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个体化管理缺血性卒中急性期的血压
缺血性脑卒中急性期的血压如何处理一直存在争议[1],一半以上缺血性脑卒中患者在急性期血压高,而高血压病又是脑卒中的一个重要危险因素,那么急性期降压是否合理呢?近期发表的 CATIS 试验和 ENOS 试验(Efficacy of nitric oxide,with or without continuing antihypertensive treatment,for management of high blood pressure in acute stroke,急性缺血性脑卒中患者血压管理试验)又燃起了这种争议。CATIS(The China Antihypertens-ive Trial in Awte Ischemic Stroke,中国急性缺血性卒中的降压试验)试验的干预组降压快,而且恒定,在随机分组后24 h 内干预组比对照组收缩压低8.2 mmHg,2周时低8.5 mmHg,但血压这种大幅度降低并没有改变2周和3个月时的主要终点事件,干预组与对照组的病死率、重度残废者(改良 Rankin评分≥3分)没有差异[2]。ENOS 试验募集了发病48 h 内的缺血性(83%)和出血性(16%)脑卒中患者,随机分组后第一天干预组血压比对照组平均低7.0/3.5 mmHg,但到第3 d 这种差异已不明显。90 d 的主要终点事件,脑死亡率和改良 Rankin 评分两组没有差异[3]。这两个 RCT (randomizedcon-trolledtrial,随机对照试验)试验提示缺血性脑卒中急性期降压安全,但仍没有改变指南对急性期血压处理的描述[4-5]。2013年美国急性缺血性卒中早期处理指南对急性缺血性卒中早期的高血压处理进行了2点修订[4]:(1)指出许多病人发病后24 h 内血压会自行下降,没获得肯定的证据前,不能确定急性缺血性脑卒中患者降压能否获益;(2)血压明显高的非溶栓患者,在发病后第1个24 h 将血压降低15%是合理的。除非有降压的禁忌症,有高血压病史、神经功能稳定的患者发病后24 h 内降压合理。同时保留了原指南的推荐,即不宜药物降压,除非收缩压>220 mmHg 或舒张压>120 mmHg。
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国产新型血浆代用品在术中预防低血压的临床观察
晶花注射液全称晶花缩合葡萄糖氯代钠注射液,是由重庆大新药业公司首创的一种新型优良血浆扩充剂,该胶体液与血浆等渗,可增加肾血流量,能有效扩充血容量和防治低血压.我院从2000年1月开始用于术中补液,现将晶花液在术中预防低血压的临床效果报道如下.1资料与方法
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阿魏酸哌嗪在腹膜透析患者残余肾功能中的应用
目的 探索持续性腹膜透析(CAPD)的尿毒症患者使用阿魏酸哌嗪对残余肾功能(RRF)的影响.方法 43例CAPD治疗的尿毒症患者随机分为治疗组与对照组,治疗组22例,对照21例;治疗组在对照组基础上加用中成药阿魏酸哌嚷,每次150mg,每天3次,疗程12个月;观察治疗前、后的血压(BP)、体重(BW)、血色素(Hb)、血尿素氮(BUN)、肌酐(Scr)、血白蛋白(Alb)等指标;分别检测二组治疗6、12、18个月的RRF及尿量.结果 与对照组相比,治疗后的治疗组RRF下降速度减慢(P<0.05).尿量减少明显减缓(p<0.01),BP控制对照组满意(p<0.05).Hb、BW、Alb好于对照组(P<0.05~0.01).结论 阿魏酸哌嗪对CAPD尿毒症患者的RRF有保护作用,延缓尿量的减少,改善患者营养,提高CAPD患者的生活质量.
