地尔硫卓注射液治疗高血压急症的疗效观察

目的观察地尔硫卓注射液治疗高血压急症的疗效和安全性。方法采用随机对照方法将72例高血压急症患者分为地尔硫卓组(38例)与硝普钠组(34例),分别用地尔硫卓注射液和硝普钠注射液治疗,剂量分别为5～15μg.kg-1.min-1和10～30μg/min。观察两组用药前与用药后60min血压和心率变化。结果地尔硫卓组与硝普钠组血压均显著下降,总有效率均为100%,两组间比较差异无统计学意义(P0.05)。结论地尔硫卓治疗高血压急症安全、有效,与硝普钠相似,而在降低心率作用方面更优于硝普钠。     

急性脑卒中降压治疗原则

近年来临床上对高血压伴急性脑卒中患者的降压治疗存在诸多争议，急性脑卒中的治疗方案还不统一。本文总结目前诸多降压治疗与脑卒中防治的大型临床试验结果，旨在简述急性脑卒中的高血压治疗原则。     

地尔硫卓注射液治疗老年人非心脏手术后高血压的临床应用

目的 观察地尔硫卓注射液治疗老年人非心脏手术后高血压的疗效和安全性.方法 采用随机、对照方法将58例老年非心脏手术后高血压患者分为地尔硫卓组(n=30)与硝酸甘油组(n=28),分别用地尔硫卓注射液与硝酸甘油注射液治疗,剂量分别为每分钟5～15 μg/kg 和每分钟5～15 μg.观察两组用药前后30、60、120分钟血压和心率变化.结果 地尔硫卓组与硝酸甘油组血压均显著下降,总有效率分别为80%和82.1%,组间比较差异无显著性(P＞0.05),不良反应轻.结论 地尔硫卓治疗老年人非心脏手术后高血压安全、有效,与硝酸甘油相似,而在降低心率作用方面更优于硝酸甘油.     

联用不同作用机制的钙拮抗剂治疗顽固性高血压45例

目的 探讨新的联合降压方案对顽固性高血压病人的疗效.方法 联用不同作用机制的钙拮抗剂苯磺酸氨氯地平和地尔硫卓治疗顽固性高血压病人45例.结果 调整治疗后血压达标率明显提高(P<0.01),且随着治疗的继续达标率还有增加,血压比较有统计学意义(P<0.01),治疗费用较调整前亦有减少(P<0.01),心率差异无统计学意义.治疗后不良反应有所增多,但无不能耐受而需要调整用药者.随访期间病人未有严重的高血压不良事件如心肌梗死、心力衰竭、脑卒中等发生.结论 联用不同作用机制的钙拮抗剂对顽固性高血压病人治疗有效,血压达标率明显提高,且治疗费用相对较低,未有严重的不能耐受的不良反应,病人的依从性高.     

急性脑卒中：降压或不降压？

急性脑卒中时的降压问题是个临床上很棘手的问题，应当视卒中的性质、血压升高的程度等具体情况而决定是否降压和降压的速度和幅度。高血压脑出血病人血压极度升高时，即当SBP≥200mmHg，和／或DBP≥120mmHg，和／或MAP≥125mmHg时(MAP=SBP 2DBP／3)，     

地尔硫[艹卓]注射液治疗老年人非心脏手术后高血压的临床应用

目的观察地尔硫[艹卓]注射液治疗老年人非心脏手术后高血压的疗效及安全性。方法采用随机、对照方法将58例老年非心脏手术后高血压患者分为地尔硫[艹卓]组（n=30）与硝酸甘油组（n=28），分别用地尔硫[艹卓]注射液与硝酸甘油注射液治疗，剂量分别为5～15μg／（min·kg）和5～15μg／min。观察用药前及用药后30、60、120min各血压及心率变化。结果地尔硫[艹卓]组与硝酸甘油组血压均显著下降，总有效率分别为80％和82．1％，组间差异无统计学意义（P〉0．05），不良反应轻。结论地尔硫[艹卓]治疗老年人非心脏手术后高血压安全、有效，与硝酸甘油相似，而在降低心率作用方面更优于硝酸甘油。     

地尔硫卓治疗支气管哮喘1例

1病历摘要患者,女,74岁,因反复咳嗽、咳痰31年,喘息1年,加重伴呼吸困难2 w于2010年11月18日由我院胸外科转入呼吸内科。既往无高血压、冠心病病史。患者2 w前于外院诊断为自发性气胸,于左下胸部置入1枚胸腔闭式引流管,未见好转。5 d前,转入吉林大学中日联谊医院胸外科,再次于左下胸部置入1枚胸腔闭式引流管后,呼吸困难好转。但患者于2010年11月18日早8:20无明显     

