VENTILATORY CONTROL IN TWO ASTHMATICS RESUSCITATED FROM RESPIRATORY ARREST*

Two female patients revived from fulminant attacks of asthma are described. Ventilatory responses to asphyxia in these patients were 0.70 ± 0.10 I min^-1% SaO₂^-1 and 0.64 ± 0.21 I min^-1% SaO₂^-1 (mean ± SEM), respectively. These values were significantly less than the responses of seven normal female subjects (1.54 ± 0.11 I min^-1% SaO₂^-1 mean ± SEM; p<0.01). Ventilatory responses to hypercapnia of the two patients were in the low normal range. Dopamine-receptor blockade with prochlorperazine significantly increased the ventilatory response to asphyxia in normal subjects (p<0.05 or less for each subject) but did not alter the depressed responses in the asthmatic patients. In one patient, naloxone in a dose of 400 μg reversed the decreased ventilatory responsiveness; the response to asphyxia was increased from 0.72 I min^-1% SaO^-1 to 1.80 I min^-1% SaO₂^-1 (p<0.01) and the response to hypercapnia was increased from 0.90 I min^-1 mmHg^-1 to 4.80 I min^-1 mmHg^-1 (p<0.01). Naloxone had no effect in the second asthmatic patient nor in five normal subjects. Defective chemoreceptor responses to chemical stimuli may play a role in sudden death from asthma; endogenous opioids may mediate this disorder of ventilatory control.     

ACTH AND CORTISOL RESPONSES TO OVINE CORTICOTROPHIN-RELEASING FACTOR IN PATIENTS WITH PRIMARY AND SECONDARY ADRENAL FAILURE

The ACTH and cortisol responses to an intravenous bolus injection of 100 μg ovine CRF were studied in 19 patients with adrenal failure. In all eight patients with primary adrenal failure, plasma ACTH levels increased from a mean basal level of 1494·431 (SEM) pg/ml to a peak value of 2601±220 pg/ml at 10 min. In comparison with healthy subjects absolute ACTH increments after ovine CRF were significantly augmented in the patients with Addison's disease (P* > 0.001), and the absolute ACTH responses after ovine CRF were positively correlated with the basal plasma ACTH levels. The 11 patients with secondary adrenal insufficiency could be subdivided into two groups: (A) those having little or no ACTH and cortisol response to ovine CRF (five patients) and (B) those having prolonged and pronounced ACTH responses with a biphasic pattern and a delayed second peak (six patients), followed in all patients by a marked cortisol increase. These data demonstrate that the CRF-test can discriminate between hypothalamic and pituitary causes of secondary adrenal failure.     

糖皮质激素对哮喘患者CD4T淋巴细胞和嗜酸细胞活化的影响

为研究口服糖皮质激素泼尼松对哮喘患者体内ＣＤ４Ｔ淋巴细胞，嗜酸细胞活化的影响，用酶联免疫法对治疗前后哮喘患者血清白细胞介素－５，嗜酸细胞阳离子帽白浓度进行了检测。结果表明，口服泼泥松治疗１周后，血清ＩＬ－５，ＥＣＰ浓度降低，提示糖皮质激素可能通过抑制ＣＤ４Ｔ淋巴细胞活化，减少细胞因子的释放而对哮喘发挥抗炎作用。     

特拉唑嗪对充血性心力衰竭的急性血液动力学效应

观察10例充血性心力衰竭(CHF)患者口服特拉唑嗪4mg的急性血液动力学效应。服药后30分钟,周围动脉血压(BP)、平均右房压(MRAP)、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)即明显降低,心脏指数(CI)明显增加,此作用维持15 h以上。服药后心率无明显改变。患者自觉症状亦明显好转。这证明特拉唑嗪可用于CHF的治疗。     

