硝普钠联合氢氯噻嗪治疗老年慢性心力衰竭患者的临床研究

目的:探讨硝普钠联合氢氯噻嗪治疗老年慢性心力衰竭患者的疗效。方法:选取92例慢性心力衰竭患者,随机分为观察组和对照组,每组各46例。对照组患者给予常规治疗:β受体阻滞剂、血管紧张素转化酶抑制剂、洋地黄、髓袢利尿剂,并营养心肌;观察组患者在对照组的基础上加用硝普钠50 mg配比5%葡萄糖500 ml,静滴,频率75~250μg/min,再根据患者病情调整用量及滴速,1次/d,氢氯噻嗪片25 mg/次,2次/d口服,连续用药2周。治疗期间密切监测两组患者的血压;治疗前后,观察两组患者的心动图检测结果,对比左心室射血分数(LVEF)、左心室舒张末期内径(LVDD),并进行实验室检测;比较两组患者的肿瘤坏死因子α(TNF-α)、心肌肌钙蛋白(c Tn T)和C反应蛋白(CRP)。结果:治疗前,两组患者的LVEF、LVDD比较,差异不显著,无统计学意义(P>0.05);治疗后,两组患者的LVEF、LVDD均有改善,但观察组患者的LVEF上升、LVDD下降更明显,组间差异显著,具有统计学意义(P<0.05);治疗前,两组患者的TNF-α、c Tn T、CRP比较差异不显著,无统计学意义(P>0.05);治疗后,两组患者的TNF-α、c Tn T、CRP均有改善,但观察组患者的改善明显优于对照组,组间差异显著,具有统计学意义(P<0.05)。结论:硝普钠联合氢氯噻嗪治疗老年慢性心力衰竭患者,能增加其LVEF,降低LVDD,减少TNF-α、c Tn T、CRP,疗效显著,值得临床推广。     

不同浓度的硝普钠治疗慢性心力衰竭疗效观察

目的探讨不同浓度的硝普钠治疗慢性心力衰竭（chronic heart failure,CHF）的临床疗效。方法将我院2008年1月～2009年12月128例CHF患者随机分为四组,对照组、硝普钠低浓度、硝普钠中浓度、硝普钠高浓度四组,观察治疗前、后心功能改善情况。结果高浓度硝普钠治疗CHF疗效优于其它实验组（P〈0.05）,LVEF、LVDD、等观察指标都得到一定程度改善,治疗后CRP（10.75±1.02）、cTnT（0.01±0.01）及TNF-α（95.86±10.68）显著低于治疗前CRP（20.76±2.58）、cTnT（0.51±0.07）及TNF-α（149.65±16.78）水平（P〈0.01）。结论高浓度硝普钠可以有效地治疗CHF。     

厄贝沙坦氢氯噻嗪联合注射用硝普钠治疗急性心衰的临床观察

目的 探讨厄贝沙坦氢氯噻嗪联合注射用硝普钠对急性心衰患者左心功能及1年病死率的影响.方法 采用随机数表法,将2018年3月～2019年3月我院收治的98例急性心衰患者分为2组,各49例.对照组予以注射用硝普钠治疗,观察组予以厄贝沙坦氢氯噻嗪联合注射用硝普钠治疗,两组均治疗5d.比较两组治疗前及治疗5d后左心功能指标及随访1年内病死率.结果 治疗后,两组左室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)水平均低于对照组,左室射血分数(LVEF)高于对照组,差异有统计学意义(P<0.05);观察组1年内病死率低于对照组,差异有统计学意义(P<0.05).结论 厄贝沙坦氢氯噻嗪联合注射用硝普钠可有效改善急性心衰患者的左心功能及预后,降低病死率.     

