托拉塞米和呋塞米对心功能不全的疗效比较研究

目的比较托拉塞米和呋塞米对心功能不全患者电解质、尿量及心功能的影响。方法选择74例中、重度充血性心力衰竭患者,随机分为托拉塞米组和呋塞米组,两组均同时给予常规心力衰竭治疗(ACEI、ARB、β受体阻滞剂、地高辛、螺内酯),连用7d,记录两组患者治疗前及治疗后24h尿量、测定用药前后血电解质水平及心功能分级评定。结果治疗24h后托拉塞米组尿量明显增加(3685±365.5)ml/d,多于呋塞米组(2764±350.4)ml/d,托拉塞米组和呋塞米组24h尿量差异具有统计学意义(P0.05);治疗24h后两组血钾均降低,但托拉塞米组血钾降低水平要明显低于呋塞米组(P0.05),两组对血钠、血肌酐的影响无明显差异,无统计学意义。治疗7d后两组心功能分级改善总有效率托拉塞米组(97.3%)明显高于呋塞米组(78.4%),差异有统计学意义(P0.05)。结论心功能不全患者短期应用托拉塞米疗效肯定,利尿作用及对机体内环境的稳定性、心功能的改善均明显优于呋塞米。     

冻干重组人脑钠肽对慢性心力衰竭患者稀释性低钠血症的治疗观察

目的：观察新活素（冻干重组人脑钠肽）对慢性心力衰竭患者稀释性低钠血症的治疗作用.方法：伴稀释性低钠血症的慢性心力衰竭患者65例按就诊顺序被随机分常规治疗组（32例,进行限水、利尿、高渗盐水等基础治疗）,新活素组（33例,另加用新活素,负荷量为1.5 g/kg静脉注射,然后以0.0075 g·kg-1·min-1连续静脉点滴72h）.监测比较两组血钠、尿钠水平,24h尿量及体质量指数（BMI）变化.结果：治疗后2组血钠水平升高,平均24h尿量增多,BMI降低,均有统计学意义（P＜0.01）.优效性检验显示：与常规治疗组比较,新活素组血钠升高幅度[（12.9±1.5） mmol/L比（14.1±1.5） mmol/L]、平均24h尿量增加幅度[（0.33±0.02）L/d比（0.35±0.03） L/d]及BMI降低幅度[（2.2±0.4）kg/m2比（3.6±0.6） kg/m2]显著增加,差异有统计学意义（P均＜0.01）.结论：冻干重组人脑钠肽可显著改善慢性心力衰竭患者的低钠及水负荷状态,值得临床推荐.     

静脉补钠纠正肝硬化患者的低钠血症

目的研究静脉补钠对肝硬化腹水患者病情及血钠和尿量的影响。方法将125例肝硬化腹水患者随机分为治疗组(53例)和对照组(72例),两组常规治则(保肝、利尿、补充白蛋白等)相同,治疗组加用补充氯化钠和/或谷氨酸钠静滴治疗,对照组采取限钠。结果治疗组血钠为134.5±23.6mmol/L,尿量为1873.6±645.7ml/24h;对照组血钠为128.6±25.4mmol/L,尿量为1347.3±623.9ml/24h。两组比较差异显著(P<0.05)。治疗前后对肝功能无明显影响。结论肝硬化腹水出现低钠血症时通过静脉补钠可提高利尿效果,提高血钠水平,防止肝性脑病的发生。     