ANDROGEN AND CORTISOL RESPONSES TO ACTH STIMULATION IN WOMEN WITH HYPERPROLACTINAEMIA

Basal serum concentrations of androgens (testosterone and dihydrotestosterone) and dehydroepiandrosterone sulphate (DHAS) were measured in 7 normal and in 14 anovulatory women with raised serum prolactin. No patient had detectable skull x-ray abnormalities. The mean DHAS, but not the androgens, were significantly higher in the women with hyperprolactinaemia (p < 0.01) and in 7 of the 14 the values were above the normal range which is 2.9–11.2 μmol/l. The 7 normal subjects and 9 of the women with hyperprolactinaemia were given ACTH (0.5 mg twice daily for four days). Cortisol and androgen concentrations in response to ACTH were not significantly different in the two groups, but the levels of DHAS (p < 0.001) were significantly higher over the four days in patients with hyperprolactinaemia. The concentrations of DHAS in these women were significantly higher by two days and continued to rise on day four of the test, but the concentration of androgens was greatest at two days as in the normal group. Treatment with bromocriptine to suppress plasma prolactin concentrations also lowered DHAS within 2–4 weeks, (p < 0.01) and the suppression was maintained for three months. Androgens initially increased significantly (p < 0.05) but by three months decreased again to the initial values. Taken together these results suggest that in the hyperprolactinaemic state biosynthesis by the Δ⁵ pathway to DHAS is favoured and there is partial inhibition of 3β-ol-dehydrogenase isomerase resulting in impaired conversion of Δ⁵ to Δ⁴ steroids.     

无创通气治疗慢性阻塞性肺部疾病轻中度呼吸衰竭疗效观察

目的探讨BiPAP经鼻罩或口鼻罩正压通气,对COPD轻中度呼吸衰竭早期无创通气的应用价值。方法将36例患者随机分为治疗组和对照组,两组各为18例。治疗组给予常规治疗加BiPAP通气,对照组单予常规治疗。在治疗前和治疗后2h及10h分别检测血气、呼吸频率(RR)和心率(HR),出院时统计插管率、病死率和住院天数。结果两组病人在治疗10h后PH、PaCO2、PaO2、RR和HR均得到明显改善(P<0.01),治疗组在治疗2h后PaCO2、RR和HR改善优于对照组(P<0.01)。两组需要插管机械通气分别为3例(16.3%)和7例(38.9%),差异无统计学意义(P>0.05)。治疗组死亡率2例(11.1%),对照组5例(27.8%),无统计学意义(P>0.05)。两组住院天数分别为(21±12)d和(32±19)d(P<0.05)。结论早期使用无创通气治疗能较快地改善COPD轻中度急性发作的通气功能,缩短住院天数。     

DIALYSIS AND TRANSPLANTATION IN PATIENTS WITH RENAL FAILURE DUE TO SYSTEMIC LUPUS ERYTHEMATOSUS. THE AUSTRALIAN AND NEW ZEALAND EXPERIENCE

Abstract Between 1977 and 1985, 5726 patients in Australia and New Zealand entered end stage renal failure programmes. Of these, 63 patients had renal failure due to systemic lupus erythematosus (a prevalence of 1.1% of patients entering renal replacement programmes). When compared with patients with other forms of glomerulonephritis, there was a female preponderance and a younger age distribution in patients with renal failure due to lupus nephritis. Integrated patient, dialysis, and transplant survival data showed that results in patients with renal failure due to lupus nephritis were comparable with those in patients with other forms of glomerulonephritis or in patients with renal failure due to any cause. Age at entry significantly affected survival, with significant differences being found in those patients under as opposed to over 50 years of age. Causes of death in patients with lupus nephritis were similar to those in patients with renal failure due to other causes. It is concluded that dialysis and transplantation are acceptable forms of treatment for patients with end stage renal failure due to systemic lupus erythematosus.     