地尔硫卓治疗高血压急症的临床观察

目的 观察静脉用地尔硫卓治疗高血压急症的临床疗效.方法 选择2008年5月-2010年3月35 例高血压急症患者,合并脑血管意外8例,肾功能不全16例,心律失常21例,伴有头痛、恶心、呕吐、视物模糊等高血压危象、高血压脑病症状14例,就诊后给予地尔硫卓10 mg+生理盐水5 mL静脉推注(1 min),然后以2 μg/(kg·min)～5 μg/(kg·min)速度静脉输注,治疗同时停用其他药物,观察患者症状改善情况.结果 用药后降压显效29例(83%),有效6例(17%),总有效率100%.治疗后患者血压明显控制,心律失常发作显著减少,尿素氮、肌酐亦有不同程度下降.结论 地尔硫卓在高血压急症治疗中有疗效,对伴发心律失常者疗效更为明显.     

冠状动脉内注射地尔硫卓治疗急性冠脉综合征疗效观察

目的观察经冠状动脉（冠脉）注射地尔硫卓治疗对急性冠脉综合征（ACS）患者血清心脏标志物、可溶性Fas配体（sFasL）浓度及心室重构的影响。方法纳入106例ACS患者,随机分为观察组（n=55）和对照组（n=51）,观察组在经皮冠状动脉介入术（PCI）中（第一次球囊扩张）后即刻冠脉内注射地尔硫卓1000μg,输注速度为50μg／s;对照组在PCI后即刻注射生理盐水10ml,输注速度为1mYs。PCI术前、术后24h检测心脏标志物[肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）、心肌肌钙蛋白I（cTNI）1;PCI术前、术后2周检测sFasL浓度;PCI术前、术后3个月、术后6个月及术后12个月行超声心动图检查,观察心室重构情况。结果PCI术前,观察组与对照组心脏标志物和sFasL浓度无统计学差异（p〉0．05）;术后24h心脏标志物检测和术后2周sFasL检测示对照组水平明显高于观察组（P〈0．05）。PCI术前,两组患者的超声结果[包括左室射血分数（LVEF）、舒张末期容积指数（EDVI）和收缩末期容积指数（ESVI）1无统计学差异;PCI术后各检查时间点,观察组上述值均较对照组有明显改善（P〈0．05）。结论冠脉内注射地尔硫卓治疗ACS可减少心肌细胞损伤和心肌细胞凋亡,抑制心室重构,改善心功能。     

Hypertension is an independent predictor of mean platelet volume in patients with acute ischaemic stroke

Introduction: Mean platelet volume (MPV) was shown to be significantly increased in patients with acute ischaemic stroke, especially in non‐lacunar strokes. Moreover, some studies concluded that increased MPV is related to poor functional outcome after ischaemic stroke, although this association is still controversial. However, the determinants of MPV in patients with acute ischaemic stroke have never been investigated. Subjects and methods: We recorded the main demographic, clinical and laboratory data of consecutive patients with acute (admitted within 24 h after stroke onset) ischaemic stroke admitted in our Neurology Service between January 2003 and December 2008. MPV was generated at admission by the Sysmex XE‐2100 automated cell counter (Sysmex Corporation, Kobe, Japan) from ethylenediaminetetraacetic acid blood samples stored at room temperature until measurement. The association of these parameters with MPV was investigated in univariate and multivariate analysis. Results: A total of 636 patients was included in our study. The median MPV was 10.4 ± 0.82 fL. In univariate analysis, glucose (β= 0.03, P= 0.05), serum creatinine (β= 0.002, P= 0.02), haemoglobin (β= 0.009, P < 0.001), platelet count (β=?0.002, P < 0.001) and history of arterial hypertension (β= 0.21, P= 0.005) were found to be significantly associated with MPV. In multivariate robust regression analysis, only hypertension and platelet count remained as independent determinants of MPV. Conclusions: In patients with acute ischaemic stroke, platelet count and history of hypertension are the only determinants of MPV.     

