缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响

目的 比较缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性及一氧化氮、内皮素的影响.方法选取61例2、3级老年高血压患者,随机分为两组,分别给予缬沙坦+氨氯地平或缬沙坦+氢氯噻嗪行降压治疗,观察入选时、治疗第8周和第16周各种相关指示的变化.人选时检测血脂、空腹血糖、血尿酸,试验各个阶段监测24 h动态血压,检测血浆一氧化氮、内皮素水平.结果在患者入选时、治疗第8周和第16周三个时间点,缬沙坦+氨氯地平组和缬沙坦+氢氯噻嗪组24 h血压及白昼血压比较差异无统计学意义.治疗第16周,缬沙坦+氨氯地平组晨峰收缩压较缬沙坦+氢氯嚷嗪组明显降低[(22.6±8.8)mm Hg(1 mm Hg=0.133 kPa)比(26.3±13.7)mm Hg,P＜0.05];缬沙坦+氨氯地平组及缬沙坦+氢氯噻嗪组24 h收缩压变异性(SBPV)进行性降低[缬沙坦+氨氯地平组:(12.5±2.8)mm Hg比(10.2 ±2.2)mm Hg比(8.8±1.6)mm Hg,P＜0.01;缬沙坦±氢氯噻嗪组:(12.5±2.5)mmHg比(10.7±2.2)mm Hg比(9.6±2.0)mmHg,P＜0.01],缬沙坦+氨氯地平组及缬沙坦+氢氯噻嗪组白昼SBPV明显降低[缬沙坦+氨氯地平组:(12.2±3.0)mm Hg比(10.1±2.3)mm Hg比(8.4±1.9)mm Hg,P＜0.01;缬沙坦+氢氯噻嗪组:(11.8±2.7)mm Hg比(10.4±1.9)mm Hg比(9.6±2.2)mm Hg,P＜0.01],缬沙坦+氨氯地平组24 h舒张压变异性(DBPV)显著降低[(15.5±3.4)mm Hg比(13.0±3.5)mm Hg比(12.3±2.5)mm Hg,P＜0.01],缬沙坦+氢氯噻嗪组24 h DBPV无显著性变化;缬沙坦+氨氯地平组第16周白昼SBPV低于缬沙坦+氢氯噻嗪组[(8.4±1.9)mm Hg比(9.6 ±2.2)mm Hg,p＜0.05],缬沙坦+氨氯地平第8周、第16周的24 h DBPV、白昼DBPV低于缬沙坦+氢氯噻嗪组(P ＜0.01～0.05);缬沙坦+氨氯地平组一氧化氮进行性升高[(27.3±13.6)μmol/L比(47.2±16.3)μmol/L比(69.5±18.9)μmol/L,P＜0.01]、内皮素进行性降低[(45.3±8.0)ng/L比(37.4±3.9)ng/L比(34.2±4.4)ng/L,P＜0.01];缬沙坦+氢氯噻嗪组一氧化氮进行性升高[(33.5±13.9)μmol/L 比(49.7±21.9)μmol/L比(66.7 ±24.7)μmol/L,P＜0.01]、内皮素显著降低[(46.6±10.4)ng/L比(37.0±5.4)ng/L比(36.1±8.2)ng/L,P＜0.01].治疗第8周,缬沙坦+氨氯地平组收缩压变异性的降幅与一氧化氮的升幅有相关性(r =0.401,P=0.025).结论缬沙坦联合氨氯地平或氢氯噻嗪均能降低老年高血压患者血压变异性、改善血管内皮功能,缬沙坦联合氨氯地平可能更适合于老年高血压患者.     

