卡维地洛与美多心安对高血压患者治疗效果的比较研究

目的　评价国产卡维地洛的降压效应与安全性。方法　 90例原发性高血压患者随机分为观察组与对照组 ,分别口服国产卡维地洛 1片 (10mg)或美多心安 1片 (2 5mg) ,2次 /d ,4周为 1疗程。 结果　卡维地洛组服药 4周后收缩压 (SBP)及舒张压 (DBP)与治疗前比较分别下降 (18.92± 11.5 8)、(12 .34± 7.2 5 )mmHg(P <0 .0 1) ,美多心安组与治疗前比较分别下降 (19.13± 9.70 )、(13.5 0± 7.4 6 )mmHg(P <0 .0 1) ;观察组与对照组总有效率分别为 89.4 8%与 80 .4 3% ,两组比较无显著差异 (P >0 .0 5 )。两药的不良反应均轻微 ,发生率分别为 2 .7%和 4 .4 %。结论　卡维地洛是一种安全有效的抗高血压药物     

卡维地洛对老年高血压病的疗效观察

6 5例老年高血压患者口服卡维地洛 10mg ,bid ,服药 2周末血压下降未达有效标准者增加至 2 0mg ,bid ,疗程共 8周。结果治疗第 1周有效率 5 0 %,第 2周达 6 7.5 %,服药 4周总有效率达 80 .1%;谷峰比 (T/P)SBP 78%、DBP 77%;对75 .38%患者异常的血压昼夜节律有逆转作用 ;卡维地洛服药前后患者肝肾功能、空腹血糖、血脂、血常规、尿常规、心电图均无明显改变 (P >0 .0 5 ) ,不良反应轻。卡维地洛治疗轻中度EH有效且安全性良好。     

伊贝沙坦治疗轻、中度原发性高血压的临床研究

目的观察伊贝沙坦对轻、中度原发性高血压患者的降压疗效。方法5 0例轻、中度高血压患者服用伊贝沙坦 ,每天 1次 ,每次 15 0mg ,连服 6周。采用偶测血压和 2 4h动态血压监测。结果临床总有效率为 84 % ,显效为 72 % ,有效为 16 % ,未达标者 8例 ,收缩压 (SBP)从治疗前的 (15 2 .4± 11.5 )mmHg降至治疗后 (130 .2± 8.2mm)Hg(P <0 .0 1) ,舒张压 (DBP)从治疗前 (96 .4± 4 .8)mmHg降至治疗后 (82 .1± 4 .6 )mmHg。动态血压监测SBP下降幅度为 (18.9± 0 .9)mmHg ,DBP下降幅度为(12 .8± 3.1)mmHg。降压谷 /峰比率 :SBP为 6 8% ,DBP为 6 3% ,血压负荷均有不同程度的降低。结论口服安博维对轻、中度原发性高血压降压疗效确切 ,不良反应少而轻。     

卡维地洛对中国高血压病人的疗效及安全性观察

目的：评价卡维地洛对中国高血压病人的降压疗效及安全性。方法：按照1999年WHO高血压的诊断标准．将62例门诊高血压病人随机分为A组(卡维地洛组)42例，B组(比索洛尔组)20例，服用安慰剂2周后进行药物治疗8周．治疗前后测定血压、生化、血脂、血常规。结果：治疗后血压A组SBP下降18mmHg，DBP下降13．3minHg；B组SBP下降24．5mmHg.DBP下降20．3mmHg，两组间血压下降无显著差异。并且卡维地洛组在降低低密度脂蛋白方面优于比索洛尔组。结论：卡维地洛对中国轻、中型高血压病人使用可达到全日有效的降压效果，无明显不良反应。     

