螺内酯联合培哚普利治疗老年扩张型心肌病心力衰竭临床观察

目的评价螺内酯联合培哚普利治疗老年扩张型心肌病（DCM）心力衰竭的有效性和安全性。方法以60例老年DCM心力衰竭病人为研究对象,随机分为观察组和对照组,每组各30例。观察组为螺内酯联合培哚普利,加基础用药（地高辛、双氢克尿噻）;对照组为培哚普利加基础用药。治疗10周后复查两组动态心电图、超声心动图及血清钾、镁和肝肾功能。结果治疗后两组左室射血分数（LVEF）均较治疗前显著增加（P〈0.05）,左室收缩末期容积（LVESV）和左室舒张末期容积（LVEDV）、24h室性早搏（VA）数均有减少（P〈0.05或P〈0.01）;观察组与对照组比较,LVEF显著增加（P〈0.05）。两组均未发现高血钾及肝肾功能损害。结论在老年DCM心力衰竭常规用药的基础上,加用螺内酯联合培哚普利治疗较有效、安全。     

螺内酯培哚普利与常规抗心力衰竭药物联用治疗心力衰竭的疗效观察

目的:观察螺内酯、培哚普利与常规抗心力衰竭药物联用治疗心力衰竭的疗效。方法:按入院顺序将82例心力衰竭患者均分为治疗组(螺内酯、培哚普利加常规抗心力衰竭药物)和对照组(培哚普利加常规抗心力衰竭药物),疗程2周。结果:治疗组心力衰竭总有效率88%,对照组为68%,2组比较差异有统计学意义(P<0·05)。结论:治疗组对心力衰竭疗效明显优于对照组。螺内酯、培哚普利与常规抗心力衰竭药物联用是一种较好的抗心力衰竭疗法。     

观察培哚普利、美托洛尔片联合螺内酯治疗慢性心力衰竭的效果分析

目的观察分析培哚普利、美托洛尔片联合螺内酯治疗慢性心力衰竭效果。方法随机选取2016年7月至2018年7月我科收治的慢性心力衰竭患者36例,然后随机分成两组,采用SPSS21.0将入组患者按先后序列号(1-36)随机分为两组:一组培哚普利、美托洛尔片联合螺内酯治疗组(治疗组18例),一组卡托普利、美托洛尔片等常规治疗组(对照组,18例),对两组患者的临床疗效、不良反应发生情况、再住院情况及死亡情况进行统计分析。结果治疗组患者治疗的总有效率88.9%(16/18)显著高于对照组72.2%(13/18)(P0.05),再住院率、死亡率33.3%(6/18)、5.6%(1/18)均显著低于对照组55.6%(10/18)、16.7%(3/18)(P0.05)。结论培哚普利、美托洛尔片联合螺内酯治疗慢性心力衰竭效果较卡托普利、美托洛尔片等常规治疗好。     

美托洛尔联合螺内酯治疗扩张型心肌病并心力衰竭的疗效分析

目的分析美托洛尔联合螺内酯治疗扩张型心肌病并心力衰竭的临床效果。方法随机选取2013年3月至2014年3月在甘肃省泾川县中医院进行诊治扩张型的心肌病并发心力衰竭者108例,随机分成两组,其中对照组54例予以常规抗心衰治疗,研究组54例在对照组基础上予以美托洛尔联合螺内酯治疗,分析两组患者治疗后心功能、生存质量及心律失常发生情况。结果研究组患者治疗后LVEF、LVFS、HR、SV、CO等指标均改善,且比对照组优,差异有统计学意义(P0.05);研究组治疗后的生存质量相关指标比对照组高,差异具统计学意义(P0.05);同时研究组患者治疗期间出现心律失常情况21例(38.89%)明显少于对照组40例(74.07%),比较差异有统计学意义(P0.05)。结论美托洛尔联合螺内酯治疗扩张型心肌病并心力衰竭的临床效果显著,有效改善患者心功能及生存质量情况,降低临床不良事件发生率。     

培哚普利联合螺内酯治疗慢性心力衰竭的临床疗效研究

目的观察血管紧张素转换酶抑制剂培哚普利与醛固酮拮抗剂螺内酯联合治疗慢性心力衰竭(CHF)的疗效。方法将65例CHF患者随机分为试验组和对照组,对照组给予常规治疗,试验组在常规治疗基础上给予培哚普利2～8mg/d,螺内酯20～40mg/d,均治疗8周。结果试验组总有效率为91.0%,对照组总有效率为68.8%,两组疗效比较,差异有统计学意义(P<0.05)。治疗后试验组较对照组,左室射血分数与6min步行试验距离距离增大,左心室舒张末期内径和左心室收缩末期内径减小,差异均有统计学意义(P<0.05)。结论培哚普利联合螺内酯治疗CHF安全有效。     

非诺贝特联合贝那普利治疗扩张型心肌病并发慢性心力衰竭的临床研究

目的:观察非诺贝特联合贝那普利对扩张型心肌病并发慢性心力衰竭的临床疗效。方法:将62例患者随机分成对照组和观察组,对照组给予常规心力衰竭治疗(地高辛、利尿剂、β受体阻滞剂)及贝那普利,观察组在对照组基础上加服非诺贝特。随访患者120d,主要观察指标:NYHA分级、左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、三酰甘油(TG)及血尿酸(BUA)等。结果:治疗后120d,两组NYHA分级、LVEF、LVEDD均较治疗前明显改善(均P0.05);与对照组相比,观察组NYHA分级、LVEF、LVEDD及TG、BUA水平改善更明显(均P0.05)。结论:非诺贝特联合贝那普利能够改善扩张型心肌病并发心力衰竭的预后,延缓慢性心力衰竭的发展。     