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早产儿生后两周内营养供应对青春期身体组成及血压的影响
目的 充足的营养对早产儿至关重要.关于早期营养及其对后期生长影响的纵向信息十分有限.本研究的目的是确定早产儿的早期能量和蛋白质供应对青春期身体组成和血压的影响.方法 本研究于2007~2008年对36例男性青少年(12.3±1.7岁)和25例女性青少年(11.5±1.8岁)进行了调查,他们系出生于1989年10月1日至1995年12月31日之间胎龄23~34周、出生体重<1850 g的早产儿.根据其出生后两周内的营养模式(肠内与肠外)、能量供应(每日<70千卡/kg与每日≥70千卡/kg)及蛋白质供应情况(每日超过2.5 g/kg ≥5 d与每日超过2.5 g/kg<5 d),将调查对象分组,比较各组青春期身高、体重、血脂、血压等的差异.结果 在控制出生体重和生理成熟度的基础上,婴儿期能量摄入每天≥70千卡/kg的青少年身高(163 ±11 cm)和体重(58±16 kg)大于能量摄入每天<70千卡/kg的青少年(身高156±11 cm,体重49± 16 kg),差异有统计学意义(P<0.05);两组间血压与体脂百分含量未见明显差异.结论 婴儿期较高的能量摄入与青春期的体格大小相关,但并不会构成不利的风险因素,如血压升高或体脂增加.
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Xinmailong injection solution was invented at 1988 by prof. Li Shunan in Dali medical college. It was made from the material which has high biological activeness to the cardiac and vascular system. During the experimental shock caused by excessive loss of blood in monkey and dog, it was found by ECG that the T-wave of anterion lead on left chest elevated and became high and sharp after acute blood loss. Arterial blood pressure dropped to 8-5.3 kPa for dog and 8-5.3-2.7 kPa for monkey, changes of T-wave all recovered to near normal level after xinmailong solution was injected intravenously (0.05-0.2 mL/kg). These Results implied that xinmailong might improve the ischemia of myocardium induced by hemorrhagic shock.
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AIM:The 50-Hz magnetic field (MF) is a potential health-risk factor.Its effects on the cardiovascular system have not been fully investigated .This study was conducted to explore the effects of long-term exposure to 50-Hz MF on the cardiovascular system . METHODS:In the study , an exposure system was constructed and the distribution of 50-Hz MF was detected .Sixty-four Sprague-Dawley (SD) rats were exposed to 50-Hz MF at 100 μT for 24 weeks, 20 hours per day, while another 64 rats were sham exposed. During the exposure, blood pressure was measured every 4 weeks, and 24 weeks later, echocardiography, cardiac catheterisation and electrocardiography were performed .Moreover , heart and body weight were recorded , while haematoxylin-eosin staining and real-time PCR were conducted .RESULTS:The results showed that compared with the sham group , exposure to 50-Hz MF did not exert any effect on blood pressure, pulse rate, heart rate and cardiac rhythm.Further, echocardiography and cardiac catheterisation showed that there were no significant differences in the cardiac morphology and haemodynamics .In addition , histopathological examination showed that 50-Hz MF exposure had no effect on the structure of hearts .Finally, the expression of the cardiac hypertrophic relative genes did not show any significant differences between 50-Hz MF exposure group and the sham group .CONCLUSION: Taken together , in SD rats, exposure to 50-Hz/100-μT MF for 24 weeks did not show any obvious effects on the cardiovascular system .
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抗高血压药物对正常血压冠心病患者心血管事件的影响(摘要)
疾病冠心病目的比较氨氯地平或依那普利与安慰剂治疗冠心病人对心血管事件的影响.
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脉压与脉压指数与冠状动脉病变严重程度的相关性分析
国内外大量流行病学及大规模临床试验已证实高血压病在冠心病的发生发展中起着重要作用,血压水平与冠心病发病率呈线性关系.血压特征的描述参数有收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP)和脉压(pulse pressure,PP).
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白大衣高血压的近代研究
近年来,随着无创性动态血压监测(AmbulatoryBlood Pressure Monitoring,ABPM)技术的广泛研究和临床应用,补充了单纯诊所血压(Clinic BloodPressure,CBP)或办公室血压(Office Blood Pressure,OBP)的不足,提高了对白大衣高血压(White CoatHypertension)的认识,本文就近代白大衣高血压研究已取得的成果和争议之处综述如下.
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运动试验收缩压恢复比对冠心病的诊断价值
为研究探索提高心电图活动平板运动试验(简称运动试验)敏感性与特异性的指标,国内外一些学者开展了对收缩压恢复比(systolic blood pressure recover rate,SPRR)的研究,SPRR即运动后第n分钟的收缩压(mm Hg)与运动峰值收缩压(mm Hg)之比,一般多取运动后3min的SPRR值[1-4].我们以冠状动脉造影结果对比分析了SPRR,藉以探讨其预测冠心病的价值.
