缬沙坦联合胺碘酮对持续性心房颤动复律及复律后窦性心律维持率的影响

目的观察缬沙坦联合胺碘酮对持续性心房颤动复律及复律后窦性心律维持率的影响。方法选择持续性心房颤动患者96例,随机分为两组,治疗组49例,给予缬沙坦及胺碘酮治疗,对照组47例给予安慰剂及胺碘酮治疗。随访1年,观察两组心房颤动转复率和转复后3、12个月时心房颤动复发率,以及转复时及转复后12个月左心房内径（LAD）、左心室射血分数（LVEF）变化。结果心房颤动转复率治疗组（87．8％）与对照组（85．1％）差异无统计学意义（P〉0．05）。心房颤动复发率转复后3个月及12个月治疗组（14．0％、2312％）均小于对照组（32．5％、54．5％）（P〈0．05或0．01）,转律后12个月LAD治疗组[（44．3±065）mm）]较对照组[（469±0．54）mm]变小（P〈0＋05）,LVEF治疗组[（56．8±8．64）％]较对照组[（52．3±908）％]升高（P〈0．05）。结论缬沙坦联合胺碘酮治疗持续性心房颤动在减少心房颤动的复发率以及改善心功能方面优于单独使用胺碘酮。     

替米沙坦联合胺碘酮维持阵发性心房颤动患者窦性心律的作用

目的 观察非瓣膜病阵发性心房颤动(房颤)的患者应用替米沙坦在房颤复律后维持窦性心律的疗效. 方法 76例非瓣膜病变阵发性房颤患者,随机分为胺碘酮对照组和替米沙坦+胺碘酮治疗组(联合治疗组),观察治疗后3、6、12个月两组患者左心房内径的变化及评价窦性心律的维持效果. 结果 治疗3、6个月两组左心房内径和窦性心律维持率差异无统计学意义(分别为t=0.04、0.51和t=0.03、1.12,均为P>0.05).治疗1年后,两组窦性心律的维持率分别为48.4%和73.5%,左心房内径分别为(37.26±4.85)mm和(34.38±3.85)mm,联合治疗组窦性心律维持率高于对照组(t=4.33,P<0.05),左房内径小于对照组(t=2.66,P<0.05). 结论 替米沙坦联合胺碘酮对阵发性房颤复律后窦性心律维持优于单用胺碘酮治疗,随着时间延长,维持窦性心律效果越好,可能与替米沙坦抑制肾素血管紧张素系统,降低心脏负荷,抑制心房电及结构重构有关.     

星状神经节阻滞对心率变异性影响的实验研究

目的：探讨在家兔清醒状态下,以第7颈椎横突为标志,经皮行星状神经节阻滞的可行性和有效性．及其对心率变异性的影响。方法：健康新西兰大耳白兔16只被随机均分为左侧星状神经节阻滞组（LSGB组）、右侧星状神经节阻滞组（RSGB组）。白兔均在清醒状态下四肢固定,仰卧于动物手术台,胸前及四肢连接十二导动态心电图分析系统,稳定30min后,以第七颈椎横突为骨性标志,垂直进针,给予0．5％布比卡因1ml,行星状神经节阻滞。观察眼睑下垂程度、耳廓温度、心率变异性指标[24h正常RR间期标准差（SDNN）、低频功能（LF）、高频功能（HF）、LF／HF]。另取9只家兔同法向星状神经节处推注亚甲蓝溶液后暴露星状神经节,以其是否蓝染判断注射阻滞部位的精确程度。结果：两组动物均完成星状神经节阻滞操作,术后即刻及饲养1周均未发现并发症。阻滞10min后两组动物阻滞侧均出现上睑下垂和眼裂变小。与对侧及阻滞前相比．阻滞侧耳廓温度明显升高（P〈0．05）。两组动物阻滞前后心率无明显差异,LSGB组,阻滞前、后SDNN、LF、HF、LF/HF无显著差异。RSGB组．LF和HF值在阻滞后较阻滞前显著减小（P〈0．05）．但LF／HF、SDNN无明显改变。9只家兔行亚甲蓝注射后．解剖发现8只星状神经节被染色,精确程度为88．9％（8／9）。结论：以第7颈椎横突为标志,经皮行星状神经节阻滞建立动物模型的方法切实可行,眼睑、眼裂及耳廓温度是较好的阻滞成功判断指标。星状神经节阻滞对自主神经功能有调节作用,可能就是其阻滞治疗各种疾病的作用机制之一。     

