代谢综合征患者动态血压有关指标与冠状动脉病变的相关性分析

目的探讨动态收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压（PP）、脉压指数（PPJ）与代谢综合征（MS）患者冠状动脉病变严重程度相关性，评价各指标对冠状动脉病变的预测价值。方法对204例患者行冠状动脉造影（CAG），分析冠状动脉狭窄程度，并计算冠状动脉病变血管数和冠状动脉病变评分；同时行动态血压监测（ABPM）。分为非CHD和CHD组，按PPI≤0．40、0．41-0．50、0．51—0．60、〉0．60分为4组，按PP≤40mmHg、41-60mmHg、61—80mmHg、〉80mmHg分为4组，比较各组间冠状动脉病变程度。结果非CHD和CHD组在年龄、血脂、体重指数、SBP、PP、PPI上差异有统计学意义（P〈0．05）；PP和PPI组在冠心病发生率、冠状动脉病变的血管数、评分和冠脉狭窄程度上均差异有统计学意义（P〈0．05 or P〈0．01）；MS患者的CHD发生率及病变程度与SBP、PP、PPI显著相关（P〈0．01），与PPI相关性最为最著。结论在动态血压各指标中，PP、PPI、SBP与冠状动脉病变密切相关，可作为代谢综合征患者二级预防靶点。     

脉压、脉压指数与冠状动脉狭窄程度的相关性分析

目的探讨脉压（PP）、脉压指数（PPI）与冠状动脉（冠脉）狭窄程度的相关性,并比较两者用以评价冠脉狭窄程度的相对优越性。方法547例行冠脉造影患者的冠心病（CHD）病变的严重程度分别用冠脉病变的血管支数、冠脉狭窄程度和冠脉病变评分表示。测定外周肱动脉收缩压（SBP）和舒张压（DBP）,并计算PP及PPI。结果冠脉病变程度随增龄而逐渐加重,冠脉狭窄积分3支病变组〉双支病变组〉单支病变组〉冠脉正常组为89．1±38．6vs57．1±32．2vs26．0±22．1vs3．7±2．7（H=239．963,P〈0．01）;PP和PPI冠脉病变组〉冠脉正常组;3支病变组〉1支病变组,PP为（53±11）mmHg vs（48±11）mmHg,PPI为0．413±0．06vs0．375±0．06（均P〈0．01）;直线相关分析结果表明PP、PPI均与CHD的发生呈显著正相关（r值分别为0．547,0．632;均P〈0．01）。多因素Logistic回归分析结果显示,PPI与CHD冠脉狭窄程度的关系最为密切,（坎值为1．012,95％可信区间为（1．261,1．447）。结论脉压及脉压指数是较为简便的反映大动脉弹性的参数,与冠脉狭窄程度密切相关,且脉压指数在一定程度上较脉压有更大的优势。     

原发性高血压患者冠状动脉病变狭窄程度与脉压及脉压指数的相关性分析

【目的】探讨原发性高血压患者冠状动脉病变狭窄程度与脉压（PP）及脉压指数（PPI）的相关性。【方法】对拟诊冠心病（CHD）的164例高血压病患者以标准Judkins法行冠状动脉造影术。根据造影结果将高血压病患者分为冠心病组（合并冠心病）和非冠心病组（未合并冠心病）。计算机定量分析系统（QCA）分析冠状动脉狭窄程度并计算其冠状动脉病变积分（CAS）。标准台式水银血压计测定外周肱动脉收缩压（SBP）和舒张压（DBP）,计算PP（PP—SBP—DBP）与PPI（PPI—PP／SBP）。【结果】高血压病合并冠心病组的CAS积分、PP及PPI均较非冠心病组显著增高（66．5±28．8 vs 8．6±6．7;51．8±12．7 vs 38．7±14．2;0．47±0．12 vs 0．33±0．08,P〈0．05）。逐步回归分析显示,高血压病患者的CAS与PP及PPI显著相关。【结论】PP及PPI是预测高血压病患者冠状动脉狭窄程度的重要指标。     