普罗帕酮与毛花苷丙治疗快速心房颤动的疗效比较

目的比较静脉应用普罗帕酮与毛花苷丙治疗快速心房颤动(简称房颤)并发充血性心力衰竭(心衰)患者心室率的即时效应及安全性.方法46例房颤患者,心室率≥120次/min,心功能Ⅱ级以上(NYHA).采用随机方法分组,分别静脉应用普罗帕酮与毛花苷丙.结果普罗帕酮、毛花苷丙组控制房颤快速心室率的总有效率分别为810%和609%(P＜005);心室率平均下降幅度分别为35%和25%(P＜001);平均起效时间分别为(231±82)min和(507±104)min(P＜001).普罗帕酮有1例出现症状性低血压,1例出现第一度房室传导阻滞,无心衰加重表现.结论静脉应用普罗帕酮能迅速、安全、有效地控制房颤并发充血性心衰患者的快速心室率.     

单、复方阿米洛利对心力衰竭的保钾利尿作用

单、复方阿米洛利治疗心力衰竭109例,采用双盲、随机、分层自身及组间对照,疗程两周,分四个组:Ⅰ组阿米洛利5mg加氢氯噻嗪(双氢克尿塞)50mg/日;Ⅱ组阿米洛利5mg加氢氯噻嗪25mg/日;Ⅲ组阿米洛利10mg分2次服;Ⅳ组氨苯蝶啶50mg,每日3次。结果:四个组均有保钾利尿作用,但Ⅰ组利尿作用优于Ⅱ和Ⅲ组.Ⅲ组优于Ⅳ组(P<0.01及P<0.05)。Ⅲ组保钾作用较好,自身前后血钾P<0.05。四个组尿钾排出均较治疗前减少,自身对照P均<0.01。Ⅰ、Ⅱ、Ⅲ组中共7例治疗后室早消失。其中4例原有低钾心电图表现者亦恢复,故认为此药对心力衰竭保钾利尿作用良好。     

THYROTROPHIN RESPONSES TO INTRAVENOUS THYROTROPHIN-RELEASING HORMONE IN PATIENTS WITH HYPOTHALAMIC AND PITUITARY DISEASE

Plasma immunoreactive thyrotrophin (TSH) responses to synthetic thyrotrophin releasing hormone (TRH) have been measured in forty-five patients with pituitary or hypothalamic disease (largely non-functioning and functioning pituitary tumours) tested before and/or after ablative treatment. Subnormal TSH responses usually indicated impaired pituitary function but were less sensitive indices than those of human growth hormone (HGH) after hypoglycaemia. High basal TSH values with exaggerated rises after TRH were occasionally found with hypothyroidism and impaired HGH and cortisol secretion. Delayed TSH responses were indicative of hypothalamic disease in some cases, but in others were associated with pituitary tumours without overt hypothalamic disease. Normal TRH tests were found with hypothyroidism, while five abnormal tests (four delayed) were found in euthyroid patients. Patterns of TSH response to TRH in hypothalamic-pituitary disease are complex and their significance is not always clear.     

LH AND FSH SECRETION AND RESPONSES TO GnRH AND TRH IN PATIENTS WITH CLINICALLY FUNCTIONLESS PITUITARY ADENOMAS

Serum concentrations of LH and FSH and their response to the separate administration of GnRH (100 micrograms i.v.) and TRH (200 micrograms i.v.) have been studied preoperatively in 12 patients with a clinically functionless pituitary adenoma, of whom nine (3F: 6M) were found to secrete gonadotrophins in vitro. In three patients with a gonadotrophin-secreting adenoma (GSA) the pulsatile release of LH and FSH was also assessed preoperatively. An elevated serum FSH was recorded in six of nine patients with a GSA, and was subnormal in one, whilst an elevated LH was recorded in only two and was subnormal in six. A doubling of LH occurred in only four of the nine patients after GnRH and in three of six after TRH. None of the three patients with a non-GSA was shown to have an aberrant response to GnRH or TRH. In patients with a GSA, pulsatile release of LH and FSH was usually asynchronous and neither hormone demonstrated any regular harmonic pattern. These data show that in patients with a GSA the serum FSH level is usually elevated but this is not invariable, and the LH may well be low. Pathological responses of LH are frequently found following the administration of either GnRH or TRH and these stimulation tests should be performed separately in patients presenting with a clinically 'non-functioning' pituitary tumour to assist in the preoperative diagnosis. The absence of normal LH and FSH pulsing also appears to be a feature of GS adenomas, and suggests that tumorous gonadotrophin secretion is not under physiological control by hypothalamic GnRH.     