硝普钠治疗慢性心力衰竭的疗效观察

目的:观察硝普钠治疗慢性充血性心力衰竭的疗效及安全性。方法:将慢性心力衰竭(心功能Ⅲ~Ⅳ级)的84例心衰患者,随机分治疗组和对照组,两组均在吸氧、利尿剂等常规治疗基础上,治疗组给以硝普钠治疗,对照组给以酚妥拉明治疗;治疗观察4天,并对两组的心功能改善、症状改善及心脏彩超进行评价对比。结果:治疗组总有效率,显效率,治疗后左室射血分数(LVEF)显著高于对照组(P0.05)。结论:硝普钠治疗慢性充血性心力衰竭疗效显著,不良反应少,对常规治疗效果不佳的慢性充血性心力衰竭患者,可应用硝普钠。     

硝普钠联合芪苈强心胶囊治疗慢性充血性心力衰竭效果观察

目的探究硝普钠联合芪苈强心胶囊对慢性充血性心力衰竭(CHF)患者心功能及生活质量的影响。方法选取义马市人民医院94例CHF患者,抽签法分为观察组和对照组,各47例。对照组行硝普钠+葡萄糖液(5%)250 ml微量泵入治疗,观察组在对照组基础上加用芪苈强心胶囊治疗。比较两组治疗6个月后临床疗效、心功能相关指标[左室舒张末内径(LVEDD)、左室射血分数(LVEF)及左室收缩末期内径(LVESD)]及生活质量(SF-36)评分。结果观察组治疗6个月后总有效率(85.11%)较对照组(63.83%)高,LVEDD、LVEF、LVESD均优于对照组,SF-36评分高于对照组,差异均有统计学意义(P<0.05)。结论采用硝普钠联合芪苈强心胶囊治疗CHF患者疗效显著,可改善其心功能各指标及生活质量。     

阿托伐他汀联合曲美他嗪治疗慢性心力衰竭97例

目的 探讨阿托伐他汀联合曲美他嗪对慢性心力衰竭(CHF)患者心功能及细胞因子的影响.方法 将97例慢性心力衰竭患者随机分为对照组、阿托伐他汀组和联合治疗组,对照组行常规抗心衰治疗,阿托伐他汀组在常规抗心衰治疗的基础上加用阿托伐他汀,联合治疗组在常规抗心衰治疗的基础上加用阿托伐他汀及曲美他嗪.所有患者在治疗前及治疗6个月后检测血清C反应蛋白(CRP)、血浆脑利钠肽(BNP)、肿瘤坏死因子-α(TNF-α)水平,超声心动图检测左室射血分数(LVEF)和左室内径(LVEDD).结果 心功能Ⅳ级的患者与心功能≤Ⅲ级的患者相比,CRP、BNP及TNF-α水平均显著升高(均P<0.05).与治疗前相比,各组治疗后CRP、BNP及TNF-α水平显著下降,LVEF、LVEDD明显改善(P<0..05或P<0.01),阿托伐他汀组及联合治疗组CRP、BNP及TNF-α水平下降较对照组更为显著(均P<0.05),LVEF、LVEDD改善较对照组明显,6分钟步行试验行走距离显著延长(P<0.05).与阿托伐他汀组相比,联合治疗组治疗后CRP、BNP及TNF-α水平差异及LVEF、LVEDD变化无统计学意义,但6分钟步行试验行走距离显著延长(P<0.05).结论 在常规治疗的基础上加用阿托伐他汀可进一步降低心力衰竭患者血液中CRP、BNP及TNF-α水平,发挥抗炎作用,同时改善患者心功能,阿托伐他汀联合曲美他嗪治疗降低心衰患者心肌耗氧,提高了患者的运动耐量.     

