高血压患者脉压与心电图异常相关性的探索

目的 :探讨脉压与心电图异常及心肌肥厚的关系。方法 :收集 5 5岁以上的高血压患者 2 40例进行测压和心电图检查并加以分析。按平均压 <110 mm Hg,≥ 110 mm Hg分为两组 ;再以脉压≤ 6 0 mm Hg,6 1～ 90 mm Hg,>90 mm Hg分为3个亚组。结果 :1随着脉压增加 ,心肌肥厚 ,心电图异常均逐渐增加 ,P<0 .0 1。2血糖、总胆固醇、甘油三酯、高密度脂蛋白-胆固醇、低密度脂蛋白 -胆固醇、体重指数均不随脉压增加而改变 ,P>0 .0 5。 3脉压相同而平均压分别为 <110 mm Hg,≥ 110 mm Hg两组进行比较 ,心肌肥厚 ,心电图异常均无差异 ,而平均压≥ 110 mm Hg组的收缩压、舒张压平均压均高于平均压 <110 mm Hg组 ,两组差异有显著性 ,P<0 .0 1。结论 :高血压患者脉压比收缩压、舒张压与心电图相关性更密切     

高血压病患者脉压与左室肥厚关系的探讨

目的:探讨高血压患者脉压增大与左室肥厚的关系。方法:174例60岁以上的高血压患者测定其收缩压(SBP)、舒张压(DBP)、彩色多普勒超声检查仪测定舒张末期室间隔厚度(VSTd)、舒张末期左室内径(LVIDd)、舒张末期左室后壁厚度(PWTd),分析左室肥厚与脉压的关系。结果:随着脉压的增加,左室重量指数逐渐增加,左室肥厚程度的增加差异亦有显著性,P<0.01。当脉压相同,平均血压(MBP)<113mmHg与≥113mmHg两组进行比较,左室重量指数差异均无显著性。MBP≥113mmHg组的SBP、DBP均高于MBP<113mmHg组,两者差异有显著性。结论:左室肥厚不仅与SBP、DBP有关,而且与脉压有关,脉压是心血管事件的独立预测因子。     

原发性高血压患者动态脉压、收缩压、舒张压、平均动脉压与内皮功能损害及左心室肥厚的关系

目的:探讨原发性高血压患者诊室或动态脉压、收缩压、舒张压及平均动脉压变化与内皮功能损害、左心室肥厚之间的关系,以了解原发性高血压后左心室肥厚、血管内皮损伤的可能机制。方法:选择1998-06/2002-11在首都医科大学宣武医院心血管内科高血压门诊就诊的初诊或停服所有降压药物2周以上的轻中度原发性高血压患者555例。根据诊室脉压及24h动态脉压水平将555例患者分为脉压≤40mmHg(1mmHg=0.133kPa)组,40mmHg<脉压≤50mmHg组,50mmHg<脉压≤60mmHg,脉压>60mmHg。以左室心肌质量指数:男性>134g/m2,女性>110g/m2作为左室肥厚的标准分为肥厚组237例,非肥厚组318例。结果:随24h动态脉压增大,血浆内皮素水平增加(P<0.01),一氧化氮水平减少(P<0.05),内皮素与一氧化氮比值增加(P<0.05)。24h动态脉压、白天脉压、夜间脉压、诊室脉压均与内皮素、内皮素/一氧化氮比值呈显著正相关(r=0.171～0.377,P<0.01);与一氧化氮呈显著负相关(r=-0.269,-0.259,-0.167,P<0.01;r=-0.141,P<0.05)。脉压较收缩压、24h动态脉压较诊室脉压与内皮素、一氧化氮的相关性更明显。而舒张压及平均动脉压与以内皮素、一氧化氮水平均无相关性。左室肥厚组较非肥厚组收缩压及脉压明显增高(P<0.001),舒张压无明显差异,脉压增高的主要因素是收缩     