国产和进口赖诺普利在高血压治疗中的临床比较

目的　评价国产与进口赖诺普利在原发性高血压治疗中降压疗效及安全性的临床等效性。方法　本研究采用多中心随机、单盲、平行对照的方法。 18～ 70岁不拘性别的原发性高血压患者 ,坐位血压 <180 /90～ 10 9mmHg ,不伴有严重靶器官损害。符合入选条件者经两周的安慰剂清洗期后随机分为国产或进口赖诺普利组 ,两组分别服国产或进口赖诺普利10mg/d一次两周 ,两周后坐位舒张压仍≥ 90mmHg者 ,加量至 2 0mg到试验结束。总计服药时间为 6周。服国产赖诺普利者完成 2 4h动态血压监测 2 0例。结果　完成 6周观察者 192例 ,其中赖诺普利组 94例 ,总有效率 5 0 0 %。进口赖诺普利 (捷赐瑞 )组 98例 ,总有效率为 5 4 1%。两组总有效率无显著差异。两组服药 4周后的血压与用药前比较均有显著性差异 ,无严重不良反应。咳嗽的发生率为赖诺普利组 2 8 7% ( 2 7/94) ,捷赐瑞组 2 6 5 % ( 2 6/98)。两组无统计学差异。赖诺普利组共完成 2 4h动态血压监测 2 0例。赖诺普利的降压谷 /峰比值大于 5 0 %。结论　国产与进口赖诺普利相比 ,两者具有相同的疗效 ,主要不良反应咳嗽的发生率相似 ,国产赖诺普利同样可以作为长效制剂用于原发性高血压治疗     

Very high blood pressure in acute stroke

In a study sample consisting of 388 unselected, consecutive acute stroke patients, 27 with systolic blood pressure greater than or equal to 200 mmHg and diastolic blood pressure greater than or equal to 115 mmHg were compared with the other 361 patients. The patients with high blood pressure were younger (65 vs. 73 years) and much more often had a history of hypertension (78 vs. 42%). Cardiac and vascular hypertensive manifestations were more frequent, particularly when only those patients with a history of hypertension were compared in the two groups. Alcohol abuse was mentioned in a higher proportion of hypertensives in the summaries of their medical records. No definite conclusions could be drawn with regard to the size and location of the brain lesions. Clinical symptoms did not differ between the groups, neither did the proportion of patients who could be discharged from hospital immediately. Mortality was higher in the high blood pressure group (30 vs. 14%, P less than 0.05). Thus the characteristics of patients with very high blood pressure were: younger age, much more frequent and severe previous hypertension. Alcohol abuse might be an important factor. The type, size and location of the brain lesion itself could not be statistically related to the high blood pressure, but very large lesions, particularly haemorrhages, might be associated with a reactive blood pressure response.     

急性脑卒中后非感染性发热的临床特征研究

目的 探讨急性脑卒中后非感染性发热的临床特征。方法 采用前瞻性试验设计，在住院治疗期、发病3周和3个月对246例急性脑卒中后发热患者进行是否伴有感染及各相关临床因素调查，并行对比统计分析。结果 以下临床因素在感染性发热与非感染性发热中存在统计学差异：卒中分型（P〈0．01）、吞咽困难（P〈0．01）、首次发热持续时间（P〈0．020）、Glassgow评分在发病3周与48h评分的差异（Glass1-2，P〈0．046）。结论 同急性脑卒中后感染性发热相比，非感染性发热持续时间短，但同感染性发热一样严重影响患者的预后。     

Treatment of acute stroke: an update

Stroke is the second leading cause of global mortality after coronary heart disease, and a major cause of neurological disability. About 17 million strokes occur worldwide each year. Patients with stroke often require long‐term rehabilitation following the acute phase, with ongoing support from the community and nursing home care. Thus, stroke is a devastating disease and a major economic burden on society. In this overview, we discuss current strategies for specific treatment of stroke in the acute phase, focusing on intravenous thrombolysis and mechanical thrombectomy. We will consider two important issues related to intravenous thrombolysis treatments: (i) how to shorten the delay between stroke onset and treatment and (ii) how to reduce the risk of symptomatic intracerebral haemorrhage. Intravenous thrombolysis has been approved treatment for acute ischaemic stroke in most countries for more than 10 years, with rapid development towards new treatment strategies during that time. Mechanical thrombectomy using a new generation of endovascular tools, stent retrievers, is found to improve functional outcome in combination with pharmacological thrombolysis when indicated. There is an urgent need to increase public awareness of how to recognize a stroke and seek immediate attention from the healthcare system, as well as shorten delays in prehospital and within‐hospital settings.     

