24h动态血压监测在高血压合并冠心病患者中的应用

目的 应用24 h动态血压监测高血压合并冠心病患者,探讨相关数据的临床意义.方法 收集单纯高血压病患者80例(对照组)和高血压伴冠心病患者60例(观察组),对所有患者行24 h动态血压监测并对相关数据进行对比分析.结果 观察组24 h平均收缩压及舒张压、昼间平均收缩压及舒张压和夜间平均收缩压及舒张压显著高于对照组,差异有统计学意义(P＜0.05);观察组患者夜间收缩压和舒张压下降率明显小于观察组,差异有统计学意义(P＜0.05),观察组收缩压及舒张压非杓型比例和晨峰现象显著大于对照组,差异有统计学意义(P＜0.05).结论 24 h动态血压监测可客观地测量高血压患者的昼夜血压及其变化规律和波动情况,有助于指导临床调整高血压的治疗方案以降低心、脑、肾等靶器官的损害.     

原发性高血压患者动态血压参数与左室肥厚的关系

目的探讨原发性高血压患者动态血压参数与左室肥厚的关系。方法 128例确诊的原发性高血压患者经超声心动图检查被分为左室肥厚组49例和非左室肥厚组79例,经体检排除高脂血症、糖尿病、脑卒中、冠心病,测定其动态血压参数并进行比较。结果 2组比较左室肥厚组24 h收缩压、24 h脉压、日间收缩压、夜间收缩压、24 h收缩压负荷、左室质量指数明显升高(P<0.05);而24 h舒张压、日间舒张压、夜间舒张压、24 h舒张压负荷值变化不明显(P>0.05),差异无显著性。左室肥厚组夜间收缩压下降率小于10%(非杓型高血压),占75%;非左室肥厚组夜间收缩压下降率大于10%而小于20%(杓型高血压),占79.41%,2组比较差异有显著性(P<0.05)。2组夜间舒张压下降率比较无显著性差异(P>0.05)。结论原发性高血压动态血压参数对左室肥厚有显著影响。     

血压变异性与非高血压冠状动脉病变程度相关性研究

目的对非高血压合并冠心病患者的24 h动态血压进行分析,探讨非高血压合并冠心病患者血压变异性与冠状动脉病变程度的相关性。方法选择300例诊断冠心病行冠脉造影的非高血压患者纳入研究,分为非冠心病组和冠心病组,对入选患者进行24 h动态血压监测和冠状动脉造影,观察24 h收缩压变异系数(24 h SBPCV)、白天收缩压变异系数(dSBPCV)、24 h舒张压变异系数(24 h DPBCV)、白天舒张压变异系数(dDBPCV)、夜间收缩压变异系数(nSBPCV)、夜间舒张压变异系数(nDBPCV)。并分析两组血压变异性与冠状动脉病变程度和冠状动脉SSS评分的相关性。结果冠心病组24 h收缩压变异系数(r=0.075)、24 h舒张压变异系数(r=0.090)、夜间收缩压变异系数(r=0.628)、夜间舒张压变异系数(r=0.708)均明显高于非冠心病组,且血压变异性随冠状动脉狭窄支数的增加而增加。患者夜间收缩压变异系数(nSBPCV)、夜间舒张压变异系数(nDBPCV)均与SSS值之间呈正相关(回归系数B分别为0.028,0.033,P0.05)。结论血压变异性与非高血压患者冠状动脉病变程度密切相关,是冠心病的一项重要预测指标。     

2型糖尿病合并高血压患者24小时动态血压分析

目的观察2型糖尿病合并高血压患者24h动态血压昼夜节律的变化。方法选取60例住院患者,按诊断标准分为2型糖尿病合并高血压组和单纯高血压组,对所有患者进行24h动态血压监测,比较24h平均收缩压、24h平均舒张压、白天平均收缩压、夜间平均收缩压、白天平均舒张压、夜间平均舒张压、24h平均脉压、白天平均脉压、夜间平均脉压及血压昼夜节律。结果 24h平均舒张压、白天平均收缩压、白天平均舒张压、白天平均脉压2组比较差异无统计学意义（P均〉0.05）,24h平均收缩压、夜间平均收缩压、24h平均脉压、夜间平均脉压及血压昼夜节律2组比较差异有统计学意义（P均〈0.05）。结论 2型糖尿病合并高血压患者建议尽早进行24h动态血压监测,同时降压和降血糖,纠正异常的昼夜血压节律,对于减少心脑血管并发症、防止靶器官的损害具有积极意义。     

冠心病合并高血压患者动态血压的监测及护理

目的：探讨冠心病合并高血压患者动态血压的监测及护理方法。方法选择2012年5月—2014年6月间我院收治的高血压患者155例,其中单纯高血压患者92例,设为对照组;冠心病合并高血压患者63例,设为观察组,给予患者护理干预,并动态监测其24 h血压变化。结果对照组舒张压与收缩压的24 h平均值、昼间平均值、夜间平均值、24 h血压总负荷、晨峰出现率均明显低于观察组,舒张压与收缩压杓型比例、夜间舒张压与收缩压的下降率均明显高于观察组,组间比较差异有统计学意义（P<0.05）。结论对冠心病合并高血压患者实施24 h动态血压监测,可客观反映其血压情况,有助于早期预防与治疗心血管病。     