静脉滴注高渗盐水联合持续静脉注射呋塞米治疗重症心力衰竭伴低钠血症的临床疗效观察

目的 观察静脉滴注高渗盐水联合持续静脉注射呋塞米治疗重症心力衰竭伴低钠血症的临床效果.方法 将我院2010年3月-2013年3月收治的60例重症心力衰竭伴低钠血症患者随机分成试验组和对照组,各30例.对照组患者给予口服补盐＋间断静脉注射呋塞米＋常规抗心力衰竭治疗;试验组患者给予静脉滴注2.0%高渗盐水＋持续静脉注射呋塞米＋常规抗心力衰竭治疗.比较两组患者治疗前后心功能分级和血钠水平及治疗效果.结果 试验组治疗总有效率为96.7%（29/30）,高于对照组的70.0%（21/30）（P＜0.05）;治疗后试验组血钠水平高于对照组（P＜0.05）,心功能分级优于对照组（P＜0.05）.结论 静脉滴注高渗盐水联合持续静脉注射呋塞米治疗重症心力衰竭伴低钠血症具有较好的治疗效果,能有效地改善患者的心功能,改善低钠血症.     

心肾综合征低钠血症患者抗利尿激素测定及高渗盐水强化利尿的疗效

目的:探讨抗利尿激素(ADH)在心肾综合征(CRS)伴低钠血症中的作用及高渗盐水强化利尿(HS aggDiu)对心肾功能和ADH释放的影响。方法:CRS伴低钠血症患者25例,测定其血浆ADH水平。将患者随机分为(HS aggDiu)13例和单纯强化利尿组(aggDiu组)12例,分别给予高渗盐水并大剂量呋塞米静脉滴注和单纯大剂量呋塞米静脉滴注,记录2组患者心肾功能、水钠潴留和血钠的变化。结果:HS aggDiu组尿量增加、体重减轻、血肌酐下降、NYHA心功能分级改善等方面显著改善、水钠潴留减轻,血钠水平升高,其疗效显著优于aggDiu组。同时,血ADH水平并未随着血钠和渗透压的恢复而明显升高,说明HS aggDiu减少了ADH的非渗透性释放。结论:CRS伴低钠血症与ADH的非渗透性释放有关;可有效减轻水钠潴留,改善心肾功能,并减轻ADH的非渗透性释放。     

呋塞米并心脉隆注射液对心衰患者左室射血分数及血乳酸的影响

目的:研究呋塞米与心脉隆注射液联合使用对慢性心力衰竭(CHF)患者左室射血分数(LVEF)及血乳酸值的影响,并探讨其治疗效果。方法:回顾性分析于我院接受治疗的95例CHF患者的临床资料,其中使用呋塞米治疗的患者48例(呋塞米组),心脉隆注射液与呋塞米联合治疗的患者47例(联合治疗组),两组均治疗15d。比较两组患者疗效及治疗后LVEF、乳酸水平、CA125等指标。结果:联合治疗组总有效率明显高于呋塞米组(87.23%比64.58%),P=0.01;治疗后,与呋塞米组比较,联合治疗组LVEF[(49.6±3.6)%比(54.5±3.9)%]、6min步行距离[(274.4±38.9)m比(359.5±56.4)m]、最大代谢当量[M ETmax,(32.4±3.9)M ETs比(39.8±3.6)M ETs]明显增加,血乳酸水平[(1.2±0.5)mmol/L比(0.7±0.3)mmol/L]、CA125[(55.6±6.9)IU/ml比(42.3±5.8)IU/ml]、N末端脑钠肽前体[NT-pro BNP,(2345.4±338.6)pg/ml比(1689.6±226.9)pg/ml]、血清尿酸[(402.4±43.9)mol/L比(359.8±53.7)mol/L]水平均显著降低(P均=0.001);两组患者均无严重不良反应发生。结论:呋塞米与心脉隆注射液联合治疗可明显提高慢性心力衰竭患者左室射血分数,降低其血乳酸水平,改善心功能,安全有效,值得在临床上推广和使用。     

