轻中度高血压合并早期肾损害脉压、脉压指数检测及意义

目的　探讨轻中度高血压患者早期肾损害与脉压、脉压指数的关系。方法　 10 0例轻中度高血压患者检测血、尿β2 MG及尿白蛋白同时计算脉压、脉压指数 ,根据有无肾损分组检测脉压、脉压指数差异 ;根据脉压、脉压指数分组检测血、尿β2 MG及尿白蛋白。结果　PP >6 0mmHg的高血压患者血 β2 MG (4 2 4± 1 18)mg/L ,尿 β2 MG (1 17±0 88)mg/L ,尿白蛋白 (2 4 8± 7 3)mg/L ;PP <6 0mmHg的高血压患者血 β2 MG(2 5 6± 1 34)mg/L ,尿 β2 MG(0 4 2±0 10 )mg/L ,尿白蛋白 (18 3± 4 7)mg/L ;PPI >0 6的高血压患者血 β2 MG (4 5 6± 1 2 3)mg/L ,尿 β2 MG (1 0 9±0 5 6 )mg/L ,尿白蛋白 (2 5 3± 4 5 )mg/L ;PPI <0 6的高血压患者血β2 MG(2 4 9± 1 0 9)mg/L ,尿 β2 MG(0 33± 0 0 9)mg/L ,尿白蛋白 (17 4± 3 3)mg/L。结论　高血压合并早期肾损害患者脉压、脉压指数明显升高。     

Ambulatory blood pressure monitoring (ABPM) in nonagenarians

The objective of the study is to investigate ambulatory blood pressure monitoring (ABPM) in a sample of Spanish nonagenarians. We also analyzed the misdiagnosis of hypertension and investigated blood pressure (BP) control in treated hypertensive nonagenarians. Twenty-four-hour ABPM was undertaken in a group of 42 nonagenarians. The 24-h mean, daytime BP, nighttime BP and heart rate (HR) were extracted from the ABPM. Sociodemographic data, the ability to perform basic daily activities, measured by the Barthel index (BI) or instrumental activities revealed by the Lawton and Brody index (LI), cognition, and comorbidity were evaluated. Thirty-one subjects were receiving antihypertensive drug treatment. Twenty-four hour, daytime and sleeping pressures averaged 130/65, 131/68 and 128/63mmHg, respectively. Seventeen (40.5%) of the 42 patients had a daytime BP of 135/85 or higher. In terms of the BP pattern, 8 (19%) subjects were dippers, 19 (45%) non-dippers, and 15 (36%) were risers. Five (45.46%) out of 11 patients with no evidence of hypertension (normotensive patients) had a daytime BP of 135/85 or higher. The mean daytime BP was 135/85 or higher in 12 (38.7%) out of 31 nonagenarians who had previously received therapy for hypertension. In, conclusion a high prevalence of hypertension, misdiagnosis and inadequate BP control was found in nonagenarians treated for hypertension.     

Localized pressure pain in the diagnosis of generalized tendomyopathy (fibromyalgia)

56 tender points were examined in 100 patients and 50 age- and sex-matched healthy volunteers using a dolorimeter. 24 of the 56 points were especially selected according to ability of discrimination, best possible distribution on the body, and easy localization. All 56 points as well as the 24 specially selected points were examined as to their sensitivity and specificity in the diagnosis of generalized tendomyopathy. The sensitivity and the specificity for both point-combinations were acceptable. The sensitivity and specificity of the 24 points were superior to the 56 points in the case of discrimination ability. A 100% sensitivity and specificity could not, however, be achieved. It remains to be considered if functional and vegetative symptoms must still be used to support the diagnosis of generalized tendomyopathy (fibromyalgia).     

Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET)

To report blood pressure control in the Hypertension in the Very Elderly Trial, a placebo-controlled trial of hypertensive (systolic blood pressure (SBP) 160-199?mm?Hg, diastolic blood pressure (DBP) <110?mm?Hg) participants over the age of 80 years, given treatment in three steps: indapamide slow release 1.5?mg alone, indapamide plus 2?mg perindopril and indapamide plus 4?mg perindopril. The difference in control between participants with combined systolic and diastolic hypertension (SDH, DBP90?mm?Hg) and those with isolated systolic hypertension (ISH, DBP<90?mm?Hg) is determined together with the effects of increments in the treatment regimen. At 2 years, the active treatment lowered blood pressure by 16.5/6.9?mm?Hg more than that on placebo in participants with SDH and by 19.3/4.8?mm?Hg more in those with ISH. The 2-year falls in pressure on placebo alone were 13.2/8.5?mm?Hg in SDH and 8.2/1.5?mm?Hg in ISH participants. With full titration of active treatment, 62% of SDH participants achieved goal SBP (<150?mm?Hg) by 2 years and 71% of those with ISH. The corresponding results for DBP control (<80?mm?Hg) were 40 and 78%. The addition of active perindopril 2?mg roughly doubled the percentage controlled, as did increasing to 4 from 2?mg. Blood pressure control was good with ISH and better than with SDH. The fall in SBP accounted for the observed 30% reduction in strokes, but the 21% reduction in total mortality and 64% reduction in heart failure were greater than predicted.     

Continuous measuring of intracranial pressure (ICP) via epidural pressure transducer (author's transl)]

Continuous epidural monitoring of ICP was performed on 20 patients during a 6 day's period with the model 77450 of Philips. A significant decrease of intracerebral pressure after application of sorbitol and dexamethasone could be demonstrated. Comparing the very low rate of complications with the resulting advantages, the described method can be recommended for controlled treatment of elevated ICP.     

Comparison of the oscillometric blood pressure monitor (BPM-100(Beta) ) with the auscultatory mercury sphygmomanometer

BACKGROUND: To compare directly the accuracy of the BPM-100(Beta) monitor (an automated oscillometric blood pressure device) with standard auscultatory mercury sphygmomanometry. DESIGN: The BPM-100(Beta) was connected in parallel via a T-tube to a mercury sphygmomanometer. The BPM-100(Beta) and two trained observers (blinded from each other and from the BPM-100(Beta)) measured the sitting blood pressure simultaneously. METHODS: Means, standard deviations and ranges were calculated for all the demographic data: age, arm size, heart rate and blood pressure. The agreement between the BPM-100(Beta) and the mean of two observers (the reference) was determined and expressed as the mean +/- SD, as well as the percentage of differences falling within 5, 10 and 15 mmHg. RESULTS: Of the 92 subjects recruited, 85 (92.4%) met the inclusion criteria, and 391 sets of sitting blood pressure and heart rate measurements were available for analysis. The mean difference between the BPM-100(Beta) monitor and the reference was -0.62 +/- 6.96 mmHg for systolic blood pressure, -1.48 +/- 4.80 mmHg for diastolic blood pressure and 0.14 +/- 1.86 beats/min for heart rate. The only limitation of the device was its tendency to underestimate higher systolic blood pressures. This problem has been addressed by a minor change in the algorithm (see the companion publication, Blood Press Monit, 6, 161-165, 2001). CONCLUSION: The BPM-100(Beta) is an accurate blood pressure monitor for the office setting, meeting all requirements of the Association for the Advancement of Medical Instrumentation and achieving an 'A' grade according to the British Hypertension Society protocol.     

