The systemic and coronary haemodynamic effects of felodipine in patients with coronary heart disease

The cardiovascular effects of felodipine, a new arteriolar vasodilator,were studied in 22 patients with coronary heart disease. Therewere significant falls in blood pressure and systemic vascularresistance of 16 and 38% respectively (P = 0.001), thus affectingafter-load. Cardiac index and stroke index increased by 35 and12% respectively. There was reflex tachycardia-from 75 ±3to 85 ±3 b.p.m. (P =0.005). Coronary sinus blood /lowincreased from 134±9 to 191 ±17 ml/min (P<0.005)and myocardial arterio- venous oxygen difference narrowed from12.l±0.5 to 9.0±0.4 vols% (P<0.001) indicatingless oxygen usage. With the heart rate held constant by atrialpacing, cardiac index and stroke index increased by 30 and 26%(P<0.001), whilst systolic blood pressure and systemic vascularresistance fell by 20 and 29% (P<0.001). This would suggestthat the improved haemodynamics were largely secondary to after-loadreduction.     

ASSESSMENT OF THE CORONARY VASODILATOR ACTION OF SK&F 24260 IN THE DOG

1. The effects of SK&F 24260 administered intravenously or intraduodenally on the coronary outflow, coronary arteriovenous oxygen difference (A-V O2), myocardial oxygen consumption (MVO2), systemic blood pressure, heart rate and atrioventricular (AV) conduction time were examined in open-chest dogs. 2. SK&F 24260 in doses of 0.3-10 microgram/kg, i.v., caused a dose-dependent increase in coronary sinus outflow, but the increase was smaller with 30 microgram/kg, i.v., than with 10 microgram/kg, i.v. 3. SK&F 24260 (0.3-30 microgram/kg, i.v.) decreased A-V O2 and MVO2 in a dose-dependent manner. 4. SK&F 24260 (0.3-30 microgram/kg, i.v.) decreased systemic blood pressure and heart rate, and increased AV conduction time. 5. Intraduodenal administration of SK&F 24260 (1 mg/kg) produced almost the same effects on coronary sinus outflow, A-V O2, MVO2, systemic blood pressure, heart rate and AV conduction time as did the intravenous administration of the compound (10 microgram/kg). 6. The property of SK&F 24260 to increase the coronary blood flow and to moderately decrease MVO2, systemic blood pressure and heart rate indicates that this agent is a potential antianginal drug.     

扩血管剂治疗突发性聋随机对照试验的系统评价

目的评价扩血管剂治疗突发性聋的疗效及安全性.方法通过对Medline,Embase,Cochrane临床对照试验参考文献的查阅,选出以扩血管剂为干预文摘数据库的机检,5种中文耳鼻咽喉科杂志手检,和资料库,中国生物医学措施来治疗突发性聋的随机对照试验(randomizedcontrolledtrials,RCT),并且至少有两位研究者独立评估试验质量和提取数据.结果共13篇文章,1155例病人(耳)符合纳入标准进入研究.扩血管剂与安慰剂比较的4个试验中,没有一个发现扩血管剂疗效优于安慰剂.扩血管剂相互比较的7个试验中,没有发现哪一种扩血管剂疗效更好.扩血管剂与其他疗法进行比较的两个试验,提示其他治疗(泛影葡胺或腹蛇抗栓酶)可能优于某些扩血管剂(低右、烟酸、654-2、丹参).8个试验描述了瘙痒、过敏等副作用.结论尚缺乏证据表明扩血管剂治疗突发性聋的疗效优于安慰剂或其他治疗,也缺乏证据表明哪一种扩血管剂疗效最佳.扩血管剂对突发性聋的疗效尚不能作最后结论,并且须防止它的副作用.     

