生脉注射液联合多巴胺对急性左心衰竭并低血压的院前急救观察

生脉注射液是将古方生脉散经科学加工而成的中药注射液，由人参、麦冬、五味子组成。目前，生脉注射液在临床上广为应用，主要用于治疗心力衰竭、抢救心源性休克等。我院120急救中心于2006年3月--2006年12月使用生脉注射液联合多巴胺于院前抢救器质性心脏病导致急性左心衰竭并合并低血压病人68例，旨在观察生脉注射液在30min内对急性左心衰竭合并低血压病人血压的干预作用。     

多巴胺、多巴酚丁胺联合治疗心源性休克的临床研究

目的:研究多巴胺、多巴酚丁胺联用治疗心源性休克的临床疗效。方法:临床确诊的心源性休克病人30例。入院后予以测定血压及无创血流动力学指标(左室收缩时间间期STI),继而给予多巴胺,多巴酚丁胺各100mg加入5%葡萄糖溶液500 ml中持续静脉滴注,初始量4~8μg·kg-1·min-1,并分别于实施治疗后第1、2小时再次测定血压以及STI。结果:治疗前平均收缩压(48.8±5.9mmHg)与治疗后第1小时(81.8±0.4mmHg)、第2小时(100.9±2.6mmHg)相比,均有显著性差异(P<0.01),STI亦由开始时的0.55±0.01分别降低至0.5±0.01和0.46±0.01,前、后比较均有显著性差异(P<0.01),未见不良反应。结论:多巴胺、多巴酚丁胺两药联用抢救心源性休克及时、有效。在迅速升高血压的同时又能有效地改善患者的心脏功能。     

冠状动脉内支架术治疗急性心肌梗死并发心源性休克的临床评价

目的　观察急性心肌梗死并发心源性休克的状态下 ,紧急冠状动脉内支架术对挽救患者生命的疗效及安全性。方法　急性前壁心肌梗死患者 15例 ,平均年龄 (70 1± 8 4)岁 ,动脉血压 <85 / 6 0mmHg(1mmHg=0 133kPa) ,心动超声检查射血分数 (EF) <42 % ,伴有明确的急性泵衰竭征象。患者发病 2 4h内紧急行左前降支冠状动脉支架术 ,其中 4例同时行右冠状动脉内支架术 ,3例行回旋支冠状动脉内支架术。介入治疗术前及术后观察血压、心率 ,应用心动超声测定心功能变化情况。结果　 15例患者支架术后完全阻塞的左前降支血管再通良好 ,术后 30min血压与术前比较明显升高[收缩压 (10 6 0± 11 8)vs (76 2± 4 9)mmHg ,P <0 0 1;舒张压 (82 4± 9 7)vs (5 6 2± 6 1)mmHg ,P<0 0 1];心率明显下降 [(79 2± 8 4)vs (10 9 2± 9 1)次 /分 ,P <0 0 1]。术后 4h ,心动超声测定心功能明显改善 [EF(48 8± 4 7) %vs (34 3± 4 5 ) % ,P <0 0 1]。结论　急性心肌梗死并发心源性休克状态时 ,尤其是年老患者 ,治疗的关键是尽早使完全阻塞的血管再通 ,而冠状动脉内支架术是十分有效和较安全的治疗方法。     

持续静脉滴注硝苯啶合用或不合用美托洛尔对不稳定型心绞痛患者的心肌代谢和血液动力学效应

作者测试持续静脉滴注硝苯啶或者硝苯陡加美托洛尔对14例不稳定型心绞痛患者早期治疗的作用。经24小时准备后,逐步调整硝苯啶剂量(平均27±7μg/min)。硝苯啶治疗后冠脉血流量从150±66增加到183±74ml/min(P<0.05),而心率血压乘积、心肌氧耗量、动脉和冠状窦(去甲)肾上腺素浓度均无改变。心肌乳酸摄取量从3.4±26.1增加到31.1±26.6μmol/min(P<0.05),游离脂肪酸摄取量从7.2±22.1增加到34.5±33.7μmol/min(P<0.05)。氨基酸代谢略有改善,但无显著性。对了例患者加用美托洛     

血压控制正常的中老年高血压病病人动态脉压变化及其对靶器官功能的影响

目的探讨血压控制正常的中老年高血压病病人动态脉压的变化规律及其对靶器官功能的影响。方法血压控制正常的中老年高血压病合并无症状心肌缺血病人95例,根据基础脉压水平,小于或等于40mmHg(1mmHg=0.133kPa)为A组(23例);大于40mmHg但等于或低于60mmHg为B组(25例);大于60mmHg,但等于或低于80mmHg为C组(23例);超过80mmHg为D组(24例)。所有病人血压控制稳定于正常水平后查动态血压和动态心电图。结果24小时脉压曲线面积:A组为(983±95)mmHg·h,B组为(1204±111)mmHg·h,C组为(1456±115)mmHg·h,D组为(1689±126)mmHg·h。心肌缺血总负荷:A组为(94±8)mm·s;B组为(129±12)mm·s,C组为(166±19)mm·s,D组为(198±20)mm·s。24小时脉压曲线面积与缺血总负荷显著正相关(r=0.324,P<0.005)。每分钟尿白蛋白排泄率:A组为(89±11)μg/min,B组为(101±17)μg/min,C组为(132±17)μg/min;D组为(178±19)μg/min,24小时脉压曲线面积与每分钟尿白蛋白排泄率呈显著正相关(r=0.412,P<0.001)。结论血压控制正常的中老年高血压病病人基础脉压能间接反映动态脉压,基础脉压超过60mmHg病人昼夜脉压波动较大,血压控制正常后,脉压增大病人靶器官的损害较重。     

