用桡动脉脉搏波估测硝酸甘油对中心动脉压的影响

目的：通过测量桡动脉波定量硝酸甘油降低中心动脉反射波增压的效应。方法：１９名志愿者,年龄５４±７岁,无严重器质性疾病,试验前停用所有心血管药物至少３天,试验当天禁食。先测基础仰卧位肱动脉血压和桡动脉脉搏波,随后随机贴上安慰剂或 ５ ｍｇ硝酸甘油贴剂,每隔半小时以同样的方式记录血压和脉搏波,共 ５个小时后撕去贴膜,再记录 ２ 小时。动脉脉搏波分析仪实时把桡动脉脉搏波换算为中心动脉脉搏波,显示中心动脉反射波增压（ＡＵＧ）和中心动脉反射波增压指数（ＡＩ）。结果：安慰剂组（９例）,用药前后比较,心率（ＨＲ）,射血时间（ＥＤ）,肱动脉收缩压（ＰＳＰ）,肱动脉舒张压（ＰＤＰ）和肱动脉平均压（ＰＭＰ）及计算的中心动脉波增压、增压指数、中心动脉收缩压等各项参数均无显著变化。 ５ ｍｇ硝酸甘油贴剂组 （ １０例）用药前后比较,射血时程、中心动脉波增压、增压指数、中心动脉收缩压在用药后半小时即显著下降,至３．５小时达高峰,撕去贴膜后２小时恢复到基础水平,但心率、肱动脉收缩压、肱动脉舒张压和肱动脉平均压无明显变化。结论：通过分析桡动脉脉搏波,可以定量中心动脉反射波增压,阐明硝酸甘油的作用,显示其起效、维持、撤除的动态变化,同时也阐明了硝酸     

长期服用氢氯噻嗪对中心动脉压的影响

目的:观察长期服用单药氢氯噻嗪对高血压患者中心动脉压的影响。方法:回顾性分析了参加非洛地平降低心血管事件试验(FEVER)的3个研究中心的受试者资料,选择其中只服用氢氯噻嗪且完成3年以上脉搏波检查随访的76例患者的资料。脉搏波检查在入组时做1次作为基线值,随后每12个月1次至研究结束。观察的中心动脉脉搏波主要指标包括:中心动脉第一峰收缩压、中心动脉第二峰收缩压、中心动脉舒张压、反射波增压及反射波增压指数。结果:与基线值比较,12、24和36个月随访时肱动脉的收缩压和舒张压及中心动脉第一峰收缩压和中心动脉舒张压均有极显著的下降(P<0.001),反射波增压有所下降(P<0.05),而反射波增压指数和心率无显著变化(P>0.05)。结论:长期服用小剂量氢氯噻嗪降低肱动脉压及中心动脉压一样,对反射波增压指数无影响,提示不能产生额外的中心动脉降压获益。     

盐与中心动脉压和脉搏波传导速度的关系

<正>高血压增加患心血管病的风险,也是脑卒中和慢性肾脏病主要危险因素,高血压及其相关并发症已经在世界范围内造成巨大的社会经济负担。高血压发病的危险因素包括吸烟、年龄、性别、家族史和生活方式等诸多方面。而饮食中盐摄入的多少与人群血压水平和高血压发病率息息相关。计算饮食中钠钾摄入量的方法主要有膳食回顾调查问卷法和24 h留尿法2种,有研究者对双方进行比较后发现,采用     

中心动脉压及其相关指标的临床意义

中心动脉压不同于肱动脉血压,其与一些相关指标是心血管疾病及事件的真正关联因素。在许多生理及病理状态下中心动脉压及其相关指标会发生变化,检测中心动脉压及其相关指标具有重要的临床意义。     

高血压病脉搏波速度与脉压关系的研究

目的　研究高血压病患者主动脉脉搏波速度 (PWV)与脉压的关系。方法　 3 15 6例高血压患者入选了我们的横断面研究 [平均年龄 ( 5 3 7± 11 6 )岁 ]。应用自动脉搏波速度测定仪测量颈动脉 股动脉PWV作为反映大动脉硬度的指标 ,血压测量采用标准水银柱血压计。结果　脉压≥ 6 0mmHg ( 1mmHg =0 133kPa)者PWV显著大于脉压 <6 0mmHg者 [( 12 4 6± 2 4 6 )比 ( 10 96± 1 79)m s ,P <0 0 1]。脉压和PWV与年龄显著正相关 (脉压r =0 396 ,P =0 0 0 0 ;PWVr =0 5 31,P =0 0 0 0 )。收缩压一定时 ,PWV随舒张压的降低显著升高 ;舒张压一定时 ,PWV随收缩压的升高显著升高。结论　PWV与脉压密切相关 ,PWV由高到低依次为单纯收缩期高血压、收缩舒张期高血压、单纯舒张期高血压和正常血压者。     

