单硝酸异山梨酯致老年人游走性关节红肿1例报告

1　病例患者女 ,88岁 ,于 2 0 0 1年 3月 13日因发作性胸闷、心悸、气短 4月 ,加重 1周 ,以冠心病、心功能不全入院。既往冠心病 10余年 ,否认糖尿病、关节炎及痛风病史。入院体检 :体温 3 6 4℃ ,脉搏 84次·ｍｉｎ 1,血压 14 0 /80ｍｍＨｇ ,神志清 ,双肺呼吸音清 ,心律齐 ,心率 84次·ｍｉｎ 1,腹平软 ,肝脾肋下未触及 ,双下肢轻度浮肿 ,血常规 :白细胞 8 3× 10 9·Ｌ 1,中性 0 70 ,淋巴 0 3 0 ,心电图Ｖ3 ～Ｖ6导联ＳＴ Ｔ段下移大于 0 1ｍＶ。Ｔ波低平 ,心脏超声检查 :主动脉瓣及二尖瓣轻度返流 ,主动脉硬化 ,左室舒张功能减低 ,甲…     

单硝酸异山梨酯静滴治疗老年冠心病探讨

目的探讨单硝酸异山梨酯静滴治疗老年冠心病患者的实际效果。方法选取2013年06月~2014年06月我院收治的老年冠心病患者80例,按随机数字表法将其分成实验组40例,对照组40例,实验组病例应用单硝酸异山梨酯治疗,对照组病例应用硝酸异山梨酯治疗,比较临床疗效。结果治疗后,实验组SV为（62.21±14.02）ml/次,LVEF为（0.31±0.13）,临床症状控制有效率为90.0%,与对照组相比,差异有统计学意义（P〈0.05）。结论单硝酸异山梨酯静滴治疗老年冠心病,效果佳,安全性高,值得临床进一步应用。     

静脉滴注单硝酸异山梨酯治疗冠心病心绞痛的临床疗效观察

目的探讨静脉滴注单硝酸异山梨酯治疗冠心病心绞痛的临床疗效及不良反应。方法以我院76例冠心病性心绞痛患者为研究对象,将其随机分为观察组和对照组,分别采用静脉滴注单硝酸异山梨酯与静脉滴注硝酸甘油进行对比治疗,观察疗效。结果观察组总有效率为94.7%,对照组总有效率为78.9%,两组疗效比较,差异有统计学意义(P<0.05)。结论单硝酸异山梨酯静脉滴注治疗冠心病心绞痛疗效显著,吸收好、生物利用度高,较硝酸甘油作用时间长而不良反应少,值得在临床推广使用。     

单硝酸异山梨醇酯致老年低血压的临床分析

目的对单硝酸异山梨醇酯缓释片导致老年低血压进行分析,以便更好的进行防治。方法对8例因鼻饲单硝酸异山梨醇酯缓释片后,导致低血压状态的老年患者的临床特点、救治情况进行分析,并与同期相同方式用药未出现低血压的9例患者进行对比分析。结果 8例患者均为60 mg/日,用药后出现低血压,6例患者使用多巴胺升压、扩容等综合治疗后好转,严重1例并发急性心肌梗死及急性肾功能衰竭,经机械通气等抢救好转。与非低血压组比较,病情不稳定、单硝酸异山梨醇酯用药剂量大、时间长、并用降压药物、近期鼻饲给药比例较高,差异有统计学意义(P0.05)。结论高龄老年患者尤其是病情不稳定、并用降压药物、近期鼻饲使用高剂量单硝酸异山梨醇酯缓释片容易出现低血压,甚至可导致严重并发症。     

5-单硝酸异山梨酯治疗心肌缺血42例

我科自1995年4月至1996年3月用山东鲁南药厂生产的鲁南欣康片(5-单硝酸异山梨酯IS-5-MN)治疗心肌缺血42例，观察结果如下。     

单硝酸异山梨酯注射液治疗充血性心力衰竭80例

目的 观察单硝酸异山梨酯注射液治疗充血性心力衰竭(CHF)的临床疗效.方法 对照组(82例)用常规治疗方法,即强心、利尿,扩血管等治疗.治疗组(80例)在常规治疗方法的基础上加用单硝酸异山梨酯注射液100 mL静脉输注,每日1次,7 d为1个疗程.结果 经治疗(1～2)个疗程后,治疗组总有效率97.5%,对照组为76.8%.结论 单硝酸异山梨酯治疗CHF安全有效.     

