从循征医学看老年心血管病药物治疗进展(上)

20 世纪心血管疾病研究的成就是举世瞩目的,其突出的表现是随机对照试验(ran domize (controlled trials,RCT)作为一种方法和标准被医学界广泛接受.与此同时,荟萃分析(meta analysis)作为对大量RCT的概括和总结也日益得到认可.     

从循征医学看老年心血管病药物治疗进展（下）

三、老年冠状动脉粥样硬化性心脏病（冠心病）的药物治疗 1．他汀类药物：对这类药物的药理研究发现它除了良好的降胆固醇、甘油三酯的作用外,还具有重要的非调脂作用,如抑制炎症、稳定斑块,改善内皮功能,抗血小板聚集、改善血流状态,抑制平滑肌细胞增殖等作用。因而他汀类药物在临床得到广泛的应用。甚至有人认为它所带来的贡献可以与20世纪40年代青霉素所带来的贡献相媲美。因此,他汀类药物成为目前研究的热点和重点。     

老年心血管病康复进展

老年心血管疾病患者和有高危因素者养成日常大肌群节律性运动锻炼的习惯，可以产生心血管适应，减轻症状，提高运动耐力和肌力，改善生活质量，并有可能预防冠心病（CAD）的发生和发展。所有的医务人员都应该熟悉并强调积极的生活方式的重要性。     

从时间医学角度看心血管病的治疗

本文综合临床所见和近年文献发现某些疾病的不良转归与时间关系密切,心血管病的高发时段集中在0~9时,并从物理引力、神经内分泌、子午流注等几方面对这一现象进行了分析,并提出了调整服药时间和方式、调整运动习惯、改善睡眠等对策。     

从循证医学看CRT治疗适应证的进展

心力衰竭(心衰)是各种器质性心脏病的晚期表现,并有殊途同归的趋向,心衰的恶劣预后,以及高比例的致残、致死率已激起临床医生极大的关注及攻关的热望。近年来,随着各种心血管疾病治疗新技术、新方法、预防新理念的不断涌现,使更多的心血管病患者得以生存。相应之下,心衰的发生率出现明显的上升趋势。心衰的治疗包括药物治疗与非药物两大方面,这两方面的治疗近年来都展现出“质”的提高与飞跃。尤其是非药物治疗,涌现了心脏移植、全人工心脏、心室辅助装置、背阔肌心肌成形、左室复形装置,外科左室减容术、干细胞移植、双室再同步化起搏(CR…     

老年糖尿病心血管病诊治进展

据最新调查数据显示,目前我国20岁及以上城镇人口中,糖尿病的患病率已达11．6％,另外还有15％为糖调节受损。若任其发展,对我们这样一个人口众多的发展中大国,将是个何等沉重的经济和社会负担!糖尿病的患病率随增龄呈逐年增高趋势,在糖代谢障碍的人群中,老年糖尿病患者占到相当大的比例,据解放军总医院1996～2000年对一组老年人群的随访调查资料显示60～69岁人群糖尿病患病率为17．6％,70～79岁为30．2％,80岁及以上为37．8％,60岁及以上老年人群糖尿病的平均患病率为28．7％,     

老年糖尿病的药物治疗进展

老年糖尿病系指在老年期发病和中青年期发病而进展至老年期的糖尿病患者。老年糖尿病绝大多数（９５％）属２型糖尿病，而２型糖尿病是一种与年龄相关的疾病，其发病率随年龄的增加而增加，据报道在６０岁以上的美国人中其发病率为１０％，８０岁以上者为１６％～２０％。...     

老年糖尿病药物的治疗进展

目前我国人口老龄化进程不断加快,糖尿病的发病率也在不断地提高,老年人对药物的敏感性与代谢能力都与年轻人不同,老年糖尿病的药物治疗也与中青年糖尿病的治疗有一定的区别,该文通过对老年糖尿病患者的特点进行总结,并结合中外近期文献,对老年糖尿病的药物治疗进展进行分析,为老年糖尿病患者药物治疗提供依据。     

老年糖尿病药物的治疗进展

目前我国人口老龄化进程不断加快,糖尿病的发病率也在不断地提高,老年人对药物的敏感性与代谢能力都与年轻人不同,老年糖尿病的药物治疗也与中青年糖尿病的治疗有一定的区别,该文通过对老年糖尿病患者的特点进行总结,并结合中外近期文献,对老年糖尿病的药物治疗进展进行分析,为老年糖尿病患者药物治疗提供依据。     

老年高血压的药物治疗进展

原发性高血压是老年高血压的主要原因,但继发性尤其是动脉粥亲硬化肾血管性高血压随增龄而增多,高血压除是心血管意外的前兆外,老年高血压与并存的糖尿病可共同导致终末期肾脏疾病,抗高血压药治疗能预防致命性脑血管发和心血管并发症,利尿剂仍然是治疗高血压的较好药物,所有高血压患者的治疗均应从改变生活方式开始,单用或与药物并用治疗取决于血压水平和危险因素。     

