卡维地洛治疗缺血性心脏病心力衰竭及对QT离散度的影响

目的观察卡维地洛对缺血性心脏病心力衰竭的临床疗效及对QT离散度(QTd)和恶性室性心律失常发生的影响。方法选择128例缺血性心脏病心力衰竭患者随机分成卡维地洛治疗组和常规治疗组(每组64例)。监测治疗前及治疗6个月后6 min步行距离,每搏输出量(SV)及每分心输出量(CO);超声心动图监测左室射血分数(EF)、左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD);同时监测心功能、收缩压、舒张压及心率的变化;QTd及恶性室性心律失常。结果治疗6个月后,两组心功能均见明显改善。卡维地洛组6 min步行距离较常规治疗组明显改善;射血分数(EF)、每搏输出量(SV)及每分心输出量(CO)较常规治疗明显增加;左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD)较常规治疗组明显降低;收缩压、舒张压、心率及QTd较常规治疗组明显降低;恶性室性心律失常发生率明显降低。结论卡维地洛能显著改善缺血性心脏病心力衰竭,改善左室重构,使QTd缩短而减少恶性室性心律失常的发生。     

酒石酸美托洛尔联合螺内酯治疗扩张型心肌病并心力衰竭30例临床观察

目的:探讨左酒石酸美托洛尔联合螺内酯治疗扩张型心肌病并心衰的临床疗效。方法:选取扩张型心肌病合并心衰患者60例随机分为两组,对照组予以常规抗心力衰竭治疗,观察组常规治疗同时给予美托洛尔联合螺内酯治疗。观察治疗前后心功能的变化、每搏输出量(SV)、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)。结果:两组治疗后心功能均明显改善,观察组和对照组总有效率分别为90.0%和63.3%,存在显著性差异(P<0.05)。LVEF及SV均显著提高(P<0.05),LVEDD及LVESD均明显降低(P<0.05),且观察组明显优于对照组,差异均有统计学意义(P<0.05)。结论:美托洛尔联合螺内酯治疗扩张型心肌病,可显著改善心功能,临床疗效显著。     

依那普利联用缬沙坦治疗高血压慢性充血性心力衰竭

目的:研究依那普利联用缬沙坦治疗高血压慢性充血性心力衰竭与单独用药的疗效比较。方法:选择高血压致慢性充血性心力衰竭(CHF)的患者77例,随机分为两组:对照组和治疗组。对照组按照"2007年慢性心力衰竭诊断治疗指南"的标准治疗,血管紧张素转换酶抑制剂用依那普利10mg/d;治疗组为在对照组治疗基础上加用缬沙坦80mg/d,随访半年。观察治疗后两组患者心率、血压、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)的变化以判断疗效。结果:与对照组比较,治疗组心率、血压、LVESD、LVEDD及LVEF均有明显改善(P<0.01)。结论:依那普利联用缬沙坦治疗高血压慢性充血性心力衰竭疗效优于单独应用依那普利。     

依那普利联合美托洛尔对老年心力衰竭患者心功能及心电图变化的影响

目的分析依那普利联合美托洛尔对老年心力衰竭患者心功能及心电图变化的影响。方法选取2017年2月至2019年3月郑州大学附属洛阳中心医院收治的77例老年心力衰竭患者,依照治疗方案分为两组,对照组(38例)接受美托洛尔治疗,观察组(39例)于对照组基础上接受依那普利治疗。比较两组心电图改善总有效率及治疗前后血浆脑钠肽(BNP)水平、每搏输出量(SV)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)。结果治疗后,观察组LVEF、SV较对照组高,LVESD较对照组小,血浆BNP水平较对照组低(均P<0.05);观察组心电图改善总有效率(94.87%)较对照组(73.68%)高(P<0.05)。结论对老年心力衰竭患者采用依那普利联合美托洛尔治疗,能显著改善心功能和心电图结果。     

芪参益气滴丸对急性心肌梗死患者再通后心功能的影响

目的 探讨芪参益气滴丸对急性心肌梗死患者再通后心功能的影响。方法选择2012年12月至2013年12月在本科就诊的79例诊断为急性心肌梗死(AMI)的患者,将患者分为对照组,进行AMI常规治疗,治疗组,进行常规治疗并服用芪参益气滴丸进行治疗。测定患者治疗前后心功能指标,心排血量(CO),每心搏量(SV),左室射血分数,左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)情况。结果组内比较,对照组治疗后LVEF,LVEDD,CO,SV明显高于治疗前,治疗组治疗后LVEF,LVEDD,LVESD,EF,CO,SV明显高于治疗前,且差异有统计学意义(p＜0.05)。组间比较治疗前对照组与治疗组各指标差异无统计学意义(p＞0.05),治疗后治疗组LVEF,LEVDD,LEVSD,CO,SV明显高于对照组,且差异有统计学意义(p＜0.05)。结论 芪参益气滴丸可明显改善AMI患者再通后心功能,改善患者预后。     