脉压与冠状动脉病变严重程度的相关性分析

目的:探讨脉压与冠状动脉(冠脉)病变严重程度的相关性。方法:对405例入选患者行冠脉造影术,其中男271例,女134例,年龄33~85(63.02±11.18)岁。冠脉病变的严重程度用病变的血管支数及Gensini积分表示。所有患者在术中测量主动脉血压及外周桡动脉血压。结果:冠脉三支病变组,主动脉、外周桡动脉收缩压(SBP)、脉压(PP)显著高于冠状动脉正常组,差异有显著性(P<0.05),SBP与PP随着狭窄支数的增加而逐渐增加。多因素分析结果显示,主动脉PP、外周PP、年龄与冠脉狭窄程度的关系最为密切。结论:PP是冠心病冠脉狭窄发生发展的独立危险因素,且主动脉PP的预测价值更大。     

晚期糖基化终末产物与冠状动脉病变程度的相关性研究

目的探讨晚期糖基化终末产物（AGEs）水平与冠心病（CHD）患者冠状动脉病变程度的关系。方法对132例行冠状动脉造影检查者,采用ELISA法测定血清AGEs水平。依照冠状动脉造影结果分为非冠心病组（n=38）和冠心病组（n=94）,病变程度定量采用Gemini评分系统。根据冠状动脉病变支数,分为冠状动脉正常组（n=32）、单支病变组（n=34）、双支病变组（n=35）及多支病变组（n=31）。结合AGEs、Gemini积分对各组进行比较和综合分析。结果冠心病组血清AGEs浓度显著高于非冠心病组（P〈0．01）,随冠状动脉病变支数和Gensini积分增加血清AGEs水平相应升高。校正年龄、血压、血脂、血糖等影响后,AGEs与ISI、Gensini积分呈显著正相关（r=0．717、r=0．658,P〈0．01）,与冠状动脉病变支数亦呈正相关（r=0．742,P〈0．05）。线性回归分析显示年龄、Gensini积分、BMI、ISI是影响AGEs的独立因素;ISI、BMI、AGEs、年龄、SBP是影响Gensini积分的独立因素。结论血清AGEs在冠心病患者中明显升高,且随着冠状动脉病变程度加重而升高,提示AGEs不仅参与了冠心病的病理生理过程,而且还可作为判断冠状动脉病变严重程度的一项指标。     

脉压与冠状动脉病变程度临床研究

目的：探讨脉压与冠状动脉疾病程度的关系。方法：160例入院均做冠状动脉造影检查，冠状动脉的严重程度用冠状动脉病变的支数表示，外周脓动脉压力测定收缩压、舒张压、脉压，分析脉压与冠状动脉病变的关系。结果：脉压〈65mmHg组冠状动脉正常者发生率高（P〈0．05），与脉压〈65mmHg的患者相比，脉压≥65mmHg的患者3支血管病变、左主干病变发生率显著增高（P均〈0．05），冠心痛、心肌梗死、心力衰竭的发生率亦显著增高（P均〈0．05）。结论：脉压与冠心痛的发生、冠状动脉严重程度密切相关，是心血管事件的一个重要危险信号。     

冠状动脉病变范围、程度与心率变异性的关系

目的：研究冠心痛患者冠状动脉病变支数、冠状动脉狭窄程度、冠状动脉病变部位与心率变异性（HRV）的关系。方法：对冠状动脉造影的121例患者进行HRV分析．根据冠状动脉造影结果分为造影正常组。单支、双支及三支病变组，轻度及重度狭窄组。左冠状动脉和右冠状动脉病变组。结果：冠状动脉病变组HRV指标显著低于造影正常组（P〈0．05）；双支厦三支病变组分别与单支病变组相比，SDNN、rMSSD、PNN50、LF指标差异均有显著性（P〈0．05）；三支病变组与双支病变组相比只有LF指标差异有显著性（P〈0．05），其余指标无统计学意义（P〉0．05）；重度狭窄组HRV指标均显著低于轻度狭窄组（P〈0．05）；右冠状动脉病变组HRV指标虽低于左冠状动脉病变组但无统计学意义（P〉0．05）。结论：冠心病患者HRV下降，且与冠状动脉狭窄范围程度相关。提示冠状动脉缺血病变可导致自主神经功能改变．     