Relation of vasodilator response of the brachial artery to inflammatory markers in patients with coronary artery disease

Endothelial dysfunction of the coronary artery is closely related to elevated levels of systemic inflammatory markers and cardiovascular events in patients with coronary artery disease (CAD). We hypothesized that patients with CAD may have a higher risk of endothelial dysfunction of the peripheral artery than patients without evidence of CAD, and that endothelial dysfunction of the peripheral artery also may be related to elevated levels of inflammatory markers. Using high resolution ultrasound, we assessed the brachial vasodilator response to reactive hyperemia (endothelium-dependent) and sublingual nitroglycerin (endothelium-independent). As inflammatory markers, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels, and lipid profiles were measured in patients with CAD (n = 30, 16 male and 14 female) and normal subjects without evidence of CAD (n = 45, 23 male and 22 female). Patients with CAD (Group II) showed a significantly reduced endothelium-dependent vasodilation as compared with normal subjects (Group I) (4.4 +/- 3.6 vs 7.4 +/- 6.1%, P < 0.05). However, endothelium-independent vasodilation was not significantly different between the two groups (7.7 +/- 7.1 vs 9.7 +/- 8.0%, P > 0.05). In Group II, CRP level was inversely related to endothelium-dependent vasodilation (r = -0.398, P = 0.029). In contrast, ESR level was not significantly associated to endothelium-dependent vasodilation (r = -0.113, P = 0.552). On multivariate analysis, CRP and low density lipoprotein cholesterol levels were significant independent predictors of a blunted endothelium-dependent vasodilation in Group II. Our study showed that elevated CRP level was associated with blunted endothelium-dependent vasodilation of the brachial artery in patients with CAD. Thus, identification of elevated CRP levels combined with demonstration of endothelial dysfunction of the brachial artery may have a possible clinical application for the detection of high risk CAD patients.     

吡格列酮对慢性肾脏病患者血管内皮功能和肾功能的影响

目的 探讨吡格列酮对慢性肾脏病（CKD）患者血管内皮功能和肾病进展的影响.方法 采用随机、对照的方法选取非糖尿病的慢性肾脏病3～4期约60例,均予常规治疗,处理组27例患者同时加吡格列酮片（30 mg/d）,治疗4个月,观察治疗前及治疗4个月后的肱动脉内皮依赖性舒张功能（FMD）、超敏C反应蛋白（hs-CRP）、血清肌酐（Scr）、尿蛋白定量（Upr）等指标的变化.结果 吡格列酮处理组FMD改善、hs-CRP、Scr、Upr下降,与对照组比较差异有统计学意义（P＜0.05或0.01）,且内皮依赖性血管舒张率升高与hs-CRP水平的降低呈负相关.结论 吡格列酮可以减轻非糖尿病CKD患者炎症,改善血管内皮功能,延缓肾病进展.     

吸入伊洛前列素在儿童先天性心脏病肺血管扩张试验中的应用

目的:该研究在心导管检查中通过对先天性心脏病(CHD)合并肺动脉高压(PAH)儿童,吸入伊洛前列素前后的血流动力学参数的测定,评价吸入伊洛前列素在CHD相关性PAH儿童急性肺血管扩张试验的安全性、有效性。方法:研究选择2007年6月至2010年5月,于北京安贞医院小儿心脏科住院的左向右分流型CHD合并重度PAH患儿,所有患儿行左、右心导管检查,并采用雾化吸入伊洛前列素,监测吸药前后血流动力学参数改变及不良反应。结果:该研究入选43例左向右分流型CHD合并重度PAH患儿,年龄(8.52±4.76)岁。吸入伊洛前列素后肺动脉平均压由(77.14±12.14)mmHg(1 mmHg=0.133 kPa)降至(69.35±12.14)mmHg(P<0.05);肺体循环血流量比值(Qp/Qs)由1.80±1.26升至3.06±2.90(P<0.05);肺血管阻力指数(PVRI)下降约5 Wood unit.m2〔吸入前(14.51±8.46)Wood unit.m2,吸入后(9.58±7.43)Wood unit.m2,P<0.05),体循环血压无明显变化〔吸入前(83.16±13.69)mmHg,吸入后(83.09±11.03)mmHg,P>0.05〕。以吸入伊洛前列素后PVRI较基础水平下降至少20%以上作为急性肺血管扩张试验阳性标准。肺血管反应阳性患儿31例,占72%,阴性反应患儿(PVRI下降<20%)12例,占28%。结论:对左向右分流型CHD合并重度PAH儿童在心导管检查中吸入伊洛前列素可明显降低肺血管阻力,体循环血压无明显变化,无明显不良反应发生,可作为安全有效的急性肺血管扩张试验的用药。     

