上海某社区高血压人群抗高血压药物的应用分析

目的 调查社区高血压人群抗高血压药物的应用情况,分析不合理因素,指导社区临床用药.方法 采用分层整群抽样方法,于2009年4月至6月对上海大华社区中3个居委和1个村的703例高血压患者进行问卷调查,对用药品种、类型、联合用药及合理性进行分析.结果 在703例资料完整的高血压患者中,582例在服用高血压药物（82.8%）,其中271例单用非复方制剂者治疗（38.5%）,182例单用复方制剂（25.9%）,2种药物联用的117例（16.8%）,3种药物联用的12例（1.6%）.包含单用复方制剂者在内合计有311例（53.4%）在服用2种及以上药物.服用钙离子拮抗剂（CCB）的患者266例,占服药人数的47.5%,服用复方制剂的205例,占35.2%.结论 联合用药比例明显高于单一用药,三联治疗中遵循高血压防治指南较少;CCB在社区高血压人群用药中占主导地位;非长效复方制剂使用比例较高;建议加强社区医生高血压用药规范性的培训和高血压患者的社区管理.     

社区高血压人群抗高血压药物应用分析

目的调查社区高血压人群抗高血压药物的应用情况,以指导规范用药。方法采用问卷调查方法,于2009年3月—8月对我院所管辖的社区452例高血压患者进行相关病史资料搜集及问卷调查,对用药名称、类型,联合用药等进行分析。结果在452例高血压患者中,343例患者服用降血压药物(75.88%),其中151例单用非复方制剂(44.02%),89例采用2种药物联用(25.95%),11例采用3种药物联用(3.21%),采用复方制剂92例(26.82%)。服用钙离子拮抗制剂(CCB)184例(53.64%),血管紧张素转换酶抑制剂(ACEI)61例(17.78%),血管紧张素Ⅱ受体拮抗剂(ARB)66例(19.24%),β受体阻滞剂51例(14.86%)利尿剂11例(3.2%),氨氯地平及复方降压片处于排序前两位。结论规范社区高血压患者降压药物的合理应用,可以干预各种危险因素,提高降压效果,减少并发症的发生。     

成都社区医生高血压防治知识及社区高血压治疗现状

目的了解成都社区医生高血压防治知识及社区高血压治疗现状。方法成都市80％城区社区医生现场答卷调查高血压相关知识;随机整群抽样选取成都市城区、城乡结合区及1个县级社区卫生机构覆盖的人群作基线调查。结果55．8％医生知道〉35岁首诊须测血压,52．9％的社区医生知道中国高血压指南。21．4％医生接受过指南相关内容培训。社区高血压治疗的特点为：单药治疗比例高36．2％,老式复方制剂使用比例高29．22％,非正规物理治疗（仪器、磁疗等）比例高9．82％,联合用药比例低10．33％。社区医生对老式固定复方制剂缺乏了解但使用多。结论社区医生高血压防治知识有待提高。社区高血压治疗需规范和优化。     

社区高血压人群抗高血压药物的利用情况、依从性及影响因素

目的 了解实际自然人群中抗高血压药物的分布和使用情况。方法 利用抗高血压药物的用药监测系统,统计高血压人群中各类抗高血压药物的使用情况和依从性;对依从性的影响因素进行非条件logistic回归分析。结果 社区高血压病有2522例,未用药539例（占21．37％）,不规则服药1059例（占41．99％）,规则服药924例（占36．64％）,（单一服药375例,联合服药549例）;单独服用复方降压片173例,单独服用硝苯地平108例,单独服用其他药物94例;复方降压片与硝苯地平联合服用（复方降压片＋硝苯地平）252例,卡托普利与硝苯地平联合服用（卡托普利＋硝苯地平）132例,其他联合用药165例。结论 社区人群抗高血压药物服药依从性低。吸烟、心脑血管病是主要不规则服药的独立危险因素;知识得分、非药物治疗、发病时间长是主要不规则服药的独立保护因素;吸烟、心脑血管病是主要未服药的独立危险因素;知识得分高、非药物治疗、发病时间长、有经济来源是主要未服药的独立保护因素。     

高校社区高血压管理模式的探讨

目的：探索高血压等慢病有效的社区管理模式。方法：依“社区高血压防治指南”的要求，参照卫生局下发的慢病管理软件，开发适合本中心高血压患者的随访管理监测系统及相关管理软件。以全科医生、全科护士、防保科人员共同组成管理团队。结果：应用慢病管理系统有效进行高血压患者分级、分层及并发症的管理，随访669例，优良319例（49．7％）、尚可99例（15．5％）。调查1000例，高血压知晓率60．5％，高血压危险因素知晓率83．5％，高血压用药知晓率62．7％，高血压防治知识知晓率86．00％。结论：社区高血压自我管理模式可以明显提高患者的知晓率、高血压的控制率。     