丹参冻干粉与单硝酸异山梨酯治疗肺心病疗效观察

目的 探讨丹参冻干粉与单硝酸异山梨酯治疗肺心病的临床疗效.方法 选择我院2009年1月-2011年7月100例肺心病患者为研究对象,随机将100名患者分成治疗组与对照组,每组个50例,对照组在常规治疗的基础上单纯应用单硝酸异山梨酯,治疗组在对照组的基础上应用丹参冻干粉,比较两组的临床疗效及治疗前后的心功能变化.结果 治疗组的临床疗效及治疗前后心功能变化均明显优于对照组.结论 丹参冻干粉与单硝酸异山梨酯治疗肺心病的临床疗效肯定,应在临床推广应用.     

注射用单硝酸异山梨酯协同低分子右旋糖酐对合并急性右室心肌梗死患者低血压的治疗作用

目的探讨单硝酸异山梨酯（商品名：欣奥星，海口康力元制药有限公司生产）对急性心肌梗死合并右室梗死患者低血压的治疗作用。方法选择符合急性心肌梗死合并右室梗死诊断标准的住院患者98例，其中合并低血压的患者75例，随机分为治疗组（加用单硝酸异山梨酯＋低分子右旋糖酐）和对照组（未使用单硝酸异山梨酯，单用低分子右旋糖酐），比较两组使多巴胺持续时间及使用的最大浓度，观察床临症状改善情况。结果治疗组与对照组相比，使用单硝酸异山梨酯可缩短多巴胺的维持时间（P〈0．05），并使多巴胺的最大使用浓度减低（P〈0．05），临床症状改善显效率高。结论在急性心肌梗死合并右室梗死患者出现低血压并发症时配合使用单硝酸异山梨酯是安全有益的，可以达到更好的治疗效果。     

葛根素并单硝酸异山梨酯治疗冠心病心绞痛的疗效观察

目的探讨葛根素并单硝酸异山梨酯（理新彤）对冠心病心绞痛的治疗效果。方法将50例冠心病心绞痛患者随机分成两组。分别为观察组（葛根素并理新彤）和对照组（理新彤）。结果和对照组相比较，治疗组患者的临床症状和心电图改变明显改善（P〈0．01）。结论葛根素并理新彤联合治疗冠心病心绞痛比单独应用理新彤更为有效。     

二羟丙茶碱联合单硝酸异山梨酯治疗慢性肺心病60例疗效观察

近2年笔者用二羟丙茶碱联合单硝酸异山梨酯治疗慢性肺心病患者60例,取得了较好疗效.     

Inhibition of vascular oxidative stress in hypercholesterolemia by eccentric isosorbide mononitrate

OBJECTIVES: We sought to determine if the nitric oxide (NO) donor isosorbide mononitrate (ISMN) (200 mg/kg body weight/day) decreases vascular bioavailability of superoxide in atherosclerosis. BACKGROUND: Vascular oxidative stress limits the bioavailability of endothelial NO and promotes atherosclerosis, while NO itself exerts antioxidative effects. It is unknown if therapeutic NO impacts on vascular oxidative stress in atherosclerosis. METHODS: New Zealand white rabbits (n = 10 each group) were fed either normal chow (control), cholesterol chow (CHOL) (0.75%), or cholesterol chow enriched with ISMN (CHOL-ISMN). Rabbits were fed twice daily. After 16 weeks we used aortic segments to measure vascular superoxide (5-microM lucigenin), intimal lesion formation, and vasoreactivity to acetylcholine (ACH) and ISMN. RESULTS: Plasma cholesterol increased by 40-fold in CHOL and CHOL-ISMN. The plasma concentration of ISMN in CHOL-ISMN was 1,529 +/- 447 ng/ml. Superoxide formation (control: 228 +/- 20 counts/20 min/mg) was strongly enhanced in CHOL (345 +/- 46 counts/20 min/mg, p = 0.02) but not in CHOL-ISMN (229 +/- 23 counts/20 min/mg) demonstrating antioxidative effects of eccentric ISMN in vivo. In parallel, intima-media thickness of thoracic aorta (159 +/- 4 microm in control) was reduced from 645 +/- 41 microm (CHOL) to 440 +/- 51 microm (CHOL-ISMN, p < 0.05). Likewise, eccentric ISMN partially restored vascular responses to the NO donor S-nitroso-N-acetyl-D,L-penicillamine and improved endothelium-dependent vasorelaxation. The maximal ACH relaxation increased from 26.3 +/- 9.6% in CHOL to 49.7 +/- 8.1% in CHOL-ISMN; ISMN treatment induced a moderate nitrate tolerance as evidenced by diminished ISMN-induced vasodilation. CONCLUSIONS: These data suggest that eccentric ISMN can completely inhibit the increase of vascular bioavailability of superoxide and partially prevent intimal lesion formation and endothelial dysfunction in hypercholesterolemia.     