Intravenous diuretic and vasodilator therapy reduce plasma brain natriuretic peptide levels in acute exacerbation of chronic obstructive pulmonary disease

Background and objective: Plasma concentrations of brain natriuretic peptide (BNP) are elevated in patients with chronic obstructive pulmonary disease (COPD), and high plasma BNP levels are associated with a poor prognosis. We aimed to evaluate the effects of a diuretic and a vasodilator on plasma BNP levels and health‐related quality of life (HRQOL) in patients with acute exacerbations of COPD (AECOPD). Methods: Forty patients with an AECOPD and high plasma BNP levels, but without any clinical evidence of cor pulmonale, were selected. The patients were randomly divided into two groups of 20 patients. In addition to standard treatment for AECOPD, the patients in group I were treated with a mild diuretic, and those in group II were treated with the diuretic and a vasodilator. Twenty patients with stable COPD were selected as a control group. Plasma BNP concentrations were measured on admission and on the third and sixth days. The patients' HRQOL was evaluated using the short‐form 36‐item (SF‐36) questionnaire before and after treatment. Results: Plasma BNP concentrations in patients with AECOPD were significantly decreased after treatment, and this decrease was more striking in group II than in group I. There were no significant differences in SF‐36 domain scores between patients with stable COPD and those with acute exacerbations who were treated with a diuretic and a vasodilator. Conclusions: Plasma BNP levels decreased rapidly in patients with an AECOPD after therapy with a diuretic and a vasodilator, and the treatment did not impair their health status.     

电刺激糖尿病大鼠血管舒张神经反应性变化的研究

目的 :研究不同病期的糖尿病大鼠外周血管舒张神经是否发生病变。方法 :将不同病期链佐霉素(STZ)性糖尿病及对照组大鼠制成毁脑脊髓大鼠模型 ,在用六烃季胺阻断内源性去甲肾上腺素释放及在甲氧明升压基础上 ,对比观察了脊髓内电刺激诱发的外周血管舒张效应。结果 :4周和 8周糖尿病大鼠脊髓内电刺激诱发的血管舒张反应未见明显改变 ,而 12周糖尿病大鼠反应性明显降低。结论 :随着糖尿病病程的延长及病情的进展 ,外周血管舒张神经可能发生病变而导致其功能降低。     

Haemodynamic effects of different doses of dopexamine hydrochloride in low cardiac output states following cardiac surgery.

We studied the haemodynamic effects of dopexamine hydrochloride, a beta 2-adrenergic agonist with dopaminergic (DA1) activity, in 20 patients with low cardiac output following surgery for coronary artery bypass grafting and/or valve replacement or repair. Following titration of four doses (1, 2, 4 and 6 micrograms.kg-1.min-1), the dose producing the optimal response was infused for up to 48 h (five patients). During the infusion, significant increases in cardiac index and stroke volume were accompanied by significant decreases in systemic vascular resistance. Heart rate increased significantly up to 6 h and thereafter returned to control levels. Mean blood pressure was reduced but did not fall below 60 mmHg. However, in five patients treated for 48 h mean blood pressure had returned to control levels. Unwanted effects (tachycardia and hypotension) were seen chiefly at higher doses, leading us to conclude that infusion rates of 4 micrograms.kg-1.min-1 or less will be useful in the treatment of low cardiac output following cardiac surgery.