左旋氨氯地平联合贝那普利治疗2型糖尿病肾病合并高血压22例效果观察

目的探讨左旋氨氯地平与贝那普利联用治疗2型糖尿病肾病合并高血压患者的效果。方法将确诊的62例2型糖尿病肾病合并高血压患者随机分为氨氯地平组、贝那普利组各20例及联合组22例。三组均口服降糖药或皮下注射诺和灵30R等,洗脱期2周后口服降压药物治疗。氨氯地平组、贝那普利组分别予左旋氨氯地平2.5 mg、贝那普利10 mg;联合组予左旋氨氯地平2.5 mg＋贝那普利10 mg;用药1次/d,疗程为4个月。观察治疗前后血压、24 h尿蛋白排泄量和肾功能变化。结果治疗后联合组血压、24 h尿蛋白量及血肌酐均明显低于氨氯地平组及贝那普利组（P均〈0.05）,治疗过程中均未见明显不良反应。结论左旋氨氯地平联合贝那普利治疗糖尿病肾病合并高血压效果优于单独用药,且较为安全。     

咪达普利和贝那普利致咳嗽不良反应及降压疗效比较研究

目的　比较咪达普利和贝那普利治疗 1～ 2级高血压病的降压疗效和咳嗽发生率。方法　采用随机、双盲、双模拟、交叉对照法 ,1～ 2级高血压病患者经安慰剂治疗 2周 ,血压符合入选标准者 ,随机分为二组。分别给予咪达普利 5mg每日 1次或贝那普利 10mg每日 1次 ,第 3周末 ,如舒张压≥ 90mmHg(1mmHg =0 133kPa)则剂量加倍。第 7周末 2组交叉 ,咪达普利组改服贝那普利 ,贝那普利组改服咪达普利 ,继续治疗 6周。观察两组降压疗效及咳嗽发生率。结果　试验Ⅰ期(交叉前 )与试验Ⅱ期 (交叉后 )咪达普利和贝那普利组血压显著下降 ,治疗前后均有显著差异 ,P <0 0 1,但二组之间无显著性差异。Ⅰ期咪达普利组咳嗽发生率为 14 5 % ,贝那普利组为 2 4 6 % ,Ⅱ期咪达普利组为 16 9% ,贝那普利组为 2 3 0 % ,Ⅰ期、Ⅱ期二组差异有统计学意义 ,P <0 0 5。结论　咪达普利和贝那普利均具有良好的降压效果 ,二组降压效果相似 ,咪达普利的咳嗽发生率明显低于贝那普利。     

阿托伐他汀联合贝那普利、氨氯地平对高血压患者动态动脉硬化指数及肾功能的影响

目的：观察阿托伐他汀联合贝那普利、氨氯地平对原发性高血压患者动态动脉硬化指数（ AASI ）及肾功能的影响。方法选择原发性高血压患者196例,随机分为A组47例、B组50例、C组51例、D组48例。 A、B组（联合降压组）给予贝那普利和氨氯地平治疗,C、D组（调脂联合降压组）在A、B组治疗基础上加用阿托伐他汀。检测联合降压组及调脂联合降压组治疗前及治疗3、6个月AASI和尿微量白蛋白／肌酐比值（ ACR ）。结果 A、B组治疗3、6个月虽然血压明显下降（P均＜0．05）,但对AASI、ACR影响不明显;C、D组治疗3、6个月,血压、AASI、ACR较治疗前明显下降（P均＜0．05）,且AASI、ACR治疗6个月较治疗3个月下降更明显（P均＜0．05）。结论阿托伐他汀联合贝那普利、氨氯地平对原发性高血压患者AASI及肾功能有明显改善作用。     

