卡维地洛治疗充血性心力衰竭66例临床分析

目的:观察卡维地洛治疗充血性心力衰竭的疗效.方法:选择充血性心力衰竭(CHF)患者66例,随机分为常规治疗组(33例)和卡维地洛治疗组(33例),后者在常规抗心衰治疗基础上加用卡维地洛,两组治疗前和治疗6个月均使用超声心动图分别测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室射血分数(LVEF),并观察6min步行距离和心率变化.结果:CHF患者应用卡维地洛治疗后,LVEDD、LVESD和LVEF的改善均优于常规治疗组(P＜0.01),6min步行距离增加较常规治疗组更为显著(P＜0.01)、心率有所下降.结论:在心衰常规治疗基础上加用卡维地洛治疗CHF,可明显改善心功能.     

卡维地洛治疗慢性充血性心力衰竭患者的临床疗效

目的:探讨卡维地洛对慢性充血性心力衰竭(CHF)患者的症状、心功能、心室重构和细胞因子的影响。方法:随机选择CHF患者72例随机分为心力衰竭常规治疗组(n=34)和卡维地洛治疗组(n=38),后者在常规抗心力衰竭治疗基础上加用卡维地洛,剂量平均为12.5～37.5mg/次,2次/d,患者经治疗随访达6～12个月,观察两组治疗前和治疗后6个月、12个月,对患者症状、心室重构及心功能的影响,分别测定左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)和6min步行距离。测定健康对照组(n=35)和两组心衰患者治疗前和治疗6个月血浆肿瘤坏死因子(TNF-α)、B形脑钠尿肽(BNT)和白细胞介素-6(IL-6)的浓度。结果:CHF患者在强心、利尿和血管紧张素转换酶抑制剂治疗基础上,用卡维地洛治疗6、12个月后,能显著改善慢性心力衰竭患者的运动耐量、心功能和心室重构,LVEDD、LVESD、LVEF和6min步行距离的改善均优于常规治疗组(P<0.01,P<0.05)。心衰患者3种细胞因子血浆浓度均高于对照组(P<0.001),卡维地洛治疗后细胞因子的下降明显优于常规抗心力衰竭治疗(P<0.01)。结论:卡维地洛可明显改善CHF患者心功能,提高运动耐量,抑制左室重构,降低细胞因子TNF、BNT和IL-6的浓度。     

卡维地洛治疗充血性心力衰竭72例临床分析

目的：观察卡维地洛治疗充血性心力衰竭（CHF）的疗效和安全性。方法：选择CHF患者72例,随机分为心衰常规治疗组（35例）和卡维地洛治疗组（37例）,后者在常规抗心衰治疗基础上加用卡维地洛,从小剂量开始,渐增至最大耐受量,疗程6个月,两组治疗前和治疗3、6个月均使用超声心动图分别测定左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）和左心室射血分数（LVEF）,并观察6min步行距离,心率变化,记录不良反应。结果：CHF患者用卡维地洛治疗后,LVEDD、LVESD和LVEF的改善均优于常规治疗组（P〈0．01）,6min步行距离增加较常规治疗组更为显著（P〈0．01）、心率有所下降,但在治疗6个月后,心率稳定,治疗期间无严重不良反应出现。结论：在心衰常规治疗基础上加用卡维地洛治疗CHF,可明显改善心功能,提高运动耐量,缩小心室,改善左室重构。     

卡维地洛治疗慢性心力衰竭的临床疗效观察

目的:观察卡维地洛对慢性心力衰竭(心衰)的疗效.方法:选择80例慢性心力衰竭患者,按照纽约心脏病协会(NYHA)心功能分级标准分组,随机分为常规治疗组(40例)和卡维地洛治疗组(40例),前者应用血管扩张剂、利尿剂、ACEI和强心剂纠正心衰,后者在常规纠正心衰治疗基础上联合应用卡维地洛,两组在治疗后6个月超声心动图测定左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD),并测定6min步行试验(6-MWT).结果:在常规纠正心衰治疗的基础上应用卡维地洛,LVEF明显增加,LVESD、LVEDD明显缩小,6-MWT明显提高,心功能的改善明显优于常规治疗组(P<0.05).结论:在进行慢性心力衰竭的常规临床治疗中联合应用卡维地洛,可有效纠正血流动力学异常,提高运动耐量,改善心功能.     

卡维地洛、美托洛尔长期治疗老年慢性心力衰竭的疗效比较

目的 比较卡维地洛·美托洛尔长期治疗老年慢性心力衰竭(CHF)的疗效.方法 将82例NYHA心功能Ⅱ～Ⅳ级CHF老年患者随机分为两组:卡维地洛组40例,采用常规治疗(ACEI、利尿剂、血管扩张剂、洋地黄) 卡维地洛;美托洛尔组42例,采用常规治疗 美托洛尔.治疗12个月,观察两组治疗后左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)、左室射血分数(LvEF)及心功能变化.结果 两组治疗后LVEDD、LVESD、LVEF、心功能改善均较治疗前有显著改善(P<0.01);而卡维地洛组在LVEDD、LVESD、LVEF方面的改善上较美托洛尔组更明显(P<0.01),在心功能改善方面较美托洛尔组差异有统计学意义(P<0.05).两组均无不良反应发生.结论 长期应用卡维地洛治疗老年CHF的疗效优于美托洛尔.     