Outpatient treatment of patients with cardiovascular diseases

In Germany, cardiovascular disturbances belong to the diseases most frequently treated in the offices of general practitioners and internal specialists. With comprehensive monitoring and the taking of adequate therapeutic measures, the average mortality age of the majority of the 18 million patients suffering from circulatory diseases lies at 79.4 years. In the age group of over 70 years, 70 to 80% of the patients receive treatment against cardiovascular disturbances, most of them against hypertension. One of the most important goals of monitoring and intervention in the outpatient sector is the treatment of hypertension, especially in connection with measures taken against disturbances in lipometabolism in order to prevent secondary diseases. The success of treatment is shown by the decreasing age standardized rate of cardiac infarctions, especially among men, and the decreasing mortality rate of patients below 65. The increasing treatment in the outpatient sector is accompanied by additional interventions, especially by bypass surgery in the hospital sector. The concerted actions in both the outpatient and the inpatient sector result in a higher service provision to come to a higher quality of life in the patients and to prevent early death.     

脂蛋白(a)与心血管疾病的关系

脂蛋白(a)[Lp(a)]结构类似于低密度脂蛋白(LDL),高水平Lp(a)是一种公认的心血管疾病危险因子。体内存在氧化型Lp(a)更易于促进动脉粥样硬化的发生发展。Lp(a)中的载脂蛋白(a)[apo(a)]存在异质性,研究显示其危险性可能是由于apo(a)等位基因水平差异引起的,而且apo(a)的多态性影响到Lp(a)水平的临床测定,如何降低apo(a)对结果的影响还需要更多深入研究。目前针对高Lp(a)水平的人群尚无统一的治疗标准,但降脂治疗有益于预防心脑血管疾病的发生。     

循证医学在内科系统疾病诊治中的应用

随着医学模式从经验医学向现代医学转变,单纯依靠临床医生或同道既往对同种疾病治疗的成功经验为依据,或者单纯依靠病理生理学机制进行医疗决策或新药开发是不够的。例如,从疾病的病理生理进程来看,心肌梗死患者发生室性心律失常是猝死的重要危险因素。因此,我们有充足理由对此类患者常规使用抗心律失常药物。但随后的随机对照试验证明,I类抗心律失常药虽然能抑制室性心律失常,却增加病人的病死率;短效钙拮抗剂虽然能有效降低高血压患者的血压水平,却增加心梗和死亡风险。因此,医务人员必须将个人的临床专业知识和临床经验与现有的最佳临床研究结果和患者的选择相结合,为患者制定最佳的医疗决策,这就是循证医学的核心思想。     

Gene transfer with ultrasound and microbubbles (optison) as a potential treatment for cardiovascular diseases

Cardiovascular diseases are the leading causes of mortality and morbidity in developed countries. Most conventional therapy is inefficient and tends to treat the symptoms rather than the underlying causes of the disorder. Gene therapy based on ultrasound with microbubbles offers a novel approach for the prevention and treatment of cardiovascular diseases. The major development of gene transfer has importantly contributed to intense investigation of the potential of gene therapy in cardiovascular medicine. The amazing advances in molecular biology have provided a dramatic improvement of the technology that is necessary to transfer target genes into somatic cells. Gene transfer methods have been surprisingly improved. In fact, some of them (retroviral vectors, adenoviral vectors or liposome based vectors, etc) have been used in clinical trials already. However, some severe side effects were reported in clinical gene therapy using such viral vector, so people wish for safe and efficient clinical gene therapy. Transfection with ultrasound and microbubbles has been reported as a new powerful tool in a new class for gene therapy.     

Study of the carotid pulse with lead II (acceleration carotidogram) in cardiovascular diseases. Introductory note]

The relationship between heart dynamic and the carotid pulse has been studied by using the second derivative as a function of the time of the carotid pulse. This method permits a detailed analysis of the systolic phase of the carotid pulse: in protosystole a positive wave preceeds a negative wave and in telesystole a negative wave preceeds a positive wave. The morphology of the acceleration carotid pulse (CDA Carotidogramma Di Accelerazione), represented by a series of formulas which relate between themselves the protosystolic and the telesystolic waves, is a characteristic as well as statistically significant in each class of the cardiovascular disease in which we examined aortic insufficiency and stenosis, mitral insufficiency and stenosis, aortic angiosclerosis and hypokinetic myocardiopathy. We propose the use of the CDA for a precise analysis of the process of contraction and relaxation of the left ventricle. Since the acceleration with which a phenomenon evolves is the expression of the strength that has generated it, the CDA is particularly effective for the study myocardial dynamic.     

促红细胞生成素治疗心血管疾病的研究进展

慢性心功能不全患者普遍存在贫血。促红细胞生成素(EPO)不仅改善贫血,同时改善心功能不全患者的左心室功能,提高生活质量。EPO的非促红细胞生成作用包括抑制细胞凋亡,促进细胞增殖和血管生成。这些作用可能是其能治疗卒中、心肌缺血/再灌注损伤等心血管疾病的治疗学基础。