联用心通口服液与硝酸异山梨醇酯治疗冠状动脉粥样硬？…

目的：探讨联用中药心通口服液与西药硝酸异山梨醇酯治疗冠心状动脉粥样硬化性心脏病（冠心病）心绞痛的疗效。方法：将６８例冠心病心绞痛患者随机分为２组。治疗组（３６例）用中药心通口服液与西药硝酸异山梨醇酯治疗,对照组（３２例）单用硝酸异山梨醇酯治疗;药物剂量;心通口服液１０ｍｌ,硝酸异山梨醇酯１０ｍｇ,均为每日３次口服,３周为１个疗程。结果：治疗组及对照组临床症状改善总有效率分别为８８．９％及６１．８％     

联用心通口服液与硝酸异山梨醇酯治疗冠状动脉粥样硬化性心脏病心绞痛疗效观察

目的：探讨联用中药心通口服液与西药硝酸异山梨醇酯治疗冠状动脉粥样硬化性心脏病（冠心病）心绞痛的疗效。方法：将６８ 例冠心病心绞痛患者随机分为２ 组。治疗组（３６ 例）用中药心通口服液与西药硝酸异山梨醇酯治疗,对照组（３２ 例）单用硝酸异山梨醇酯治疗;药物剂量：心通口服液１０ ｍ ｌ,硝酸异山梨醇酯１０ ｍ ｇ,均为每日３ 次口服,３ 周为１ 个疗程。结果：治疗组及对照组临床症状改善总有效率分别为８８９％ 及６１８％ ,有显著性差异（ Ｐ＜ ００５）;心电图改善总有效率分别为８０６％ 及５３１％ ,亦有显著性差异（ Ｐ＜ ００５）。结论：心通口服液与硝酸异山梨醇酯合用治疗冠心病心绞痛对心绞痛症状及心电图的心肌缺血改善均优于单用硝酸异山梨醇酯。     

国外医学简讯

治疗严重肺水肿：大剂量硝酸异山梨酯还是大剂量呋塞米更有效？硝酸异山梨酯和呋塞米均是治疗肺水肿的常用药物，作者应用前瞻性随机对照的方法，对上述药物治疗严重肺水肿的效果与安全性进行了研究。选择具有心衰症状，肺水肿体征并经Ｘ线检查证实，氧饱和度小于０．９０...     

双水平气道正压通气治疗急性心源性肺水肿临床观察

目的探讨双水平气道正压通气（bi—levelpositiveairwaypressure,BiPAP）治疗急性心源性肺水肿的临床效果。方法急性心源性肺水肿患者63例随机分为2组,对照组30例给予吸氧、强心、利尿、扩血管等常规治疗等,治疗组33例在对照组治疗基础上给予BiPAP治疗,比较2组治疗效果及治疗前与治疗后1,3h呼吸、心率、平均动脉压、脉搏血氧饱和度、pH、P（O2）、P（CO2）等指标。结果治疗组总有效率100％高于对照组总有效率76．67％（P〈0．01）;2组治疗后呼吸、心率、平均动脉压、pH、p（O2）,p（CO2）、血氧饱和度均较治疗前改善（P〈0．05）,治疗组治疗1,3h后上述指标改善优于对照组（P〈0．05）。结论BiPAP无创机械通气治疗急性心源性肺水肿可取得满意疗效。     

无创双水平正压通气治疗急性心源性肺水肿的临床观察

目的:探讨无创双水平正压(BiPAP)通气治疗急性心源性肺水肿的疗效.方法:将58例急性心源性肺水肿病人随机分为常规组28例和BIPAP组30例,在常规治疗基础上,常规组予40%酒精湿化、高流量面罩吸氧;BIPAP组予无创双水平正压通气治疗.比较两组治疗后0.5 h、1 h、2 h的呼吸频率和血氧饱和度.结果:在治疗后0.5 h、1 h和2 h,BIPAP组在缓解呼吸窘迫和提升血氧饱和度均优于常规组(P＜0.001);BIPAP组2 h治疗有效率优于常规组(P＜0.001).结论:BiPAP能迅速提升急性心源性肺水肿患者血氧饱和度和缓解呼吸窘迫.     

