卡托普利加美托洛尔治疗慢性心力衰竭的临床观察

目的　观察卡托普利加美托洛尔治疗慢性心力衰竭(CHF)的远期疗效。方法　将47例CHF患者随机分为对照组(2 3例)和治疗组(2 4例) ,对照组采用常规治疗。治疗组在此基础上加用卡托普利(6 .2 5～75mg/d)和美托洛尔(6 2 5～75mg/d)。治疗前和观察期满3年分别行多普勒超声心功能指标检查,对心功能NYHAⅡ～Ⅲ级患者作6min步行试验,记录步行距离。结果　3年间,治疗组与对照组病死率分别为8 3 .3 %和3 9. 13 %(P <0 . 0 5 ) ,与治疗前比较,治疗组多普勒超声心功能指标及6min步行距离有明显改善(P <0 . 0 5 )。结论　卡托普利加美托洛尔长期治疗可使心功能明显改善,能降低病死率。     

缬纱坦、依那普利治疗充血性心力衰竭96例疗效观察

目的 :探讨缬沙坦联合依那普利治疗慢性充血性心力衰竭 (CHF)的临床疗效。方法 :96例CHF患者随机分成治疗组和对照组。治疗组 5 1例给予缬沙坦 80mg/d ,依那普利 10mg/d ;对照组给予依那普利 10mg/d及安慰剂治疗。两组基础治疗类同 ,疗程 6个月。观察治疗前后两组患者的临床症状、超声心动图、心功能指标、6分钟步行距离的变化及不良反应。结果 :治疗后 ,治疗组临床总有效率为 94 1% ,对照组总有效率 77 8% (P <0 .0 5 ) ,具有显著性意义 ;两组治疗前后相比左室射血分数 (LVEF) ,每搏量 (SV)、心脏指数 (CI)、6分钟步行距离均有显著改善 (P <0 .0 1)。治疗组LVEF、CI及 6分步行距离的改善优于对照组。结论 :缬沙坦联合依那普利治疗CHF可以增强疗效。     

依那普利联合美托洛尔及螺内酯治疗心力衰竭临床观察

目的：观察血管紧张素转换酶抑制剂依那普利和β-受体阻滞荆关托洛尔联合小剂量螺内酯对慢性心力衰竭（CHF）的远期疗效。方法：共选择CHF患者110例,随机分为对照组（54例）和治疗组（56例）。对照组采用常规治疗（即强心、利尿、扩血管）。治疗组在此基础上加用依那普利5～10mg／日、美托洛尔25～100mg／日、螺内酯20mg／日,在治疗前和观察期满5年时分别对心功能NYHAⅡ～Ⅲ级患者做6分钟步行试验,记录步行距离。结果：5年期间,对照组和治疗组因心力衰竭加重再住院率分别为81．48％和28．57％（P〈0．05）,病死率分别为33．33％和8．92％（P〈0．05）;与治疗前比较,治疗组心功能（NYHA分级）及6分钟步行距离有明显改善（P〈0．05）,而对照组无明显改善。结论：依那普利联合美托洛尔及螺内酯可显著改善CHF患者的远期预后。     

依那普利联合比索洛尔治疗慢性心力衰竭的临床观察

目的:观察血管紧张素转换酶抑制剂依那普利和β-受体阻滞剂(比索洛尔)联合应用对慢性心力衰竭(CHF)的远期疗效.方法:共选择CHF患者98例,随机分为治疗组(50例)和对照组(48例).对照组采用常规治疗(即强心、利尿、扩血管);治疗组在此基础上加用依那普利(5～20)mg/d和比索洛尔(3.75～10)mg/d.依那普利初始剂量为2.50 mg,每日一次;比索洛尔初始剂量为1.25 mg,每日一次,逐渐加量至患者所能忍受的最大剂量并长期维持治疗至试验结束,随访时间为一年.在治疗前和观察满一年分别做超声心动图检查测定左室射血分数(EF)和左室缩短分数(FS)及6min步行试验并记录步行距离.结果:一年后,对照组和治疗组因心力衰竭加重再住院率分别为47.9%和22.9%(P＜0.05),病死率分别为18.8%和4.2%(P＜0.05);与治疗前比较,治疗组心功能(EF和FS)及6min步行距离有明显改善(P＜0.01),而对照组改善不明显.结论:依那普利联合比索洛尔可显著改善CHF患者的远期预后.     

