经皮腔内肾动脉成形术及自体肾移植治疗肾血管性高血压(附7例报告)

自1980到1986年,我院泌尿外科对4例单纯右侧肾动脉狭窄(RAS)性和3例双侧RAS性高血压病人进行了治疗。7例右侧 RAS皆进行了自体肾移植治疗,其中3例双侧RAS者采用PTA治疗,全部病人术后8天内血压皆恢复正常,随诊10个月到6年,无复发且都恢复工作。1例17岁女孩,术后2年结婚,又2年生一女孩,母女健在血压维持正常。     

高血压脑梗死患者血管紧张素转换酶基因多态性分析

目的 探讨血管紧张素转换酶（ACE）基因多态性与高血压脑梗死发病的关系。方法 采用聚合酶链反应技术（PCR），对158名健康成人和50例原发性高血压、90例高血压脑梗死患者ACE基因插入／缺失（I／D）多态性进行检测，并且非条件Logistic回归筛选出与高血压脑梗死发病相关的因素。结果 DD基因型、D等位基因频率高血压脑梗死组高于正常对照组（P＜0.01)和高血压组（P＜0.05)。发病年龄在60岁以上者，DD基因型、D等位基因频率高血压脑梗死组高于高血压组和正常对照组（P＜0.05、P＜0.01)；而60岁以下起病者，DD基因型、D等位基因频率高血压脑梗死组则与高血压组、正常对照组无差别（均P＞0.05)，而高血压组D等位基因频率高于正常对照组（P＜0.05)。ACE DD基因型是高血压脑梗死独立的危险因素，发现高血压时间是高血压脑梗死的保护因素。结论 ACE DD基因型携带者发生高血压脑梗死的危险性增高，早期发现及治疗高血压对降低高血压患者脑梗死发生有意义。     

硬膜外阻滞对高血压患者血压的影响

目的:比较未经正规治疗的高血压患者中位和低位硬膜外阻滞时对血压的影响。方法:有明确的高血压病史的急诊中上腹部手术麻醉病例42例(Ⅰ组)和下腹部手术麻醉病例47例(Ⅱ组),采用硬膜外阻滞后,比较手术时间、局麻药总量、麻醉后动脉血压下降的幅度和时相。结果:(Ⅰ组)手术历时62.3±17.8min,局麻药总量为利多卡因387.0±31.2mg,(Ⅱ组)手术历时56.8±14.9min,利多卡因总量366.7±30.1mg,均无显著差异。Ⅰ组硬膜外麻醉前平均动脉压为123.6±13.2mmHg,麻醉后最低的平均动脉压为69.5±10.0mmHg,出现最低平均动脉压的中位时间为26.3min,Ⅱ组麻醉前的平均动脉压为117.3±15.7mmHg,麻醉后最低平均动脉压为71.0±7.4mmHg,出现最低平均动脉压的中位时间为21.3min。两组在硬膜外阻滞后平均动脉压下降幅度及下降时间方面无显著差异。结论:未经很好控制的高血压患者硬膜外阻滞后均可引起血压急骤下降,低位硬膜外阻滞与中高位阻滞引起的血压下降幅度和时相相似。     

Low-dose erythropoietin is effective and safe in children on continuous ambulatory peritoneal dialysis

Hypertension is one of the most important complications of erythropoietin (rHuEPO) therapy in dialysis patients. In this study, the effect of two different dosage regiments of subcutaneous rHuEPO on blood pressure [BP] was evaluated in 20 anemic children on continuous ambulatory peritoneal dialysis (CAPD). Patients were randomized to receive rHuEPO 50 U/kg, either once a week (group 1, 50 U/kg per week) or three times a week (group 2, 150 U/kg per week). At the beginning of the study, 8 patients in group 1 and 8 patients in group 2 were on antihypertensive therapy. In group 1, the hematocrit increased gradually and significantly from 18.98%±1.79% to 30.1%±1.62% after 6 months, while in group 2 it rapidly increased from 19.53%±1.86% to 32.4%±1.11% after 3 months. A significant increase in the mean arterial BP was observed in group 2. Antihypertensive therapy had to be increased in all of the 8 previously hypertensive patients and had to be initiated in 1 of the 2 originally normotensive patients in the same group. None of the patients in group 1 required a change in antihypertensive medication. We conclude that during treatment with rHuEPO pre-existing hypertension and the dose of rHuEPO are the most important risk factors for the development or worsening of hypertension in children on CAPD, and gradual elevation of hematocrit by low-dose rHuEPO avoids the development of severe hypertension. Received December 11, 1995; received in revised form September 16, 1996; accepted September 19, 1996     