双水平正压通气治疗急性心源性肺水肿的临床观察及护理

目的探讨双水平正压通气治疗急性心源性肺水肿的临床效果及针对性治疗护理的应用效果。方法选取急性心源性肺水肿患者84例随机分为观察组和对照组各42例,对照组患者采用吸氧、扩血管、强心等常规治疗及护理,观察组患者在对照组的基础上采用双水平正压通气及针对性治疗护理措施。比较2组患者治疗前后p(CO2)、p(O2)、血氧饱和度等血气指标的变化,并调查患者的满意度。结果双水平正压通气能降低急性心源性肺水肿患者p(CO2),升高p(O2)、血氧饱和度,观察组治疗后p(CO2)、p(O2)、血氧饱和度与对照组比较,差异具有统计学意义(P0.05);观察组患者的护理满意度显著高于对照组,差异具有统计学意义(P0.05)。结论双水平正压通气治疗急性心源性肺水肿的临床效果好,采用针对性治疗护理措施能提高患者的满意度。     

无创通气治疗急性心源性肺水肿44例临床观察

目的观察无创正压通气治疗急性心源性肺水肿的临床疗效。方法 44例急性心源性肺水肿依据是否应用无创通气（noninvasive ventilation,NIV）分为NIV组30例和常规治疗组14例,监测2组治疗前、后各项生理指标、动脉血气分析、血乳酸和血B型利钠肽的变化。结果与治疗前比较,NIV组治疗后心率、血压、呼吸频率、脉搏血氧饱和度、氧分压、乳酸和B型利钠肽水平有明显改善;常规治疗组仅血压、呼吸频率、脉搏血氧饱和度、氧分压和B型利钠肽水平有改善（P〈0.05）;治疗后NIV组心率、呼吸频率、脉搏血氧饱和度、pH值、氧分压和B型利钠肽水平均较常规治疗组改善明显（P〈0.05）;NIV组气管插管率低于常规治疗组（P〈0.05）。结论 NIV是治疗急性心源性肺水肿快速有效的方法,疗效可靠。     

舒血宁联合单硝酸异山梨酯治疗冠心病心绞痛47例

目的 探讨舒血宁注射液联合硝酸异山梨酯注射液对冠心病心绞痛的临床疗效.方法 将94例确诊的冠心病心绞痛患者按照随机方式进行分组,其中对照组接受常规的单硝酸异山梨酯静脉注射治疗,实验组采用舒血宁联合单硝酸异山梨酯静脉注射治疗;疗程均为2周.结果 实验组中,总体有效43例,而对照组总体有效34例,有效率分别为91.5％和72.3％,实验组疗效显著优于对照组.结论 舒血宁联合单硝酸异山梨酯注射液的治疗方案可以扩张血管、改善血液循环、有效改善心肌供血的情况,并且能够有效地缓解心绞痛状况.     

无创正压通气治疗急性心源性肺水肿的临床疗效观察

目的：观察无创正压通气（ NPPV）治疗急性心源性肺水肿的临床疗效。方法对48例急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV，观察治疗期间心率和经皮血氧饱和度的变化，比较治疗前及治疗后2 h血气情况。结果急性心源性肺水肿患者治疗后2h缺氧症状得到明显改善，心悸、呼吸困难及紫绀明显好转，心功能评级明显降低（P﹤0.01）。结论对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著，具有良好的临床实用价值，值得推广。     

双水平正压无创通气治疗急性心源性肺水肿的研究

目的 观察双水平正压（BiPAP）无创通气治疗急性心源性肺水肿的临床疗效。方法 对35例常规治疗不能改善症状的急性心源性肺水肿患者应用BiPAP无创通气，观察通气前后心率（HR）、呼吸（R），经皮测定动脉血氧饱和度（SaP2）和动脉血气分析等指标变化。结果 35例患者经BiPAP治疗2h后临床体征和动脉血气分析明显改善（P〈0．05），29例顺利停机，抢救成功率82．9％。结论 早期合理使用BiPAP无创通气，可较迅速改善急性心源性肺水肿患者临床症状和低氧血症，提高抢救成功率。     