贝那普利联合氨氯地平治疗高血压的降压效果

目的分析贝那普利联合氨氯地平治疗高血压的降压效果及平稳降压、保护靶器官的效果。方法选取符合条件的126例高血压患者,随机分为贝那普利联合氨氯地平治疗组(试验组)和氨氯地平组(对照组),同时由专人对两组患者降压效果和超声心动图进行观察和记录。结果两组高血压患者治疗前后收缩压、舒张压、脉压、收缩压昼夜节律、舒张压昼夜节律相比有统计学意义(P<0.05);两组高血压患者收缩压下降值、舒张压下降值、脉压下降值和收缩压谷峰比值分别相比有统计学意义(P<0.05)。治疗结束后两组高血压患者舒张期室间隔厚度、舒张期左室后壁厚度、左室舒张末期内径、左室射血分数、A/E值与治疗前相比有统计学意义(P<0.05)。结论贝那普利联合氨氯地平治疗高血压效果显著,能够提高降压效果和治疗依从性。     

氨氯地平贝那普利片治疗高血压合并冠心病的临床观察

目的分析氨氯地平贝那普利片治疗高血压合并冠心病的效果。方法选择130例高血压合并冠心病患者为研究对象,分为常规组、联合组,给予两组常规氨氯地平治疗、氨氯地平联合贝那普利治疗。结果联合组治疗总有效率高于常规组(P0.05)。联合组疗程结束时舒张压、收缩压均低于常规组(P0.05)。联合组治疗1个月后心前区疼痛评分低于常规组(P0.05)。结论氨氯地平联合贝那普利用于高血压联合冠心病治疗,效果显著,可有效改善患者的症状及体征。     

阿托伐他汀联合贝那普利、氨氯地平对非杓型高血压患者降压疗效观察

【】目的：观察阿托伐他汀联合贝那普利、氨氯地平对非杓型高血压患者昼夜血压变化的影响。方法：将60例非杓型高血压患者随机分为单纯降压组和调脂联合降压组,治疗3个月后对治疗前后降压疗效及昼夜血压变化进行比较并作出评价。结果：治疗3个月后,调脂联合降压组及单纯降压组血压水平均较前下降,调脂联合降压组对降低患者夜间血压较单纯降压组明显,差异性比较有统计学意义(P<0.05)。结论：阿托伐他汀联合贝那普利、氨氯地平能有效降低高血压,在有效降压的同时,可减少昼夜血压波动,改善昼夜节律消失现象。     

贝那普利联合氨氯地平对老年高血压患者的治疗影响

目的探讨贝那普利联合氨氯地平对老年高血压患者的治疗影响。方法选取2016年3月~2016年10月我科诊治的老年高血压患者126例。由电脑随机数表排列法完成随机分组,对63例采用贝那普利联合氨氯地平治疗的老年患者设为老年1组,对63例采用贝那普利治疗的老年患者设为老年2组,对比老年高血压患者分组治疗的差异性效果。结果在血压水平的下降程度上,老年1组优于老年2组,且差异有统计学意义(P0.05);在治疗总有效率上,老年1组同样高于老年2组,差异有统计学意义(P0.05)。结论贝那普利联合氨氯地平对老年高血压患者的治疗影响要显著优于仅采用贝那普利,因此,老年高血压患者应积极选择贝那普利联合氨氯地平进行针对治疗,可得到满意的血压控制效果,此药物方案具有重要的疗效影响意义。     

贝那普利联合氨氯地平治疗原发性高血压的疗效分析

目的探讨贝那普利联合氨氯地平治疗原发性高血压的疗效。方法选取2014年1月~2015年1月原发性高血压的患者80例,将其随机分为实验组和对照组各40例,实验组采用贝那普利联合氨氯地平进行治疗,对照组采用贝那普利进行治疗,结合两组治疗数据,进行比较分析。结果实验组显效20例,有效17例,总有效率为92.5%;对照组显效16例,有效11例,总有效率为67.5%。对两组数据进行整理分析,两组治疗效果存在明显差异(P0.05),具有统计学意义。结论贝那普利联合氨氯地平治疗原发性高血压有明显临床疗效,显著控制血压,依从性好,安全且不良反应小,应该在临床上推广使用。     