冠脉钙化积分在冠心病诊断及风险预测的临床价值

【目的】探讨冠脉钙化积分（CACS）在冠心病诊断及早期风险预测中的临床价值。【方法】回顾性分析行64-MSCT冠脉成像和冠脉造影检查的285名住院患者冠脉钙化积分与血管狭窄程度、病变支数、心血管事件的关系。【结果】180例冠心病组中3支病变组CACS值（967．18±896．95）高于2支病变组（456．61±376．83）及单支病变组（243．40±239．85）（P〈0．05，P〈0．01）。重度狭窄组值CACS（314．06±486．27）高于中度狭窄组（162．74±161．80）、轻度狭窄组（97．35±120．37）（P〈0．01）。轻度狭窄组与中度狭窄组相比无显著性差异（P〉0．05）。CACS与狭窄程度、病变支数呈正相关（r=0．569，r=0．496，均P=0．000）。【结论】冠脉钙化积分对预测冠心病有较高的敏感性，与冠脉狭窄支数和狭窄程度呈正相关。     

胰岛素敏感性和血脂水平与冠状动脉病变程度相关性

目的：探讨冠心痛患者胰岛素敏感性和血脂水平与冠状动脉病变范围及程度的关系。方法：检测100例冠状动脉造影阳性患者（冠心病组）、50例冠状动脉造影阴性患者（阴性组）和50例健康者（对照组）的空腹血脂、血糖、胰岛素浓度及胰岛素敏感性指标。分别以冠状动脉狭窄分数和病变冠状动脉支数为因变量,血脂、血糖、胰岛素和胰岛素敏感性指标为自变量,进行单元直线相关分析和多元逐步回归分析。结果：冠心病组与对照组除总胆固醇、血糖外,血脂、胰岛素和胰岛素敏感性差异均有统计学意义（P〈0．05）;冠心病组仅有高密度脂蛋白和胰岛素敏感性指数明显低于阴性纽（P〈0．05）。冠心病纽胰岛素和胰岛素敏感性指数与冠状动脉狭窄分数显著相关（r=0．25,P〈0．05;r=-0．32,P〈0．01）,病变冠状动脉支数与任何自变量无相关性。逐步回归分析显示,胰岛素敏感性指数与冠状动脉病变程度独立相关。结论：冠心病存在胰岛素抵抗、高胰岛素血症和血脂尤其是高密度脂蛋白异常,均为冠心病发病危险因素;胰岛素敏感性指数是影响冠状动脉病变程度独立影响因子。     

血清同型半胱氨酸与冠状动脉病变的相关性研究

目的探讨血清同型半胱氨酸（HCY）水平与急性冠状动脉（下称冠脉）综合征患者冠脉病变支数及冠脉狭窄程度（以Gensini冠脉病变积分为评价标准）的相关性。方法以酶联免疫吸附试验（ELISA）法检测急性冠脉综合征患者（ACS组,n=51）、稳定型心绞痛患者（SA组,n=20）、非冠心病患者（NCHD组,n=23）的血清HCY水平,并分析其与冠心痛严重程度的关系。结果ACS组患者血清HCY水平高于NCHD组和SA组患者,差异均有统计学意义（均P〈0．01）;SA组患者血清HCY水平高于NCHD组,差异有统计学意义（P〈0．05）;ACS组患者外周血清HcY水平与冠脉病变支数呈正相关,差异有统计学意义（r=0．497,P〈0．01）,且与Gensini积分呈正相关,差异有统计学意义（r=0．446,P〈O．01）。结论ACS组患者血清HCY水平明显高于SA组和NCHD组患者,表明该指标可能与冠脉易损斑块的病理生理相关;ACS患者血清HCY水平与冠脉病变支数及Gensini积分呈正相关,进一步提示血清HCY水平的升高可能与急性冠脉综合征的发生发展相关。     

Non-infectious hyperthermia in acute brain injury patients: relationships to mortality, blood pressure, intracranial pressure and cerebral perfusion pressure

