老年原发性高血压患者动态脉压与心脏损害的关系

目的:探讨老年原发性高血压患者动态脉压与心脏损害的关系。方法:入选老年原发性高血压患者82例,按动态脉压分为40～60mmHg组(n=39)和脉压>60mmHg组(n=43),对超声心动图左室质量指数、左室舒张末内径等指标进行组间对比分析。结果:脉压>60mmHg组左室质量指数(116±19)g/m2、左室舒张末内径(52±5)mm均高于脉压40～60mmHg组(t=2.31,2.12,P均<0.05)。心脏损害的发生率高于脉压40～60mmHg组(51%和28%;t=2.47,P<0.05)。结论:老年原发性高血压患者心脏损害与脉压有关,脉压增大是心血管事件的主要危险因素。     

老年原发性高血压患者动态脉压与心脏损害的关系

目的：探讨老年原发性高血压患者动态脉压与心脏损害的关系。方法：人选老年原发性高血压患者82例，按动态脉压分为40～60mmHg组(n=39)和脉压&;gt;60mmHg组(n=43)，对超声心动图左室质量指数、左室舒张末内径等指标进行组间对比分析。结果：脉压&;gt;60mmHg组左室质量指数(116&;#177;19)g／m^2、左室舒张末内径(52&;#177;5)mm均高于脉压40～60mmHg组(t=2．3l，2．12，P均&;lt;0．05)。心脏损害的发生率高于脉压40～60mmHg组(51％和28％；t=2．47,P&;lt;0．05)。结论：老年原发性高血压患者心脏损害与脉压有关，脉压增大是心血管事件的主要危险因素。     

小剂量多种降压药合用治疗中青年高血压短期疗效观察

目的探讨和观察常规小剂量多种降压药以何种复合剂方式对中青年单纯性高血压患者短期疗效更佳.方法156例中青年单纯高血压患者分为2类共5组.其中A类3组,均为高血压Ⅲ级(高危),起始1～3 d各用1种钙拮抗剂(CCB),其后于第4 d和第7 d合用巯甲丙脯酸与倍他乐克.B类2组,为高血压Ⅲ级(高危)和Ⅱ级(中危)患者,开始即予吲哒帕胺与上组后2种药物合用.结果A类3组高血压Ⅲ级(高危)患者,口服硝苯地平GITS、氨氯地平或吲哒帕胺后,早期见血压下降,继分别加用巯甲丙脯酸及倍他乐克后MAPs随着心率下降明显,并达到持续明显稳步降压作用.经28 d治疗达目标血压者(＜130/85 mmHg,下同)占71.9%～74%,另有22.0%～23.3%达到Ⅱ级(中危)患者预期目标血压水平(120/80 mmHg).高血压Ⅲ级(高危)和Ⅱ级(中危)患者治疗起始3类药物同时伍用效果好,用药后(1～3 d)较用药前血压下降显著(t=7.61,5.87;P＜0.01,0.05),且高血压Ⅲ级(高危)组至观察结束达到短期治疗高血压目标者占75%,另有18.8%患者达到Ⅱ级高血压治疗目标水平(＜120/80 mmHg),而高血压Ⅱ级(中危)组患者达目标血压者为90.1%,用药过程中无明显不良反应.结论小剂量3种CCB剂分别合用巯甲丙脯酸及倍他乐克,对单纯高血压Ⅲ级(高危)短期治疗效果较单一种CCB好,尤以吲哒帕胺起始时即合用巯甲丙脯酸及倍他乐克作为复合剂形式疗效更好,不良反应小,费用低,值得提倡对广大收入较低的中青年高血压患者,作为短期抗高血压治疗复方剂使用.     