饮热水联合硝酸异山梨醇酯对贲门失弛缓的治疗作用

  目的  探讨饮热水、含服硝酸异山梨醇酯及两者联合对贲门失弛缓是否具有治疗作用  目的  顺序纳入2012年10月至2013年5月在北京协和医院消化内科门诊就诊的初治贲门失弛缓患者, 随机分为两组, A组为饮水-联合药物治疗组, 20例; B组为药物-联合饮水治疗组, 22例, 疗程4周。A组患者第1周仅予饮水治疗, 第2~4周饮水联合药物治疗; B组第1周仅予药物治疗, 第2~4周药物联合饮水治疗。所有纳入患者于基线期(治疗前2周)、治疗1周及治疗4周均进行临床症状评估, 于基线期和治疗4周行食管动力监测及食管造影检查  结果  最终41例患者纳入分析, 其中A组19例, B组22例。两组患者性别、年龄及病程差异无统计学意义(P > 0.05)。与基线期比较, A组治疗1周和治疗4周症状明显改善(P < 0.05), 且治疗4周症状改善明显优于治疗1周(P < 0.05);与基线期比较, B组治疗4周症状明显改善(P < 0.05);A组和B组之间症状积分比较差异无统计学意义(P > 0.05)。与基线期比较, 两组患者治疗4周下食管括约肌压力(lower esophageal sphincter pressure, LESP)和吞咽时下食管括约肌综合松弛压(integrated relaxation pressure, IRP)无明显降低(P > 0.05);然而基线期和治疗4周, 饮热水或药物干预后LESP及IRP较干预前明显降低(P < 0.05)。与基线期比较, 两组患者治疗4周食管宽度无明显变化(P > 0.05)  结论  饮水或药物干预通过短暂降低下食管括约肌压力和提高下食管括约肌松弛功能改善临床症状, 两者联合干预效果更佳, 但饮水、药物或联合干预不能持续改善下食管括约肌压力或松弛功能。饮水联合药物为不能耐受或不接受有创治疗及有创治疗后复发的患者提供一个可供选择的保守治疗方法。     

Sublingual Flunarizine: a New Effective Management of the Migraine Attack. A Comparison versus Ergotamine

SYNOPSIS
Flunarizine was found to be effective in the acute treatment of isosorbide dinitrate induced migraine attacks, when given in a dosage of 10 mg sublingually.
The present study consists of two parts: in the first preliminary investigation, 7 out of 8 migraine patients who developed a typical migraine attack after isosorbide dinitrate were relieved of pain within about 10 minutes. On the basis of this result a second, randomized controlled open trial was performed, in which the acute efficacy of flunarizine was compared with ergotamine tartrate, 0.25 mg i.m., on 40 migraine patients. Flunarizine was found as effective as ergotamine (75% positive responses in the flunarizine group, 70% in the ergotamine group). The mean latency of the flunarizine effect was significantly lower than that of the ergotamine ( r < 0.001, Student's t test). Moreover sublingual flunarizine was found to be virtually devoid of side effects.     

输注硝酸酯类防治血透高血压对左室舒张功能的效应

目的　观察输注硝酸酯类药物防治血透中血压明显升高对左室舒张功能的效应。方法　血透中血压明显升高并左室舒张功能不全 84例次。将其随机分为三组 :A组予硝酸甘油 5mg ,B组予异舒吉 (二硝酸异山梨酯 ) 2 0mg ,C组予异舒吉 10mg。分别为非透析日、血透开始半小时、血透中血压明显升高时 ,输注硝酸酯类药物 10 0分钟时行超声心动图检查 ,并记录患者血压及基本临床表现。结果　A、B组可将血压维持在透析前水平 ,并显著改善超声心动图指标及临床表现。C组血压无显著下降 ,超声心动图指标及临床表现亦无显著改善。结论　硝酸甘油及大剂量异舒吉对血透中高血压并左室舒张功能不全有较好的疗效。     

