氨氯地平治疗高血压伴左室肥厚和糖尿病的疗效评价

目的 :观察氨氯地平 (AM)对高血压 (HT)及高血压合并糖尿病 (EHCD)患者心、肾功能的保护作用。方法 :自身对照的临床试验法。结果 :19例 EHCD和 2 0例 HT伴有左室肥厚 (L VH)的患者进行超声左室结构和功能检测表明 ,AM治疗后 EHCD组左室重量指数 (L VMI)下降 (30 .35± 10 .94) g/m2 ,室间隔厚度 (IVSD)和左室后壁厚度 (L VPWT)分别减少 (0 .16± 0 .0 9) cm和 (0 .12± 0 .0 7) cm;HT组则分别下降了 (2 7.45± 18.99) g/m2 ,(0 .2 1± 0 .13) cm和 (0 .15± 0 .11) cm (P<0 .0 0 1) ,两组心输出量 (CO)和心脏指数 (CI)增加 (P<0 .0 5 ) ,峰值速度 A(PA)下降 ,PA:峰值速度 E(PE)小于 1,舒张晚期血流速度 -时间积分 (Ai) /舒张早期血流速度 -时间积分 (Ei)下降 (P<0 .0 5 ) ;AM降压治疗后 ,两组肾动脉内径均增大 ,搏动指数 (PI)和阻力指数 (RI)减小。结论 :AM对 EHCD和 HT患者均可通过消退室间隔、左室后壁肥厚而显著减轻左室重量 ;改善左心室舒张功能 ;并可降低肾动脉阻力 ,减轻肾脏损伤。     

氯沙坦、福辛普利对高血压大鼠心肌纤维化、血管紧张素Ⅱ及左室重构的影响

目的　评价氯沙坦、福辛普利对自发性高血压大鼠 (SHR)心肌纤维化、左室重构及血浆和心肌组织中血管紧张素Ⅱ的效应。方法 :16周龄SHR随机分为 3组 ,即氯沙坦治疗组 (SHR L组 )、福辛普利治疗组 (SHR F组 )、空白对照组 (SHR C组 ) ,每组各 10只。分别采用病理检查及放射免疫测定方法对治疗 8周、16周的SHR心肌胶原容积分数 (CVF)和心肌血管周围胶原面积 (PVCA)、血浆和组织中血管紧张素Ⅱ进行检测。结果 :在治疗 8周、16周后 ,两治疗组的收缩压较对照组均有明显下降 ;治疗组组间比较差异无显著性 (P >0 .0 5 ) ;心脏重量 (HW )、心脏重量指数(HWI)、左室重量 (LVW)、左室重量指数 (LVMI)均有显著性改善 ,且治疗 16周后SHR F组较SHR L组LVMI显著性降低 (P <0 .0 5 )。两治疗组CVF和PVCA与对照组比较明显下降 (P <0 .0 1)。治疗 16周后SHR F组CVF较SHR L组下降更明显。SHR L组血浆及心肌组织中AngⅡ显著增加 ,而SHR F组心肌组织AngⅡ显著下降 ,但对血浆AngⅡ无明显影响。结论 :氯沙坦、福辛普利均能有效逆转心脏肥厚及抗心肌纤维化 ,以福辛普利作用显著。其作用机制可能与拮抗心肌组织中肾素 血管紧张素 醛固酮系统 (RAS)效应有关。     

左室临界肥厚患者运动缺血及心脏储备功能的探讨

目的　探讨冠状动脉造影正常 ,左室重量指数正常高限患者运动缺血及心脏储备功能。方法　选择 5 8例冠状动脉造影正常患者行平板运动试验和超声心动图检查 ,计算左室重量指数 (LVMI) ,根据LVMI将患者分为两组 :左室临界肥厚组 2 2例 ,其中并有高血压 9例 ,无并高血压 13例 ;正常对照组 3 6例。结果　左室临界肥厚组平板运动试验阳性率 ( 5 5 %)明显高于正常对照组 ( 2 5 %) (P <0 .0 5 )。左室临界肥厚并有高血压组心脏代谢当量 (METs)、最大氧耗量 (VO2 max)和左室射血分数 (LVEF)分别为 11.9± 3 .0、41.6± 10 .5和 60 .5± 5 .5。结论　左室临界肥厚患者运动时心肌缺血发生率增加 ,高血压左室临界肥厚患者心功能及储备功能是良好的     