原发性高血压患者踝臂动脉脉搏波传导速度与中心动脉压及颈动脉内膜厚度的相关性

目的:探讨原发性高血压患者踝臂动脉脉搏波传导速度(baPWV)与颈动脉内膜中层厚度(IMT)及中心动脉压(CAP)的关系。方法:收集原发性高血压患者共444例,对所有患者进行IMT、baPWV及CAP的测定。根据baPWV分为异常组(baPWV≥14m/s,208例)和正常组(baPWV14m/s,236例)。用简单相关分析检测baPWV与CAP及IMT的相关性。采用Logistic回归分析baPWV与CAP及IMT的关系。结果:Pearson相关分析显示,baPWV与年龄、24h平均收缩压(24hSBP)、白昼平均收缩压(dSBP)、夜间平均收缩压(nSBP)、中心动脉收缩压(CASP)、中心动脉舒张压(CADP)、中心动脉脉压(CAPP)、反射波压力(AP)、中心动脉压增强指数(AIx)、75次心率AIx校正指数(AIx75)及IMT相关(P0.05)。进一步控制年龄、24hSBP、dSBP、nSBP后,CASP、CADP、CAPP、AP、AIx75、IMT仍与baPWV相关。Logistic回归分析显示,CASP、CAPP、IMT与baPWV相关。结论:CASP、CAPP、IMT是baPWV增加的危险因素。     

以钙拮抗剂为基础的联合降压对高血压患者中心动脉压和脉搏波传导速度的对比研究

目的探讨氨氯地平联合复方阿米洛利或联合替米沙坦对高血压患者中心动脉压(CAP)和脉搏波传导速度(PWV)的影响。方法采用随机抽样方法选取2008-03-2011-02济南4个社区查体人群中高血压患者275例,年龄50～79岁。随机分为氨氯地平联合复方阿米洛利组(A组,134例)或联合替米沙坦组(B组,141例)。排除68例应用调脂药物的患者后,对207例(A组,102例;B组,105例)患者进行分析。在基线、治疗12、24月,分别应用动脉脉搏波分析仪测量CAP和增强指数,应用PWV测定仪测定颈桡动脉PWV(crPWV)。结果两组治疗12月后,中心动脉收缩压、舒张压、脉压,增强指数及crPWV均明显降低。24月时,B组crPWV较12月时进一步降低[(8.9±2.0)比(9.5±2.2)m/s,P<0.05],然而A组患者的crPWV并未随着时间的延长进一步改善(P>0.05)。治疗12和24月后,B组crPWV下降幅度[12月(-3.5±2.1)m/s,24月(-4.1±2.3)m/s]均较A组[12月(-2.3±1.6)m/s,24月(-2.5±1.8)m/s]更明显(均P<0.01)。结论以钙拮抗剂氨氯地平为基础,联合替米沙坦或复方阿米洛利均能够降低CAP、增强指数和改善大动脉顺应性,其中氨氯地平联合替米沙坦改善动脉弹性更明显,并且随着治疗时间的延长,效果更佳。     

硫氮酮对高血压患者中心动脉压和波反射的影响

对行左心导管术中高血压病患者分别静注硫氮酮10mg(观察组)、舌下含化硝酸异山梨酯5mg(对照组),观察两组用药前后中心动脉压及波反射变化。结果用药后两组中心动脉收缩压和舒张压均明显下降,反射波增压值、反射波增压指数降低,以观察组舒张压降低明显。认为硫氮酮对高血压病患者中心动脉舒张压的影响优于硝酸异山梨酯。     

硝酸甘油对2型糖尿病患者动脉弹性功能的影响

目的　观察大动脉弹性指数C1与小动脉弹性指数C2在 2型糖尿病患者中的变化及硝酸甘油对它们影响。方法　采用CVProfilerDO - 2 0 2 0动脉功能检测仪测定 4 4例 2型糖尿病患者和 5 2名健康人的C1、C2 ,并观察糖尿病患者舌下含服硝酸甘油后C1和C2的变化。结果　糖尿病患者的C2显著低于健康人 (3 4 8± 1 6 5vs 6 70± 2 6 5 ,P <0 0 5 ) ,C1无明显降低 (14 4± 5 2vs 15 2± 3 8,P >0 0 5 ) ;含服硝酸甘油后糖尿病患者的C2明显升高 (4 97± 2 5 8vs 3 4 8± 1 6 5 ,P <0 0 5 ) ,但C1无明显变化 (15 8± 5 5vs 14 4± 5 2 ,P >0 0 5 )。结论　 2型糖尿病患者的小动脉弹性功能 (C2 )显著降低 ,硝酸甘油可有效逆转这一变化。动脉内皮功能障碍可能是 2型糖尿病患者小动脉弹性功能下降的主要原因     

