吲达帕胺联合厄贝沙坦对高血压并发充血性心力衰竭患者的疗效及凝血-纤溶系统的影响

【摘要】目的 探讨吲达帕胺联合厄贝沙坦对高血压并发充血性心力衰竭（CHF）患者的疗效及凝血 纤溶系统的影响。方法 纳入2018年10月~2019年10月我院86例高血压并发CHF患者将其随机分为对照组和观察组，每组各43例。对照组给予厄贝沙坦治疗，观察组基于以上加予吲达帕胺片治疗。对比两组治疗前及治疗3个月后的血压水平和心功能情况，评估两组临床疗效，比较治疗前及治疗3个月后的血小板标志物和血浆凝血 纤溶系统指标水平。结果 治疗3个月，两组患者的收缩压(SBP)、舒张压(DBP)、左心室舒张期内径(LVEDD)、左室收缩末期内径(LVESD)值较治疗前显著降低(P＜005)，左室射血分数(LVEF)值较治疗前显著增加(P＜005)，观察组显著高于对照组(P＜005)；观察组的临床总有效率显著高于对照组(P＜005)；治疗3个月，两组患者的血小板糖蛋白Ⅱb/Ⅲa受体(PAC 1)、P 选择素(CD62P)水平相比治疗前有显著降低(P＜005)，两组患者的血浆D D、纤维蛋白原(FIB)、纤溶酶原激活抑制物 1(PAI 1)水平相比治疗前有显著降低，血浆组织型纤溶酶原激活物(t PA)相比治疗前有显著升高(均P＜005)，以上指标观察组的变化幅度显著大于对照组(P＜005)。 结论 吲达帕胺片联合厄贝沙坦治疗能提高高血压并发CHF患者的临床疗效，有效改善患者的血压水平和心功能，且对血小板PAC 1、CD62P有明显抑制作用，并改善凝血 纤溶系统指标。     

心力衰竭患者血清甲状腺激素水平变化及临床意义

目的 探讨心力衰竭患者血清甲状腺激素水平的变化及其临床意义.方法 选择2016年2～12月深圳市光明新区人民医院收治的60例心力衰竭患者作为观察组,选择同期因心绞痛、心律失常等住院治疗的55例患者作为对照组,检测各组甲状腺激素水平,比较两组患者之间以及心力衰竭不同心功能分级患者之间三碘原氨酸(T3)、甲状腺素(T4)、游离三碘原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平的差异.结果 观察组患者的T3、T4、FT3、FT4水平分别为(1.57±0.23)μg/L、(98.09±20.46)μg/L、(4.32±0.75)pmol/L、(15.28±0.26)pmol/L,均明显低于对照组的(2.42±0.24)μg/L、(113.3±20.43)μg/L、(6.83±0.77)pmol/L、(20.36±0.28)pmol/L,TSH水平为(16.61±1.57)U/L,明显高于对照组的(6.72±1.58)U/L,差异均有统计学意义(P<0.05);观察组患者随心功能分级的升高,T3、T4、FT3、FT4水平降低,TSH浓度升高,各组间比较差异均具统计学意义(P<0.05).结论 心力衰竭患者存在甲状腺激素代谢紊乱现象,监测甲状腺激素水平变化有利于合理应用药物治疗,改善预后.     

中药复方联合运动康复对CHF大鼠心肌重构机制的定量试验研究

目的 探讨中医药结合康复运动治疗慢性心衰(CHF)的可行性.方法 建立CHF动物模型,施加不同治疗方案,6周后提取动物模型心肌,利用实时荧光定量PCR及蛋白印迹法分析标本.结果 基质金属蛋白酶-1(MMP-1)在中药组、西药组、中药加运动组、运动组、对照组、模型组蛋白印迹法测量值分别为(90.387±6.606)、(83.197±4.919)、(56.01±2.097)、(147.205±5.923)、(51.938±6.919)、(180.232±3.047);中药组与西药组比较,差异有统计学意义(P<0.05),中药加运动组与西药组比较,差异有统计学意义(P<0.01).结论 心肌重构是CHF基本病理因素,中药治疗CHF心肌重构有效;通过实验提出CHF治疗中给予足量供氧,适量补充血容量、降低血液粘稠度及降脂治疗可能更加有效.     

Prognostic value and diagnostic potential of cardiopulmonary exercise testing in patients with chronic heart failure

Cardiopulmonary exercise testing (CPET) is a well established technique for stratifying cardiovascular risk in patients with chronic heart failure (CHF). Important prognostic variables include a reduced peak oxygen uptake which has a central use in cardiac transplant selection, and the abnormal relation between minute ventilation (VE) and carbon dioxide production (VCO(2)), often referred to as the elevated VE/VCO(2) slope. We will discuss the pathophysiology of these abnormal responses to exercise in CHF, and how these are interpreted during CPET. The potential of CPET for diagnosing circulatory, respiratory, metabolic, musculoskeletal or mixed limitations is an emerging field of research. We will speculate on how CHF manifests during CPET, and clarify the pathophysiological basis of these exercise responses. To improve our understanding of the diagnostic value of CPET, further investigation is required by clinicians to develop reference ranges for CHF patients from a co-ordinated multicentre approach. The use of CPET technology is becoming increasingly prevalent in cardiology services, and it is likely that, in the future, CPET will take a more prominent role in guiding patient management provision.     