舒张压与高龄老年高血压患者死亡的关联性研究

目的探讨收缩压和舒张压水平对高龄老年人死亡率的影响。方法选取2013年4月至6月间80岁以上驻沈地区军队离退休干部年度体检者666例,对其血压及生存状况进行为期43个月的随访。结果666例80岁以上高龄老人中,高血压患者521例,占78. 2%,在43个月随访期间高血压组死亡率21. 9%,非高血压组死亡率13. 8%,两组之间差异有统计学意义(P 0. 05)。高血压组平均血压137/71 mmHg,收缩压(SBP)≥140 mmHg组与SBP 140 mmHg组在死亡率方面差异无统计学意义(P 0. 05)。高血压组患者根据舒张压(DBP)不同进行分组后发现DBP 70 mmHg组死亡率为15. 9%,60 mmHg DBP≤70 mmHg组死亡率为21. 1%,DBP≤60 mmHg组,死亡率高达43. 8%,差异有统计学意义(P 0. 05)。结论高血压明显增加80岁以上高龄老人死亡风险,高龄老年高血压患者更应关注其舒张压水平,尤其是DBP≤60 mmHg的低舒张压的高血压患者,死亡风险明显增高。     

社区高血压患者舒张压两分层中血压与尿酸间的关系

目的探讨社区高血压患者不同舒张压分层中舒张压(DBP)和收缩压(SBP)与血尿酸之间的关系。方法设健康对照组、社区高血压患者中DBP100mmHg组、DBP≥100mmHg组。分别用比色法检测健康对照组和高血压患者组血清高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)以及血尿酸(UA)水平,用酶法检测尿素氮(BUN)、肌苷(Cr);由专人负责测量收缩压与舒张压。结果 1.DBP100mmHg组及DBP≥100mmHg组与健康对照组比较,SBP、DBP、UA之间差异有统计学意义,均P0.001;而LDL-C间P0.05～0.001,差异有统计学意义;而HDL-C、BUN、Cr之间差异均无统计学意义,P0.05。DBP100mmHg组与DBP≥100mmHg组之间比较,SBP、UA和LDL-C均P0.01,差异有统计学意义;其余项目差异均无统计学意义,P0.05。2.DBP≥100mmHg组中,SBP与UA间呈正相关关系,r=0.529,P=0.008。结论针对不同舒张压分层的高血压患者(DBP100mmHg或DBP≥100mmHg)进行降血尿酸治疗时,应当采取不同的治疗方案。     

动态血压比较洛汀新与络活喜降压疗效

目的比较洛汀新与络活喜对轻中度原发性高血压的疗效.方法分别选取38例与31例原发性高血压(essentialhypertension,以下简称EH)患者,以洛汀新10mg或络活喜5mg每天晨服一次,治疗4周,比较两药治疗前后的动态血压检测(ambulatory blood Pressure monitoring,以下简称ABPM)结果.结果两药治疗后24小时平均血压分别由SBP 143.75±13.66,147.63±14.37(mmHg)降至125.13±14.85,126.63±11.92(mmHg),DBP 98.87±9.14,94.13±8.53(mmHg)降至76.75±9.94,80.25±11.45(mmHg);白昼平均血压分别由SBP 147.38±10.86,151.63±15.30(mmHg)降至127.25±12.10,130.63±12.84(mmHg),DBP 90.25±9.29,97.5±8 37降至76.25±13.63,83.13±9.45(mmHg);夜间平均血压分别由SBP131.25±11.93,133.25±12.37(mmHg)降至115.88±7.30,117.13±8.82(mmHg),DBP 88.75±8.07,91.75±8.07(mmHg)降至73.25±8.07,74.75±10.55(mmHg);两药降压幅度无显著差异(P＞0.05);两药降压谷峰比值分别为SPB 68.51%,DBP 74.10%和 SBP 70.36%,DBP 76.29%;洛汀新治疗前后心率无明显变化(P＞0.05),络活喜治疗后心率有所增加(P＜0.05);两药不良反应均较少(分别为21.05%和19.35%),耐受性良好.结论洛汀新与络活喜均能持续稳定地控制轻中度EH,值得在临床广泛应用.     

