硝酸甘油与乌拉地尔注射液治疗重度心力衰竭的临床疗效观察

目的　观察经静脉乌拉地尔与硝酸甘油注射液治疗重度心力衰竭短期临床疗效。方法　重度左心衰竭的患者 4 8例 ,NYHA心功能均为Ⅳ级。随机分为乌拉地尔组 2 4例 ,硝酸甘油组 2 4例。两组年龄、心率、血压无显著性差异。在心力衰竭常规处理 (利尿剂、洋地黄 )的同时 ,两组分别给予持续静脉使用乌拉地尔 5 0～10 0 μg/min或硝酸甘油 10～ 2 0 μg/min 2 4h (根据血压情况调节 ) ,期间不用其它血管扩张剂。用药前后检查心率、血压、超声心动图。结果　两组患者用药后心率、舒张期血压无显著性差异 ;硝酸甘油组患者用药后收缩功能指标射血分数明显增大、舒张功能指标二尖瓣血流E峰减速时间明显延长 ,与用药前比较均有显著性差异 (P<0 0 5 )乌拉地尔组患者用药后 2h、 4h收缩期血压减低较明显 ,超声心动图收缩功能指标每搏输出量、射血分数均明显增大、主动脉瓣最大血流速度明显增快 ,与用药前比较均有显著性差异 (P <0 0 5 )。结论　小剂量静脉泵入乌拉地尔可有效的用于重度心力衰竭患者的短期治疗 ,能明显改善心力衰竭患者的心脏收缩功能 ,对于高血压病心衰患者效果更佳 ,同时患者耐受性好 ,比较安全。     

比索洛尔治疗顽固性心力衰竭患者临床观察

目的观察选择性β-受体阻滞剂比索洛尔治疗顽固性心力衰竭患者的临床效果。方法随机将顽固性心力衰竭患者100例分为β-受体阻滞剂治疗组和安慰剂对照组,两组年龄、心衰病程、原发病及心功能分级均具有可比性。在常规抗心衰治疗中,治疗组加服比索洛尔片剂,从小剂量1.25mg/d开始,缓慢加量至有效量或达2.5～5mg/d,对照组给予安慰剂1片/d,4周后观察两组NYHA心功能分级、左室射血分数（LVEF）、血压、心率和24h室性早搏〉2 000次的发生率、病死率及副作用等。结果治疗组较对照组NYHA心功能分级、左室射血分数均有明显改善;血压、心率明显降低;室性早搏〉2000次/24h的发生率、病死率明显下降（P〈0.05）。结论除常规抗心衰治疗顽固性心力衰竭外加用比索洛尔可明显改善患者的心脏功能,提高患者的生活质量,并减少室性早搏的发生率,其副作用小,可作为顽固性心力衰竭治疗的首选辅助用药。     

小剂量PGE1治疗重症心力衰竭的疗效观察

目的观察前列地尔（注射用前列腺素E1，PGE1）治疗重症心力衰竭的疗效。方法按NYHA心功能分级为Ⅲ～Ⅳ级、超声心动图左室射血分数〈35％的53例，在常规抗心衰治疗基础上，随机分为PGE，组27例和常规治疗组26例。PGE1组在常规治疗的基础上加用PGE1注射液80μg深静脉滴注，2次／d，10d为1疗程。两组均于治疗两周后复查超声心动图。结果治疗两周后，按NYHA分级，PGE1组较常规治疗组临床疗效更为显著；比较治疗前后超声心动图心功能指标左室舒张末内径、左室收缩末内径、左室射血分数，两组治疗后均有明显改善，而PGE1组患者改善更为明显；无明显副作用。结论在常规治疗基础上加用前列地尔深静脉滴注，重症心力衰竭患者的临床症状及心功能均有明显的改善，短期疗效显著，副作用小。     

倍他乐克治疗慢性充血性心力衰竭86例疗效观察

目的 :观察β受体阻滞剂倍他乐克对慢性充血性心力衰竭 (CHF)的疗效。 方法 :将慢性CHF16 8例随机分为治疗组和对照组 ,两组年龄、心衰病程、原发病及心功能分级相似 ,具可比性 ,均给予常规抗心衰治疗 ,治疗组加用倍他乐克片剂 ,从小剂量 6 .2 5mg/d开始 ,缓慢加量至有效剂量或达 2 5～ 5 0mg/d。观察 12周后两组患者的NYHA心功能分级、左室射血分数、心排血指数、血压、心率、病死率及副作用等。结果 :治疗组较对照组NYHA心功能分级、左室射血分数、心排血指数均明显改善 ,血压、心率均明显降低 ,病死率下降 ,P <0 .0 5或 <0 .0 1。结论 :在常规抗心衰治疗的基础上加用倍他乐克治疗慢性CHF ,可明显改善患者心脏功能 ,提高患者生存率 ,且副作用小 ,值得临床推荐使用。     

小剂量高渗盐水加大剂量速尿治疗心力衰竭伴顽固性水肿的疗效观察

心力衰竭合并顽固性水肿的临床治疗是个棘手问题。我院 2 0 0 1年至 2 0 0 3年住院心力衰竭 (心衰 )并顽固性水肿病人6 1人次 ,随机分为治疗组小剂量高渗盐水加大剂量速尿静脉点滴 31例 ,对照组大剂量速尿静脉推注 30例 ,作疗效对比。1　资料和方法1.1　一般资料　病例选择将 6 1例次慢性充血性心力衰竭(心功能 级～ 级 ,按 NYHA分级 )患者 ,随机分为治疗组31例和对照组 30例。两组的平均年龄分别为 (6 6± 8.2 )岁和(6 5± 7.6 )岁。两组心衰病因 :冠心病 2 7例 (治疗组 14例 ,对照组 13例 ) ;风湿性心脏病 10例 (治疗组 5例 ,对照组 5…     