贝那普利与氨氯地平治疗老年单纯收缩期高血压临床疗效比较

目的比较贝那普利与氨氯地平治疗老年单纯收缩期高血压临床疗效。方法将我院收治的96例老年单纯收缩期高血压患者随机分成两组，A组50例，给予氨氯地平5rag／次，1次／d，晨服；B组46例，给予贝那普利10mg／次，1次／d晨服，均治疗12周。第4周A组根据血压情况调整氨氯地平为10mg／次，1次／d；B组贝那普利为20mg／次，1次／d治疗9周。每周记录血压及不良反应。结果两组患者治疗前、后SBP、PP间差异均有非常显著性意义（P〈0.01）。A组有效率为89．1％，B组有效率为88．5％，两组患者有效率间差异无显著性意义（P〉0.05）。结论氨氯地平与贝那普利降低老年收缩期高血压临床疗效确切，两药降压效果相近，不良反应少，均为有效长效降压剂。     

贝那普利联合胺碘酮预防阵发性房颤复发的作用

目的 评价贝那普利联合胺碘酮预防阵发性房颤复发的疗效。方法随机选取阵发性房颤复律后患者66例，分为治疗组（Ⅱ组）32例和对照组（Ⅰ组）34例。Ⅰ组常规口服胺碘酮，Ⅱ组口服胺碘酮加贝那普利，观察12个月。结果Ⅱ组治疗后复发率明显下降并低于对照组（P〈0．05）有显著差异，左房内径亦有显著性缩小。结论 贝那普利联合胺碘酮能更有效预防阵发性房颤复发。     

卒中单元对卒中患者二级预防依从性的影响

目的:探讨卒中单元对卒中患者卒中发病后1年时二级预防依从性的影响.方法:采用回顾性研究设计,研究对象为在卒中单元(500例)和普通病房(445例)接受治疗的卒中或短暂性脑缺血发作患者.卒中单元组通过到院随访、电话随访或入户随访1年,普通病房组通过电话随访1年.观察指标为:抗栓药物的使用率、戒烟人数比率、卒中早期症状知晓率和患者自身卒中危险因素知晓率.结果:(1)卒中单元组抗栓药物使用率为92.76%,显著高于普通病房组的51.49%(P＜0.01);(2)卒中单元组戒烟人数比率、卒中早期症状知晓率和自身危险因素知晓率分别为82,33%、91.04%和94.03%,显著高于普通病房组的54.75%、65.53%和70.37%(P均＜0.01).结论:卒中单元重视卒中的二级预防和强调规范化治疗,显著提高卒中患者二级预防的依从性.     

Could immunosuppressive drugs reduce recurrence rate after second resection for Crohn disease?

BACKGROUND: The aim of this study was to assess the possible benefit of postoperative immunosuppressive drugs administration (ie, azathioprine, 6-mercaptopurine, or methotrexate) on long-term surgical recurrence rate after second anastomotic ileocolonic resection. METHODS: From 1984 to 2000, 26 patients with CD underwent second resection for ileocolonic anastomotic recurrence. There were 14 women and 12 men (mean age +/- SD: 34 +/- 9 years). Two groups of patients were compared according to the postoperative treatment: immunosuppressive (IS) drugs group was composed of 14 patients, and control group was composed of 12 patients receiving either salicylates (n = 5) or no treatment (n = 7). RESULTS: Clinical recurrence rate at 3 years was significantly lower in the IS group than in the control group (3/12, 25% vs 6/10, 60%; P < 0.05). Although not significant, after a mean follow-up of 80 +/- 46 months (extr. 17-178 months) after the second resection, clinical recurrence rate at follow-up was also lower in IS group (6/14, 43%) than in control group (9/12, 75%). The mean delay of recurrence was similar in both groups (27 +/- 13 months vs 28 +/- 21; NS). A third intestinal resection was performed less frequently in the IS group than in control group (2/14, 17% vs 7/12, 58%; P < 0.02). CONCLUSIONS: In patients treated with IS drugs, the rate of postoperative recurrence after second ileocolonic CD resection is lower than in untreated patients. Our results suggest that IS drugs should be evaluated prospectively for prevention of second postoperative CD recurrence.     