Pharmacological treatment of hypertrophic cardiomyopathy: current practice and novel perspectives

Hypertrophic cardiomyopathy (HCM) is entering a phase of intense translational research that holds promise for major advances in disease‐specific pharmacological therapy. For over 50 years, however, HCM has largely remained an orphan disease, and patients are still treated with old drugs developed for other conditions. While judicious use of the available armamentarium may control the clinical manifestations of HCM in most patients, specific experience is required in challenging situations, including deciding when not to treat. The present review revisits the time‐honoured therapies available for HCM, in a practical perspective reflecting real‐world scenarios. Specific agents are presented with doses, titration strategies, pros and cons. Peculiar HCM dilemmas such as treatment of dynamic outflow obstruction, heart failure caused by end‐stage progression and prevention of atrial fibrillation and ventricular arrhythmias are assessed. In the near future, the field of HCM drug therapy will rapidly expand, based on ongoing efforts. Approaches such as myocardial metabolic modulation, late sodium current inhibition and allosteric myosin inhibition have moved from pre‐clinical to clinical research, and reflect a surge of scientific as well as economic interest by academia and industry alike. These exciting developments, and their implications for future research, are discussed.     

Contribution of I Ks to ventricular repolarization in canine myocytes

The role of the slow delayed rectifier K⁺ current (I _Ks) in cardiac repolarization seems to be largely influenced by the experimental conditions including the species and tissue studied. The aim of this study was to determine the contribution of I _Ks to repolarization in canine ventricular myocytes by measuring the frequency dependent action potential lengthening effect of 10 μM chromanol 293B using sharp microelectrodes. Pretreatment with isoproterenol (2 nM), E-4031 (1 μM), and injection of inward current pulses were applied to modify action potential configuration. Chromanol alone caused moderate but statistically significant lengthening of action potentials at cycle lengths longer than 500 ms. The lengthening effect of chromanol, which was strongly enhanced in the presence of either isoproterenol or E-4031, was proportional to the amplitude of plateau, whereas poor correlation was found with action potential duration. Similar results were obtained when action potential configuration was modified by injection of depolarizing current pulses. Computer simulations revealed that activation of I _Ks is a sharp function of the plateau amplitude within the physiological range, while elongation of repolarization may enhance I _Ks only when it is excessive. It was concluded that the effect of I _Ks on ventricular repolarization critically depends on the level of action potential plateau; however, other factors, like action potential duration, cycle length, or suppression of other K⁺ currents can also influence its contribution.     

Comparative efficacy of seven Chinese patent medicines for early diabetic kidney disease: A Bayesian network meta-analysis