氢氯噻嗪并缬沙坦对高血压患者疗效、心功能及血清RBP4、Vaspin水平的影响

目的:研究氢氯噻嗪联合缬沙坦对老年原发性高血压(EH)患者的疗效,及其对心功能、血清视黄醇结合蛋白4(RBP4)、内脏脂肪组织来源的丝氨酸蛋白酶抑制剂(Vaspin)水平的影响。方法:选择2014年12月~2015年12月期间在我院进行治疗的148例老年EH患者。按照随机数字表法,患者被随机均分为缬沙坦组和联合治疗组(在缬沙坦组基础上接受氢氯噻嗪治疗)。观察比较两组治疗前后血压、左心室质量(LVM)、左心室质量指数(LVMI)、血清RBP4和Vaspin水平。结果:与缬沙坦组比较,联合治疗组治疗6个月后收缩压[(154.35±11.64)mm Hg比(138.37±12.85)mm Hg]、舒张压[(98.68±9.97)mm Hg比(80.35±8.57)mm Hg]、LVM[(204.75±12.35)g比(198.77±12.64)g]、LVMI[(128.68±6.54)g/m2比(118.35±5.74)g/m2]及血清RBP4水平[(26.56±5.67)g/ml比(24.75±5.36)g/ml]均显著降低,血清Vaspin水平[(10.23±1.10)pg/ml比(12.43±1.12)pg/ml]显著升高,P均0.01。与缬沙坦组比较,联合治疗组总有效率显著升高(64.8%比82.4%,P=0.015)。结论:老年原发性高血压患者应用氢氯噻嗪联合缬沙坦治疗,血压和血清RBP4水平明显下降,Vaspin水平显著升高,值得临床推广。     

缬沙坦联合氢氯噻嗪治疗急诊高血压的疗效

目的急诊高血压应用氢氯噻嗪联合缬沙坦治疗效果情况分析。方法选取2018年8月～2019年8月本院诊治90例高血压急诊患者资料,随机分为两组,对照组予缬沙坦,研究组予以氢氯噻嗪联合缬沙坦,分析两组血压、ET及NO指标、心血管事件情况。结果治疗后,研究组SBP(130.33±11.46)mm Hg、DBP(90.13±3.22)mm Hg比对照组低,差异有统计意义(p0.05);且研究组ET(30.25±2.59)umol/L比对照组低,研究组NO指标(55.17±2.95)ng/L比对照组高,差异有统计意义(p0.05);研究组心律失常等心血管事件17.78%比对照组37.78%少(p0.05)。结论高血压急诊患者应用氢氯噻嗪联合缬沙坦治疗,能有效降低血压水平,改善机体ET及NO指标,降低心血管事件发生,具一定临床应用价值。     

氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的临床疗效观察

目的观察氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的临床疗效。方法选择2010年3月—2013年3月在河池市金城江区南桥社区卫生服务中心进行治疗的老年原发性高血压患者110例,随机分为治疗组和对照组,各55例。治疗组患者给予氯沙坦钾氢氯噻嗪片治疗,对照组给予氯沙坦钾片治疗,两组患者均治疗2个月。比较两组患者治疗前后收缩压(SBP)、舒张压(DBP)及心率(HR);观察两组患者临床疗效及治疗期间不良反应发生情况。结果治疗组患者总有效率为96.4%,高于对照组的83.6%(P0.05)。治疗前两组患者DBP、SBP及HR比较,差异无统计学意义(P0.05)。治疗后治疗组患者DBP和SBP低于对照组(P0.05);两组患者治疗后HR比较,差异无统计学意义(P0.05)。观察组患者不良反应发生率为5.5%,与对照组的7.2%比较,差异无统计学意义(P0.05)。结论氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的临床疗效确切,且安全性较高。     