卡托普利与倍他乐克联合治疗充血性心力衰竭疗效观察

目的：观察卡托普利与倍他乐克联合治疗充血性心力衰竭(CHF)的临床疗效。方法：对62例CHF患者随机分成对照组30例，治疗组32例，对照组使用洋地黄类、利尿剂、硝酸酯类等药物，治疗组在使用上述药物的基础上加用卡托普利与倍他乐克，随访1a，评价左心功能改善情况和左心室射血分数。结果：1a后，对照组总有效率73％，治疗组总有效率97％，两组的差异具有显著性(P＜0．05)。结论：卡托普利与倍他乐克联合治疗CHF，可改善CHF症状，提高射血分数，改善患者生活质量。     

长期应用美托洛尔治疗慢性心力衰竭的疗效观察

目的探讨长期服用美托洛尔对慢性心力衰竭(CHF)的远期预后.方法60例CHF患者,随机分成对照组(29例)和治疗组(31例).对照组采用常规综合疗法.治疗组在上述基础上加用美托洛尔.结果2年期间,对照组和治疗组因心力衰竭加重而再次住院率分别为44.8%和16.1%,死亡率分别为27.5%和6.5%;治疗期满后6分钟步行距离试验提示,治疗组较对照组运动量有明显改善.结沦美托洛尔可显著提高CHF患者的运动耐量,降低其因心力衰竭恶化所致再住院率与病死率.     

倍他乐克治疗慢性心力衰竭的初期反应

目的 :观察倍他乐克在慢性心力衰竭 (CHF)治疗中的初期反应。方法 :将 15 3例CHF患者分为治疗组和对照组 ,两组常规治疗相同 ,治疗组加用倍他乐克口服 ,疗程 4周 :比较两组治疗后临床症状、体征、心功能及心电图变化 ,观察倍他乐克治疗初期的反应。结果 :治疗组和对照组的临床症状和体征改善的有效率分别为 86 %和 88% ,两组比较无显著差异性 (P >0 .0 5 )。结论 :在CHF治疗中使用小剂量倍他乐克治疗初期不良反应较小     

倍他乐克治疗慢性充血性心力衰竭86例疗效观察

目的 :观察β受体阻滞剂倍他乐克对慢性充血性心力衰竭 (CHF)的疗效。 方法 :将慢性CHF16 8例随机分为治疗组和对照组 ,两组年龄、心衰病程、原发病及心功能分级相似 ,具可比性 ,均给予常规抗心衰治疗 ,治疗组加用倍他乐克片剂 ,从小剂量 6 .2 5mg/d开始 ,缓慢加量至有效剂量或达 2 5～ 5 0mg/d。观察 12周后两组患者的NYHA心功能分级、左室射血分数、心排血指数、血压、心率、病死率及副作用等。结果 :治疗组较对照组NYHA心功能分级、左室射血分数、心排血指数均明显改善 ,血压、心率均明显降低 ,病死率下降 ,P <0 .0 5或 <0 .0 1。结论 :在常规抗心衰治疗的基础上加用倍他乐克治疗慢性CHF ,可明显改善患者心脏功能 ,提高患者生存率 ,且副作用小 ,值得临床推荐使用。     

卡托普利、美多心安、螺内酯治疗慢性充血性心力衰竭患者远期疗效观察

目的:观察卡托普利、美多心安、螺内酯治疗慢性充血性心力衰竭(CHF)患者远期预后。方法:选择CHF患者58例,随机分为对照组(28例)和治疗组(30例)。对照组采用综合疗法。治疗组在上述基础上加用卡托普利、美多心安、螺内酯。在治疗前和观察期满3年时对患者心功能进行评价。结果:3年期间,对照组和治疗组因心衰加重再住院率分别为82.14%和26.67%(P<0.01),病死率分别为25.0%和6.7%(P<0.01)。与治疗前相比,治疗组心功能(NYHA分级)明显改善(P<0.01)。结论:卡托普利、美多心安、螺内酯可显著改善CHF患者的远期预后。     

新联疗法治疗慢性心衰60例临床疗效分析

目的:观察新联疗法:①血管紧张素转换酶抑制剂(ACEI)如:卡托普利或血管紧张素受体阻滞剂(ARBS)如厄贝沙坦;②利尿剂如呋塞米、双克片;③β受体阻滞剂:如倍他乐克;④醛固酮受体拮抗剂如安体舒通;⑤洋地黄制剂如西地兰、地高辛。治疗慢性心衰的临床疗效。方法:50例慢性心力衰竭患者随机分成治疗组和对照组,每组25例,对照组给予西地兰静推,氢氯噻嗪片,口服,等常规治疗。治疗组采用新联疗法,主要是卡托普利、倍他乐克、利尿剂、安体舒通联合地高辛。观察两组治疗前后心功能。治疗前和治疗后6周分别进行心功能(NYHA)分级评估,超声心动图、6分钟步行距离为客观指标,评价心功能改善程度。结果:治疗9周后治疗组的总有效率为96%,大于对照组的总有效率68%,差异有显著的统计学意义(P0.05),治疗组的心功能分级、左室收缩末期内径、6分钟步行距离均有明显改善(P0.05)。与对照组相比,治疗组改善更显著(P0.05)。结论:新联疗法治疗慢性心衰疗效显著。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.