Measles in Milwaukee

All measles cases in Milwaukee for 1989 and the first quarter of 1990 are analyzed according to epidemiological and clinical parameters. Two major outbreaks are described with special attention to the demographics of the populations involved and the variety and severity of clinical outcomes. Health care and health insurance as they relate to the treatment and prevention of measles during this time are also discussed.     

Shigellosis winter trends in Milwaukee

Shigellosis cases reported to the Milwaukee Health Department have been highest during the months November, December, and January for eight of the past 11 years (1978 to 1988). Shigellosis in the United States has classically been described as a summer or late summer-early fall disease.     

动态血压监测揭示高血压病患者的血压模式及昼夜节律

目的研究高血压患者血压模式及昼夜规律。方法选择50例高血压病患者(EH)24小时动态血压(ABPM)记录资料，得到日间6AM～10PM，夜间10PM～6AM两个时间段的平均血压及每小时的血压均值，比较昼夜间的血压差异，了解夜间血压下降水平。并描记24小时动态血压的趋势图，收缩压与舒张压相关图，收缩压与心率的相关图，血压分布直方图等。结果夜间血压明显低于日间。轻度高血压患者血压模式呈“杓型”，具有昼夜节律性，重度高血压患者血压模式呈“非杓型”，昼夜节律消失。结论24小时动态血压监测对高血压病的诊断有重要意义，血压模式的改变及昼夜节律的消失见于重度高血压或心、脑、肾靶器官受损害者。     

Clinic blood pressure measurements and blood pressure load in the diagnosis of hypertension.

We have retrospectively compared the blood pressure load derived from 24 hour ambulatory blood pressure monitoring in patients with all clinic blood pressure readings elevated with those with only some elevated pressures to establish whether clinic readings alone are good predictors of blood pressure status. Fifty-seven patients attending a district general hospital hypertension clinic who were not on anti-hypertensive treatment were selected. Between two and six clinic readings were taken over a period of 1-6 months. Forty out of 57 patients had at least one clinic diastolic blood pressure reading of < 90 mmHg and, of these, 14 (35%) had a high blood pressure load and 26 (65%) had a normal blood pressure load. Patients with all diastolic blood pressure readings > 90 mmHg totalled 17 and of these 11 (65%) had high load and six (35%) had normal load. Patients with clinic diastolic blood pressure > 90 mmHg were significantly more likely to be truly hypertensive on the basis of blood pressure load than if one or more clinic readings was below 90 mmHg (P < 0.05). Diastolic pressures have some predictive power as to the blood pressure status defined by blood pressure load, but even consistently raised diastolic pressures do not necessarily indicate hypertension. Likewise one or more clinic diastolic blood pressure < 90 mmHg does not assuredly indicate normotension. Twenty-four hour ambulatory blood pressure monitoring may have an increasingly important role in the assessment of hypertension.     

天津地区气象因素对不同人群血压影响的探索研究

[目的]初步探讨气温、相对湿度、天气状况等气象因素对1级高血压、正常高值血压及正常血压人群血压影响的规律。[方法]同期筛选天津市符合纳入排除标准的1级高血压、正常高值血压及正常血压受试者各10例,每日规定时间点测量并连续记录血压1 a;同步记录血压测量期间天津市的气象数据,建立数据库,运用SPSS 19.0软件进行统计分析。[结果]1级高血压组日均收缩压（SBP）、日均舒张压（DBP）和正常高值血压组日均SBP与候均温、日平均气温及相对湿度均呈负相关（r<-0.5,P<0.05）;1级高血压组及正常高值血压组晨SBP与候平均气温、日平均气温及相对湿度负相关程度均最高（r<-0.6,P<0.01）。1级高血压组SBP、DBP与正常高值血压组SBP升高与雾霾相关（P<0.05）、降低与雨天相关（P<0.05）。[结论]气象因素对1级高血压、正常高值血压人群血压有明显影响,需加强气象因素变化时对该两组人群早晨血压的管理。     

Age-related characteristics of ambulatory blood pressure load and mean blood pressure in normotensive subjects

Ambulatory blood pressure monitoring has become increasingly popular for diagnosing and treating hypertension. However, data from normotensive subjects are needed for interpretation of hypertensive readings. Ambulatory blood pressure was monitored in 126 normotensive subjects (age range, 20 to 84 years). Mean systolic and diastolic blood pressure and blood pressure loads (percentage of systolic readings greater than 140 mm Hg and diastolic readings greater than 90 mm Hg) were obtained and interpreted. Mean awake systolic and diastolic pressures ranged from 125 +/- 10 to 137 +/- 17 mm Hg and 70 +/- 8 to 71 +/- 9 mm Hg, respectively. The systolic and diastolic trends of subjects' blood pressures taken during office visits and the 24-hour measurements were similar. Ranges for systolic and diastolic blood pressure loads from youngest to oldest ages were 9% +/- 14% to 25% +/- 20% and 3% +/- 7% to 4% +/- 7%, respectively. A comparison of blood pressure means from our sample that were taken during office visits and blood pressure means from a 2122-patient community survey demonstrated that our sample was reflective of an unselected population.     

Lowering blood pressure in 2003

The foundation of treatment for patients with hypertension is ongoing use of lifestyle measures such as physical exercise, weight reduction, and salt restriction. There should be emphasis on reduction of total cardiovascular risk, including smoking cessation and achievement of goal blood pressures. There are now five classes of first-line blood-pressure-lowering drugs - diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and calcium antagonists. In most patients, the choice of drug will be guided by the clinical situation in the individual patient, including the presence of target organ damage, diabetes, established vascular or kidney disease, or other comorbidities. In the absence of such clinical indications, start drug therapy with a low-dose diuretic. Combination therapy will be needed in around two-thirds of patients, and a diuretic will normally form one element of most combinations, with the second or third drug coming from among the remaining four. Consider the use of fixed-dose combinations to improve adherence to therapy. Use long-acting, once-daily preparations.     

