,左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)缩小,左心室心肌质量(LVMW)减轻,左心室射血分数(LVEF)和左心室后壁收缩期增厚率(ΔT%)上升,较治疗前均显著改善(P0.05);血清cTnI水平较治疗前均显著下降(P0.05),而治疗组下降更明显(P0.05)。结论盐酸法舒地尔能改善扩张型心肌病患者心脏泵功能     

大剂量缬沙坦治疗老年高血压合并肾病患者的疗效及对肾功能相关指标、电解质的影响

目的探讨大剂量缬沙坦治疗老年高血压合并肾病患者的疗效及对肾功能相关指标、电解质的影响。方法 166例老年高血压合并肾病患者抽签分为观察组(86例)和对照组(80例),所有纳入者先采用缬沙坦80 mg/d导入治疗,2 w后对照组继续缬沙坦80 mg/d治疗;观察组给予大剂量缬沙坦(160 mg/d)治疗。治疗3个月观察血压控制情况,并比较治疗前后肾功能指标〔血肌酐(Scr)、尿素氮(BUN)、胱抑素(Cys)-C、血清β2微球蛋白(β2-MG)、尿白蛋白排泄率(UAER)〕及电解质〔血钾(K~+)、血钙(Ca~(2+))、血氯(Cl~-)、血磷(P~(3+))、血钠(Na~+)〕的变化。结果治疗后观察组收缩压、舒张压,显著低于对照组(P0.05);治疗后,两组肾功能相关指标BUN、Scr、Cys-C、β2-MG以及UAER均较治疗前明显改善(P0.05),且观察组改善更明显,与对照组治疗后同期比较差异均有统计学意义(P0.05);两组治疗前后血清电解质变化均不明显。结论大剂量缬沙坦治疗老年高血压合并肾病时控制血压效果更好,能显著改善肾功能、保护肾组织,且不引起电解质紊乱,临床可尝试扩大应用。     

洛汀新与缬沙坦对老年急性心肌梗死患者心室重塑及心功能的影响

目的比较洛汀新与缬沙坦对老年急性心肌梗死(AMI)患者心功能的影响。方法选择AMI患者100例,随机分为两组,其中缬沙坦组50例、洛汀新组50例,两组均行AMI常规治疗,缬沙坦组加用缬沙坦80 mg/d、洛汀新组加用洛汀新10 mg/d,疗程3个月。比较两组患者治疗前后临床症状、心功能及心室重塑指标变化。结果两组间患者治疗后16 w临床症状评分及心功能NYHA分级与治疗前比较有差异(P0.05);两组间间患者治疗后16 w临床症状评分及心功能NYHA分级比较有差异(P0.05);两组间患者治疗16 w后左室收缩期末容积(LVESV)、左室舒张期末容积(LVEDV)、左室射血分数(LVEF)与治疗前比较有差异(P0.05);两组间患者治疗后16 w LVESV、LVEDV、LVEF比较有差异(P0.05);两组患者治疗16 w后舒张末期室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室心肌重量指数(LVMI)与治疗前比较有差异(P0.05);两组患者治疗后16 w IVST、LVPWT、LVMI比较有差异(P0.05);洛汀新组患者发生中度以上心力衰竭4例,缬沙坦组患者发生中度以上心力衰竭12例,两组比较有差异(P0.05)。结论洛汀新和缬沙坦均能明显改善左室功能,阻抑左室重塑过程,提高左室收缩的同步性;而洛汀新的效果优于缬沙坦。     

沙库巴曲缬沙坦在心力衰竭患者临床应用中的观察

目的:总结分析沙库巴曲缬沙坦在真实世界临床实际中治疗扩张型心肌病心力衰竭患者的情况、疗效和安全性。方法:本研究是一项前瞻性注册观察性研究。连续性纳入85例诊断为扩张型心肌病心力衰竭的患者,首先给予患者血管紧张素转化酶抑制剂、β受体阻滞剂及醛固酮受体拮抗剂等进行常规治疗,再停用血管紧张素转化酶抑制剂36h,改用沙库巴曲缬沙坦钠片口服,50mg/次,2次/d,根据患者的血压及耐受情况,逐步调整剂量为400mg/d或至最大耐受量,连续治疗12个月,观察真实世界心力衰竭患者使用沙库巴曲缬沙坦治疗的剂量、治疗效果及其对患者血压、心脏结构和功能、血常规和肾功能等生化指标的影响。结果:沙库巴曲缬沙坦平均使用剂量为136.18mg/d,治疗的总有效率为73%。患者治疗后左心室射血分数(LVEF)明显提高(△■=5.84%,P=0.000),左心室舒张末期内径(LVEDD)(△■=-3.05mm,P=0.000)、收缩压(△■=-9.01mmHg,1mmHg=0.133kPa,P=0.000)、血红蛋白(△■=-8.14g/L,P=0.026)均明显降低。治疗对患者肝肾功能及血脂无明显影响。结论:在真实世界的扩张型心肌病心力衰竭患者治疗中,沙库巴曲缬沙坦使用剂量偏低,但也可以取得较好的治疗效果。在使用过程中除了需要关注患者血压,还需要关注血红蛋白的下降情况。     

缬沙坦治疗慢性心力衰竭的临床疗效

目的观察缬沙坦治疗慢性心力衰竭的临床疗效。方法心力衰竭患者58例,随机分为两组:即缬沙坦治疗组30例服用缬沙坦80 mg/d;常规治疗组28例未服用缬沙坦及其他血管紧张素Ⅱ-1型受体拮抗剂。缬沙坦组和常规治疗组均于治疗前,治疗后半年分别行心脏彩色多普勒检查。结果两组在治疗前及治疗后对比,缬沙坦组比常规治疗组左心室舒张末期容积(LVEDV)[(102.6±25.6)mlvs.(117.2±28.5)ml,P<0.05]及左心室收缩末期容积(LVESV)[(53.1±20.6)mlvs.(66.4±28.7)ml,P<0.05]明显减小,而左室射血分数(LVEF)明显提高[(56.1±9.6)%vs.(47.4±13.2)%,P<0.01]。随访1年,结果缬沙坦组(24.0%)比常规治疗组(46.7%)心力衰竭再发生率降低有统计学意义(P<0.05)。结论应用缬沙坦治疗心力衰竭,患者心功能有明显的改善。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.