通过脉搏波分析比较咪达普利对中心和外周动脉压的影响

目的:比较咪达普利对中心动脉压和外周动脉压的影响.方法:经2周的安慰剂洗脱后,年龄18～79岁的53例轻、中度原发性高血压患者每日服用咪达普利5～10 mg共治疗6周.所有患者在开始服药前及研究结束时均做脉搏波检查.只有完成6周治疗的患者列入最终分析.结果:共有48例患者完成该研究.经6周治疗后,脉搏波所有观察指标显著下降(P均＜0.05～0.001),且中心动脉收缩压和脉压下降幅度显著大于肱动脉收缩压和脉压下降(P值分别为0.002和0.003).结论:咪达普利降低外周动脉压和中心动脉压均有效,且降低收缩压和脉压在中心动脉比外周动脉显著,其差异可能系波反射降低所致.     

Effect of Glyceryl Trinitrate on Gastric Accommodation and Symptoms in Functional Dyspepsia

The purpose of this study was to investigatewhether sublingual glyceryl trinitrate influences thesize of the proximal stomach and postprandial symptomsin patients with functional dyspepsia. Twenty patients with functional dyspepsia were included in adouble-blind, placebo-controlled crossover study withsublingual glyceryl trinitrate. All patients werescanned twice on consecutive days, receiving eitherplacebo or 0.5 mg glyceryl trinitrate randomly 5 minprior to ingestion of 500 ml meat soup. Total symptoms,pain, nausea, and bloating were scored on a visualanalog scale before and after the meal. Standardized ultrasonograms were obtained 1, 10, and 20 minpostprandially of the proximal and distal stomach. Theproximal stomach was larger in the sagittal section at1 min postcibally (26.5 ± 3.9 vs 24.8 ±4.9 cm², P = 0.036) and 10 min postprandially (22.0± 5.1 vs 19.8 ± 5.3 cm², P =0.009) after administration of glyceryl trinitratecompared with placebo, whereas a tendency was observedafter 20 min (18.7 ± 5.5 vs 17.3 ± 5.7 cm², P = 0.076). The correspondingchanges in the frontal diameters were 8.3 ± 1.1vs 7.8 ± 1.2 cm (P = 0.067) after 1 min, 7.2± 0.9 vs 6.4 ± 0.8 cm (P = 0.001) after 10min, and 6.3 ± 1.1 vs 5.6 ± 1.2 cm (P =0.016) after 20 min. The area of the distal stomach was notdifferent (P = 0.31) in the two groups. Afteradministration of glyceryl trinitrate, the patientsreported less pain (P = 0.048) and nausea (P = 0.023) 5min postprandially, but this effect was reduced 15min later. Total symptom score was improved by glyceryltrinitrate treatment (P = 0.042). Sublingual glyceryltrinitrate improves accommodation of the proximal stomach to a meal and reduces postprandialsymptoms in a group of patients with functionaldyspepsia.     

用导管法评定硝酸酯类药物对中心动脉压的影响

目的了解硝酸酯类药物对中心动脉压的影响.方法52例行左心导管术患者,平均年龄(53.3±10.8)岁.其中冠心病32例,合并高血压和(或)糖尿病18例;原发性高血压6例;其它14例.晨起停服心血管药物,在冠状动脉造影或射频导管消融术(左心室旁道)后,用导管直接测定升主动脉压,并记录血压波形;同时用袖带汞柱血压计测定右臂肱动脉压,连续测定2次,取均值.其中33例舌下含化硝酸异山梨酯10 mg;19例舌下含化硝酸异山梨酯5 mg后10分重复上述操作.结果舌下含化硝酸异山梨酯10 mg或5 mg后升主动脉收缩压下降均较肱动脉明显,而舒张压变化不大.用药前后升主动脉收缩压差值与升主动脉脉压虽无显著相关,但相关系数为0.2026.结论硝酸酯类药物有降低动脉收缩压的作用,且降低中心动脉收缩压的作用明显大于肱动脉收缩压.     