The present study was conducted to investigate the frequency of hyperthermia during the first 72 h after acute brain injury, and to compare subjects that developed hyperthermia with those that did not with respect to blood pressure, intracranial pressure (ICP), cerebral perfusion pressure (CPP), Glasgow Coma Scale (GCS) score and mortality. This study was conducted by performing a retrospective medical record review of 126 brain injury patients admitted to the neurological intensive care unit of a university hospital located in Incheon, South Korea. Our results showed that 25.4% of the subjects had hyperthermia for at least 1 day during the first 3 days of hospitalization. Hyperthermic subjects demonstrated higher mortality and ICP, and lower CPP and GCS scores than non-hyperthermic subjects, indicating a reduced cerebral blood flow. The findings may provide a possible explanation for poor clinical outcome and offer justification for the careful monitoring of body temperature in patients with acute brain injury.     

原发性高血压患者红细胞分布宽度与血压水平、中心动脉压及血压变异性的相关性

目的 探讨原发性高血压患者红细胞分布宽度（RDW）与血压水平、中心动脉压及血压变异性的相关性。方法 选择河南省人民医院确诊的原发性高血压患者531例。以RDW四分位数为截点，将患者分为4组［A1组(n=138), A2组(n=137), A3组(n=132), A4组(n=124)］。比较4组血压水平、中心动脉压及血压变异性的相关性。结果 4组间24小时平均收缩压（SBP），白昼平均SBP，4组间夜间SBP，4组中心动脉压差异有统计学意义（P<0.01）。各组间全天SBP变异系数、白昼SBP变异系数和夜间SBP变异系数差异有统计学意义（P<0.01），A4组显著高于其他3组。相关分析结果显示，RDW与24小时平均SBP、白昼平均SBP、夜间平均SBP、全天SBP变异系数、白昼SBP变异系数、夜间SBP变异系数和中心动脉压呈正相关关系。结论 原发性高血压患者RDW与血压及血压变异性中心动脉压呈正相关。     

老年高血压患者脉压、脉压指数变化及与动脉粥样硬化的关系

目的观察老年高血压患者脉压(PP)、脉压指数(PPI)的变化,以及二者与大动脉粥样硬化发生的关系.方法测量124例老年高血压患者24小时动态血压,计算昼夜PP、PPI水平,及PP、PPI变化幅度.根据PP水平分为两组:PP≤60 mm Hg组和PP>60 mm Hg组;又根据PPI水平再分为两组: PPI≤0.40组和PPI>0.40组.多普勒超声检查颈动脉、下肢动脉、肾动脉粥样斑块发生率.结果不同个体PPI变化幅度(0.203±0.026)明显低于PP的变化幅度(0.327±0.034)(t=2.534,P<0.05);PPI昼夜变化(昼:0.420±0.074;夜:0.433±0.077)差异有统计学意义(P<0.05); PP≤60 mm Hg组与PP>60 mm Hg组比较,年龄、PPI、收缩压(SBP)、舒张压(DBP)差异均有统计学意义(t=4.13,P<0.05),PPI≤0.4组与PPI>0.4组比较,年龄、TC、HDL、LDL、PP、SBP、DBP、大动脉粥样硬化发生率的差异有统计学意义(P<0.05).结论 PPI是一个反映血管硬化的良好指标.其克服了脉压评价血管硬化的相对性,在反映血管顺应性中比PP更敏感,更合理.     

不同学历实习护生压力源、压力及其应对的相关性研究

[目的]了解不同学历实习护生压力源及其产生的压力水平、应对方式和自我效能感的水平,探讨实习护生应对方式、自我效能感与压力水平的关系。[方法]选择在上海交通大学医学院附属的5所医院中实习的312名护生,其中本科86人,大专127人,中专99人,应用实习护生压力源量表、简易应对方式问卷、一般自我效能感量表,于实习期进行调查。[结果]①不同学历护生在实习期间各方面的压力源产生的压力差异有统计学意义（P〈0.01）;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大。②不同学历实习护生应对方式差异无统计学意义;压力水平与消极应对呈正相关（r=0.148,P〈0.01）。③中专实习护生的自我效能感处于低水平;实习护生的一般自我效能感与压力水平呈负相关（r=-0.145,P〈0.05）。[结论]不同学历护生实习期间存在中等水平的压力;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大;应对方式与压力水平密切相关,积极的应对方式有助于降低压力水平;自我效能感与压力水平存在密切关系,提高自我效能感水平有助于降低压力水平。     

