高血压合并焦虑障碍患者用药探究

<正>“十二五”高血压抽样调查显示,我国成人高血压患病率达23.2%,约有2.45亿高血压患者^[1]。中国主要精神障碍中焦虑障碍占比最高,终身患病率可达7.6%,约有1亿焦虑障碍患者^[2]。我国高血压患者合并焦虑症发生率达11.6%～38.5%^[3]。在临床实践中,常常忽视高血压患者心身反应和心理障碍,重视并规范降压治疗联合抗焦虑治疗是生物-心理-社会综合医学模式对临床医生提出的更高要求。     

18例顽固性肾血管性高血压患者介入治疗的疗效分析

<正>肾血管性高血压是继发性高血压的常见病因之一,是由于单侧或双侧肾动脉主干或分支狭窄引起的高血压。常见病因有多发性大动脉炎,肾动脉纤维肌性发育不良和动脉粥样硬化。我国肾动脉狭窄(Renal artery stenosis,RAS)的主要病因为动脉粥样硬化,大动脉炎次之[1]。在成年恶性高血压患者中,肾血管性高血压约占6%～27%[2]。我院自2004年以来采用介入治疗RAS18例,现分析如下。     

血管紧张素受体拮抗剂联合氢氯噻嗪治疗老年高血压

<正>当前全球人口老龄化日趋严重。2008年美国年龄≥65岁的人群约占13%,预计到2030年将达20%,我国也不例外[1]。据国家统计局数据显示,我国目前年龄≥65岁老年人口为1.5831亿,占人口总数的11.4%[2]。高血压作为一种常见的慢性疾病在老年人群中尤为多见,西方国家老年高血压患病率为60%～70%,我国约为50%[3]。高血压是老年患者心血管事件与死亡的主要危险因素,尤其是收缩压升高显著增加心血管事件的风     

高血压合并糖尿病的治疗

高血压和糖尿病在临床上非常常见 ,二者的发病率都在逐年增高。流行病学研究显示 ,高血压与糖尿病有一定的关联[1～ 3 ] 。目前我国高血压患者近 1亿 ,糖尿病患者近 30 0 0万 ,其中 90 %为 2型糖尿病 ,高血压合并糖尿病的患者约 1 5 0 0万。在高血压患者中 ,糖尿病的患病率约为 1 0 %～ 2 0 % ,糖尿病患者中约 5 0 %合并高血压。WHO1 997年报告 1 996年全世界糖尿病患者 1 .32亿 ,预测到 2 0 1 0年将增至 2 .4亿 ,2 0 2 5年达到近 3亿 ,成为世界第五大死亡原因。新增加的病人将约 2 /3～ 3/4在中国、印支亚大陆及非洲等发展中国家 ,在糖尿…     

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在我国35~74岁人群高血压发生率达27.2%[1]。高血压造成的靶器官损害日益受到人们的重视,心力衰竭是高血压的重要靶器官损害之一。2002年研究结果显示,心力衰竭患病率为0.9%[2]。高血压造成的心力衰竭约占住院心力衰竭患者的13.9%,为心力衰竭住院病因的第2位[3]。1高血压引起心     

慢性肾脏病与肾素-血管紧张素-醛固酮系统及高血压

慢性肾脏病(CKD)患者高血压发生率很高,尤其在出现慢性肾衰竭时.成人高血压患者中,CKD的患病率居第二位(仅次于原发性高血压,约占全部高血压的5%～10%);而在儿科高血压患者中,其患病率居首位(约占全部高血压的2/3).CKD患者的高血压危害极大,它不但诱发严重心脑血管并发症(约1/2终末肾脏病患者死于此并发症),而且能加速肾损害进展,促进慢性肾衰竭发生[1].     

主动脉夹层的研究进展

主动脉夹层 (ＡｏｒｔｉｃＤｉｓｓｅｃｔｉｏｎ ,简称ＡＤ)系主动脉内膜撕裂后循环中的血液通过裂口进入主动脉壁内 ,导致血管壁分层。其最主要的易患因素为高血压 ,系高血压的严重并发症之一 ,约有 70 %～ 90 %的ＡＤ患者并存高血压[1] ;其它易患因素包括Ｍａｒｆａｎ氏综合征、Ｅｈｌｅｒｓ Ｄａｎｌｏｓ综合征、二叶主动脉瓣、主动脉狭窄、妊娠、主动脉粥样硬化及创伤等[2 ,6] 。ＡＤ以男性多见 ,男女性别比约 3∶1 [3 ] 。根据美国 1 980年以前的资料估计 ,ＡＤ的年发病率约 5～ 1 0例 /百万[4] ,由于近2 0年来心血管影像诊断技术的飞…     