Comparative study of isosorbide dinitrates and mononitrates in patients with ischemic heart disease and stable angina pectoris caused by stenosing coronary atherosclerosis

In an open clinical trial 19 patients with angina pectoris (functional class II-III) received in turn either non-retard tablets of isosorbide dinitrate (nitrosorbid, cardiket) in a mean dose 80 mg/day or isosorbide 5-mononitrate (mono mac) in a mean dose 51.5 mg/day. Each drug was given for a month. The effect was assessed by changes in frequency of anginal attacks and exercise tolerance. Non-retard isosorbide dinitrate and isosorbide 5-mononitrate demonstrate a good antiischemic effect, are safe and well tolerated. Isosorbide dinitrate and mononitrates do not differ significantly in reduction of the anginal attacks and by an increase in exercise tolerance but the effective dose of mono mac was 1.5-2 times less than that of nitrosorbide or cardiket, thus it is more cost-effective.     

99m Tc-MIBI 心肌显像定量分析用于判定急性心梗溶栓术后存活心肌的价值

目的采用硝酸酯类药物介入心肌断层显像,研究急性心梗病人溶栓术后存活心肌的范围。方法将32例接受急性溶栓术的病人分成溶栓再通组(19例)和未再通组(13例),10天后行异舒吉介入的心肌断层显像,并分别计算出静态的及异舒吉介入的心肌缺损面积(%)和体积(%),得出存活心肌的面积(%)和体积(%)。结果溶栓再通组和未再通组比较静态显像缺损面积(%)为32.04±17.95和52.13±22.99(P<0.05),异舒吉介入显像缺损面积(%)为26.62±15.13和51.93±21.10(P<0.05),存活心肌面积(%)9.45±6.43和2.75±3.57(P<0.05)。静态显像缺损体积(%)为28.45±12.79和39.56±11.89(P<0.05),异舒吉介入显像缺损体积(%)为18.61±16.52和36.94±11.35(P<0.05),存活心肌体积(%)为9.84±2.39和2.62±1.45(P<0.05)。结论急性心肌梗塞溶栓再通是否成功与存活心肌的面积、体积有明显的关系,并且异舒吉介入心肌显像定量分析方法判断存活心肌的范围有一定临床价值。     

双水平正压通气在急性心源性肺水肿中的应用

目的:探讨双水平正压通气治疗急性心源性肺水肿的疗效。方法:收集内科2003年1月至2007年8月收治的92例急性心源性肺水肿患者的临床资料并进行分析。治疗组46例在应用常规抗心源性肺水肿药物的同时联用BiPAPS/T30或BiPAP-Synchrony呼吸机进行无创通气治疗,对照组46例只应用常规药物治疗。结果:治疗组患者临床症状、体征明显改善,心率、呼吸频率、血压与治疗前比较显著降低,SaO2与治疗前比较显著增高(P<0.05),总有效率93.5%。对照组总有效率仅为82.6%。结论:双水平正压通气治疗急性心源性肺水肿疗效确切。     

硫氮(艹卓)酮加硝酸异山梨酯与硝酸异山梨酯对冠心病患者心功能的影响

应用硫氨(艹桌)酮加硝酸异山梨酯与硝酸异山梨酯,对65例冠心病心绞痛患者进行9项心功能指标及临床疗效观察。结果表明:硫氮革酮与硝酸异山梨酯合用组(治疗组)用药前后,左心收缩功能指标SV、EF、Fs、PEP/LVET,舒张功能指标LA、E、A、A/E、DC均有显著差异(P<0.01),改善心绞痛症状有效率为94％。而单用硝酸异山梨酯组(对照组)用药后除每搏输出量及射血分数有明显差异外(P<0.01),其它各项指标无明显差异,改善心绞痛症状有效率为59％。提示:两药联合应用对改善冠心病患者左心功能疗效好,副作用少,值得在临床进一步观察。     