福辛普利对原发性高血压患者降压作用和对内皮功能的影响

目的评价福辛普利对轻、中度原发性高血压患者的降压疗效,以及对原发性高血压患者内皮功能和肾素-血管紧张素系统(RAS)影响的机制.方法60例原发性高血压患者,随机分为福辛普利组30例和吲哒帕胺组30例.观察治疗前与治疗后6周,诊所血压(CBP)、血浆一氧化氮、内皮素、肾素活性、血管紧张素Ⅱ和醛固酮浓度变化,并对CBP和RAS、血压水平与内皮功能之间的相关性进行分析.结果治疗后2组血压水平显著下降,福辛普利组收缩压从160士14mmHg降至149±13mmHg,舒张压从96±7mmHg降至84±6mmHg,吲哒帕胺组收缩压从161±16mmHg降至154±14mmHg,舒张压从94±6mmHg降至85±7mmHg,差异有极显著性(P均＜0.001).福辛普利组血浆一氧化氮升高,肾素活性上升,内皮素下降,血管紧张素Ⅱ下降,醛固酮下降,差异有极显著性(P均＜0.001),吲哒帕胺组上述参数未见明显变化(P均＞0.05).结论福辛普利对于轻、中度原发性高血压患者疗效显著,福辛普利降压同时能改善动脉内皮功能,降低RAS活性.     

乌拉地尔治疗高血压急症80例疗效观察

高血压急症是指高血压患者血压在短时间内急骤升高,同时伴有心、脑、肾、视网膜等重要靶器官功能损害的一种严重危及生命的临床综合征,可见于高血压病和某些继发性高血压。2001年3月以来,我院采用乌拉地尔治疗80例高血压急症,效果良好。报告如下。1 资料与方法1.1 临床资料 高血压急症患者80例,男44例,女36例;年龄39～81岁,平均(48±9.6)岁。收缩压(182.3±17.2)mmHg,舒张压(117.0±14.3)mmHg;心率(89±19.5)次/min。其中高血压脑病22例,急性心肌梗死12例,合并急性左心衰竭、肺水肿     

苯磺酸左旋氨氯地平片治疗原发性高血压60例

目的 观察苯磺酸左旋氨氯地平片(施慧达)治疗高血压的降压作用.方法 选择原发性高血压病人60例,予以口服施慧达(2.5～5.0)mg/d,疗程4周,其中26例病人运用24 h动态血压监测.结果 60例病人经治疗4周后,24 h收缩压为(121±11)mmHg,舒张压为(78±6)mmHg,白昼及夜间血压均控制在130/90 mmHg以下.心率无明显变化.无明显毒副反应.结论 施慧达是一种安全有效且服用方便的药物,每日服药一次能有效控制24 h血压及清晨高峰期血压.     

卡维地洛治疗老年原发性高血压的疗效观察

目的探讨卡维地洛治疗老年原发性高血压的安全性和有效性。方法随机选择132例老年原发性高血压病人,服用卡维地洛(12.5mg/d~25.0mg/d),观察时间为12周,测定临床血压值。结果服药12周后有效率达84.13%(106/126),收缩压治疗前(164.2±20.3)mmHg,治疗后(142.3±16.1)mmHg,舒张压治疗前(105.6±12.3)mmHg,治疗后(91.2±8.6)mmHg,治疗前后比较,P<0.001;心率治疗前为(71.8±6.2)/min,治疗后为(63.8±5.3)/min,治疗前后比较,P<0.001。有6例病人因心动过缓和心悸不适不能耐受而停药,无严重不良反应。结论卡维地洛治疗老年原发性高血压有较好的疗效和安全性,临床耐受性好。     

替米沙坦对老年高血压的降压作用及逆转左心室肥厚的疗效

目的:观察血管紧张素Ⅱ1型受体拮抗剂-替米沙坦对高血压左心室肥厚的影响。方法:50例老年高血压病合关左心室肥厚的病人服替米沙坦(40～80 mg/d,部分病例加用氢氯噻嗪6.25～12.5 mg/d),共20周.服药前、后分别测量血压及作超声心动图检查。结果:50例患者血压由(160.7±13.1)/(100.5±6.4)mmHg降为(136.0±11.1)/(84.4±7.2)mmHg.P<0.01;左室重量指数由(129.8.0±16.2)g/m2降至(111.6±22.3)g/m2,P< 0.01。只1例发生轻度皮疹。结论:对于老年高血压.替米沙坦降压疗效确切,不良反应小,且对左室肥厚有不同程度的逆转作用。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.