U-shaped relationship between mortality and admission blood pressure in patients with acute stroke

Objective. To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke. Design. Prospective study of hospitalized first‐ever stroke patients over 8 years. Setting. Stroke unit and medical wards in a University hospital. Subjects. A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months. Main outcome measures. Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP. Results. Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a ‘U‐curve pattern’. After adjusting for known outcome predictors, the relative risk of 1‐month and 1‐year mortality associated with a 10‐mmHg SBP increase above 130 mmHg (U‐point of the curve) increased by 10.2% (95% CI: 4.2–16.6%) and 7.2% (95% CI: 2.2–12.3%), respectively. For every 10 mmHg SBP decrease, below the U‐point, the relative risk of 1‐month and 1‐year mortality rose by 28.2% (95% CI: 8.6–51.3%) and 17.5% (95% CI: 3.1–34.0%), respectively. Low admission SBP‐values were associated with heart failure (P < 0.001) and coronary artery disease (P = 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P = 0.005) more frequent in patients with high admission SBP‐values, whereas death due to cardiovascular disease was more frequent (P = 0.004) in patients with low admission SBP‐values. Conclusion. Acute ischaemic or haemorrhagic stroke patients with high and low admission BP‐values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP‐values. Death due to neurological damage from brain oedema is associated with high initial BP‐values.     

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

There are concerns that specific risk factors may alter the benefits of thrombolysis in stroke patients with controlled contraindications including hypertension. The objective of this study was to evaluate the association between clinical risk factors and outcomes in ischemic stroke patients that received thrombolysis therapy pretreated with antihypertensive medications. Using data obtained from a stroke registry, a non‐randomized retrospective data analysis was conducted on patients with the primary diagnosis of acute ischemic stroke with hypertension pretreated with antihypertensive medications. The association between clinical risk factors and functional ambulatory outcome was determined using logistic regression while odd ratios (OR) were used to predict the odds of achieving improved ambulatory outcome in thrombolysis treatment status. Improved or poor functional ambulatory outcome was considered as the end point in our analysis. A total of 4665 acute ischemic stroke patients were identified, of whom 1446 (31.0%) were eligible for thrombolysis, while 3219 were not, and 595 received rtPA, of whom 288 were on antihypertensive medications, while 233 were not. In the rtPA group with antihypertensive (anti‐HTN) medication, only NIHSS score (OR = 1.094, 95% CI, 1.094‐1.000, P = 0.005) was associated with improved functional outcome while patients with congestive heart failure (OR = 0.385, 95% CI, 0.385‐0.159, P = 0.035) and patients with a history of previous TIA (OR = 0.302, 95% CI, 0.302‐0.113, P = 0.017) were more likely to be associated with poor functional outcomes. Congestive heart failure and TIA are independent predictors of functional outcomes in stroke patients pretreated with antihypertensive medications prior to thrombolysis therapy.     

联合脉搏血氧监测法评估急性卒中误吸风险临床价值研究

目的探讨联合脉搏血氧监测法对急性卒中误吸风险的评估价值。方法选择2005年4月至2007年7月首都医科大学附属北京世纪坛医院连续收治的急性脑卒中患者117例。急性脑卒中患者入院后24 h内分别按普通检查法(颅神经检查和洼田饮水试验)及联合脉搏血氧监测法(颅神经检查、洼田饮水试验联合同步的脉搏血氧监测法)评估患者的误吸风险。结果联合脉搏血氧监测法发现存在误吸风险的患者47例(40.2%),常规检查法为25例(21.4%),该方法评估误吸风险的比率明显高于普通检查法(P<0.01)。联合脉搏血氧监测法预测吸入性肺炎的敏感度是82.4%,普通检查法预测吸入性肺炎的敏感度是41.2%,两种方法的敏感度比较差异有统计学意义(P=0.001)。结论联合脉搏血氧监测法是一种评估误吸和吸入性肺炎风险的敏感方法。     

Left ventricular hypertrophy in acute stroke patients with known hypertension

Background: Despite effective treatments, hypertension remains uncontrolled in nearly half of the people with hypertension in the United States. Uncontrolled hypertension leads to end organ damage, such as left ventricular hypertrophy (LVH). To identify reasons for uncontrolled hypertension, we interviewed acute stroke patients with a history of hypertension and evaluated for LVH. Methods: Using a standardized questionnaire, we collected demographic, socioeconomic, and health-care data in 300 acute ischemic and hemorrhagic stroke patients in one hospital. We also collected relevant clinical data from medical records. We analyzed factors associated with echocardiographic LVH as a marker of uncontrolled hypertension in 190 acute stroke patients with a history of hypertension. Results: Overall, 46% (88/190) of patients had LVH. In univariate analysis, lower household income and self-reported poor adherence to hypertension treatment were significantly associated with increased risk of LVH. In multiple logit modeling, only poor adherence to hypertension treatment remained significantly associated with LVH, odds ratio 1.77 (95% CI: 1.01–3.11), p < 0.05. Conclusions: In acute stroke patients, poor adherence to hypertension treatment is a significant independent predictor of LVH. A clear reason for poor adherence to treatment is elusive in a large proportion of these patients in our study. Further research is needed to identify and develop strategies to combat the key factors responsible for poor adherence to hypertension treatment.