间歇地连续滴注多巴酚丁胺(Dobutamine)用于门诊治疗充血性心力衰竭

多巴酚丁胺系充血性心力衰竭短期治疗有效的收缩能药物。虽然会产生耐药性,但其在使用上的主要限制乃为必须静脉给药。作者在门诊对难治性充血性心力衰竭患者采用多巴酚丁胺静脉滴注每周二次、每次24小时的治疗方法。用一便携式滴注泵,经一由手术插入颈外静脉固定于右房近端的留置静脉导管给药。导管远端经皮肤于胸骨旁区穿出。教会病人对导管进行适当护理,包括每日用生理盐水及肝素清洗以及无菌地将导管连接于滴注泵。多巴酚丁胺由药剂人员稀释于生理盐水中,置入泵容器。     

多巴酚丁胺治疗充血性心力衰竭的临床观察

报告以短期持续静脉滴注多巴酚丁胺治疗充血性心力衰竭32例,总有效率达96.9％。并对该药的作用机理、给药方法和注意事项等进行讨论。     

充血性心力衰竭病人短期滴注多巴酚丁胺后心脏功能的持续改善

多巴酚丁胺具有β_1肾上腺素能活性,能加强心肌收缩力,而致心律失常及加快心率作用则较儿茶酚胺为小。近年报告心力衰竭病人短期滴注多巴酚丁胺后30分钟即有收缩功能、左室喷血分数及心排出量的改善,并可持续数月之久。本文以双盲对照法测定充血性心力衰竭患者静脉滴注多巴酚丁胺72小时对血流动力学及心血管功能的影响,以及其持续改善左室功能的作用。方法:15例特发性或酒精性心肌病并有Ⅲ或Ⅳ级稳定的充血性心力衰竭患者,所有病人均在用狄戈辛和利尿剂并给予低盐饮食(2克/日)。入院后     

米力农与多巴酚丁胺治疗急性心肌梗死后心力衰竭临床疗效观察

目的:探讨米力农和多巴酚丁胺治疗急性心肌梗死(AMI)后急性心力衰竭的临床疗效及安全性。方法:选择AMI后出现心力衰竭患者180例,心功能均为KillipⅢ~Ⅳ级,随机分为基础治疗组、多巴酚丁胺组与米力农组,每组各60例。多巴酚丁胺组及米力农组均在控制心力衰竭、治疗AMI的基础治疗上加用多巴酚丁胺或米力农治疗;多巴酚丁胺组给予多巴酚丁胺的起始剂量2.5μg/(kg·min),随后根据血压情况上调多巴酚丁胺剂量,最大剂量用至10μg/(kg·min)。米力农组给予米力农负荷量50μg/kg,10 min缓慢静脉滴注,以后0.5μg/(kg·min)静脉持续泵入,5 d为1个疗程。评估患者治疗前、后心功能指标变化。结果:治疗后3组患者脑钠肽(BNP)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及心排血量(CO)等指标较治疗前均有明显改善(P0.05或P0.01),多巴酚丁胺、米力农对BNP、LVEDD、LVEF和CO的影响较基础治疗明显,而米力农组治疗后患者BNP、LVEF、HR水平的变化较多巴酚丁胺组明显(P0.05或P0.01),治疗后3组SBP、DBP比较差异无统计学意义。治疗过程中未见明显的不良事件发生。结论:米力农和多巴酚丁胺较基础治疗更能安全有效地改善心功能,且短期、小剂量持续应用米力农治疗AMI后心力衰竭更为有效。     

酚妥拉明、多巴胺、多巴酚丁胺联用治疗肺心病心力衰竭68例临床观察

目的 观察酚妥拉明、多巴胺、多巴酚丁胺配伍静脉滴注治疗肺心病心力衰竭疗效。方法男性43例，女性25例，平均年龄66岁。均用酚妥拉明10mg、多巴胺10mg、多巴酚丁胺40mg，加入10％葡萄糖溶液250ml中静滴，每天1次，7～10天为一疗程。结果本组68例病人，显效38例，有效24例，总有效率91％。结论 酚妥拉明、多巴胺、多巴酚丁胺联用治疗肺心病心力衰竭对心衰的改善有显著疗效。     