经Ｔ形管窦道纤维胆道镜取石８６例体会

目的：评价经Ｔ管窦道纤维胆道镜取出胆总管结石的临床价值。材料与方法：对肝外胆道结石术后带有Ｔ管引流的患者在拔掉Ｔ管之后,经Ｔ管窦道纤维胆道镜检查,并取净残石。结果：８６例病人一次取净结石８４例,两次取净结石２例,无并发症发生。结论：术后经Ｔ管窦道纤维胆镜取出胆总管残石的方法。安全,可靠、痛苦小。现已成为处理有Ｔ管窦道的胆总管残石的主要措施之一。     

Ventilatory and diffusion abnormalities in long-term survivors after orthotopic heart transplantation.

OBJECTIVE: To investigate the long-term development of pulmonary diffusion abnormalities after orthotopic heart transplantation (oHT). DESIGN: Retrospective analysis of pulmonary function test results of different patient groups at different time intervals after oHT was performed. PATIENTS: This investigation included 642 patients who had undergone oHT for chronic heart failure. Patients were grouped according to the time elapsed after transplantation (group 1: n = 164; age, 47 +/- 14 years; days after oHT, 324 +/- 101; group 2: n = 100; age, 48 +/- 15 years; days after oHT, 723 +/- 104; group 3: n = 106; age, 52 +/- 12 years; days after oHT, 1,092 +/- 98; group 4: n = 84; age, 51 +/- 13 years; days after oHT, 1,442 +/- 99; group 5: n = 61; age, 50 +/- 14 years; days after oHT, 1,819 +/- 105; group 6: n = 101; age, 53 +/- 12 years; days after oHT, 2,463 +/- 303; and group 7: n = 26; age, 54 +/- 14 years; days after oHT, 3,478 +/- 246). In 56 (group 8) of the 642 patients, follow-up measurements were performed with tests before and at two time points after oHT (6.5 +/- 1.7 and 12.5 +/- 9.3 months). RESULTS: Of all patients, 39% showed restrictive and obstructive abnormalities with no differences between the groups. No significant differences in lung transfer factor for carbon monoxide (DLCO) were observed (61.2 vs 63.7 vs 65.5 vs 65.6 vs 64.5 vs 65.7 vs 67.6% predicted). Differences in transfer coefficient for carbon monoxide (Kco) were significant between group 1 and 4 (58.7 vs 64.1% predicted), and group 1 and 6 (58.7 vs 63.4% predicted). No differences occurred in the rate with which patients exhibited pathologic abnormalities for DLCO and KCO. After oHT, a marked reduction in diffusion capacity occurred in group 8. On follow-up, these measurements were only slightly restored in terms of the predicted DLCO percentage. No such improvement was observed in KCO or in the rate of pathologic changes for both DLCO and KCO. We conclude, therefore, that the impairment of diffusion does not improve even after a significant period has passed after the oHT. Whether this has any effect on symptoms and/or the prognosis for these patients is extremely unclear.     

心衰模型大鼠脉搏波变化的分析

目的:研究心衰模型大鼠脉搏波的变化及其规律。方法:在麻醉状态下,采集主动脉缩窄术心衰模型大鼠双侧股动脉脉搏波,并与假手术组进行对照。选取连续的多个周期的脉搏波做为研究对象,对各个周期进行6次谐波的最小二乘回归并建立数学模型并获取33个特征参数,根据上述参数对心衰大鼠的脉搏波进行特征分析和分类,寻找出该模型大鼠脉搏波的特征参数。结果:手术前、后与模型后等不同状态时大鼠脉搏波都出现了规律性的变化,腹主动脉的缩窄手术在大鼠脉搏波上主要表现为右侧第5谐波的相位改变,而长期缩窄后对心血管系统的影响而出现了第2谐波能量的变化。结论:心衰模型大鼠股动脉脉搏波上出现了特征性改变,提示体表的动脉脉搏波可以反映机体内脏的变化,为中医脉诊方法提供了一定的科学依据和研究参考。     

中药穴位贴敷配合治疗充血性心力衰竭疗效观察

[目的]观察中药穴位贴敷对充血性心力衰竭的临床疗效。[方法]将60例随机分为两组,治疗组加中药穴位贴敷,对照组常规治疗,两组进行疗效观察。[结果]中药穴位贴敷组,心衰症状明显减轻,具有统计学差异(P<0.05)。[结论]采用中药穴位贴敷治疗充血性心力衰竭临床效果显著。