老年高血压病的不同血压参数变异度与左室肥厚的关系

目的探讨老年高血压患者动态血压各参数变异度及脉压与左室肥厚的关系。方法采用动态血压、超声心动图检查 82例年龄大于 60岁的原发性高血压患者 ,其中 5 1例无左室肥厚 ,31例有左室肥厚 ,对两组动态血压参数进行组间比较及昼夜间比较 ,并对各参数与左室质量指数 ( L VMI)进行相关性分析。结果 1昼、夜收缩压水平、脉压与 LVMI呈强相关 ,左室肥厚组的收缩压、舒张压水平及脉压明显高于无左室肥厚组 ;2两组之间血压变异无差异 ;3所有病例收缩压变异大于舒张压变异 ,收缩压变异白昼大于夜间 ,而昼夜间舒张压变异、脉压水平改变不明显。结论老年高血压患者左室肥厚与血压变异相关性较小 ,主要与收缩压水平与脉压水平相关 ,老年高血压患者 2 4小时舒张压变异与脉压水平处于相对恒定的水平 ,脉压可能是预测老年高血压性左室肥厚的一个简便易行的指标。     

原发性高血压患者动态脉压、收缩压、舒张压、平均动脉压与内皮功能损害及左心室肥厚的关系

目的：探讨原发性高血压患者诊室或动态脉压、收缩压、舒张压及平均动脉压变化与内皮功能损害、左心室肥厚之间的关系，以了解原发性高血压后左心室肥厚、血管内皮损伤的可能机制。方法：选择1998—06／2002-11在首都医科大学宣武医院心血管内科高血压门诊就诊的初诊或停服所有降压药物2周以上的轻中度原发性高血压患者555例。根据诊室脉压及24h动态脉压水平将555例患者分为脉压≤40mmHg(1mmHg=0．133kPa)组，40mmHg&;lt;脉压≤50mmHg组，50mmHg&;lt;脉压≤60mmHg，脉压&;gt;60mmHg。以左室心肌质量指数：男性&;gt;134g／m^2，女性&;gt;110g／m^2作为左室肥厚的标准分为肥厚组237例，非肥厚组318例。结果：随24h动态脉压增大，血浆内皮素水平增加(P(0，01)，一氧化氮水平减少(P&;lt;0，05)，内皮素与一氧化氮比值增加(P&;lt;0．05)。24h动态脉压、白天脉压、夜间脉压、诊室脉压均与内皮素、内皮素／一氧化氮比值呈显著正相关(r=0．171～0，377，P&;lt;0，01)；与一氧化氮呈显著负相关(r=-0，269，-0．259，-0，167，P&;lt;0．01；r=-0．141，P&;lt;0．05)。脉压较收缩压、24h动态脉压较诊室脉压与内皮素、一氧化氮的相关性更明显。而舒张压及平均动脉压与以内皮素、一氧化氮水平均无相关性。左室肥厚组较非肥厚组收缩压及脉压明显增高(P&;lt;0．001)，舒张压无明显差异，脉压增高的主要因素是收缩压增高。分别以内皮素、一氧化氮为因变量，以诊所或24h收缩压、舒张压、脉压、平均动脉压为自变量，只有诊室或24h脉压进入回归方程[诊室血压参数结果：内皮素=0．497&;#215;诊室脉压+44．613(R^2=0，029，P&;lt;0．01)；一氧化氮=-0．398&;#215;诊室脉压+100．454。24h血压参数结果：内皮素=1.269&;#215;24h脉压+12．536(R0=0．090，P&;lt;0．01)；一氧化氮=-015&;#215;24h动态脉压+130．266(R^2=0．072，P&;lt;0．01)]。以左室心肌质量为因变量，以诊所或24h收缩压、舒张压、脉压、平均动脉压为自变量，只有诊所或24h收缩压进入回归方程[诊室血压参数结果：左室心肌质量=0．405&;#215;诊室收缩压+37．769(R^2=0．072，P&;lt;0．01)；24h血压参数结果：左室心肌质量=0．611&;#215;24h收缩压+19．821(R^2=0．174，P&;lt;0．01)]。结论：脉压与收缩压增高均可导致原发性高血压患者左心室肥厚、内皮功能损伤及舒张功能减退；脉压增高是导致原发性高血压患者内皮功能损伤的主要决定因素，随脉压升高，血管内皮功能损害加重；收缩压增高是导致原发性高血压患者左心室肥厚的主要决定因素；舒张压及平均动脉压增高对左心室肥厚及血管内皮功能损伤无明显影响。     