正常高值血压的研究概况

高血压是世界公认的心脑血管疾病的危险因素,全球每年约有710万人的死亡与高血压相关[1]。虽然目前医疗水平明显提高,但高血压的治疗率仅占60%～70%,控制率仅30%～40%[2-3],而相关研究指出未能有效控制血压的药物治疗将会增加心脑血管疾病发生的风险[4]。因此,高血压的预防成为近10年来最重要的健康需求之一[5],正常血压和高血压之间的过渡血压(120～139/80～89mm Hg,1 mm Hg=0.133kPa)亦逐渐受到医学界的关注,该阶段血压的危害、治疗等成为研究的焦点,《中国高血压防治指南     

糖尿病肾损害及其临床处理

据统计,1型糖尿病和2型糖尿病(T2DM)发展为DN者分别为25%～40%和5%～40%[1],微量白蛋白尿(MA)发生率约39%[2],马来群岛人T2DM合并高血压患者中大量蛋白尿患病率为15.7%,MA为39.7%[3].在ESRD透析患者中,DN约占1/3.     

经皮导管射频消融去肾脏交感神经术治疗顽固性高血压的研究进展

<正>高血压是一个全球范围内的公共健康问题,它是导致心血管疾病如猝死和心肌梗死的主要因素[1]。因此,合理、有效地控制血压是改善人群生存率和生活质量的重要措施。有研究显示,23%~30%的高血压患者治疗效果不佳,此类人群为心血管事件的高危群体[2-3]。在美国,顽固性高血压在成人中占8.9%,并且占所有经药物治疗的成人高血压的12.8%[4-5]。顽固性高血压有     

Value of post-operative programmed ventricular stimulation after map-guided surgery for ventricular tachyarrhythmias -- epicardial versus endocardial stimulation

To assess the efficacy of map-guided antitachycardia surgery,induction of ventricular tachycardia has mostly been performedusing endocardial stimulation. In addition, epicardial stimulationcan be done using temporary epicardial wires, thus not requiringpost-operative catheterization. However, the diagnostic valueof epicardial versus endocardial stimulation for the post-operativeevaluation of patients undergoing map-guided surgery for drug-refractoryventricular tachycardia is not known, especially with regardto the induction of non-clinical tachyarrhythmias. Therefore,we compared the results of epicardial and endocardial programmedventricular stimulation in 58 consecutive patients in whom pairsof steel wires were placed over the right ventricle during surgery.The stimulation protocol consisted of single and/or double prematurestimuli during sinus rhythm and paced ventricular drives of500, 430, 370 and 330 ms. Pre-operatively, all patients hadinducible monomorphic ventricular tachycardia by endocardialstimulation. Post-operatively, 36 patients were not inducibleby either epicardial or endocardial programmed ventricular stimulation,whereas epicardial and endocardial stimulation induced the clinicalventricular tachycardia in six patients and non-clinical ventriculartachycardia in three patients (45/58 patients, 77% concordant).However, in two patients the clinical ventricular tachycardiawas induced only by endocardial programmed ventricular stimulation.Non-clinical ventricular tachycardia was inducible in threepatients by epicardial stimulation only, and in eight patientsby endocardial stimulation only (13/58 patients, 23% discordant). Thus, in 77% of patients an identical result of programmed ventricularstimulation was obtained using epicardial and endocardial stimulation,whereas the results were discordant in 23%. Therefore, epicardialstimulation alone is not sufficient for the post-operative evaluationafter map-guided surgery.     

Inhibitory Effects of Gastrointestinal Electrical Stimulation on Rectal Tone are both Organ-Specific and Distance-Related in Dogs

Purpose A phenomenon of cross-talk has been noted that electrical stimulation of one part of the gut affects another part of the gut. This study was designed to investigate whether the effect of electrical stimulation of one part of the gut on another part of the gut was related to the organ or the distance between the stimulation site and the affected organ, and the mechanism of ileum electrical stimulation on rectal tone. Methods This study was performed in 13 healthy dogs (16–28 kg) in the fasting state. Experiments were performed to study 1) effects of gastric electrical stimulation, duodenal electrical stimulation, ileum electrical stimulation, and colonic electrical stimulation on rectal tone, and 2) the sympathetic and nitrergic pathways involved in the effects of ileum electrical stimulation on rectal tone. A computerized barostat was used to assess rectal tone. Results All methods of stimulations significantly inhibited rectal tone. Duodenal electrical stimulation was least effective in reducing rectal tone. The percentage of increase in rectal volume was distance-related with duodenal electrical stimulation, ileum electrical stimulation, and colonic electrical stimulation but organ-specific with gastric electrical stimulation. The inhibitory effect of ileum electrical stimulation on rectal tone was abolished by N _ω -nitro-L-arginine but not guanethidine. Conclusions Electrical stimulation of the stomach, intestine, or colon with long pulses has an inhibitory effect on rectal tone. This inhibitory effect is organ-specific as well as associated with the distance between stimulation site and affected organs. The inhibitory effect of ileum electrical stimulation on rectal tone is mediated by the nitrergic but not sympathetic pathway. Presented at Neurogastroenterology and Motility Joint International Meeting, Boston, Massachusetts, September 14 to 17, 2006.     