氨氯地平联合缬沙坦治疗社区老年原发性高血压合并糖尿病的临床疗效观察

目的观察氨氯地平联合缬沙坦治疗社区老年原发性高血压合并糖尿病的临床疗效。方法选择2013年1月—2014年7月广东省东莞市长安社区卫生服务中心沙头第一社区卫生服务站收治的老年原发性高血压合并糖尿病患者100例,随机分成研究组和对照组,各50例。两组患者治疗前两周停止服用其他降压药,对照组患者给予氨氯地平治疗,研究组患者给予氨氯地平联合缬沙坦治疗,均治疗两个月。观察两组患者治疗前后血压〔收缩压(SBP)、舒张压(DBP)〕、血糖〔空腹血糖(FBG)、餐后2 h血糖(2 h PG)〕及胰岛素〔空腹血清胰岛素(FINS)、胰岛素敏感性指数(ISI)〕变化情况。并记录治疗期间两组患者不良反应发生情况。结果研究组患者治疗后SBP下降(27±2)mm Hg、DBP下降(23±4)mm Hg,分别大于对照组的(18±3)mm Hg、(14±3)mm Hg(P0.05);研究组患者临床疗效优于对照组(u=1.990,P=0.047)。治疗前两组患者FBG、2 h PG、FINS及ISI比较,差异无统计学意义(P0.05);治疗后研究组患者FBG、2 h PG及FINS低于对照组,ISI高于对照组(P0.05)。研究组患者不良反应发生率为4.0%,对照组为14.0%,差异无统计学意义(χ2=1.954,P=0.162)。结论缬沙坦联合氨氯地平治疗社区老年原发性高血压合并糖尿病疗效确切,能有效降低患者血压、控制血糖、提高胰岛素敏感性,且安全性较高。     

厄贝沙坦联合氢氯噻嗪治疗老年原发性高血压86例

目的 探讨厄贝沙坦联合氢氯噻嗪(依伦平)治疗老年原发性高血压的临床疗效.方法 将86例老年原发性高血压患者随机分为观察组和对照组,各43例.观察组服用厄贝沙坦150 mg,氢氯噻嗪12.5 mg;对照组给予缬沙坦(平欣)40 mg联合左旋氨氯地平(施慧达)2.5 mg 口服,1次/日.结果 观察组显效35例,有效5例,总有效率为93.0%;对照组显效27例,有效6例,总有效率为76.8%(P<0.05).结论 厄贝沙坦联合氢氯噻嗪治疗老年原发性高血压疗效可靠.     

缬沙坦联合氨氯地平对原发性高血压患者的BPV的影响及其作用机制

目的探讨缬沙坦联合氨氯地平治疗原发性高血压患者的降压效果、对患者血压变异性的影响及其作用机制。方法选取2010年1月~2015年12月于海门市第四人民医院心血管内科治疗的140例原发性高血压患者进行研究,随机分为试验组和对照组,试验组70例采用缬沙坦联合氨氯地平治疗,对照组70例采用缬沙坦联合氢氯噻嗪治疗,分别在治疗6周、12周后对比两组患者的血压控制效果、血压变异性、血浆一氧化氮(NO)、内皮素(ET)水平。结果治疗前、治疗6周、12周后,两组患者的24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)、日间收缩压(d SBP)、日间舒张压(d DBP)、夜间收缩压(n SBP)、夜间舒张压(n DBP),指标差异均无统计学意义(P0.05);治疗6周、12周后,试验组患者24 h收缩压变异性(24 h SBPV)、24 h舒张压变异性(24 h DBPV),显著低于对照组(P0.05),试验组的ET低于对照组、NO高于对照组,差异均有统计学意义(P0.05);两组血压达标率比较,差异无统计学意义(84.29%vs.80.00%,P0.05)。结论缬沙坦联合氨氯地平治疗原发性高血压的疗效与缬沙坦联合氢氯噻嗪效果相近,但是能够更好的减低血压变异性,其作用机制可能与改善血管内皮功能有关。     

缬沙坦联合氨氯地平或氢氯噻嗪改善高血压患者血压变异性及生活质量

目的:比较缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性及生活质量的影响。方法:纳入127例2、3级老年高血压患者,随机分为缬沙坦联合氨氯地平组(Val+Am组,64例)和缬沙坦联合氢氯噻嗪组(Val+Hyd组,63例),观察治疗前后各组血压昼夜节律及变异性、生活质量情况。结果:(1)两组治疗后24hSBP、DBP、SBPV、DBPV,白昼SBP、DBP、SBPV、DBPV,夜间、晨峰的SBP、DBP均明显下降(P<0.05或P<0.01);(2)与Val+Hyd组比较,Val+Am组24hSBP[(120.6±10.2)mmHg比(110.9±11.3)mmHg]、白昼SBP[(120.6±11.3)mmHg比(111.6±11.37)mmHg]、夜间SBP[(118.5±11.6)mmHg比(108.6±11.9)mmHg]、晨峰SBP[(26.2±13.7)mmHg比(23.0±10.4)mmHg]下降更显著(P<0.05或P<0.01);24hSBPV[(10.7±2.2)mmHg比(8.2±2.0)mmHg]、白昼SBPV[(10.4±1.9)mmHg比(8.1±2.1)mmHg]下降更显著(P均<0.01);生活质量的体力、精神健康,总体功能改善的百分比明显升高(P<0.05或<0.01)。结论:缬沙坦联合氨氯地平或氢氯噻嗪均能改善老年高血压患者血压变异性和生活质量,但缬沙坦联合氨氯地平效果更佳。     

缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响

目的 观察比较缬沙坦分别联合氨氯地平或氢氯噻嗪对老年高血压患者血压及其变异性的影响.方法 选取138例老年高血压患者,随机分为两组,A组70例给予口服缬沙坦80 mg联合氨氯地平5mg qd;B组68例给予口服缬沙坦80 mg联合氢氯噻嗪12.5 mg qd.分别在治疗前、治疗8w时进行24 h动态血压监测,观察24 h、白天与夜间收缩压变异性(systolic blood pressure variability,SBPV)和舒张压变异性(diastolic blood pressure variability,DBPV);24h、白天与夜间平均收缩压(systolic blood pressure,SBP)和平均舒张压(diastolic blood pressure,DBP).结果 与治疗前比较治疗后第8周A组与B组24 h、白天、夜间SBP、DBP、SBPV均下降(P＜0.05),A组下降幅度均大于B组(P＜0.05).A组治疗8w后,DBPV均有下降(分别地,P＜0.05),而B组无变化,组间比较差异有统计学意义(P＜0.05).结论 缬沙坦联合氨氯地平或氢氯噻嗪治疗均能有效控制老年高血压患者的血压,但缬沙坦联合氨氯地平具有更佳的血压达标率和更低的血压变异性.     

福辛普利联合氢氯噻嗪治疗老年原发性高血压

目的 观察福辛普利联合氢氯噻嗪治疗老年原发性高血压的临床疗效.方法 60例老年原发性高血压病人进行随机分组,治疗组30例,给予福辛普利联合氢氯噻嗪治疗.对照组30例,单用福辛普利治疗,疗程8周,两组进行疗效比较.结果 治疗组总有效率90%,对照组总有效率83%(P<0.05).结论 福辛普利联合氢氯噻嗪治疗老年原发性高血压,疗效优于单用福辛普利.     

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.     

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.     

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.     

以肥厚性硬脑膜炎为主要表现的肉芽肿性多血管炎临床病例分析

目的探讨肉芽肿性多血管炎(GPA)继发肥厚性硬脑膜炎(HCP)的临床特点。方法回顾性分析北京协和医院2004—2018年收治的GPA继发HCP病例资料的特点。结果①GPA患者315例,19例继发HCP,占6.0%;②男性12例,女性7例;年龄19~64岁,中位年龄57岁。③神经系统表现:19例均有头痛,16例颅神经受累。受累部位:额部8例,颞部8例,颅底8例(鞍旁4例,其中海绵窦3例,眶尖2例),小脑幕6例,大脑镰2例,顶部1例,枕部1例,1例合并硬脊膜炎。④系统表现:发热10例,体质量下降8例,肺部受累4例,肾脏受累3例,16例鼻窦炎,10例中耳炎,16例局限型GPA。⑤15例ANCA抗体阳性,8例蛋白酶3(PR3)-ANCA阳性,6例髓过氧化物酶(MPO)-ANCA阳性。⑥16例行腰椎穿刺检查:脑脊液压力9例升高、5例正常、2例降低;脑脊液蛋白升高10例。⑦15例(78.9%)伯明翰系统性血管炎评分(BVAS)>15分。⑧19例均使用糖皮质激素、免疫抑制剂治疗,其中12例行甲泼尼龙冲击治疗,12例鞘内注射地塞米松(或+甲氨蝶呤),19例病情均缓解。结论HCP是GPA少见且严重的表现,主要表现为颅高压和颅神经受累,多见于局限型GPA患者,常伴有全身疾病的活动,需积极治疗。