Effect of 0.2 Percent Glyceryl Trinitrate Ointment on Wound Healing After a Hemorrhoidectomy

PURPOSE: Glyceryl trinitrate ointment acts as a dilator of the internal anal sphincter. It has been used as a treatment modality that replaces the lateral sphincterotomy in chronic anal fissures. When glyceryl trinitrate ointment is applied to the wound from a hemorrhoidectomy, it is thought that it will shorten the healing time and decrease postoperative pain. Our study focused on the efficacy of using 0.2 percent glyceryl trinitrate ointment to shorten the healing time after a hemorrhoidectomy. METHODS: A randomized, prospective, double-blind, and placebo-controlled study was designed. The power test indicated that 55 patients should be in each group to give a 90 percent chance of finding a 30 percent difference in healing time. The selection criteria for inclusion in this study were patients with third-degree or fourth-degree hemorrhoids and patients undergoing hemorrhoidectomies for three or more piles. From November 2000 to July 2001, the first 110 patients to meet our criteria were selected, 55 in the nitroglycerin group and 55 in the placebo group. The same physician performed all of the hemorrhoidectomies, and intravenous patient-controlled analgesia was not used. Cases involving other procedures for fissures or fistulas were excluded. The patients randomly received glyceryl trinitrate and placebo ointments from the pharmacologist. The pain score was checked using a visual analog scale (minimum = 0, maximum = 10) during the hospital stay, and complete wound healing was checked at three weeks after the operation. Demands for analgesics and the frequency of postoperative complications were recorded. RESULTS: When the trial was completed, 49 patients remained in the nitroglycerin group and 53 patients in the placebo group. No significant differences in the gender and the age distributions, the number of excised piles, the time for the procedures, the length of hospital stay, and the consumed amounts of analgesics existed between the two groups. The pain score in the nitroglycerin group showed a significant difference with the repeated measures analysis (P < 0.001). The wound healing rates at three weeks postoperative were 74.5 percent in the nitroglycerin group and 42 percent in the placebo group (P = 0.002). There was no significant increase in complications in the nitroglycerin group. CONCLUSION: More rapid healing of hemorrhoidectomy wounds without any specific complications was effected by 0.2 percent glyceryl trinitrate ointment.     

Manometric Effect of Topical Glyceryl Trinitrate and Its Impact on Chronic Anal Fissure Healing

INTRODUCTION The duration of physiologic action of topical glyceryl trinitrate in the management of anal fissure has been the source of some controversy. This study was designed to assess the manometric effect of glyceryl trinitrate on internal sphincter resting tone with continuous monitoring.METHODS Twenty-seven patients with a chronic anal fissure were assessed with fissure, pain, bleeding, and continence scores. Twenty-two were randomized to 1 cm of topical 0.2 percent glyceryl trinitrate paste, applied to the lower anal canal. Five patients were randomized to 1 cm of water-soluble lubricating jelly to the lower anal canal. Continuous stationary six radial channel water perfusion anorectal manometry was performed for 5 minutes before treatment and then for a further 30 minutes. The 22 glyceryl trinitrate patients were then advised to apply topical 0.2 percent glyceryl trinitrate, three times daily, for eight weeks. Twenty-four hours after completing treatment, all baseline assessments were repeated. The lubricant jelly cohort was discharged from the study after the initial assessment.RESULTS During the initial manometric assessment, 21 glyceryl trinitrate patients (95 percent) had 20 percent or more reduction in mean and maximum anal resting pressure after treatment. However, there was no statistical difference at 20 minutes compared with 0 minutes (P > 0.1). After eight-week treatment, 16 patients (73 percent) reported symptom resolution and 15 (67 percent) were found to be healed on examination. Clinical healing and resolution of symptoms positively correlated with a higher pretreatment maximum anal resting pressure in the mid anal canal (P < 0.0001), lower fissure score (P < 0.0001), and greater percentage reduction of the maximum resting pressure after application of glyceryl trinitrate (P < 0.001). The mean and maximum anal resting pressure at Week 8 was not significantly different from the baseline values (P > 0.05). During continuous manometry, the anal resting pressure did not significantly change in the patients treated with lubricating jelly.CONCLUSIONS In those patients with a lower fissure score, a higher mid anal canal anal resting pressure, and a greater resting pressure reduction after glyceryl trinitrate application, a favorable clinical outcome can be expected with glyceryl trinitrate treatment. However, because the physiologic response has resolved in fewer than 20 minutes, the dosing regime should be reassessed.Supported by the Harry Triguboff Colorectal Research Scholarship, administered through Sydney Colorectal Associates.Reprints are not available     

Noninvasive Studies of Central Aortic Pressure

Our purpose is to review noninvasive methods for measuring central arterial pressure. Indices of central arterial pressure measured from central aortic and peripheral arterial waveforms have shown value in predicting cardiovascular events and death, as well as in guiding therapeutic management. This article reviews noninvasive techniques of measuring central arterial pressure that have been validated against intra-arterial pressure. This paper explains methods to derive central (aortic and carotid) pressure from radial and brachial sites. It focuses on specific issues of brachial calibration applied to carotid pressure waveforms, which were regarded as a surrogate of aortic pressures used in three major studies (Framingham, Asklepios, and Australian National Blood Pressure 2 studies). We explain why radial-based methods are superior to carotid-based methods for estimating central pressure. Physiological principles of pressure measurement need be satisfied to ensure accurate recording.