动态血压变异性对高血压病评价的探讨

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社区综合干预对高血压患者血压达标的影响

目的:探讨社区综合干预对高血压患者血压达标的影响。方法:选择560例临床确诊高血压病患者,其中住院门诊患者280例,社区患者280例。住院门诊患者给予常规降压、门诊随访;社区患者给综合干预治疗,包括健康教育、药物治疗、行为心理治疗、社会监督等。6个月后观察两组血压达标率。结果:社区综合干预者血压达标显著优于住院门诊患者组(P<0.01)。结论:社区综合干预高血压治疗能提高患者对高血压的认知水平及血压达标率。     

重症患者NBP与IBP监测的相关性研究

目的观察重症患者不同病理状态下有创血压测量(IBP)与无创血压测量(NBP)间的差异性及其相关性。方法将100例重症患者根据入科时NBP检测收缩压水平分为三组,即A组(SBP<90 mmHg)、B组(90mmHg≤SBP<140 mmHg)、C组(SBP≥140 mmHg),同时进行桡动脉IBP和肱动脉NBP监测,所得数据进行对比分析。结果①A组,有创收缩压及舒张压均相应显著低于无创检测值(P<0.05);②B组I,BP和NBP间比较无统计学意义(P>0.05);③C组,有创收缩压值显著高于无创收缩压值,而有创舒张压的值显著低于无创舒张压值(P<0.05);④两种检测方法间相关性分析显示,A组患者收缩压下两种方法的相关系数为0.595、0.492,C组患者相应为0.633、0.650,而B组患者达0.8160、.837。结论不同病理状态下IBP与NBP存在一定差异,对低血压及高血压的重症患者应积极进行IBP监测,以利于及时准确地了解血压和组织灌注,以提高抢救成功率。     

Patterns of red blood cell use in southeastern Wisconsin

We conducted a retrospective study of red blood cell use in southeastern Wisconsin to characterize transfusion practices and provide data for designing educational programs. Charts of 533 patients who received 3,006 units of blood at ten hospitals were reviewed. Demographic, diagnostic, surgical, and laboratory data and indications for transfusion were obtained. Mean blood use per patient (U/pt) was 5.6, 7.2, and 4.1 units for all patients, surgical and non-surgical, respectively. Fifty percent of the patients underwent surgery, used 64% of the blood, and required more postoperatively (4.2 U/pt) than intraoperatively (2.8 U/pt). Open-heart surgeries required 32% of all blood. Eighty-two percent of postoperative transfusions occurred when the hematocrit was less than or equal to 30%. Only 2.8% of eligible elective surgery patients made pre-deposit autologous donations and contributed 1% of the total blood used.     

无创和有创血压监测在手术中的应用

急危重手术患者病情变化快、手术风险大,有创血压监测可以持续、准确并动态的监测血压变化,及时判断体内血容量、心肌收缩力、外周血管阻力,及时发现并处理病情。我院2003年6月-2006年6月对430例行大手术患者进行有创和无创血压同步比较监测,并对比分析。1资料与方法1·1一般资     

血压负荷、血压变异性与左室肥厚的相关性

目的 探讨原发性高血压(EH)患者血压负荷、血压变异性和血压夜间下降率与左室肥厚(LVH)的关系.方法 对未治疗的EH患者96例和正常血压者50例进行心脏超声及24小时动态血压检查.高血压患者根据左室质量指数分为LVH组和无LVH组.分析LVH组、非LVH组和正常对照组的24小时动态血压监测获得的血压平均值、血压负荷、血压变异系数和夜间血压下降率等参数的统计学差异.结果 与非LVH组比较,LVH组24 小时、白昼、夜间的平均收缩压及夜间的平均舒张压、24小时收缩压变异系数、24小时收缩压负荷显著升高.与正常组相比,非LVH组和LVH组收缩压、舒张压的夜间下降率降低和夜间心率升高,但只有LVH组与正常组两组间差异有显著性.结论 平均收缩压、24小时收缩压负荷和24小时收缩压变异性增加是LVH的预测因素.24小时收缩压负荷大于50%和(或)收缩压和舒张压的夜间下降率均小于10%的患者,应进一步检查排除左心室肥厚的存在.     

脑卒中急性期动态血压变化、血压与预后关系研究

目的:探讨脑卒中急性期入院7d内(第1、3、7d)血压动态变化规律,血压与卒中7d预后的关系,为脑卒中急性期血压的控制及脑血流的管理提供科学依据。方法:选择ICU急性脑卒中患者41例,利用心电监护仪观测急性脑卒中动态血压变化及预后关系。结果:①脑卒中急性期血压升高,首次血压增高者约占87.1%,以收缩压升高为主,并且存在自发性下降趋势,在无特殊降压措施的情况下与第24h相比,第72h、第7d的收缩压及舒张压均有明显的下降。②出血性卒中组急性期的收缩压及舒张压显著高于缺血性卒中组。③缺血性卒中者入院时收缩压与7d预后呈U型,舒张压与7d预后呈L型,出血性卒中患者入院时收缩压与7d预后呈U型,舒张压与7d预后呈J型。结论:①脑卒中急性期多伴有血压明显升高,伴随着时间的变化有自发性下降的倾向及趋势,出血性卒中组血压要明显高于缺血性卒中组。②脑卒中急性期脑血流的自动调节功能受损。③脑出血可将血压控制在160/90¹00mmHg,而脑梗死将血压控制在(160100mmHg,而脑梗死将血压控制在(160¹80)/(90180)/(90¹00)mmHg水平为宜。