缬沙坦与依那普利、氨氯地平治疗高血压疗效比较

目的　与依那普利及氨氯地平相比较评价缬沙坦治疗原发性高血压病的疗效及安全性。方法　采用随机双盲试验 ,将 2 3 5例轻、中度高血压病患者随机分为缬沙坦组 (n =82 )、依那普利组 (n =76)和氨氯地平组 (n =77)。分别服用缬沙坦 80mg/d、依那普利 10mg/d或氨氯地平 5mg/d ,共 8周。用药 4周后对舒张压≥ 90mmHg者 ,以上剂量加倍。 结果　 8周末缬沙坦、依那普利和氨氯地平均能有效降压 ,有效率分别为 63 .4%、65 .8%、64 .9% ;组间差异无统计学意义。三者降压幅度无显著性差异 (P >0 .0 5 )。依那普利组干咳发生率达 14 .5 % (11/ 76) ,缬沙坦组干咳发生率为 1.2 % (1/82 ) ,二者相比差异有显著性 (P <0 .0 1) ,氨氯地平组出现面部潮红 3 .9% (3 / 77) ,踝肿 2 .6% (2 / 77) ,与前两组相比有显著性差异 (P <0 .0 1)。结论　缬沙坦治疗轻、中度高血压病疗效确切 ,可逆转患者心肌重塑 ,耐受性好     

厄贝沙坦治疗前后原发性高血压患者血浆内皮素-1的变化

目的　观察厄贝沙坦治疗前后原发性高血压 (EH)患者血浆内皮素 - 1(ET - 1)水平的变化 ,探讨ET - 1在EH发展中所起的作用。方法　 88例高血压患者作为EH组 ,服用厄贝沙坦治疗 4周 (剂量 15 0～ 30 0mgd-1) ,4 8例健康人作为对照组。测量两组血压和血浆ET - 1水平 ,检测厄贝沙坦治疗后EH组血压和血浆ET - 1的变化。结果　3例患者因不良反应退出研究。EH组与对照组血浆ET - 1水平分别为 90 .2 4± 2 9.2 3ng/L、5 8.31± 11.4 2ng/L ,前者较后者显著增高 (P <0 .0 5 ) ,且高血压III级ET - 1水平显著高于高血压II级 (P <0 .0 5 ) ,高血压II级ET - 1水平显著高于高血压I级 (P <0 .0 5 )。厄贝沙坦组治疗后ET - 1水平为 6 8.98± 8.2 0ng/L ,较治疗前显著降低 (P <0 .0 1)。厄贝沙坦组治疗前SBP和DBP分别为 16 8.34± 12 .92、112 .33± 8.0 4mmHg ,治疗后分别为 12 8.32± 18.4 3、82 .76± 4 .2 2mmHg ,均较治疗前明显降低 (P <0 .0 5 )。结论　EH患者血压与ET - 1水平正相关 ,厄贝沙坦在有效降压的同时 ,血浆ET - 1水平亦降低。     

卡维地洛与比索洛尔治疗老年慢性心力衰竭的疗效对比

目的 比较卡维地洛与比索洛尔治疗老年慢性心力衰竭(CHF)的效果差别.方法 华北石油总医院心内科收治的CHF患者126例,随机分为两组,卡维地洛组(n=63),比索洛尔组(n=63).卡维地洛组给予卡维地洛3.125 mg,每天2次,比索洛尔组给予比索洛尔1.25 mg,每天1次,应用超声心动图测量治疗前和治疗6个月后左心室舒张末内径(LVEDD)和左心室射血分数(LVEF)变化,纽约心脏病协会(NYHA)心功能分级,6分钟步行距离,收缩压(SBP)和舒张压(DBP);用放射免疫法测定血浆中脑钠肽(BNP)和N末端B型利钠肽原(NT-proBNP)浓度.结果 卡维地洛组在NYHA心功能分级改善上优于比索洛尔组,总有效率分别为96.9%(62/64)、70.9%(44/62)(P＜0.05).两组治疗后的LVEDD、BNP、NT-proBNP、SBP和DBP比治疗前均有明显降低(P＜0.01或＜0.05),而LVEF及6分钟步行距离较治疗前有明显升高(P＜0.05);两组治疗后各项指标比较差异均有统计学意义(P＜0.01或＜0.05).结论 卡维地洛及比索洛尔均能明显改善心功能,但卡维地洛的疗效更为显著.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。