β-七叶皂苷钠治疗肺心病全身水肿临床观察

目的观察肺心病全身水肿时呋塞米合用β-七叶皂苷钠利尿效果。方法肺心病心力衰竭患者53例,随机分为两组,试验组为呋塞米合用β-七叶皂苷钠,对照组单独静脉注射呋噻米。结果两组之间的一般资料无明显差异,试验组24 h出量为2840.4±110.7 ml,对照组为2118.7±97.3 ml（P〈0.001）,水肿消退天数试验组为4.5±0.9 d,对照组为7.1±1.3 d（P〈0.05）。两组发生电解质紊乱主要为低钾血症,试验组（4例）低于对照组（9例,P〈0.05）,低钠血症试验组（3例）与对照组（5例,P〉0.05）无差异。结论β-七叶皂苷钠与呋塞米有协同利尿作用,治疗肺心病全身水肿明确效果并且不良反应少。     

高渗盐水联合呋塞米在难治性心力衰竭治疗中的应用

将136例难治性心力衰竭患者随机分为观察组与对照组各68例。两组均予常规治疗。对照组治疗过程中予呋塞米80~160 mg静注,2次/d;观察组予1.3%~3%氯化钠150~250 ml静注,并予呋塞米80~160mg分别于输液中及输液后静注。观察两组治疗前、治疗后7 d的体质量、血压、心率变化,同时检测血清脑钠肽(BNP)水平,比较两组治疗效果。结果观察组每日尿量和尿钠排泄明显增加,治疗7 d和60 d后的心功能和水钠潴留的缓解状况明显好于对照组,BNP水平、再住院率、病死率和猝死发生率明显低于对照组。证实高渗盐水(HSS)联合呋塞米对伴利尿剂抵抗的难治性心力衰竭患者有显著疗效。     

托伐普坦治疗顽固性腹水疗效及安全性分析

目的：观察高度选择性血管加压素V2受体拮抗剂托伐普坦治疗顽固性腹水的疗效和安全性。方法在39例终末期肝病（20例肝硬化、19例肝硬化合并肝癌）引起的顽固性腹水患者,常规给予利尿剂（呋塞米80 mg/d;螺内酯160 mg/d）及白蛋白治疗的基础上,给予托伐普坦15 mg/d口服,治疗5～14 d。观察尿量、腹水消退、双下肢水肿改善及血清钠和肝功能变化情况。结果在托伐普坦治疗结束后24 h,患者平均尿量为（3533.3±154.65）ml/d,明显高于治疗前（1851.3±167.12） ml/d（P〈0.01）;82.5%（32/39）患者腹水改善,2例I型肝肾综合征患者对托伐普坦治疗无明显效果;在21例低钠血症患者中,血清钠较治疗前[（128.1±4.25） mmol/L]明显上升[（132.9±4.1） mmol/l,P〈0.01];治疗前后患者MELD评分[（37.5±5.6）对（38.1±5.7）]、血钾水平[（4.1±0.5） mmol/L对（4.2±0.6） mmol/L]无明显变化;该药的不良反应以口干、口渴为主,发生率为15.4%。结论托伐普坦对终末期肝病引起的顽固性腹水患者有一定的利尿作用,可同时纠正低钠血症,短期应用托伐普坦对肝功能无明显影响。     

高渗氯化钠在肝硬化腹水治疗中的疗效观察

目的探讨高渗氯化钠在肝硬化腹水患者治疗中的意义。方法 30例肝硬化腹水患者常规保肝、利尿、补充白蛋白治疗,并给予2.5%-5%高渗氯化钠100-250ml缓慢静脉滴注,7-10天;对照组不给予补钠治疗。结果治疗组治疗后平均血钠141.63±4.31mmol/L、血氯103.26±1.41mmol/L、尿钠271.31±25.13mmol/d,尿量2189.18±552.16ml/d;对照组治疗后平均血钠126.63±6.10mmol/L、血氯95.51±2.29mmol/L、尿钠189.12±27.21mmol/d,尿量1223.10±281.70ml/d;治疗组发生肝肾综合征1例（3.3%）,而对照组发生低钠血症16例（53.3%）,肝肾综合征6例（20%）,差异均有统计学意义（P〈0.05）。结论应用高渗氯化钠治疗肝硬化腹水疗效确切,不良反应轻,可减少并发症,提高患者生活质量。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.