苯那普利对自发性高血压大鼠血管内皮舒张功能的改善作用

目的 :探讨苯那普利能否改善自发性高血压大鼠 (SHR)血管内皮舒张功能。　　方法 :采用体外灌注法测定苯那普利治疗组 (治疗组 )及对照组胸主动脉环对乙酰胆碱的舒张反应 ,并比较两组血清中 NO3- 浓度、动脉组织中环鸟苷酸 (c GMP)水平。　　结果 :与对照组比较 ,治疗组胸主动脉环对乙酰胆碱的最大舒张反应明显增强 (P<0 .0 1)。左旋硝基精氨酸 (L-NNA)几乎完全消除了治疗组和对照组舒张反应之间的差异。治疗组血清 NO3-浓度和动脉组织 c GMP的含量均明显增加 (P均 <0 .0 1)。　　结论 :苯那普利长期治疗可明显改善 SHR血管内皮舒张功能 ,其机制可能是增加了内皮一氧化氮的合成或释放     

Efficacy of anticoagulation for secondary stroke prevention in older people with non-valvular atrial fibrillation: a prospective case series study

BACKGROUND AND PURPOSE: Despite large randomised trials that demonstrated the efficacy of oral anticoagulants in the primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation (AF), anticoagulation therapy remains largely under-used in older patients, who are at risk of first ever or recurrent stroke. The aim of the present study was to assess the influence of anticoagulation therapy on long-term prognosis in the oldest old stroke patients with AF after adjusting for baseline risk factors. METHODS: We evaluated prospectively a consecutive series of 207 older people (>75 years) with AF and first ever ischaemic stroke. During the follow-up period (mean 88.4 months, range 3-120), the study population was under either oral anticoagulants (n = 72) or aspirin (n = 135). Death and recurrent vascular events (stroke and systemic embolism) were documented. Statistical analyses were performed by means of the Kaplan-Meier product limit method and the Cox proportional hazards model. RESULTS: The cumulative 10 year mortality and recurrence rate were 92.5% (95% CI 85.7-99.3) and 66.1% (95% CI 43.1-89.1), respectively. Cox regression analysis revealed increasing age, functional dependency at hospital discharge and antiplatelet versus anticoagulation therapy as independent determinants of mortality. Antiplatelet versus anticoagulation therapy was the sole determinant of vascular recurrence. Anticoagulation was associated with decreased risk of death (hazards ratio (HR) 0.47, 95% CI 0.31-0.72, P = 0.001)) and recurrent thromboembolism (HR 0.31, 95% CI 0.16-0.62, P = 0.002). CONCLUSIONS: Our results suggest that the benefits of anticoagulation for secondary stroke prevention in AF patients extend to the oldest old. Prospective randomised clinical trials are needed to verify the potential benefit of anticoagulation in such patients.     

Non-vitamin K antagonist oral anticoagulation versus left atrial appendage occlusion for primary and secondary stroke prevention after cardioembolic stroke