持续静脉泵入硝酸甘油联合多巴酚丁胺治疗顽固性心力衰竭的临床观察

目的观察硝酸甘油联合多巴酚丁胺治疗顽固性心力衰竭的疗效。方法对90例Ⅲ～Ⅳ级顽固性心力衰竭患者,在采用常规综合治疗2～3d无效的基础上,给予微量注射泵持续静脉泵注治疗量的硝酸甘油和多巴酚丁胺,疗程5～7d,观察患者临床症状、体征、心功能改善情况。结果用药后,患者临床症状、体征、心功能明显改善,总有效率为95.5%。其中显效73例(81.1%),有效13例(14.4%),无效4例(4.5%),疗效确切,不良反应无增加。结论持续静脉泵入治疗量的硝酸甘油、多巴酚丁胺治疗顽固性心力衰竭有较好的临床效果。     

多巴酚丁胺与含镁极化液治疗难治性心力衰竭40例体会

应用多巴酚丁胺与含镁极化液治疗难治性心力衰竭40例,常规卧床、休息、吸氧、限盐、利尿剂、血管扩张剂基础上停用洋地黄类药物,加用多巴酚丁胺80～100mg,含镁极化液(10％葡萄糖500ml,10％氯化钾15ml,25％硫酸镁10ml,胰岛素8u)静脉滴注,每天一次,连用5～7天,用药期间密切观察病情。对照组40例,使用洋地黄类药物,不用多巴酚丁胺及含镁极化液,其他治疗与治疗组相同。根据临床上心功能改善程度来进行分析并判定疗效。结果:总有效率95％,多巴酚丁胺与含镁极化液治疗难治性心力衰     

静脉滴注硝酸甘油和多巴酚丁胺对难治性心力衰竭的血流动力学观察

硝酸甘油和多巴酚丁胺已广泛用于充血性心力衰竭(CHF)的治疗,但两药伍用对CHF的血流动力学效应,国内尚未见报道。为探索两药同时静脉滴注所产生的血流动力学效应,本文对120例难治性CHF患者在间断静脉滴注硝酸甘油和多巴酚丁胺过程中,动态监测了血流动力学各项指标。现将结果报告如下:对象与方法病例选择　各种原因所致的CHF患者均符合难治性心衰的诊断标准[1],强心剂、利尿剂、血管扩张剂联合治疗无效者。120例中,男88例,女32例,年龄28～70岁(平均49岁)。其中扩张型心肌病26例,缺血性心脏病30例,风心病45例,高血压性心脏病19例。心功能…     

口服左旋多巴治疗儿童充血性心力衰竭的血流动力学及临床效果的观察

治疗儿童充血性心肌病及充血性心力衰竭目前仍局限于洋地黄、利尿剂和血管紧张素转换酶抑制剂,对重症患儿通常需住院接受静脉内强心药物(多巴胺、多巴酚丁胺及氨力农)治疗。有报道口服左旋多巴治疗成人充血性心力衰竭能改善心功能。选择对常规方法治疗无效的心力衰竭患儿采用口服左旋     

左西孟旦对比多巴酚丁胺治疗心力衰竭的疗效分析

目的:应用meta分析的统计学方法,探究注射用左西孟旦与多巴酚丁胺对比治疗心力衰竭患者的临床疗效。方法:采用计算机检索Cochrane图书馆临床对照试验资料库、EMbase、MEDLINE检索国外文献,收集有关左西孟旦对比多巴酚丁胺治疗心力衰竭的临床随机试验,对纳入的6篇文献进行质量评价,并应用RevMan5.1软件对数据进行meta分析。结果:6个随机对照试验共997例充血性心力衰竭患者纳入研究,以上所有纳入文献均为多中心国外研究,通过meta分析结果显示:应用左西孟旦对比多巴酚丁胺治疗心力衰竭后,前者在对心力衰竭患者的左心室射血分数、心输出量、心脏指数及高敏C反应蛋白的影响上优于后者,两者间差异有统计学意义。结论:左西孟旦能有效改善心力衰竭患者心功能,效果优于多巴酚丁胺,且前者可能通过抗炎途径发挥心功能改善作用。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.