培哚普利治疗老年慢性心力衰竭的疗效观察

目的评价培哚普利在老年慢性心力衰竭(CHF)患者中应用的安全性及疗效.方法73例老年CHF患者,男50例,女23例,平均年龄63岁,心功Ⅱ～Ⅳ级,左室射血分数(LVEF)≤45%.从小剂量开始使用培哚普利,只要能耐受,递增至4～8mg/d,治疗中严密观察监测各项指标.结果平均随访时间20周,随访期间死亡4例,其中猝死2例,心力衰竭1例,非心脏原因死亡1例.治疗后心功能较治疗前明显改善[(2.04±0.66)比(3.04±0.63),P＜0.001];6min步行距离也有较明显改善[(330.11±18.32)m比(240.19±16.83),P＜0.01];超声心动图检查示左室舒张末径(LVEDD)和收缩末径(LVESD)减小[(61.07±9.86)mm比(63.76±10.10)mm和(47.20±11.06)mm比(51.59±10.97)m,P＜0.01];LVEF(%)明显增加[(43.80±10.40)%比(34.79±8.21)%,P＜0.01].本组患者治疗后血压略有下降,血钾略升高,但均在正常范围,血肌酐无明显变化.结论应用培哚普利治疗老年心力衰竭是安全的,并且能提高老年患者生活质量,改善心功能,增加LVEF.     

非肺心病与肺心病心力衰竭患者血浆内皮素－1浓度的对比研究

应用放射免疫方法测定４２例正常人和３３例非肺心病心力衰竭患者、２１例肺心病心力衰竭患者的血浆内皮素－１（ＥＴ－１）浓度。结果表明，与正常对照组相比，非肺心病心力衰竭组和肺心病心力衰竭组血浆ＥＴ－１浓度明显升高（Ｐ＜０．０００１），而两组心力衰竭之间则无显著性差异（Ｐ＞０．０５）。这证明，非肺心病心力衰竭和肺心病心力衰竭二者虽然在引发心力衰竭的病因不同，但共同表现为血浆ＥＴ－１浓度升高，提示血浆ＥＴ－１在参与两种心力衰竭病理生理过程中作用机制是相同的。     

充血性心力衰竭患者血浆一氧化氮、内皮素含量变化及其意义

目的 探讨充血性心力衰竭(CHF)患者血浆一氧化氮(NO)和内皮素(ET)含量变化及其关系。方法 检测65例CHF患者血浆NO和ET含量,另选30例健康体检者作为正常对照组。结果 CHF患者血浆NO和ET水平明显高于正常对照组(P<0.01)。且心衰程度越重,NO和ET水平越高。直线相关分析表明:NO与ET呈正相关(r=0.6457,P<0.001)。结论 血浆NO和ET水平增高是CHF病理生理特征之一。NO和ET共同参与CHF的发生发展过程。     

血、尿β_2微球蛋白测定在心力衰竭、高血压病中的意义

本文测定50例心力衰竭、37例高血压患者及30例正常人的血、尿β_2微球蛋白(β_2-MG)浓度。结果显示,两组患者的血、尿β_2-MG水平均显著高于正常人(P<0.001),随着心衰程度或高血压病程度加重,血、尿β-MG逐渐升高,血清β_2-MG与血肌酐高度正相关。提示血、尿β_2-MG可作为评价心功能损害和高血压性肾功能损害程度的客观敏感指标。     