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。     

心血通对高血压病患者血浆内皮素的影响

我们用心血通注射液治疗高血压病患者55例,同时测定了治疗前后血浆内皮素(ET)的变化,以探讨心.血通对高血压病患者ET的影响。1 资料与方法1.1 研究对象 55例高血压病患者均为我院1998年3月至1999年1月期间住院患者,男39例,女16例,平均年龄(54.8±5.9)岁。其中轻度高血压[舒张压95～104mmHg(1mmHg=0.133kPa)]11例,中度高血压(舒张压105～114mmHg)28例,重度高血压(舒张压≥115mmHg)16例。全部患者均符合WHO高血压病诊断标准。病程1～5年27例,5～10年20例,10年以上8例。合并冠心病6例。对照组50例系健康查体者,其性别、年龄均具可比性(P>0.05)。     

原发性高血压230例心理分析及护理干预

近年来,我们对230例住院治疗的原发性高血压患者的心理进行分析,并采取针对性的心理护理干预,效果满意.现报告如下. 1 临床资料 本组230例,男144例,女86例,39～67岁,平均58岁.均符合2003年版美国高血压防治指南(JNC7)的诊断标准.入选标准:3次非同日测血压,均为高血压Ⅰ期(级)(140～159/90～99mmHg)和(或)高血压Ⅱ期(级)(≥160/100mmHg)[1].     

超声心动图对老年性高血压心脏病的临床应用价值

目的:探讨超声心动图对诊断老年性高血压性心脏病的临床应用价值.材料与方法:选取我院老年病区60 ～ 80岁高血压组患者88例,同年龄段非高血压组60例作对照,应用彩色多普勒超声对心脏进行探测,记录心脏的腔室大小、室壁厚度、室壁回声、左右室舒张功能等,检查结果与非高血压组对照分析.结果:老年高血压组与非高血压组比较,心脏室间隔(IVS)、左室后壁(LVPW)明显增厚,左房(LA)增大、主动脉(AO)扩张,E/A明显减低,差异有统计学意义.结论:超声心动图在心电图发现异常之前就能发现左心室肥厚等特征性改变,超声心动图可作为老年高血压性心脏病的常规检查方法,为临床更准确地了解老年高血压患者心脏结构和功能的变化提供了重要的临床应用价值.     

原发性高血压230例心理分析及护理干预

近年来,我们对230例住院治疗的原发性高血压患者的心理进行分析,并采取针对性的心理护理干预,效果满意.现报告如下. 1 临床资料 本组230例,男144例,女86例,39～67岁,平均58岁.均符合2003年版美国高血压防治指南(JNC7)的诊断标准.入选标准:3次非同日测血压,均为高血压Ⅰ期(级)(140～159/90～99mmHg)和(或)高血压Ⅱ期(级)(≥160/100mmHg)[1].     

高血压危象与脑卒中关系探讨

回顾性分析近 4年来本院住院的 180例患者资料。结果脑卒中发生率 :血压 <14 0 / 90mmHg组占 11.7% ,血压14 1～ 179/ 91～ 119mmHg组占 2 7.7% ,血压 >180 / 12 0mmHg组占 60 .6% ;组间比较有显著差异 (P <0 .0 1)。脑卒中在高血压危象患者中的发生率显著增高。     

小剂量尼群地平、巯甲丙脯酸治疗13例原发性高血压

我们自1990年10月～1991年2月,应用小剂量尼群地平加巯甲丙脯酸治疗原发性高血压13例,收到满意疗效,报告如下。 1 临床资料 1.1 资料及方法 选择门诊无明显心、脑、肾合并症的原发性高血压患者13例。其中男11例,年龄31～65岁,平均46.9岁,女2例,年龄46～52岁。 根据1979年郑州心血管病流行病学及人群防治汇报讨论会上修改的高血压标准,13例中临界高血压[19.95/12.1kPa(150/91mmHg)]1例;轻度高血压[18.62～21.28/13.3kPa(140～160/100mmHg)]10例;重度高血压[21.94～23.94/15.56～15.96kPa(165～180/117～120mmHg)]2例。13例收缩期高血压的范围为18.62～23.94kPa(140～180mmHg),平均为19.89kPa(149.61mmHg);舒张压的范围为12.1～15.96kPa(91～120mmHg),平均为13.58kPa(102.15mmHg)。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.