福辛普利、比索洛尔和氨氯地平对高血压左室肥厚的作用对比

目的　对比研究长期应用福辛普利、比索洛尔和氨氯地平对高血压合并左室肥厚的作用效应和相互之间的差异。方法　 112例高血压并左室肥厚的患者随机分 3组 ,分别接受福辛普利、比索洛尔和氨氯地平治疗 12个月 ,观察期间每月测量血压 ,服药前、后作超声心动图检查 ,测量左室舒张末内径、舒张期室间隔厚度和左室后壁 ,并计算左室质量指数。结果　 3组患者治疗后血压有显著下降 (P <0 0 1) ,组间无差别。福辛普利组和比索洛尔组均可减少左室质量指数、舒张期室间隔和左室后壁厚度 ,福辛普利组最显著 (P <0 0 1) ,氨氯地平组变化不明显。结论　福辛普利、比索洛尔均可降低左室质量指数 ,即减轻左室肥厚程度 ,福辛普利更加显著。此种作用与血压无关。氨氯地平对左室肥厚逆转作用不明显     

福辛普利对实验性糖尿病大鼠心肌细胞外基质的影响

目的　观察糖尿病大鼠福辛普利治疗后心肌层粘连蛋白 (L N)、纤维连接蛋白 (FN)及胶原蛋白含量 (CL )的改变对心肌细胞外基质的影响及对心肌的保护作用 .方法　大鼠2 0只建立糖尿病模型后 ,随机分为福辛普利治疗组 (福辛普利组 )及糖尿病未治疗组 (未治疗组 ) ,每组 10只 .福辛普利组以福辛普利 (15 mg· kg- 1 · d- 1 )用水溶解后 ig,未治疗组以等体积水 ig.另取 10只正常大鼠作为空白对照 (正常组 ) .实验周期 5 wk.结果　经图像分析显示心肌组织 L N的吸光度 A值在正常组、福辛普利组及未治疗组分别为 0 .12 5 1± 0 .0 0 35 ,0 .1337± 0 .0 0 98和 0 .2 36 4± 0 .0 136 .FN的 A值在正常组、福辛普利组及未治疗组分别为 0 .0 5 81± 0 .0 0 42 ,0 .0 86 6± 0 .0 0 5 4和 0 .140 4± 0 .0 0 96 .CL 的 A值在正常组、福辛普利组及未治疗组分别 0 .12 0 0± 0 .0 10 4,0 .310 8± 0 .0 2 12和0 .5 114± 0 .0 42 0 .未治疗组 L N,FN和 CL 的表达均明显高于正常组及福辛普利组 ,差异有显著性意义 (P<0 .0 1) .结论　福辛普利虽不能降低血糖 ,然而通过抑制心肌局部肾素 -血管紧张素系统 ,可抑制心肌 L N,FN和 CL的表达 ,明显减轻糖尿病大鼠心肌细胞外基质增生 ,而减轻其心肌损害     

原发性高血压患者福辛普利治疗前后血清碱性成纤维细胞生长因子水平的变化

目的 :探讨原发性高血压 (EH)患者抗高血压治疗前后血清碱性成纤维细胞生长因子 (b FGF)水平的变化。方法 :用酶联免疫吸附测定法 (EL ISA)测定 34例 EH患者福辛普利治疗前、治疗 3个月后及 32例正常对照组的血清 b FGF水平。结果 :EH患者的基础血清 b FGF水平明显高于对照组 [(15 .94± 4 .31) ng/ L 比 (11.4 0± 1.98) ng/ L,P <0 .0 1]。 期患者的平均血清b FGF水平显著高于 期患者 [(17.6 8± 3.85 ) ng/ L 比 (13.90± 4 .18) ng/ L,P<0 .0 1];伴有左心室肥厚 (L VH)者高于无L VH者 [(18.99± 4 .0 3) ng/ L比 (15 .2 2± 2 .74 ) ng/ L ,P <0 .0 2 ];有肾功能损害者也高于无相应病变者 [(19.2 3± 4 .5 4 ) ng/L 比 (15 .16± 3.2 8) ng/ L,P <0 .0 2 ]。福辛普利治疗 3个月后 ,EH患者的血清 b FGF水平降至 (13.12± 2 .92 ) ng/ L(P <0 .0 1) ,但 L VH或肾功能损害者仍高于无相应病变者 (均 P <0 .0 5 )。结论 :EH患者的血清 b FGF水平升高 ,尤其是伴 L VH和肾功能损害的患者 ,福辛普利治疗后其水平显著下降 ,说明 b FGF可能以自分泌和 (或 )旁分泌的方式对高血压的心肌肥大起重要作用     