难治性心力衰竭的临床治疗分析

目的观察米力农联合乌拉地尔治疗难治性心力衰竭的疗效。方法选取心功能IV级的顽固性心力衰竭患者80例,随机分为治疗组和对照组。均经洋地黄、利尿剂、血管紧张素转换酶抑制剂以及纠正心力衰竭诱因、吸氧等治疗心力衰竭难以改善,治疗组给予米力农2mg静脉注射后以025～1．00ug／（kg．min）微量泵静脉泵入,乌拉地尔2mg／h开始微量泵静脉泵入,并逐渐增加剂量;对照组给予多巴酚丁胺3～5μg／（kg·min）,硝普钠15～250ug／min微量泵静脉泵入;7d为1疗程。观察2组心功能改善情况和血压变化。结果两组均未发生低血压现象,治疗组总有效率为92.5％,对照组为70.0％,组问比较差异有统计学意义（P〈0.05）。结论米力农联合乌拉地尔治疗难治性心力衰竭效果明显。     

参麦注射液合门冬氨酸钾镁治疗顽固性心衰60例

我们在常规抗心衰治疗的基础上用参麦注射液联合门冬氨酸钾镁治疗顽固性心衰32例 ,并以常规抗心衰治疗顽固性心衰( RHF) 2 8例作了对照。1　临床资料本组 6 0例为 1 995年 6月至 1 999年 6月我院收治的慢性充血性心力衰竭患者 ,经临床诊断符合 RHF,随机分治疗组男 2 2例 ,女 1 0例 ,年龄 5 2～ 71岁 ,平均年龄为 6 1岁。病程 2～ 1 0年 ,平均为 6 .5年 ;对照组男 1 8例 ,女 1 0例 ,年龄 5 1～ 72岁 ,平均年龄 6 0岁。病程 3～ 1 0年 ,平均 6 .3年。两组间年龄、性别及病程有可比性。基础心脏病、心功能分级 (采用 NYHA标准 )见表 1。表 …     

乌拉地尔与硝酸甘油在治疗尿毒症合并心衰的临床疗效观察

目的:观察静脉使用乌拉地尔与硝酸甘油在治疗尿毒症合并心衰的短期临床效果。方法:80例慢性肾功能衰竭尿毒症并发心力衰竭患者,心功能在Ⅲ-Ⅳ级,随机分为乌拉地尔组40例,硝酸甘油组40例。两组年龄、心率、血压无显著性差异。在心衰常规处理(吸氧、利尿)的同时,两组分别使用乌拉地尔(0.1mg/分钟)、硝酸甘油(10μg/分钟),开始静滴,用药48小时后检查临床表现评价心功能、超声心动图、查肾功能。结果:使用乌拉地尔组患者心功能改善明显,心脏收缩指标明显高于硝酸甘油组,且对肾脏功能无明显影响。结论:在尿毒症合并心力衰竭患者使用乌拉地尔治疗短期临床效果优于硝酸甘油。     

黄芪注射液对慢性心力衰竭患者外周血清BNP水平与心衰程度的相关性研究

目的:探讨黄芪注射液对慢性心力衰竭患者外周血清脑钠肽(BNP)水平与心衰程度的相关性研究。方法:选取我院循环科收治的慢性心力衰竭患者92例,根据美国纽约心脏病协会(NYHA)心功能分级分为4组,心功能Ⅰ级(NYHAⅠ组,23例)、心功能Ⅱ级(NYHAⅡ组,23例)、心功能Ⅲ级(NYHAⅢ组,23例)、心功能Ⅳ级(NYHAⅣ组,23例),予强心、利尿、扩血管、降压常规对症治疗,加用黄芪注射液,50 m L加入100 m L浓度为0.9%的氯化钠注射液中静脉滴注,1周为1个疗程,连续治疗2个疗程。治疗结束后,对比治疗前后患者外周血中BNP水平,分析与心衰程度的关系。结果:1治疗前,按照NYHA分级从Ⅰ~Ⅳ级,BNP水平逐渐升高,且各心衰级别的BNP水平相比有明显差异,差异有统计学意义(P0.001);2治疗后,各级心衰患者BNP水平明显下降,但从NYHAⅠ到Ⅳ级BNP水平逐渐升高,且各心衰级别的BNP水平相比有明显差异,差异有统计学意义(P0.001);3黄芪注射液治疗后心衰患者血清BNP水平在不同程度心衰与心功能级别呈正相关(n=136,R=0.9727,P0.001)。结论:黄芪注射液能够明显降低慢性心力衰竭患者外周血清BNP水平,改善心功能,但无法完全恢复心功能,治疗后患者外周血血清BNP水平与心衰程度呈正相关。黄芪注射液对早期心衰治疗效果较好,对心衰程度越高者疗效越差。     

乌拉地尔对心力衰竭患者血流动力学效应及临床疗效

目的　观察α1受体阻滞剂乌拉地尔对左心瓣膜返流所致的心力衰竭患者的血流动力学效应和临床疗效。方法　 15例二尖瓣和 (或 )主动脉瓣关闭不全患者 ,平均年龄 ( 4 1 0± 16 0 )岁 ,心功能IV级 ,静注乌拉地尔 4～ 10μg/(kg·min) ,2 4h维持 3～ 5d。结果　乌拉地尔可降低总外周阻力、肺血管阻力、肺毛细血管嵌压及肺动脉压 ,增加心输出量及心脏指数。心功能明显改善 13例 ,改善者 2例 ,总有效率 10 0 %。结论　静注乌拉地尔对左心瓣膜返流所致的充血性心力衰竭有良好的血流动力学效应及临床疗效。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.