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24h动态血压监测的临床应用现状
高血压是重要的一种可防可控的心血管危险因素,是心、脑、肾等靶器官损害的主要原因[1]。正确诊断高血压并给予恰当的治疗,对减少靶器官的损害、延长人类寿命、提高生活质量具有重要意义。目前,血压监测方法主要有诊室偶测血压(clinical blood pressure, CBP)、动态血压监测(ambulatory blood pressure monitoring,ABPM)、家庭自测血压(family blood pressuremonitoring,FBPM)。其中ABPM在临床已经得到广泛的应用于临床实践,在诊断白大衣高血压、评测高血压对靶器官的损害和评价降压药物的效果具有独特的优越性。
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Progress on renal sympathetic nerve ablation for refractory hypertension
Hypertension is a chronic cardiovascular disease worldwide.Its association with major adverse cardiac and cerebral events and favorable effects of antihypertensive therapy are ndisputed.It has been estimated that the total number of patients are more than one billion people[1].In recent years, the drug reatment of hypertension has made great progress, especially for a large number of long-acting antihypertensive drugs and the application of the new compound preparation so that the control rate of hypertension significantly increased.However, hypertensive patients received diuretics, including more than three high-dose antihypertensive drug treatment, but has not yet reached the target blood pressure, clinically known as refractory hypertension (treatment resistant hypertension) about the total number of patients with 20% to 30% [2], and such patients have a higher incidence of adverse cardiovascular events[3].efractory hypertension is not only caused by many reasons, but also illustrates the limitations of the medication.Therefore, people began to say, non-drug treatment of hypertension.Most recently, attention has been redirected to the sympathetic nervous system in the pathogenesis of hypertension.In addition, interruption of the renal sympathetic nervous system in humans with resistant hypertension has been studied with promising results.In 2009, Monash University, Australia Krum professor′s first report of renal sympathetic nerve ablation(Renal sympathetic denervation) was used in the treatment of resistant hypertension, creating a non-drug treatment of essential hypertension in new ways.In this review, a brief introduction mentioned the research progress of this new technology.
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对高血压病人实施健康教育成效体会
高血压病是一种发病率高、致残率高、死亡率高的疾病.我国目前高血压患者己超过1亿人.每年患病人数以10%的数量增加,并呈年轻化趋势.由高血压引发的心、脑、肾等器官的损害,给病人、家庭、社会所带来的痛苦和负担是巨大的.众所周知,高血压病的发生除遗传因素外,与不健康的生活方式密切相关.
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急性酒精中毒对兔脑外伤早期脑血流变化的影响
国外报道,约30%~50%的成人脑外伤患者在伤前曾饮用过酒精饮料,且预后较差[1,2]。笔者采用经颅多普勒(transcranial Doppler,TCD)结合脑血管造影,研究兔急性酒精中毒后脑外伤早期脑血流动力学及脑血管形态的变化,探讨醉酒加重脑外伤的原因,为临床治疗提供实验依据。 一、材料与方法 1. 实验动物分组与处理:成年雄性家兔20只,体重1.8~2.5 kg,随机分为2组,每组10只。A组:单纯脑外伤组;B组:酒精中毒加脑外伤组。兔用质量浓度为10 g/L的戊巴比妥钠按30 mg/kg进行腹腔注射麻醉后被仰卧固定于操作台上,分离出双侧股动脉。左股动脉插管连接压力传感器,连续监测平均动脉压(mean arterial blood pressure,MABP),右股动脉置3F Cobra导管,远端插至颈总动脉,以备脑血管造影。然后取俯卧位,额顶部正中矢状切开头皮,右侧额顶部颅骨钻孔,咬开一直径约0.8 cm圆形骨窗,保持硬脑膜完整,用于放置颅内压监护仪传感器膜片测量颅内压(intracranial pressure, ICP )及作为 TCD探测骨窗。B组致伤前1 h经胃管缓慢注入乙醇4 g/kg达到中毒量,A组给予等量等渗盐水,同时间致伤。