贝那普利联合氯沙坦对老年高血压脉压、心功能及左室肥厚的影响

目的研究贝那普利联合氯沙坦并与贝那普利比较,对老年高血压患者脉压、心功能及左心 室肥厚的影响。方法100例年龄≥65岁的老年原发性高血压(高血压分级1、2级)合并左室肥厚,随机分 为两组,贝那普利联合氯沙坦治疗组50例,贝那普利对照组50例,疗程8周。于治疗前后24h动态血压 检测患者脉压,超声心动图测定左心室舒张末期内径、室间隔和左室后壁厚度,并测算左心室重量 指数,对比治疗前后脉压及左心室参数的变化。结果治疗组的脉压由治疗前的63．34±8．8mmHg缩小为 治疗后的49．04±5．5mmHg,对照组的脉压由治疗前的65．54±5．7mmHg缩小为治疗后的56．94±6．0mmHg, 治疗组脉压缩小更显著(P<0．05)。治疗组心脏指数、射血分数及平均左室周边缩短率均高于对照 组(P<0．05)。治疗后室间隔、左室后壁厚度无显著性改变,但左心室重量指数下降(与治疗前及对照 组比较均P<0．05)。结论贝那普利联用氯沙坦治疗与单用贝那普利治疗均可缩小老年高血压患者的 脉压,联合应用更显著,改善心功能作用也优于贝那普利单用,研究初步表明贝那普利联用氯沙坦治 疗老年高血压患者也是安全的。     

福辛普利联合复方丹参滴丸对老年高血压左室肥厚及舒张功能的影响

目的：观察福辛普利联合复方丹参滴丸治疗老年高血压左室肥厚及舒张功能的影响。方法：本研究选择经超声心动图检查有左室肥厚（LVH）的老年高血压病患者48例，随机分为观察组和对照组，两组均给予福辛普利治疗，观察组加服复方丹参滴丸。疗程均为6个月。结果：观察组的左室肌重量指数（LVMI）（138．8＋7．6）g/m^2。降至（131．4±6．5）g/m^2，观察组由（137．6±7．5）g/m^2。降至（135．2±6．3）g/m^2，两组治疗后比较有显著性差异（P〈0．01）。在改善左室舒张功能方面。观察组也优于对照组。结论：提示福辛普利联合复方丹参滴丸对老年高血压并左室肥厚患者有积极的治疗作用。     

卡维地洛与氯沙坦联合应用逆转老年高血压性肥厚性心肌病左室重构的疗效观察

目的:观察卡维地洛与氯沙坦联合应用逆转高血压性肥厚性心肌病左室重构的疗效;并观察可能对患者左心功能的影响。方法:按Topol标准选择36例高血压性肥厚性心肌病患者,同时给予卡维地洛及氯沙坦治疗,分别于卡维地洛及氯沙坦治疗前和治疗6个月后对36例高血压性肥厚性心肌病患者进行超声心动图检查,M型超声心动图测量舒张末期左心室内径、室间隔和左心室后壁厚度,计算左心室重量指数。根据Teichhoh公式及主动脉根部血流频谱自动计算心输出量(CO)和左室射血分数(LVEF)。结果:联合应用卡维地洛及氯沙坦治疗6个月后,左心室重量指数从124±22g/m2下降至103±20g/m2(P<0.01),心输出量、心率及左室射血分数治疗前后差异无显著性(P>0.05)。结论:卡维地洛与氯沙坦联合应用可有效控制HHCME患者左心室肥厚,逆转左室重构。     

缬沙坦和缬沙坦联用卡托普利对原发性高血压左心室肥厚的影响

目的 观察缬沙坦和缬沙坦联用卡托普利对原发性高血压患者左心室肥厚的影响。方法 选择62例原发性高血压伴左心室肥厚患者,随机分成2组,分别给予缬沙坦80-160 mg/d,缬沙坦80-160 mg/d加用卡托普利25-75 mg/d,降压治疗6个月,治疗前后分别用彩色多普勒超声诊断仪测量计算左心室心肌重量(LVM)、左心室重量指数(LVMI)。结果 LVM缬沙坦组由治疗前(228.4±40.9)g降至(202.8±38.9)g,P<0.01;缬沙坦加卡托普利组由(229.6±39.5)g降重(195.8±P<0.01。LVMI缬沙坦组由(135.5±7.9)g/m2降至(122.1±6.4)g/m2,P<0.01;缬沙坦加卡托普利组由(134.7±8.6)g/m2降至(120.8±8.1)g/m2,P<0.01。2组均使LVM、LVMI降低,但缬沙坦加卡托普利组降低的程度更大(P<0.05)。结论 缬沙坦联用卡托普利对逆转左心室肥厚的效果更好。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.