Positive end-expiratory pressure (PEEP) and cerebrospinal fluid pressure during normal and elevated intracranial pressure in dogs

The effect of up to 15 cm H₂O positive end-expiratory pressure (PEEP) on cerebrospinal fluid pressure (Pcsf) was investigated in five anaesthetised, mechanically ventilated dogs during normal and then elevated (40–50 cm H₂O) intracranial pressure (ICP). Stepwise elevations of PEEP in 5 cm H₂O increments resulted in small rises in Pcsf at normal ICP and in significantly larger rises when ICP was elevated. The regression equations for the relationships between Pcsf and end-expiratory pressure (EEP) were as follows: Pcsf=12.95+0.82 EEP for normal ICP, and Pcsf=46.41+2.06 EEP for elevated ICP. Mean PaCO₂ rose from 39.7±2.5 to 47.6±5.0 torr during normal ICP, and from 34.2±2.9 to 50.9±5.3 torr at elevated ICP as PEEP was elevated to 15 cm H₂O. We conclude that PEEP raised Pcsf, and that this increase is more severe under conditions of elevated ICP. The rise in Pcsf due to PEEP may be explained by either the rise in intrathoracic pressure or the rise in PaCO₂, or both.Dedicated to Professor Dr. Johannes Linzbach, Göttingen, on the occasion of his 70th birthday     

Influence of tissue pressure on central venous pressure/peripheral venous pressure correlation: An experimental report

BACKGROUND: Peripheral venous pressure (PVP) has been shown to correlate with central venous pressure (CVP) in a number of reports. Few studies, however, have explored the relationship between tissue pressure (TP) and PVP/CVP correlation.METHODS: PVP and CVP were simultaneously recorded in a bench-top model of the venous circulation of the upper limb and in a single human volunteer after undergoing graded manipulation of tissue pressure surrounding the intervening venous conduit. Measures of correlation were determined below and above a point wherein absolute CVP exceeded TP.RESULTS: Greater correlation was observed between PVP and CVP when CVP exceeded TP in both models. Linear regression slope was 0.975 (95% CI: 0.959-0.990); r² 0.998 above tissue pressure 10 cmH₂O vs. 0.393 (95% CI: 0.360-0.426); and r² 0.972 below 10 cmH₂O at a flow rate of 2000 mL/h in the in vitro model. Linear regression slope was 0.839 (95% CI: 0.754-0.925); r² 0.933 above tissue pressure 10 mmHg vs. slope 0.238 (95% CI: -0.052-0.528); and r²0.276 in the en vivo model.CONCLUSION: PVP more accurately reflects CVP when absolute CVP values exceed tissue pressure.     

不同学历实习护生压力源、压力及其应对的相关性研究

[目的]了解不同学历实习护生压力源及其产生的压力水平、应对方式和自我效能感的水平,探讨实习护生应对方式、自我效能感与压力水平的关系.[方法]选择在上海交通大学医学院附属的5所医院中实习的312名护生,其中本科86人,大专127人,中专99人,应用实习护生压力源量表、简易应对方式问卷、一般自我效能感量表,于实习期进行调查.[结果]①不同学历护生在实习期间各方面的压力源产生的压力差异有统计学意义(P＜0.01);不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大.②不同学历实习护生应对方式差异无统计学意义;压力水平与消极应对呈正相关(r=0.148,P＜0.01).③中专实习护生的自我效能感处于低水平;实习护生的一般自我效能感与压力水平呈负相关(r=-0.145,P＜0.05).[结论]不同学历护生实习期间存在中等水平的压力;不同学历实习护生产生压力的前10位压力源及其排序有所不同,但变化不是很大;应对方式与压力水平密切相关,积极的应对方式有助于降低压力水平;自我效能感与压力水平存在密切关系,提高自我效能感水平有助于降低压力水平.     