BackgroundBailing Capsule (BLC), Jinshuibao (JSB), Huangkui Capsule (HKC), Uremic Clearance Granule (UCG), Tripterygium glycosides (TG), Compound Xueshuantong Capsule (CXC), and Shenyan Kangfu Tablet (SYKFT) as classic Chinese patent medicines (CPMs), have been widely used and shown beneficial effects on the treatment of early diabetic kidney disease (DKD). However, the comparative efficacy of seven CPMs in the treatment of early DKD remains unknown.ObjectiveTo evaluate and compare the efficacy of seven CPMs (BLC, JSB, HKC, UCG, TG, CXC, SYKFT) combined with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) on early DKD by a Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs).MethodsA comprehensive and systematic literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials.gov, China Biology Medicine, Chinese National Knowledge Infrastructure, Chinese Scientific Journal, and Wanfang databases from inception to March 14, 2021, for full-text RCTs that evaluated the efficacy of seven CPMs combined with ACEI/ARB on patients with early DKD. Two reviewers independently screened studies for eligibility, extracted data, and assessed the risk of bias. Agreement between reviewers was measured using kappa statistics. Mean difference (MD) and odds ratio (OR) were calculated to evaluate continuous variables and dichotomous, respectively. The random effect modeling NMA was performed and the ranking probability of interventions in various outcomes was also conducted based on the surface under the cumulative ranking curve (SUCRA). Begg’s and Egger’s tests were used to evaluate publication bias. The certainty of the evidence for outcomes was evaluated according to the GRADE system.ResultsA total of 62 RCTs with 5362 patients with early DKD were identified. The value of Kappa calculated for the various parameters extracted by the two investigators was 0.821 (P < 0.001). Among these CPMs, UCG + ACEI/ARB showed the best effectiveness for urinary albumin excretion rate (UAER) (MD 32.25, 95% CrI 19.11–45.67, low certainty) with SUCRA 92%. JSB + ACEI/ARB showed the highest effectiveness for 24-h urinary total protein (24-h UTP) (MD 76.92, 95% CrI 53.54–100.58, low certainty) with SUCRA 97%. CXC + ACEI/ARB showed the highest effectiveness for serum creatinine (SCr) (MD 26.02, 95% CrI 6.10–45.95, low certainty) with SUCRA 96%. HKC + ACEI/ARB showed the highest effectiveness for blood urea nitrogen (BUN) (MD 1.46, 95% CrI 0.42–2.54, very low certainty) with SUCRA 86%. BLC + ACEI/ARB showed significant differences in triglyceride (TRIG) (MD − 1.17, 95% CrI − 1.93 to − 0.43, low certainty) with SUCRA 90%, total cholesterol (TC) (MD − 1.17, 95% CrI − 1.97 to − 0.39, very low certainty) with SUCRA 90%, and C-reaction protein (CRP) (MD − 0.90, 95% CrI − 1.51 to − 0.32, very low certainty) with SUCRA 76%.ConclusionsCPMs + ACEI/ARB might be positive efficacious interventions from which patients with DKD will derive benefit. UCG + ACEI/ARB, JSB + ACEI/ARB, CXC + ACEI/ARB, and HKC + ACEI/ARB might be potentially the preferred intervention for reducing UAER, 24-h UTP, SCr, and BUN levels, respectively. BLC + ACEI/ARB has a better impact on lowing TRIG, TC, and CRP levels in patients with early DKD. However, more high-quality, large-scale, multi-center RCTs and stronger head-to-head trials are required to confirm these findings.     

氨氯地平联用阿托伐他汀钙治疗高血压伴高血脂29例临床观察

目的观察氨氯地平联用阿托伐他汀钙治疗高血压伴高血脂的疗效。方法29例高血压伴血脂异常患者采用口服氨氯地平5~10 mg/d,阿托伐他汀钙10 mg/d,8周为1个疗程。结果疗程结束后,降压总有效率为93.1%,血脂明显改善,总有效率为86.2%,且无明显副作用。结论氨氯地平联用阿托伐他汀钙治疗高血压伴高血脂安全有效。     

维持性血液透析患者透析前后血钾状态及其影响因素分析

目的观察维持性血液透析（MHD）患者透析前后血清钾离子浓度,并探讨影响其变化的临床因素。方法57例维持性血液透析患者,根据其是否服用血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体拮抗剂（ARB）,将患者分为ACEI组、ARB组及非ACEI／ARB组;记录各组患者残余尿量及有无高钾血症临床表现,并取透析前后静脉血,测定血清钾、尿素氮（BUN）、血肌酐（SCr）、二氧化碳结合力（CO2CP）等指标,分析各组患者血钾浓度变化的差异及血钾浓度与其他临床因素之间的相关性。结果透析前高钾血症发生率36．8％（21／57）,其中76．2％（16／21）患者无高钾血症的临床表现;ACEI组、ARB组、非ACEI／ARB组透析前血钾水平分别为（6．0±0．95）mmol／L、（5．60±0．25）mmol／L、（4．72±0．95）mmol／L,其中ACEI组与其他2组之间差异有统计学意义（P〈0．01）,而ARB组与非ACEI／ARB组患者透析前血钾浓度差异无统计学意义（P〉0．05）;透析前血钾离子浓度与SCr、BUN浓度显著正相关（r=0．415、0．522,均P〈0．01）,但与患者残余尿量和透析前后CO2CP浓度变化无明显相关（r=0．559、0．411,均P〉0．05）。结论MHD患者透析前高钾血症发病率高,临床表现较隐匿,易被忽视;残余尿量并非判断患者是否易出现透析前高钾血症的可靠指标;增加透析次数,减量或停服ACEI,限制饮食中钾摄入是防治透析前高钾血症的有效方法。