24小时动态血压在老年高血压患者中的应用评价

目的:观察24 h动态血压在老年高血压患者中的应用。方法:对2008~2011年内蒙古呼和浩特市第一医院收治的老年高血压230例,原发性132例,继发性98例。给予24 h动态血压监测,观察入院4周、8周24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)。白天平均收缩压(dSBP)、夜间平均收缩压(nSBP);白天平均舒张压(dDBP)、夜间平均舒张压(nDBP);白天收缩压负荷值(dSL)、夜间收缩压负荷值(nSL)、白天舒张压负荷值(dDL)、夜间舒张压负荷值(nDL)。结果:8周原发性132例均血压控制达标,24 h平均收缩压、舒张压;白天平均收缩压、夜间平均收缩压;白天平均舒张压、夜间平均舒张压;白天收缩压负荷值、夜间收缩压负荷值;白天舒张压负荷值、夜间舒张压负荷值均优于4周前(P<0.05)。继发性90例达标,24 h平均收缩压、舒张压;白天平均收缩压、夜间平均收缩压;白天平均舒张压、夜间平均舒张压;白天、夜间舒张压负荷值均优于4周前(P<0.05)。8例无明显改善,无统计学意义(P>0.05)。结论:24 h动态血压对老年高血压治疗达标有重要作用。     

老年高血压伴脑梗死患者24h动态血压特点及临床意义

目的探讨老年高血压伴脑梗死患者24 h动态血压特点及临床意义。方法将高血压患者116例分单纯高血压组58例与高血压伴脑梗死组58例,对24 h动态血压监测并记录相关临床资料数据。结果 2组在24 h平均收缩压、24 h平均舒张压、昼平均收缩压、昼平均舒张压差异无统计学意义(P>0.05),在夜间平均收缩压、夜间平均舒张压具有统计学意义(P<0.01)。2组在动态动脉硬化指数(AASI)和夜间血压下降率比较中具有统计学意义(P<0.01),两组在24 h平均脉压无统计学意义(P>0.05)。进一步逐步Logistic回归发现,最终AASI、夜间血压下降率、糖尿病进入Logistic回归方程,AASI在对脑血管病的预测程度上可能要优于其它动脉硬化指标,其OR=3.568。结论 24 h动态血压的基本参数能准确反映老年高血压患者脑梗死的血压变化特点。AASI较其它指标对老年高血压患者发生脑梗死更有预测价值。     

24h血压动态监测仪在冠心病合并高血压患者治疗中临床效果观察

目的探讨24 h血压动态监测仪在冠心病合并高血压患者治疗中的临床效果。方法于2017年1月～2019年10月选择我院80例冠心病合并高血压患者与80例单纯高血压患者,分别设置为观察组、对照组,采用24 h动态血压监测仪对患者进行动态血压监测,比较两组动态血压监测结果。依据随机数字表法将冠心病合并高血压患者分为两组,A组实施常规降血压药物治疗,B组根据24 h动态血压监测结果指导用药,比较两组的血压水平、血压变异性指标。结果相比于对照组,观察组的平均收缩压、平均舒张压、脉压差、晨峰血压均更高(P0.05),观察组的夜间血压下降幅度更小(P0.05)。治疗后,B组的收缩压、舒张压、收缩压变异指数与A组相比均更低(P0.05)。结论 24 h动态血压监测仪用于冠心病合并高血压患者治疗中,可反映患者血压波动情况,还可指导患者用药,有利于提高治疗效果。     

老年高血压病患者昼夜血压节律与靶器官损害的关系

目的探讨老年高血压病人昼夜血压节律改变与靶器官损害的关系。方法本文对135例年龄≥60岁的老年高血压病患者进行动态血压监测,应用超声心动图检测室间隔厚度、左心室后壁厚度,并检测24 h尿蛋白定量。结果动态血压监测显示24 h血压呈非勺型者为59例(43.70%),呈勺型者为76例(56.30%);非勺型组24 h收缩压2、4 h舒张压,夜间收缩压,夜间舒张压均高于勺型组(P<0.05);非勺型组室间隔肥厚、左心室后壁肥厚,24 h尿蛋白定量异常检出率均较勺型组增加(P<0.05)。结论老年高血压病患者40%以上血压昼夜节律异常,血压昼夜节律异常者左室肥厚,尿蛋白异常的发生率明显增加。     

动态血压监测系统对ICU危重症患者预后的预测价值探讨

目的：探讨动态血压监测系统对ICU危重症患者预后的预测价值。方法：选取2020年12月—2022年4月云浮市中医院收治的142例危重症患者作为研究对象，根据2周内治疗结果分为死亡组(n=20)与非死亡组(n=122)。两组患者均行24 h动态血压监测，比较两组平均血压、血压变异系数，分析动态血压各项指标对危重症患者预后的影响。结果：死亡组24 h平均收缩压、昼间平均收缩压、夜间平均收缩压和舒张压均高于非死亡组，差异有统计学意义(P<0.05)；两组24 h平均舒张压、昼间平均舒张压比较，差异无统计学意义(P>0.05)。死亡组24 h收缩压和舒张压变异系数均大于非死亡组，差异有统计学意义(P<0.001)。24 h平均收缩压、夜间平均舒张压、24 h收缩压及舒张压变异系数为影响ICU危重症患者预后的独立因素，差异有统计学意义(P<0.05)。结论：ICU危重症患者平均血压较高，血压昼夜节律消失，血压变异以瞬时波动为主，且24 h平均收缩压、夜间平均舒张压、24 h收缩压及舒张压变异系数是ICU危重症患者预后的独立影响因素，动态血压监测可作为预测预后不良风险的方式...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.