上海市杨浦区某社区卫生服务中心门诊高血压患者药物治疗方案分析

根据上海市杨浦区长白社区卫生服务中心数据库中2009年所有高血压患者使用的降压药物,整理出患者降压治疗方案,剔除所有治疗方案不确定者（包括换药过频方案不确定者及偶尔来本中心就诊尚不能确定方案者）,进行统计分析。结果显示,4102例高血压患者药物使用情况为：钙拮抗剂（CCB）占45．6％,血管紧张素转换酶抑制剂（ACEI）占16．0％,血管紧张素受体拮抗剂（ARB）占3．6％,B受体阻滞剂占9．0％,利尿剂4．7％,复方制剂占21．1％。降压方案为：使用单药的占68．0％,二联用药的占29．3％,三联用药的占2．6％,四联用药的占0．1％,其中二联用药方案中以CCB为基础的占75．8％,三联及四联用药方案均以CCB为基础组合而成。提示,本社区门诊高血压患者使用降压药物种类和联合降压方案基本符合国际高血压治疗指南,但是单一降压药物使用比例较高,联合降压的比例仍偏低。     

甘肃省二级（县级）医院高血压治疗用药现状调查

目的了解甘肃省二级（县级）医院高血压治疗用药现状,找出高血压治疗过程中存在的不足,进一步规范治疗,提高我省高血压控制率。方法通过邮寄调查表的方式调查我省70家二级医院（心）内科医师对高血压患者的危险分层掌握程度。非药物治疗,药物使用品种、剂量、剂型以及相关危险因素治疗用药情况。结果高血压常用降压药物品种较单一,药物使用剂量较2005年《中国高血压防治指南》推荐的靶剂量亦显不足,长效制剂使用率较低。结论我省二级医院医师在高血压用药品种、使用剂量、长效制剂使用等方面与《中国高血压防治指南》仍有一定差距,高血压治疗用药水平有待提高。     

河南省某农村高血压患者用药状况调查

目的：了解河南省某农村地区高血压患者用药状况。方法：采用随机抽样和入户调查方法,对河南省遂平县和西平县4600户的13812人进行了高血压患病及用药情况调查。结果：共查出高血压患者426人,患病率为3.1%,其中76.8%的高血压患者采用单一降压药治疗,68.3%的患者服用复合制剂。服用最多的降压药为复方降压片（56.8%）,北京降压0号（14.8%）和卡拖普利（10.3%）。钙通道阻滞剂（3.5%）和利尿剂（0.8%）使用率明显低于其他地区。结论：农村大多数高血压患者服用价格低廉的复方制剂,联合用药水平及药物使用结构与《中国高血压防治指南》要求存在很大差距。     

社区门诊高血压患者降压药物应用分析

目的:调查社区门诊高血压患者降压药物的应用情况,以指导规范用药。方法:对356例高血压患者进行相关病史资料收集和问卷调查,分析患者的用药名称、类型,联合用药及血压控制率等问题。结果:在356例高血压患者中,297例患者服用降压药物(83.43%),其中125例单用非复方制剂(42.09%),93例患者两种药物联合使用(31.31%),16例患者三种药物联合使用(5.39%),采用复方制剂63例(21.21%)。服用钙离子拮抗剂(CCB)179例,血管紧张素转换酶抑制剂(ACEI)105例;血管紧张素II受体拮抗剂(ARB)79例,β-受体阻滞剂40例;利尿剂13例。联合使用降压药物的患者血压的总控制率明显高于单一用药。结论:社区门诊高血压患者降压药物选择仍以单一和廉价药物为主,高血压控制率较低,规范社区高血压患者降压药物的合理应用,针对合并其他疾病的高血压患者采用联合用药方式,可有效控制高血压,减少并发症的发生,提高患者的生活质量。     

上海四平社区高血压综合管理药物治疗情况分析

目的　分析社区高血压综合管理用药情况,探索社区医师规范用药,提高社区高血压控制率.方法　将四平社区2009年高血压综合管理药物治疗情况进行归纳、分析、总结.结果　不同危险分层高血压患者血压控制情况比较差异有统计学意义(χ2=39.75,P＜0.05).低危、中危高血压患者以服用单品种高血压药物为主;高危、极高危高血压患者多需联合用药方能达到较好的控制效果.不同危险分层患者均有使用复方制剂者.随着年龄的增加需联合用药的比例增加.女性应用β-受体阻滞剂和复方制剂较男性多,差异有统计学意义(P＜0.05).结论　社区高血压综合干预能有效提高高血压控制率,高血压综合干预药物治疗不可或缺,全科医师规范合理用药尤其重要.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.