The effects of NG-nitro-L-arginine methyl ester on systolic pressure, diastolic pressure and pulse pressure according to the initial level of blood pressure

The objective of this study was to re-examine whether the effect of the nitric oxide synthesis inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME), on blood pressure depends on peripheral vascular tone. The effects of L-NAME (10 mg/kg, i.v.) on diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP) and heart rate (HR) were studied in pithed rats. Sal-pithed rats received 0.9% NaCl, 10 microl/kg/min. Vascular tone was step-wise increased with 3, 10 and 30 microg/kg/min intravenous phenylephrine infusion (LPhe-pithed, MPhe-pithed and HPhe-pithed rats respectively). L-NAME elicited vasopressor responses in all the animals studied. L-NAME increases in SBP and DBP in Sal-pithed rats were significantly smaller than the ones obtained in phenylephrine infused rats. The increases in DBP elicited by L-NAME were greater in LPhe-pithed rats compared with those of MPhe-pithed and HPhe-pithed rats (i.e. the step-wise rises in DBP obtained with phenylephrine were inversely related to the increases in DBP produced by L-NAME); however, the increases in SBP were similar between these experimental groups. The PP increased during L-NAME-induced pressor responses in phenylephrine-infused rats. l-NAME increases in PP showed the following order: Sal-pithed < LPhe-pithed < MPhe-pithed < or = HPhe-pithed rats. HR was not modified by L-NAME. In conclusion, the vasopressor responses produced by L-NAME in pithed rats are influenced by the pre-existing vasomotor tone in complex form. We did not find a simple positive correlation between the vascular tone or level of arterial pressure, and the magnitude of the diastolic and systolic pressor responses elicited by L-NAME. Interestingly, the increase in PP induced by l-NAME was greater in accordance with the increasing value of baseline arterial pressure. NO synthesis inhibition in the arterial endothelium may possibly explain the increase in PP caused by L-NAME, as resulting from the reduction in proximal conduit artery compliance.     

高血压病合并房颤的临床特征及其与动态脉压和动态脉压指数的相关性

目的：分析动态脉压、动态脉压指数与高血压病患者心房颤动（ Af ）发生的关系。方法原发性高血压患者368例,其中伴Af的患者81例（高血压病伴Af组）,余无Af发作史的患者287例（高血压病不伴Af组）,并将上述患者根据24 h动态脉压（24 h APP）分为＜60 mmHg组和≥60 mmHg组,根据脉压指数分为＜0.5组和≥0.5组。分析比较各组Af发生情况、临床特征,及其与动态脉压和动态脉压指数的相关性。结果高血压病伴Af组24 h APP、动态脉压指数明显高于高血压病不伴Af组（ P＜0.01）。24 h APP≥60 mmHg组,24 h收缩压、动态脉压指数、左房前后径明显高于24 h APP＜60 mmHg组（ P＜0.05）。动态脉压指数≥0.5组24 h收缩压、24 h APP、左房前后径明显高于脉压指数＜0.5组（ P＜0.05）。 Spearman相关分析显示高血压病患者Af发生率与24 h APP、动态脉压指数呈正相关（ r分别为0.783和0.796,均P＜0.01）。结论高血压病患者Af发生率随动态脉压、动态脉压指数升高而增高。     

Preventing heel pressure sores: a comparison of heel pressure relieving devices

• ? It has been widely recognized that elderly patients with an orthopaedic problem are predisposed to developing heel pressure sores.
• ? In this study four pressure-reducing devices, commonly used in the prevention of heel ulcers, were objectively compared for their ability to decrease or remove pressure on the heels of patients with fractured necks of femurs and fractured femurs.
• ? Forty-one patients were randomly allocated a pressure relieving device. The efficacy of the device was evaluated by continuously assessing the skin integrity of both heels on a daily basis over a period of 12 days. Data were collected over a 30 month period.
• ? The four devices were foam splints, eggshell foam, duoderm and heel protector boots. Foam splints and eggshell foam proved to be more effective devices in relieving pressure exerted on the heel.
• ? This study recognizes that meticulous nursing care remains the critical clement in prevention of heel ulcers; however, the use of eggshell foam and foam splints in conjuction with this enhances the maintenance of skin integrity.