Stimulation ventriculaire gauche involontaire par passage transseptal ventriculaire (à propos d’une observation)

The introduction in the left ventricle of a stimulation probe, by an involuntary ventricular transseptal trajectory can pass unobserved during the implantation and can be revealed later on occasion of complications. It is a rarely described possibility and can have some serious consequences. We discuss through our observation ways to avoid this trap of the definitive cardiac stimulation.     

Electrical therapies for gastrointestinal motility disorders

Introduction: Gastrointestinal (GI) motility disorders are common in clinical settings, including esophageal motility disorders, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, chronic intestinal pseudo-obstruction, post-operative ileus, irritable bowel syndrome, diarrhea and constipation. While a number of drugs have been developed for treating GI motility disorders, few are currently available. Emerging electrical stimulation methods may provide new treatment options for these GI motility disorders.

Areas covered: This review gives an overview of electrical therapies that have been, and are being developed for GI motility disorders, including gastroesophageal reflux, functional dyspepsia, gastroparesis, intestinal motility disorders and constipation. Various methods of gastrointestinal electrical stimulation are introduced. A few methods of nerve stimulation have also been described, including spinal cord stimulation and sacral nerve stimulation. Potentials of electrical therapies for obesity are also discussed. PubMed was searched using keywords and their combinations: electrical stimulation, spinal cord stimulation, sacral nerve stimulation, gastrointestinal motility and functional gastrointestinal diseases.

Expert commentary: Electrical stimulation is an area of great interest and has potential for treating GI motility disorders. However, further development in technologies (devices suitable for GI stimulation) and extensive clinical research are needed to advance the field and bring electrical therapies to bedside.     

Focal atrial fibrillation: experimental evidence for a pathophysiologic role of the autonomic nervous system

INTRODUCTION: Focal paroxysmal atrial fibrillation (AF) was shown recently to originate in the pulmonary veins (PVs) and superior vena cava (SVC). In the present study, we describe an animal model in which local high-frequency electrical stimulation produces focal atrial activation and AF/AT (atrial tachycardia) with electrogram characteristics consistent with clinical reports. METHODS AND RESULTS: In 21 mongrel dogs, local high-frequency electrical stimulation was performed by delivering trains of electrical stimuli (200 Hz, impulse duration 0.1 msec) to the PVs/SVC during atrial refractoriness. Atrial premature depolarizations (APDs), AT, and AF occurred with increasing high-frequency electrical stimulation voltage. APD/AT/AF originated adjacent to the site of high-frequency electrical stimulation and were inducible in 12 of 12 dogs in the SVC and in 8 of 9 dogs in the left superior PV (left inferior PV: 7/8, right superior PV: 6/8; right inferior PV: 4/8). In the PVs, APDs occurred at 13+/-8 V and AT/AF at 15+/-9 V (P < 0.01; n = 25). In the SVC, APDs were elicited at 19+/-6 V and AT/AF at 26+/-6 V (P < 0.01; n = 12). High-frequency electrical stimulation led to local refractory period shortening in the PVs. The response to high-frequency electrical stimulation was blunted or prevented after beta-receptor blockade and abolished by atropine. In vitro, high-frequency electrical stimulation induced a heterogeneous response, with shortening of the action potential in some cells (from 89+/-35 msec to 60+/-22 msec; P < 0.001; n = 7) but lengthening of the action potential and development of early afterdepolar-izations that triggered APD/AT in other cells. Action potential shortening was abolished by atropine. CONCLUSION: High-frequency electrical stimulation evokes rapid ectopic beats from the PV/SVC, which show variable degrees of conduction block to the atria and induce AF, resembling findings in patients with focal idiopathic paroxysmal AF. The occurrence of the arrhythmia in this animal model was likely due to alterations in local autonomic tone by high-frequency electrical stimulation. Further research is needed to prove absolutely that the observed effects of high-frequency electrical stimulation were caused by autonomic nerve stimulation.     