老年高血压患者动态血压变化与左室肥厚的关系

目的 探讨老年高血压患者动态血压变化与左心室肥厚的关系.方法 采用超声心动图检查患者心脏,将结果分成左心室肥厚组(LVH)和非左心室肥厚组(NLVH),对两组患者动态血压检测结果进行组间对照,并对相关数据与左室质量指数(LVMI)进行相关性分析.结果 ①左室肥厚组收缩压、舒张压、脉压水平均明显高于非左室肥厚组,尤以收缩压明显;②左室肥厚组昼夜节律变化消失或减弱者较非左室肥厚组明显增多.结论 老年高血压患者动态收缩压、舒张压及脉压水平与左心室肥厚具有正相关,同时血压的昼夜节律变化对左心室肥厚具有重要影响.     

心电图和超声心动图诊断左室肥厚对高血压病患者预后的预测作用

目的 :探讨老年高血压病患者心电图和超声心动图诊断左室肥厚 (LVH)与预测心血管事件危险性的关系。方法 :对 5 8例患者进行心电图和超声心动图随访 3～ 5年 ,平均 3 .9年 ,并测定血糖、血脂及C 反应蛋白等其他相关危险因素。结果 :在随访期间 ,发生心血管事件 3 5例 ( 89.74 % ) ,超声心动图LVH测定的敏感性 /特异性 ( % ) :3 9例LVH患者 2 3例 ( 5 8.79% ) (SV1 RV5或RV6)≥ 3 .5mv ,2 0例 ( 5 1.2 8% ) (SV3 RaVL)≥ 2 .8mv ,2 4例( 61.5 3 % ) [(SV3 RaVL)×QRS间期 ]>2 4 4 μV·S ,3 5例 ( 89.74 % )V4～V5导联中ST段压低 >0 .1mv ,伴T波低平或倒置。 5 8例随访前后血压变化有显著意义 (P <0 .0 5 )。C 反应蛋白及血糖变化无显著意义 (P >0 .0 5 )。LVM/m明显下降 (P <0 .0 5 )。结论 :左室肥厚的老年患者心血管危险性明显增加 ,心电图和超声心动图诊断左室肥厚对判断高血压病患者心血管事件的危险性各有不同的临床意义     

动态脉压与诊所脉压对原发性高血压患者左室肥厚的评估价值

目的：通过比较动态脉压和诊所脉压对原发性高血压患者左室肥厚的影响，为高血压患者的康复预防和介入提供理论依据。方法：选择初诊的轻-中度原发性高血压患者337例，所有人选病例测量非同日3次诊所血压、进行24h动态血压监测和超声心动图检查。①根据动态脉压水平分为4组、根据诊所脉压水平分为5组并分别比较。②根据左室质量指数分为左室肥厚组和非左室肥厚组。结果：动态脉压和诊所脉压均与年龄、原发性高血压史、左室质量指数、动脉僵硬度指数和24h平均心率呈非常显著的相关性。动脉僵硬度随分组脉压的增大呈显著递增，其与动态脉压的相关性明显强于诊所脉压(r=0．670．P&;lt;0．0l和r=0．399，P&;lt;0．01。24h脉压和24h收缩压在左室肥厚组均明显高于非左室肥厚组[(49．0&;#177;10．2)mmHg和(44．7&;#177;8．9)mmHg，P&;lt;0．001]和[(132．1&;#177;13．1)mmHg和(126．5&;#177;12．7)mmHg,P&;lt;0．001](1mmHg=0．13kPa)；动态脉压与左室质量指数的相关性明显强于诊所脉压(r=0．277，P&;lt;0．01和r=0．105，P&;lt;0．05)。结论：脉压升高是原发性高血压患者左室肥厚的重要危险因素；与诊所脉压比较，动态脉压更能反映高血压靶器官损害的程度。     