鲁南欣康导致腹泻一例报告

患者,女,６４岁,因劳累后心前区憋闷２年,加重１周入院。患者自２年前开始出现劳累后心前区憋闷,持续数分钟,休息后媛解,未行治疗。１周来,心前区憋闷程度加重,频率增加,须舍服“速效救心丸”才缓解,查体心肺腹未见异常。心电图示：Ｖ１—Ｖ４导联ＳＴ段下压＞０．１ｍｍ。诊断为不稳定性心绞痛。给予鲁南欣康２０ｍｇ,３／日,口服：２０ｍｇ入５００ｍｌ极化液静点,１／日;另给予抗凝等治疗。治疗３天后开始出现腹泻,５－７次／日,水样便,无脓血,不伴发热及里急后重,便常规未见异常,给予保护肠粘膜、止泻治疗５天,效…     

Efficacy of continuous intravenous drip infusion of disopyramide in hypertrophic obstructive cardiomyopathy during cardiogenic shock: a case report

A 54-year-old woman was admitted to our hospital complaining of dyspnea due to hypertrophic obstructive cardiomyopathy. On admission, she was treated with 4 antiarrhythmic drugs and 2 beta-blockers. After 4 of these 6 drugs were withdrawn, the left ventricular outflow pressure gradient markedly increased and then she fell into cardiogenic shock. Therefore, disopyramide(600 mg/day) was administered by continuous intravenous drip infusion to reduce the left ventricular outflow pressure gradient. After intravenous administration of disopyramide, the left ventricular outflow pressure gradient markedly decreased from 100 to 16 mmHg and the cardiogenic shock could be improved. Continuous intravenous drip infusion of disopyramide is effective for the treatment of cardiogenic shock due to severe left ventricular outflow obstruction in patients with hypertrophic obstructive cardiomyopathy.     

Whipple's disease complicated by a retinal Jarisch-Herxheimer reaction: a case report.

A 36 year old white man was diagnosed as having Whipple's disease after a prolonged illness of lethargy, night sweats, and weight loss associated with lymphadenopathy and splenomegaly. Biopsy specimen of an inguinal lymph node confirmed the presence of periodic acid Schiff positive macrophages and culture gave a pure growth of Corynebacterium jeikeium. Twelve hours after the introduction of oral co-trimoxazole and streptomycin the patient's condition deteriorated. He became confused, feverish, and developed florid retinal vasculitis with associated visual impairment. Both the systemic symptoms and the retinal vasculitis responded to treatment with corticosteroids and his vision returned to normal. We think this was a Jarisch-Herxheimer reaction not previously described in Whipple's disease and advise inspection of the fundi of such patients before starting treatment.     

Primary prophylaxis of variceal hemorrhage: a randomized controlled trial comparing band ligation,propranolol, and isosorbide mononitrate

BACKGROUND & AIMS: This randomized controlled trial compared variceal band ligation (VBL), propranolol (PPL), and isosorbide-5-mononitrate (ISMN) in the prevention of first esophageal variceal bleed. METHODS: Over a 6-year period, 172 patients with cirrhosis, grade II or III esophageal varices that had never bled, were recruited; 44 into VBL, 66 into PPL, and 62 into ISMN. Baseline patient characteristics: age, 55 +/- 11 years; Child-Pugh score, 8 +/- 2; 65% alcohol-induced cirrhosis; follow-up period, 19.7 +/- 17.6 months (range, 0.13-72.1 months), were comparable in the 3 groups. RESULTS: On intention-to-treat analysis, variceal bleeding occurred in 7% of patients randomized to VBL, 14% to PPL, and 23% to ISMN. The 2-year actuarial risks for first variceal bleed were 6.2% (95% confidence interval [CI], 0.0%-15.0%) for VBL, 19.4% (95% CI, 0.1%-32.4%) for PPL, and 27.7% (95% CI, 14.2%-41.2%) for ISMN. A significant number of patients reported side effects with drug treatment (45% PPL and 42% ISMN vs. 2% VBL; P = 0.00), resulting in withdrawal from treatment in 30% of PPL and 21% of ISMN patients. There were no statistically significant differences in mortality rates in the 3 groups. In as-treated analysis, there was a statistically significant difference in actuarial risk for bleeding at 2 years between VBL and ISMN (7.5%, 95% CI, 2.5%-10.6% vs. 33.0%, 95% CI, 15%-49%, respectively, log rank test P = 0.03) but not between VBL and PPL. CONCLUSIONS: VBL was equivalent to PPL and superior to ISMN in preventing first variceal bleed. The side-effect profile for pharmacotherapy was considerable.