Evaluating oronasal flow with temperature (thermistor) and obstructive pressure (prongs)

The measurement of oronasal flow during sleep studies using thermistors is internationally well accepted. As an alternative the possibility exists to measure the pressure at the nose by means of nasal prongs. Our objective was to compare and evaluate the methods to detect respiratory events in clinical routine, namely O2-saturation by pulse oxymetry oronasal flow by thermistors thoraco-abdominal effort by belts oronasal flow by prongs, 8 consecutive patients suspected of sleep apnoea syndrome (7 m, 1 f), mean age 56.5 +/- 9.5 years, height 173 +/- 6.4 cm, BMI 28.7 +/- 2.6 kg/m2, Epworth sleepiness scale score 9.1 +/- 3.2, AHI 24.9 +/- 13.7 h-1, lowest SaO2 86 +/- 4.9%, were examined. Between nose and mouth we fixed an oronasal 3-point thermistor and oronasal prongs (2 openings at the mouth and 2 openings at the mouth applying a common tube). During breathing the resulting pressure was registered with a pressure transducer parallel to the signal of the thermistors and the other polysomnographic data. We defined a respiratory event if at least one of the 4 signals met the criteria of a respiratory disturbance (for exact definitions see method). The detection rate of the 4 signals was calculated in relation to the sum of all events. Of the 1824 events (100%) only 52.3% were detected by an O2-desaturation of more than 4%, but 61.0% by thermistors. An acceptable detection rate was found measuring effort with 83.4%, only nasal prongs detected 95.1% of all events. We conclude that with regard to the detection rate of respiratory events the measurement of pressure by nasal prongs is superior to the use of thermistors.     

Twenty-four hour ambulatory blood pressure in the Hypertension Optimal Treatment (HOT) study

BACKGROUND AND AIMS: The Hypertension Optimal Treatment (HOT) study showed that when antihypertensive treatment reduces diastolic blood pressure well below 90 mmHg, there can be a further reduction of cardiovascular events, particularly myocardial infarction, with no evidence of a J-shaped curve at lower pressures. Office measurement, however, gives no information about blood pressure outside the office. This paper describes a HOT substudy in which patients underwent both office measurement and 24 h ambulatory blood pressure monitoring. METHODS: The mean age of the substudy population was 62 +/- 7 years. Substudy patients were treated for a median period of 2 years. All received the dihydropyridine calcium antagonist felodipine, while some also received an ACE-inhibitor, a beta-blocker or a diuretic. Average 24 h, day and night ambulatory blood pressure values were computed at baseline (n = 277) and during treatment (n = 347): 112 patients had been randomized to a target office diastolic blood pressure 相似文献   

Synchronized nasal intermittent positive pressure ventilation (SNIPPV) decreases work of breathing (WOB) in premature infants with respiratory distress syndrome (RDS) compared to nasal continuous positive airway pressure (NCPAP)

Synchronized nasal intermittent positive pressure ventilation (SNIPPV) is non-invasive respiratory support that delivers ventilator breaths via the nasal prongs. We hypothesized that SNIPPV is more effective than nasal continuous positive airway pressure (NCPAP) in premature neonates due to decreased work of breathing (WOB). Fifteen infants (BW: 1,367 +/- 325 g, GA: 29.5 +/- 2.4 weeks) were studied on (a) NCPAP at 5 cmH(2)O (NCPAP5) and (b) three increasing SNIPPV settings achieved by NCPAP5 with additional delivered peak inspiratory pressures (PIP) of 10, 12, and 14 cmH(2)O. Tidal volumes and transpulmonary pressures were estimated via calibrated respiratory inductance plethysmography (RIP) and esophageal pressures, respectively. Inspiratory (WOB(insp)), resistive (RWOB), and elastic (WOB(E)) components of WOB were calculated using standard methods. Compared to NCPAP5, (a) WOB(insp) and RWOB were significantly lower with SNIPPV12, and were similarly lower with SNIPPV14 and (b) WOB(E) was significantly lower only with SNIPPV14. WOB components did not differ significantly for the three SNIPPV settings. Tidal volume, respiratory rate (RR), minute ventilation, compliance, and phase angle were similar for all four measurements. In conclusion, compared to NCPAP, the addition of ventilator-delivered PIP during SNIPPV decreases WOB in premature infants.     