胺碘酮对扩张型心肌病伴慢性心力衰竭患者心功能的影响

目的探讨胺碘酮对扩张型心肌病伴慢性心力衰竭患者心功能的影响.方法收集了健康对照组30 名,心力衰竭组67 例(入组前已经进行了常规治疗),根据是否服用胺碘酮片分为心力衰竭1 组30 例、心力衰竭2组37 例,4 周后结束治疗,进行统计分析各组患者治疗前后的C 反应蛋白(CRP)以及左室舒张末期直径(LVDD,mm)、左室射血分数(LVEF,%).结果①健康对照组和心力衰竭组在LVDD 、LVEF 以及CRP 含量上差异有统计学意义(P 均<0.01).②心力衰竭1 组经过常规治疗和胺碘酮4 周治疗后与入组时进行对比,CRP 值有所降低,差异有统计学意义(P <0.01);LVEF 值较治疗前有所升高,差异有统计学意义(P <0.01).③心力衰竭2 组经过常规治疗4 周后与入组时进行对比,CRP 值、LVDD 、LVEF 差异无统计学意义(P >0.01).结论对于伴有慢性心功能不全的扩张型心肌病患者给予胺碘酮治疗,可以减少CRP 的产生,减少相关的炎症反应,改善心功能,进而可能提高患者的生存率.     

硝普钠联合参附注射液治疗慢性心衰的临床研究

目的分析硝普钠联合参附注射液治疗慢性心衰的临床疗效。方法选取在本院接受治疗的慢性心力衰竭患者50例作为研究对象,随机分为两组,对照组给予常规西药治疗,治疗组在对照组基础上使用硝普钠静脉泵入以及联合参附注射液静脉滴注治疗,比较两组患者治疗前后的心率、收缩压、舒张压、平均动脉压、心胸比率、左室舒张末直径(LVD)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)和患者血液动力学相关指标及治疗有效率。结果患者在使用硝普钠联合参附注射液治疗后,其心率、收缩压、舒张压、平均动脉压、心胸比率、左室舒张末直径(LVD)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)和患者血液动力学相关指标均优于单纯使用常规西药治疗(P0.05),治疗有效率达96.00%。结论硝普钠联合参附注射液治疗慢性心衰,能显著提高患者的临床疗效。     

N末端脑钠肽前体和相关生化指标对老年慢性心力衰竭的诊断价值

目的分析N末端脑钠肽前体(NT-pro BNP)水平及心肌肌钙蛋白I(c Tn I)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)对老年慢性心力衰竭的诊断价值。方法选择2010年5月至2012年5月开封市龙海医院明确诊断为慢性心力衰竭的老年患者156例,同时选择50例老年健康体检者作为对照组,对所有受试者NT-pro BNP、c Tn I、Mb、CK-MB、Hcy、CRP指标进行检测。结果与对照组相比,不同心功能分级下,NT-pro BNP、c Tn I、Mb、CK-MB、Hcy和CRP均明显升高,差异均有统计学意义(均P<0.05)。NT-pro BNP、c Tn I、Mb、CK-MB、Hcy和CRP随着心功能分级的升高呈上升趋势。Pearson相关分析提示,NT-pro BNP与c Tn I、Mb、CKMB、Hcy、CRP均相关。结论 NT-pro BNP前体水平与c Tn I、Mb、CK-MB、Hcy、CRP指标对老年慢性心力衰竭有一定的诊断价值。     

厄贝沙坦氢氯噻嗪早期联合美托洛尔治疗老年心力衰竭效果观察

目的观察分析厄贝沙坦氢氯噻嗪早期联合美托洛尔治疗老年心力衰竭的临床效果及安全性。方法回顾性分析2015年3月至2016年3月郑州人民医院收治的78例老年心力衰竭患者的临床资料,按治疗方案分为研究组和对照组,各39例。研究组接受厄贝沙坦氢氯噻嗪+美托洛尔治疗,对照组接受单纯厄贝沙坦氢氯噻嗪治疗,统计对比两组的治疗效果、治疗前后的心功能指标(包括左室射血分数、心率、脑钠肽、6 min步行距离等)变化及不良反应发生情况。结果研究组患者的治疗总有效率(97.4%)高于对照组(76.9%),差异有统计学意义(P<0.05);治疗前,两组患者左室射血分数、心率、脑钠肽、6 min步行距离比较,差异无统计学意义(P>0.05);治疗后,两组患者左室射血分数、心率、脑钠肽、6 min步行距离水平均改善,且研究组优于对照组,差异均有统计学意义(P<0.05)。研究组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论厄贝沙坦氢氯噻嗪早期联合美托洛尔治疗老年心力衰竭效果显著,可改善患者心功能,安全性高,值得临床推广应用。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

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.