Use of peripheral vasodilators with different mechanisms of action in treating heart failure patients

The efficacy of peripheral vasodilators with various mechanisms of action was studied in 26 patents with congestive heart failure, left ventricular dilatation and valvular regurgitation. An acute pharmacological test using prazosin was used in all the patients, 20 of them were given a 15-day course of prazosin therapy, 19 patients received a prolonged course of prazosin therapy (over 3 mos.), 15 patients were given a 15-day course with a combination of isosorbide dinitrate and hydralazine. ECG monitoring, catheterization of the right cardiac chambers, thermodilution, and tetrapolar impedance plethysmography were employed. Heart rate, arterial pressure, parameters of cardiac pre- and afterload and pulmonary hemodynamics were studied. Prazosin and isosorbide dinitrate in combination with hydralazine showed a high clinical efficacy in the treatment of patients with congestive heart failure. The improvement of clinical symptomatology was accompanied by considerable positive shifts of the central and peripheral hemodynamics. No considerable differences in the efficacy of prazosin and the combination of isosorbide dinitrate with hydralazine were revealed.     

50例急性肺栓塞2周后小剂量溶栓和单纯抗凝疗效观察

目的：观察急性肺栓塞病程2周以后，溶栓加抗凝和单纯抗凝临床效果比较。方法：将50例肺栓塞病程〉2周的病人分为A、B两组。A组用250ml。生理盐水加尿激酶200000～500000u，低分子肝素钙5000u皮下注射，1次／12h，连用7d，于停用低分子肝素钙前3d开始口服华法令，疗程6个月；B组仅应用低分子肝素钙及华法令，方法同A组。观察临床症状、体征、心脏彩超、肺通气灌注显像及螺旋CT检查的变化。结果：A组总有效率为50％，B组总有效率为40％，两者比较P〉0．05。结论：急性肺栓塞病程〉2周，小剂量溶栓加抗凝与单纯抗凝无显著差别，为减少出血风险选择单纯抗凝治疗。     

Early administration of isosorbide dinitrate improves survival of cyanide-poisoned rabbits

Abstract

Context. More effective, rapidly delivered, safer antidotes are needed for cyanide poisoning. Previous study has demonstrated a beneficial effect of isosorbide dinitrate on the survival of cyanide-poisoned mice. Objective. To evaluate the effectiveness of isosorbide dinitrate compared with that of sodium nitrite in cyanide poisoning. Materials and methods. A comparative animal study was performed using 18 rabbits, randomized into 3 study groups. Animals were poisoned intravenously with potassium cyanide (1 mg/kg). The first group was not given any further treatment. The second and third groups were treated intravenously 1 min after poisoning with sodium nitrite (6 mg/kg) and isosorbide dinitrate (50 μg/kg), respectively. The primary outcome was short-term survival of up to 30 min. Secondary outcomes included time to death, a clinical score, mean blood pressure, pulse, blood pH, and lactate and methemoglobin levels. Results. Rabbits treated with isosorbide dinitrate or sodium nitrite survived while only one untreated rabbit survived. Median time to death of the 5 poisoned and untreated animals was 10 min. All the animals collapsed soon after poisoning, exhibiting rapidly disturbed vital signs and developed lactic metabolic acidosis; average peak blood lactate levels were 15.5–19.1 mmol/L at 10 min after poisoning. The treated animals improved gradually with practically full recovery of the clinical scores, vital signs, and blood gas levels. Sodium nitrite administration raised methemoglobin to an average peak of 7.9%, while isosorbide dinitrate did not change methemoglobin levels. Conclusion. Early administration of isosorbide dinitrate improved the short-term survival of cyanide-poisoned rabbits. Isosorbide dinitrate shows potential as an antidote for cyanide poisoning and may exert its effect using a nitric-oxide-dependent mechanism.