IntroductionThis study aimed to evaluate the performance of non-vitamin K antagonist oral anticoagulation (NOAC) in patients with previous stroke and non-valvular atrial fibrillation (AF) compared with left atrial appendage occlusion (LAAO) in primary and secondary stroke prevention settings.MethodsThis was a prospective, single-center, non-randomized cohort study of 302 consecutive patients with non-valvular AF and at high risk for stroke. Two treatment strategies were compared: LAAO (n=91) and long-term treatment with NOAC (n=149). The primary outcome was the composite endpoint of death, stroke and major bleeding. Propensity score and cause-of-death analyses were performed to compare outcomes.ResultsIn a mean follow-up of 13 months, there were 30 deaths (LAAO 8.8% vs. NOAC 14.8%), five strokes (LAAO 1.1% vs. NOAC 2.7%) and six major bleeds (LAAO 1.1% vs. NOAC 3.4%). There was a non-significant trend for a lower incidence of the primary endpoint in the LAAO group (11.0% vs. 20.9%; HR 0.42, 95% CI 0.17-1.05, p=0.064). Considering only secondary prevention LAAO patients (34.1% of the LAAO group), there was also a non-significant lower incidence of the primary endpoint (LAAO 6.5% vs. 20.9%; HR 0.30, 95% CI 0.07-1.39, p=0.12). While about a fifth of LAAO patients stopped antiplatelet treatment six months after device implantation due to recurrent minor bleeding, no adverse cardiovascular event or major bleeding occurred in this subset of patients.ConclusionIn this registry-based study, LAAO was a reasonable alternative to NOAC for the prevention of a composite endpoint of all-cause mortality, stroke and major bleeding in patients at high risk for stroke.     

苯那普利对原发性高血压患者脑血流量及生活质量的影响

目的：探讨苯那普利对原发性高血压（ＥＨ）患者脑血流量和生活质量的影响。方法：将１５９例ＥＨ患者随机分为苯那普利组（８０例）和卡托普利组（７９例）,每例进入试验前后均行经颅多普勒血流仪（ＴＣＤ）测定并同时做生活质量评判的自我独立答卷。结果：两组治疗前后测ＴＣＤ,其脑血流速度均较治疗前明显下降,其中苯那普利组降至正常,卡托普利组降至接近正常,两者无显著性差异（Ｐ＞０．０５）。两组治疗后其生活质量呈明显改变,两组间无明显差异。结论：苯那普利和卡托普利对ＥＨ患者均能降低其脑血流速度使生活质量有不同程度的提高。     

社区缺血性脑卒中患者二级预防现状及再发脑卒中相关危险因素的调查

目的了解北京市部分社区缺血性脑卒中患者二级预防现状及再发脑卒中的相关危险因素。方法选择北京市四个社区卫生服务中心,纳入既往确诊为缺血性脑卒中患者326例。收集患者性别、年龄、高血压病史、糖尿病病史、心房颤动(房颤)病史、脑卒中病史、以及抗栓治疗情况,以及患者身高、体重、血压、血糖、总胆固醇等指标。分析缺血性脑卒中患者危险因素的暴露和控制情况以及对再发脑卒中的影响。结果 326例患者中男性199例(61.0%),女性127例(39.0%)。高血压、糖尿病、房颤患病率分别为79.8%、20.6%、17.8%。吸烟率、饮酒率、总胆固醇异常率分别为30.2%、22.4%和21.5%。高血压患者血压控制率为15.4%,糖尿病患者血糖控制率为40.2%,阿司匹林服用率为74.2%。再发脑卒中,再发率为15.6%。在调整性别、年龄、超重肥胖、吸烟、抗栓治疗等因素后,血压控制不达标的高血压患者(OR=3.867,95%CI:1.288~11.609)、血糖控制不达标的糖尿病患者(OR=3.288,95%CI:1.458~7.415)、总胆固醇异常者(OR=2.659,95%CI:1.341~5.273)及心房颤动患者(OR=2.181,95%CI:1.063~4.477)再发脑卒中的危险明显增加(P均0.05)。结论缺血性脑卒中患者中高血压和糖尿病控制率较低,吸烟、饮酒和总胆固醇异常发生率较高,血压、血糖控制不达标以及总胆固醇异常和房颤病史与再发脑卒中显著相关。     