Postural changes in blood pressure in the general population of Cantabria (northern Spain)

OBJECTIVE: To describe the postural changes in blood pressure and correlates among the general population of Cantabria, a region in the north of Spain. METHODS: Between 2002 and 2004 blood pressure measurements were taken in a seated position and after 1 and 3 min standing on a random sample of 1178 individuals aged 18 years and above, stratified by age and sex. RESULTS: The prevalence of orthostatic hypotension was 7%, whereas 30% of the participants presented an exaggerated increase in blood pressure when standing and 36% presented one of the two alterations (postural dysregulation in blood pressure syndrome). Sixteen percent of the nonhypertensive participants presented a blood pressure figure when standing that was above or equal to 140/90 mmHg (orthostatic hypertension). In logistic regression analysis the existence of a high level of blood pressure when sitting was the only variable related to orthostatic hypotension (odds ratio: 2.407; confidence interval: 1.413-4.099). CONCLUSION: When evaluating and treating hypertensive patients, it should be taken into account that orthostatic hypotension is more frequent among those individuals who present poor levels of control of their blood pressure figures. Postural dysregulation in blood pressure syndrome is frequent among the general population, and therefore it is worthy of detailed study.     

Intraocular pressure change after laser in situ keratomileusis (LASIK)

To analyze the relationship between change in intraocular pressure (IOP) after laser in situ keratomileusis (LASIK), and preoperative central-corneal thickness (CCT), and central-corneal ablation depth (CCAD), a prospective study was conducted of 30 patients (60 eyes) with myopia or myopic astigmatism who underwent LASIK and who were followed up for a mean of 6 months. The parameters evaluated included IOP 1 week preoperatively and 3 months postoperatively, pre- and postoperative CCT, and CCAD; in addition, the anterior ocular segment and the fundus were examined, as was the apparent and cycloplegic refraction. There were 11 male patients and 19 female patients (mean age, 28.3 years) involved in the study. Mean IOP readings were 14.9 mmHg 1 week preoperatively, and 8.3 mmHg 3 months postoperatively; thus, the mean decrease in IOP after LASIK was 6.6 mmHg. Mean values for preoperative CCT, postoperative CCT, and CCAD were 537.2+/-34.7 microm, 434.0+/-32.5 microm, and 101.6+/-23.90 microm, respectively. IOP correlated with CCT both pre- and postoperatively. The mean change in IOP after LASIK for myopia and myopic astigmatism was statistically significant, but did not correlate with CCAD or age. We postulate that CCAD is not a significant predictor of IOP after LASIK.     

Respiratory resistance and intrinsic positive end-expiratory pressure (PEEPi) in patients with the adult respiratory distress syndrome (ARDS)

Fourteen consecutive ARDS patients were examined within 24 h from the onset of mechanical ventilation to determine respiratory resistance (Rrs) and compliance (Cstrs), and to assess the influence of "intrinsic" positive end-expiratory pressure (PEEPi) on the measurement of Cstrs. Flow, pressure, and changes in lung volume were measured with the transducers of the Servo 900C Siemens ventilator. Airway occlusion was performed with the end-inspiratory and end-expiratory buttons of the ventilator. We found PEEPi (3.0 +/- 2.6 cm H2O) in ten of the fourteen patients. Without the correction for PEEPi, Cstrs was underestimated by 13.9 +/- 10% on average in the group as a whole (fourteen patients), and by 19.5 +/- 5.9% in the ten ARDS patients with PEEPi. Maximum and minimum respiratory resistance (Rrsmax and Rrsmin), and frequency-dependence of Rrs were also measured. On average, there was a marked frequency-dependence of resistance, as manifested by the difference between Rrsmax and Rrsmin, with an increase of both Rrsmin (7.7 +/- 4.2 cm H2O.l-1.s) and Rrsmax (14.3 +/- 5.0 cm H2O.l-1.s). The added resistance of the endotracheal tubes and ventilator tubings was flow dependent, and averaged 13.2 +/- 2.9 cm H2O.l-1.s.(ABSTRACT TRUNCATED AT 250 WORDS)