美托洛尔治疗老年慢性充血性心力衰竭疗效观察

目的 观察美托洛尔治疗老年慢性充血性心力衰竭的疗效及安全性.方法 慢性充血性心力衰竭老年患者62例,随机分为对照组和治疗组.对照组给予常规抗心力衰竭治疗;治疗组在对照组治疗基础上加用美托洛尔6.25mg,2次/d,逐渐增加至50mg,2次/d,治疗8个月.结果 治疗组症状改善,总有效率为90.62%,明显高于对照组66.67%(P<0.05);治疗组治疗后左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)较治疗前有明显改善(P<0.01),且治疗组优于对照组(P<0.01);治疗组的心率、收缩压下降明显,优于对照组(P<0.01);所有患者能耐受50mg,2次/d的剂量.结论 美托洛尔治疗老年慢性充血性心力衰竭安全、有效,能干预左室重构.     

大剂量曲美他嗪联合左卡尼汀治疗高龄扩张型心肌病心力衰竭患者的疗效观察

目的:分析大剂量曲美他嗪联合左卡尼汀治疗高龄扩张型心肌病(DCM)心力衰竭的临床疗效。方法:选取我院2017年5月—2018年6月84例高龄DCM心力衰竭患者,根据治疗方案不同分组,各42例。对照组给予利尿、抗心力衰竭等常规治疗,观察组于对照组治疗基础上采用大剂量曲美他嗪与左卡尼汀联合治疗,比较两组治疗前后心功能[左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)]变化及日常生活活动能力(ADL)评分。结果:治疗后观察组LVESD、LVEDD较对照组低,且LVEF较对照组高(P <0. 05);治疗后两组ADL评分较治疗前明显升高,且观察组较对照组高(P <0. 05)。结论:高龄DCM心力衰竭患者采用大剂量曲美他嗪与左卡尼汀联合治疗,可有效改善心功能,提高生活自理能力。     

卡维地洛、美托洛尔长期治疗老年慢性心力衰竭的疗效比较

目的 比较卡维地洛·美托洛尔长期治疗老年慢性心力衰竭(CHF)的疗效.方法 将82例NYHA心功能Ⅱ～Ⅳ级CHF老年患者随机分为两组:卡维地洛组40例,采用常规治疗(ACEI、利尿剂、血管扩张剂、洋地黄) 卡维地洛;美托洛尔组42例,采用常规治疗 美托洛尔.治疗12个月,观察两组治疗后左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)、左室射血分数(LvEF)及心功能变化.结果 两组治疗后LVEDD、LVESD、LVEF、心功能改善均较治疗前有显著改善(P<0.01);而卡维地洛组在LVEDD、LVESD、LVEF方面的改善上较美托洛尔组更明显(P<0.01),在心功能改善方面较美托洛尔组差异有统计学意义(P<0.05).两组均无不良反应发生.结论 长期应用卡维地洛治疗老年CHF的疗效优于美托洛尔.     

卡维地洛治疗缺血性心脏病心力衰竭及对QT离散度的影响

目的 观察卡维地洛治疗缺血性心脏病心力衰竭及对QT离散度(QTD)和恶性室性心律失常发生的影响.方法 62例缺血性心脏病心力衰竭患者随机分成卡维地洛治疗组和常规治疗组(每组31例).监测治疗前及治疗6个月后6min步行距离,每搏输出量(SV)及每分心输出量(CO);超声心动图监测左室射血分数(EF)、左室舒张末期内径(LEVDD)乏左室收缩末期内径(LVESD),同时监测心功能、收缩压、舒张压及心率的变化;QTd及恶性室性心律失常.结果 治疗个月后,两组心功能均未明显改善.卡维地洛组6min步行距离较常规治疗组明显改善;射血分数(EF)、每搏输出量(SV)及每分心输出量(CO)较常规治疗组明显增加;左室舒张末期内径(LEVDD)及左室收缩末期内径(LVESD)较常规治疗组月显降低;收缩压、舒张压、心率及QTd较常规治疗组明显降低;恶性室性心律失常检出率明显降低.结论 卡维地洛能显著改善缺血性心脏病心力衰竭,改善左室重塑,使QTd缩短而减少恶性室性心律失常的发生.     

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.