充血性心力衰竭患者血浆儿茶酚胺水平与心功能的关系

本文报告26例充血性心力衰竭(心衰)患者血浆儿茶(?)胶水平与心功能的关系.结果显示:心衰患者血浆去甲肾上腺素、肾上腺素含量增高,且与心衰程度呈正相关。心衰患者血浆去甲肾上腺素水平与左室收缩时间间期舅定的PEP、PEP/LVET比值呈正相关,与LVET量负相关。血浆肾上腺素水平与射血前间期(PEP)、左室射血间期(LVET)、PEP/LVET比值无显著相关。     

充血性心力衰竭伴消化道症状患者的胃液体排空功能

观察了２７例充血性心力衰竭伴消化道症状患者的胃液体排空功能。结果发现，与正常人比较，心力衰竭患者胃排空时间延迟（２８．１２±６．３３ｍｉｎ比３５．３０±１０．２８ｍｉｎ，Ｐ＜０．０１），胃体收缩频率降低（Ｐ＜０．００１），血浆胃泌素水平较低。消化道症状及心力衰竭严重程度与胃排空障碍有关。说明胃动力学障碍是充血性心力衰竭患者产生消化道症状的机制之一。     

OESTROGEN MODULATION OF GONADOTROPHIN AND PROLACTIN RELEASE IN WOMEN WITH ANOVULATION AND THEIR RESPONSES TO CLOMIPHENE

An LHRH test was performed before and at both 44 and 92 h after the administration of 2.5 mg oestradiol benzoate in eleven patients with hyperprolactinaemia, eight with idiopathic secondary amenorrhoea and seven with oligomenorrhoea. The basal serum hormone concentrations and the responses to LHRH were compared with the same tests performed on ten normal subjects during the early follicular phase of their menstrual cycles (days 4--6). Mean basal concentrations of oestradiol in each group of patients and oestrone in those with hyperprolactinaemia were significantly lower than in the normal subjects. The mean concentration of prolactin in women with secondary amenorrhoea remained lower than in the normal women throught the tests (P less than 0.05). The LH and FSH responses to LHRH before oestrogen in patients with hyperprolactinaemia and of FSH in those with secondary amenorrhoea, were greater than in the normal subjects (P less than 0.001). After oestrogen treatment the responses were similar in all groups except in those with oligomenorrhoea where LH and FSH responses at 44 h (P less than 0.05 and P less than 0.01 respectively) and LH responses at 92 h (P less than 0.01) were lower than in normal controls. The responses at 92 h in all groups were greater than at 44 h (amplification) but the amplification at 92 h and at 44 h compared to the pre-treatment responses, tended to be lower in each group of patients compared to the normal controls. In the hyperprolactinaemic group of patients there was a negative correlation between the basal prolactin concentration and the gonadotrophin amplifications at 92 h (P less than 0.01), and a positive correlation between the basal oestrone levels and the amplifications at 92 h (P less than 0.01). The results of the oestrogen amplification test in eleven of the non-hyperprolactinaemic anovular patients were compared with the ovulatory response to 100 mg clomiphene given for 5 days. Six showed a normal oestrogen amplification and they all ovulated. Two patients failed to show greater amplification at 92 than at 44 h and required human chorionic gonadotrophin (HCG) as well as clomiphene to ovulate. The other three showed a diminished LH amplification at 92 h; they required 200 mg clomiphene and showed a prolonged follicular phase. The responses of the hyperprolactinaemic patients to clomiphene were poor and there was a negative correlation between prolactin concentration and oestrogen production (P less than 0.01). All ten hyperprolactinaemic patients treated with bromocriptine ovulated and eight conceived. The oestrogen amplification test appears to have some value in predicting the subsequent response to clomiphene in non-hyperprolactinaemic anovular women.