Prognosis in Patients with Left Ventricular Dysfunction and Ventricular Tachycardia Following Programmed Ventricular Stimulation

We performed programmed ventricular stimulation on 69 patients with left ventricular ejection dysfunction (ejection fraction < 50%) and clinically recognized ventricular tachycardia including 28 patients with sustained ventricular tachycardia and 41 patients with nonsustained ventricular tachycardia. An inducible arrhythmia (> 6 beats ventricular tachycardia) was found in 74% of patients. Patients with clinically sustained arrhythmias were frequently inducible (89%) with a high incidence of inducible monomorphic ventricular tachycardia (82%). Patients with clinically nonsustained ventricular tachycardia had a lower rate of inducibility (63%) including a high incidence of inducible polymorphic ventricular tachycardia (27%). Inducible patients with left ventricular dysfunction and ventricular tachycardia had a low incidence of electrophysiologically demonstrated effective drug therapy (16%). However, if an effective drug was found, the prognosis was good. Empirical drug therapy was associated with a poor prognosis in inducible and noninducible patients. Finally, an unfavorable prognosis was associated with a clinically sustained arrhythmia, a lower ejection fraction, and the presence of a left ventricular aneurysm. An inducible arrhythmia did not predict an unfavorable course. Indeed, patients with noninducible ventricular tachycardia in this group of patients were still at risk for sudden cardiac death.     

经颅直流电刺激联合手部功能生物反馈电刺激对卒中后手功能改善的影响

目的探讨经颅直流电刺激(t DCS)联合手部功能生物反馈电刺激对卒中后手功能改善的影响。方法回顾性连续纳入2015年9月至2016年3月于首都医科大学宣武医院康复科进行康复的卒中患者40例,均为发病1~6个月的初发卒中患者。在常规药物及传统康复训练的基础上,根据患者是否接受功能性电刺激(FES)治疗和阳极t DCS(at DCS)治疗,将患者分为康复组,即at DCS+FES组(21例)和对照组,即at DCS组(19例)。两组均为1次/d,每次20 min,疗程4周。对两组患者康复治疗前后手功能进行评定并进行组间比较。采用Fugl-Meyer评定上肢(FMA-UE)功能,采用卒中患者运动功能量表(MAS)评定手部功能,采用总主动活动度(TAM)系统评定方法评定手指总的主动关节活动度,采用专用的角度尺评定腕关节背伸的主动关节活动度(WEAROM)。结果 (1)两组康复治疗后FMA-UE评分及MAS评分均较治疗前增加[康复组:(18±5)分比(12±6)分,(25.7±5.9)分比(8.7±3.0)分,t值分别为10.24、11.89;对照组:(15±5)分比(12±5)分,(11.8±2.9)分比(8.4±3.2)分,t值分别为10.15、4.94],差异均有统计学意义(均P0.01);治疗后康复组FAM-UE评分和MAS评分与对照组治疗后比较,差异有统计学意义(t值分别为5.66、9.15,均P0.01)。(2)康复治疗后两组TAM评分及WEAROM均较治疗前增加[康复组:(2.6±0.8)分比(1.1±0.3)分,30°±12°比13°±9°,t值分别为10.95、11.41;对照组:(1.5±0.7)分比(1.1±0.4)分,19°±8°比12°±8°,t值分别为3.02、5.43],差异均有统计学意义(均P0.01);治疗后康复组TAM评分和WEAROM评分与对照组治疗后比较,差异均有统计学意义(t值分别为5.29、5.61,均P0.01)。结论在传统康复治疗的基础上,与单纯加用at DCS治疗相比,at DCS联合FES提高卒中后患者的手部运动功能及腕关节背伸关节活动度的效果更明显。     

Treatment for overactive bladder: A meta-analysis of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation

Background:We aim to compare the safety and effectiveness of transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder.Methods:A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed. The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all statistical analyses.Results:A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar performance in the voiding frequency in 24 hours (mean difference [MD] = −0.65, 95% confidence interval [CI]: −1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI: −0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: −0.13 to 0.14, P = .93), as well as in the nocturia frequency (MD = −0.14, 95% CI: −0.52 to 0.24, P = .47). Moreover, comparable results were observed regarding HRQL scores (P = .23) and incontinence quality of life scores (P = .10) in both groups. The total complication rate in the current study was 2.1% (3/142). No adverse events were identified in the TTNS group.Conclusion:Current data supported that TTNS is as effective as PTNS for the treatment of overactive bladder, moreover, with no reported adverse events. However, the evidence is low-grade and well-designed prospective studies with a large sample size are warranted to verify our findings.