动态脉压与诊所脉压对原发性高血压患者左室肥厚的评估价值

目的通过比较动态脉压和诊所脉压对原发性高血压患者左室肥厚的影响,为高血压患者的康复预防和介入提供理论依据. 方法选择初诊的轻-中度原发性高血压患者 337例,所有入选病例测量非同日 3次诊所血压、进行 24 h动态血压监测和超声心动图检查.①根据动态脉压水平分为 4组、根据诊所脉压水平分为 5组并分别比较.②根据左室质量指数分为左室肥厚组和非左室肥厚组. 结果动态脉压和诊所脉压均与年龄、原发性高血压史、左室质量指数、动脉僵硬度指数和 24 h平均心率呈非常显著的相关性.动脉僵硬度随分组脉压的增大呈显著递增,其与动态脉压的相关性明显强于诊所脉压 (r=0.670,P< 0.01和 r=0.399,P< 0.01. 24 h 脉压和 24 h收缩压在左室肥厚组均明显高于非左室肥厚组 [(49.0± 10.2)mmHg 和 ( 44.7± 8.9) mmHg,P< 0.001]和 [( 132.1± 13.1) mmHg 和( 126.5± 12.7) mmHg,P< 0.001](1 mmHg=0.13 kPa);动态脉压与左室质量指数的相关性明显强于诊所脉压 (r=0.277,P< 0.01和 r=0.105,P< 0.05). 结论 脉压升高是原发性高血压患者左室肥厚的重要危险因素;与诊所脉压比较,动态脉压更能反映高血压靶器官损害的程度.     

脉压与冠心病患者左室功能及左室肥厚的关系

目的：比较分析合并与未合并糖尿病、高血压冠心病患者脉压与心功能指标及左室肥厚的关系.方法：[1]选择2001-01/12上海交通大学附属第一人民医院心内科住院冠心病患者105例,男70例,女35例.其中仅合并高血压者29例（合并高血压组）,同时合并高血压及糖尿病者27例（合并高血压及糖尿病组）,合并糖尿病者32例（合并糖尿病组）,无高血压及糖尿病者（无高血压及糖尿病组）17例.患者均知情同意.[2]在行冠状动脉造影术过程中测定主动脉内收缩压、舒张压,计算脉压值.超声心动描记法为M型模式下测定舒张末期左室腔直径、左室后壁厚度及室间隔厚度及左室射血分数.根据公式：左室质量=1.04[（室间隔厚度＋舒张末期左室腔直径＋左室后壁厚度）3-舒张末期左室腔直径3]-13.6计算左室质量.根据公式：相对室壁厚度=（室间隔厚度＋左室后壁厚度）/舒张末期左室腔直径计算相对室壁厚度.[3]分别以脉压、左室质量、左室射血分数及相对室壁厚度为变量,以年龄、性别、伴有高血压、伴有糖尿病、同时伴有高血压及糖尿病为控制变量,进行偏相关分析.组间分析采用方差分析.结果：冠心病105例均进入结果分析.[1]各组脉压无明显差别.合并高血压及糖尿病组左室质量、相对室壁厚度大于其他3组（P＜0.05）,心功能指标左室射血分数明显低于其他3组（P＜0.05）.[2]各组脉压均与左室质量呈显著正相关（r=0.35～0.47,P＜0.05～0.01）.合并高血压组、合并高血压及糖尿病组脉压与左室射血分数呈显著正相关（r=0.33,0.41,P＜0.05）.合并高血压及糖尿病组脉压与相对室壁厚度呈显著正相关（r=0.51,P＜0.01）.结论：脉压是一独立于高血压之外的,与左室肥厚有关的独立指标;同时合并高血压及糖尿病,为影响冠心病患者左室肥厚,左室收缩功能的重要因素.     

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.