贝那普利与地尔硫卓治疗心脏X综合征患者疗效的比较

目的: 观察贝那普利与地尔硫卓对心脏X综合征患者的疗效。 方法: 心脏X综合征患者45例接受贝那普利 (22例, 贝那普利组) 或地尔硫卓(23例,地尔硫卓组)治疗,治疗3个月后随访临床情况并复查平板运动试验、冠状动脉血流储备（CFR）及血浆一氧化氮（NO）、血浆内皮素-1（ET-1）的含量。结果: 用药3个月后贝那普利组和地尔硫卓组胸痛例数及最大ST段压低幅度明显减少(分别为P<0.01,P<0.05),ET-1水平明显下降(均P<0.01),血浆CFR及NO的水平明显升高(P<0.01或P<0.05),运动总时间、ST段压低1 mm时间明显延长(P<0.01或P<0.05)。与地尔硫卓组相比贝那普利组胸痛例数及最大ST段压低幅度减少更显著(均P<0.05),ET-1水平下降更显著（P<0.01）,CFR及NO的水平升高更显著(均P<0.05),运动总时间、ST段压低1 mm时间延长更显著（分别为P<0.01,P<0.05）。结论: 贝那普利与地尔硫卓均能改善心脏X综合征患者的内皮细胞功能提高患者的运动耐量及CFR,且与地尔硫卓相比贝那普利更为有效。     

缺血性脑卒中二级预防治疗的依从性研究

目的采取有效措施减少缺血性脑卒中再发,对缺血性脑卒中或短暂性脑缺血发作(TIA)患者采取ABCDE策略,观察患者出院后1年能否维持高水平药物治疗符合率。方法选择缺血性脑卒中或TIA患者178例,采取ABcDE策略进行规范的二级预防。观察患者出院时及出院后1年二级预防中抗血小板、降压、降糖和他汀类药物治疗的符合率。结果 178例患者中既往有缺血性脑卒中或TIA史126例,其住院前抗血小板治疗比例为41.3%,服用降压、降糖和他汀类药物治疗比例分别为89.9%、83.3%和13.5%;155例完成出院1年随访,降压治疗符合率为100%,抗血小板治疗符合率为97.2%,降糖和他汀类药物治疗符合率为98.2%和84.3%。结论采取ABCDE策略对缺血性脑卒中或TIA患者进行规范干预后,明显缩小二级预防循证证据与临床实践之间的差距,患者出院1年药物治疗符合率维持在较高水平。     

Amlodipine/benazepril combination therapy for hypertensive patients nonresponsive to benazepril monotherapy

BACKGROUND: Most patients with hypertension require two or more antihypertensive medications to achieve blood pressure (BP) goals. This double-blind study compared the efficacy and safety of high-dose combinations of amlodipine besylate (5 mg and 10 mg) and benazepril hydrochloride (40 mg) to benazepril hydrochloride (40 mg) alone in hypertensive patients not adequately controlled with benazepril hydrochloride (40 mg) monotherapy. METHODS: After a 2-week washout period and a 4-week lead-in period with benazepril 40 mg daily, patients with a mean sitting diastolic BP > or =95 mm Hg (i.e., nonresponders to benazepril 40 mg) were randomly assigned to active treatment with either a combination of amlodipine 5 mg and benazepril 40 mg for 4 weeks followed by a forced titration to amlodipine 10 mg and benazepril 40 mg for an additional 4 weeks, or to benazepril 40 mg alone for 8 weeks. RESULTS: The mean reduction in sitting BP from baseline (on benazepril) to endpoint (after 8 weeks of treatment) was 17/14 mm Hg with amlodipine/benazepril and 5/7 mm Hg with benazepril (P <.0001). The percentage of patients who met the diastolic BP response criteria (<90 mm Hg at endpoint or > or =10 mm Hg decrease from baseline) was 80% in the amlodipine/benazepril group and 45% in the benazepril group (P <.0001). The incidence of adverse events was infrequent and comparable for both treatment groups. CONCLUSION: High-dose amlodipine/benazepril combination therapy (5 mg/40 mg and 10 mg/40 mg) is an effective, safe, and well-tolerated treatment option for hypertensive patients who do not respond adequately to benazepril alone.