Comparison of dobutamine stress echocardiography and technetium-99m sestamibi single-photon emission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy

Stress echocardiography has been considered an accurate method for the diagnosis of coronary artery disease in hypertensive patients and in patients with left ventricular hypertrophy. In contrast, the specificity of myocardial perfusion scintigraphy in these patients has been questioned. The aim of this study was to compare the accuracy of these two imaging modalities in conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Dobutamine (up to 40 μg kg^–1min^–1) stress echocardiography in conjunction with sestamibi (MIBI) single-photon emission tomography (SPET) was performed in 84 patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography and reversible perfusion defects at SPET. Significant coronary artery disease (≥50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%–82%), 83% (CI 75%–91%) and 75% (CI 66%–84%), those for MIBI were 67% (CI 57%–77%), 83% (CI 75%–91%) and 70% (CI 60%–80%) respectively (P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity, specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%–69%), 90% (CI 86%–94%) and 77% (CI 72%–82%). Those for MIBI were 58% (CI 51%–64%), 91% (CI 87%–94%) and 75% (CI 69%–80) respectively (P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not influence the overall or regional specificity of echocardiography or MIBI SPET. It is concluded that in hypertensive patients, dobutamine stress echocardiography and MIBI SPET have a comparable accuracy for the overall and regional diagnosis of coronary artery disease. Hypertensive patients with or without left ventricular hypertrophy should not be considered unsuitable candidates for stress myocardial perfusion scintigraphy. Received 10 July and in revised form 19 September 1997     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.     

先天性心脏病患儿肺动脉,上腔静脉血一氧化氮含量检测及意义

目的:探讨一氧化氮(NO)与先天性心脏病(CHD)引起的肺动脉高压(PH)发病间的关系。方法:应用NO试剂盒检测了CHD患儿肺动脉及上腔静脉血浆中NO含量。结果;(1)伴PH组肺动脉血浆NO含量明显高于不伴肺动脉高压组(37.58±9.99μmol/L:19.03±15.25μmol/L,P<0.01);(2)在PH组中,肺动脉血浆NO含量明显高于上腔静脉血(P<0.01);而不伴PH组,肺动脉和上腔静脉血浆NO含量无显著性差异(P>0.05)。结论:(1)伴PH的先心患儿肺动脉血浆NO含量升高;(2)NO可能介入了CHD引起的PH发病过程。     

牛磺酸对高血压和血管活性物质的影响

在原发性高血压(EH)患者、大鼠腹主动脉狭窄和高盐摄入引起高血压模型上,观察到口服牛磺酸治疗4周后均明显降低平均动脉压和收缩压,42.2%的患者血压恢复正常,并能抑制EH患者和高血压大鼠血浆内皮素(ET)、血管紧张素II(AII)水平的升高,增加高血压大鼠血浆降钙素基因相关肽(CGRP)和主动脉组织中的牛磺酸含量.以上结果表明,牛磺酸在降压作用同时伴有缩血管物质的降低和舒血管物质的增加,为以牛磺酸作为降血压辅助药物提供了依据.     

动态血压监测的临床评定

无创性动态血压（ＡＢＰＭ）能较客观地反映血压水平及其昼夜变化规律，对高血压病的诊断、指导用药、药物疗效的评定以及预后评估等均有较大价值。本文对ＡＢＰＭ的发展及临床应用等问题进行综述。