卡维地洛与美托洛尔治疗慢性充血性心力衰竭效果比较

目的:比较卡维地洛与美托洛尔治疗慢性充血性心力衰竭(CHF)的治疗效果。方法:将74例慢性CHF患者,随机分为卡维地洛组(观察组)37例 和美托洛尔组(对照组)37例,观察2组患者治疗后的心功能状态,以及左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)等变化。结果:2组患者心功能均明显的改善,而且对于血浆细胞因子以及逆转心脏的重塑也起到了良好的作用。观察组患者治疗后LVEF较对照组明显升高(P<0.01),LVEDD与LVESD下降程度均高于对照组(P<0.05和P<0.01)。结论:卡维地洛与美托洛尔均可有效改善慢性CHF患者的各种临床症状以及心功能,而且卡维地洛的效果更加明显。     

卡维地洛对慢性心力衰竭患者血清脂联素表达及心功能的影响

目的探讨卡维地洛对慢性心力衰竭(CHF)患者血清脂联素(APN)、有关心衰标志物表达及心功能的影响。方法选择行常规治疗的60例CHF患者为对照组,同期60例加用卡维地洛治疗的CHF患者为实验组,疗程6个月。观察治疗前后患者的心功能分级、超声心动图下左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室射血分数(LVEF)及酶联免疫法测定的血清APN、氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)水平变化。结果心衰患者的血清APN、NT-proBNP、cTnT水平随着NYHA分级增加而明显升高。治疗6个月后,实验组和对照组治疗总有效率分别为91.7%和73.3%,差异有统计学意义(P0.01)。治疗后两组患者LVEDD、LVESD均缩小,LVEF明显提高。治疗后,两组血清APN、NT-proBNP、cTnT水平均降低(P0.05),且实验组以上指标较对照组下降更为显著,差异有统计学意义(P0.05)。结论卡维地洛可以显著降低慢性心力衰竭患者的血清APN、NT-proBNP、cTnT水平,明显改善心功能。     

红花黄色素对老年慢性心力衰竭患者心功能及血浆胱抑素C、超敏C反应蛋白水平的影响

目的 观察红花黄色素对老年慢性心力衰竭(CHF)患者心功能及血浆胱抑素C(CysC)、超敏C反应蛋白(hs-CRP)水平的影响.方法 选择老年CHF患者90例,分为对照组和治疗组各45例,对照组给予常规抗心力衰竭治疗,治疗组在对照组基础上加用红花黄色素静脉滴注.于治疗前及治疗后4周,两组患者均行超声心动图检测左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF);两组患者行6min步行距离测试,检测两组患者血浆N-末端脑钠肽前体(NT-proBNP)、CysC及hs-CRP的水平变化.结果 治疗组总有效率(82.2％)高于对照组(60.0％)(P＜0.05).治疗4周后,两组患者6min步行距离较治疗前显著增加(P＜0.05),治疗组6min步行距离长于对照组(P＜0.05);治疗后两组患者LVEDD、LVESD及LVEF水平较治疗前改善,但差异无统计学意义(P＞0.05);治疗后两组患者血浆NT-proBNP、CysC 及hs-CRP水平较治疗前显著降低(P＜0.05),治疗组低于对照组(P＜0.05).结论 红花黄色素治疗老年CHF患者临床疗效显著,可有效改善患者的心功能,降低其血浆NT-proBNP、CysC及hs-CRP水平.     

卡维地洛治疗慢性充血性心力衰竭的疗效分析

目的:观察卡维地洛治疗慢性充血性心力衰竭(CHF)的临床疗效及安全性.方法: 60例心力衰竭患者分为卡维地洛组(36例)和常规组(24例).常规组应用血管紧张素转换酶抑制剂(ACEI)、利尿剂、洋地黄制剂.卡维地洛组在常规组治疗基础上加用卡维地洛,疗程6个月,观察治疗前后心率、血压、6min步行试验距离及心功能,进行疗效分析.结果:卡维地洛组心率、血压均较常规组明显降低,6步行试验距离增加,差异无统计学意义;卡维地洛组左室舒张末期内径 (LVEDD)、左室收缩末期内径(LVESD)显著低于常规组、左室射血分数(LVEF) 显著高于常规组.结论:卡维地洛治疗慢性心力衰竭明显改善心功能,耐受性好.     

卡维地洛对慢性心力衰竭患者血清IL-6、TNF-α及运动耐量的影响

目的:评价第三代非选择性β受体阻滞剂卡维地洛对慢性心力衰竭(CHF)血清中白介素-6(IL-6)、肿瘤坏死因子(TNF-α)水平及6min步行距离的影响.方法:将98例CHF患者分为常规抗心衰治疗组(48例)和在常规抗心衰治疗基础上加用卡维地洛组(50例),ELISA法测定所有CHF患者治疗前后血清IL-6、TNF-α水平,分析比较6min步行距离.结果:治疗前两组间各项指标比较差异无显著性(P＞0.05);治疗6个月后,常规治疗组治疗前后血清IL-6、TNF-α水平,6min步行距离差异无显著性,卡维地洛组各项指标治疗前后比较差异均有显著性(P＜0.05);治疗后卡维地洛组优于常规治疗组(P＜0.05).结论:卡维地洛可降低血清IL-6、TNF-α水平,显著改善心脏功能,对CHF疗效显著.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.