培哚普利联合厄贝沙坦对大鼠扩张型心肌病的治疗

目的:观察培哚普利联合厄贝沙坦治疗扩张型心肌病(DCM)大鼠的疗效.方法:腹腔注射阿霉素建立SD大鼠DCM模型.13周后,大鼠分为4组:A组为正常大鼠,B组为DCM大鼠,均不予药物干预;C组、D组均为DCM大鼠,C组予以培哚普利,D组予以培哚普利联合厄贝沙坦.比较各组干预3周前后血脑利钠肽(BNP)水平,左室射血分数(LVEF)及干预后心肌病理改变.结果:①D组BNP水平低于C组(P＜0.05);②D组LVEF高于C组(P＜0.05);③C、D组心肌病理损害得以减轻(P＜0.01).结论:培哚普利联合厄贝沙坦治疗DCM大鼠,在改善心功能方面优于单用培哚普利;两种方案均可减轻心肌病理损害.     

卡维地洛联合培哚普利治疗老年慢性心力衰竭患者的临床疗效

目的探讨卡维地洛联合培哚普利治疗老年慢性心力衰竭(CHF)患者的临床疗效。方法选取2015年1月—2018年1月空军军医大学西京医院收治的老年CHF患者78例,按照治疗方案分为单药组和联合组,每组39例。在常规抗心力衰竭治疗基础上,单药组患者给予培哚普利治疗,联合组患者给予卡维地洛联合培哚普利治疗;两组患者均连续治疗3个月。比较两组患者临床疗效,治疗前及治疗3个月心室重构指标[包括左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室后壁厚度(LVPWD)]、心功能指标[包括血清脑钠肽(BNP)水平及6分钟步行距离(6MWT)、心率(HR)、左心室射血分数(LVEF)]及血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)水平;观察两组患者治疗期间不良反应发生情况。结果 (1)联合组患者临床疗效优于单药组(P0.05)。(2)治疗前两组患者LVEDD、LVESD及LVPWD比较,差异无统计学意义(P0.05);治疗3个月联合组患者LVEDD、LVESD、LVPWD小于单药组(P0.05)。(3)治疗前两组患者血清BNP水平及6MWT、HR、LVEF比较,差异无统计学意义(P0.05);治疗3个月联合组患者血清BNP水平及HR低于单药组,6MWT长于单药组,LVEF高于单药组(P0.05)。(4)治疗前两组患者血清Hcy、hs-CRP水平比较,差异无统计学意义(P0.05);治疗3个月联合组患者血清Hcy、hs-CRP水平低于单药组(P0.05)。(5)两组患者治疗期间不良反应发生率比较,差异无统计学意义(P0.05)。结论卡维地洛联合培哚普利治疗老年CHF患者临床疗效确切,能有效延缓心室重构,改善心功能,降低血清Hcy水平,减轻炎性反应,且安全性较高。     

培哚普利联合美托洛尔治疗老年心力衰竭合并室性心律失常效果分析

目的探讨培哚普利和美托洛尔联合治疗老年心力衰竭合并室性心律失常的临床效果。 方法按入院顺序将88例老年心力衰竭合并室性心律失常患者分为对照组和观察组,各44例。对照组在常规治疗基础上接受培哚普利治疗,观察组接受培哚普利和美托洛尔联合治疗。比较两组患者治疗前后心率、左心室射血分数变化情况及不良反应发生率。 结果治疗后,两组患者心率均降低,左心室射血分数升高,差异有统计学意义(P<0.05);观察组患者治疗后心率较对照组低,左室射血分数较对照组高,差异有统计学意义(P<0.05)。观察组不良反应发生率(4.55%)低于对照组(15.91%),差异有统计学意义(P<0.05)。 结论采用培哚普利联合美托洛尔治疗老年心力衰竭合并室性心律失常患者,可显著改善心功能,不良反应少,值得临床推广应用。     

美托洛尔联合螺内酯治疗扩张型心肌病心力衰竭的疗效观察

目的探讨扩张型心肌病出现心力衰竭时采用美托洛尔与螺内酯联合治疗的疗效。方法选取我院心血管内科2013年4月~2015年1月收治的扩张型心肌病心力衰竭患者50例,采用美托洛尔联合螺内酯进行治疗。结果相较治疗前心率(HR)(91.3±5.9)次/min,左室射血分数(LVEF)(32.2±8.7)%,左心室舒张末期内径(LVDD)(68.9±7.1)mm,左室收缩期末内径(LVSD)(56.8±6.9)mm,左室缩短分数(LVFS)(14.8±4.9)%,治疗后依次为(70.4±3.9)次/min,(43.6±7.4)%,(55.2±5.1)mm,(40.6±6.4)mm,(30.7±4.9)%,提示患者心功能指标改善显著,差异有统计学意义(P0.05)。治疗前脑纳肽(BNP)为(6.8±4.4)pg/m L,治疗后BNP明显降低为(5.1±1.2)pg/m L,差异有统计学意义(P0.05)。治疗期间患者无严重不良反应,仅出现恶心呕吐1例,头晕2例。结论采用美托洛尔联合螺内酯治疗扩张型心肌病心力衰竭患者,能改善其心功能,提高疗效,且毒副作用小,不良反应率较低。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

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.