可逆性肺动脉高压的治疗在心脏移植围术期的应用

目的：通过早期判断并治疗心脏移植围术期可逆性肺动脉高压,降低移植手术后右心功能衰竭的发生率。方法：20例接受心脏移植手术的病人,术前放置肺动脉导管,测定肺动脉压、肺循环阻力。对肺动脉高压的病人在肺动脉端泵入硝酸甘油、前列腺素E1以确定可逆性。并在术后早期抗排异治疗的基础上应用增强心肌收缩力、降低肺动脉压力、强化氧疗和呼吸管理等综合措施。结果：20例病人中6例出现急性右心功能衰竭,其中4例经治疗后症状改善、出院,2例死亡。结论：术前早期判断并治疗可逆性肺动脉高压,可以有效预防并减少心脏移植术后右心功能衰竭的发生,提高手术成功率。     

灾难及突发事件住院信息管理系统的开发与实现

本文从系统设计目标、功能设计、结构设计等几个方面论述了灾难及突发事件住院信息管理系统的开发与实现。该系统由六大模块构成,实现了从预约管理、住院信息管理、床位管理、伤情评分、感染监测、查询统计到打印输出的灾害及突发时间住院伤病员信息全过程管理。应用本系统可规范灾害及突发事件医疗救援保障流程,大大提高了住院伤病员信息管理水平和工作效率。     

不同时间服用比索洛尔对非杓型高血压血压的影响

目的:观察不同给药时间分别给予比索洛尔对非杓型原发性高血压患者的降压疗效和血压节律恢复的影响。方法:选取60例非杓型高血压患者,采取随机平行对照试验,观察比索洛尔(n=30)每日早晨(8:00)给药2.5-10mg、比索洛尔(n=30)每日夜间(20:00)给药2.5-10mg治疗8周后的降压疗效。结果:两种给药方法均能降低非杓型高血压患者的全天血压(P<0.05)。两种给药方法在白天的血压控制上无显著性差异(P>0.05),但在夜间血压的控制上夜间服药降压效果具有显著性差异(P<0.05)。夜间服药在血压节律恢复方面优于早晨服药(P<0.05),早晨服药组有10例恢复杓型,夜间服药组有19例恢复杓型。结论:比索洛尔的两种给药方式均能安全有效的降压,但对于非杓型高血压患者夜间服药优于早晨服药,更有利于血压节律的恢复。     

Model for post-occlusive reactive hyperemia as measured noninvasively with pressure pulse waveform

Post-occlusive reactive hyperemia is a noninvasive maneuver to assess microvascular reactivity related to the bioavailability and/or bioactivity of endothelial-derived factors. The inability to respond to endogenous vasodilator substances is mostly described by a low peak flow after an event associated with a peak flow. The aim of this study is to propose a model to describe post-occlusive responses observed in the pressure waveforms after occlusion release. Model variables were investigated in search of those representatives of the endothelial response to the ischemic process. Radial pressure pulse waveforms were acquired in the anterior region of the wrist, superficial to the radial artery, using a piezoelectric transducer acquired by a 12 bits acquisition board model at a sampling rate of 1.0 kHz to increase the temporal resolution. The occlusion maneuver was performed using an arm-cuff placed over the brachial artery. A time series of pulse pressure (PP) values, calculated from successive values of beat-to-beat systolic and diastolic pressures, was found to be a useful variable representing blood pressure signal in the model. This data time series of the pulse pressure presents reduced initial values compared with the baseline measurement, and an increasing value until a steady state behavior was sustained after approximately 60 s. This behavior for the pulse pressure series was described by a hyperbolic tangent model with parameters K (rate of change of PP), PP₀ (first value of PP after cuff release), and ΔPP (change in PP). The model was applied to pulse pressure signals from normotensive and hypertensive subjects. The observed responses between groups suggest that PP₀ and ΔPP are related to an endothelial response to the ischemic process and could be used as a clinical tool to assess endothelial function in hypertension.     

Prevention and treatment of pregnancy-induced hypertension (preeclampsia) with progestogens

Available data indicate that progesterone is able to treat pregnancy-induced hypertension (preeclampsia). Dydrogesterone and 17alpha-hydroxyprogesterone caproate might also be used for this purpose. Prevention of hypertensive disorders in preeclampsia also seems possible, but studies are needed to confirm this.     

Meteorological factors and the onset of hypertensive intracerebral hemorrhage

There have been numerous studies of the relationship between intracerebral hemorrhage (ICH) and meteorological conditions, but their conclusions have been inconsistent. Poor discrimination of ICH subtypes (primary or secondary) may have obscured the conclusions. Although most studies have analyzed seasonal or monthly variation, daily meteorological data are more appropriate for determining whether weather conditions play a role in triggering the onset of ICH. No studies have examined the activity and location of patients at the time of onset. The aim of this study was to evaluate the relationship between the occurrence of hypertensive ICH and daily meteorological parameters, in addition to examining the effect of the location and activity of the patient at the time of onset. We analyzed 138 patients with severe hypertensive ICH in a hospital-based population. We assessed whether daily meteorological parameters for the days on which ICH occurred differed from the days without ICH onset. Days on which hypertensive ICH occurred had a significantly lower minimum temperature and a decreased minimum temperature from that of the previous day (P=0.0042 and 0.0012, respectively). There were no significant differences among subgroups of patients categorized according to their location and activity at the time of onset for any of the meteorological parameters.An erratum to this article can be found at     

Pyridoxine 5'-phosphate oxidase is a candidate gene responsible for hypertension in Dahl-S rats

To identify candidate genes responsible for hypertension in Dahl salt-sensitive rats (Dahl-S), an oligonucleotide microarray analysis was performed to find differentially expressed genes in kidneys of Dahl-S and Lewis rats. We obtained 101 F2 male rats from Dahl-S and Lewis rats and performed precise measurements of blood pressure (BP) and heart rate by telemetric monitoring at 14 weeks of age after 9 weeks of salt-loading. The correlation analysis between genotypes of differentially expressed genes and BP in F2 rats indicated that pyridoxine 5'-phosphate oxidase (Pnpo) and catecholamine-O-methyltransferease (Comt) showed a highly significant association with BP. However, in the case of Comt, the Dahl-S genotype correlated with low BP. Short/branched chain acyl-CoA dehydrogenase and Sah also showed a significant association with systolic blood pressure. The present study provided evidence that Pnpo is a candidate gene responsible for hypertension in Dahl-S rats.     

Catecholamine-induced Regulation in Vitro and ex Vivo of Intralymphocyte Ionized Magnesium

Despite the importance of the adrenergic activity and of the metabolism of magnesium in some important cardiovascular pathologies, very little is known about how intracellular ionized magnesium (Mg _i ²⁺ ) is regulated by catecholamines. We made an in-vitro study of the variations in the concentration of ionized magnesium in human lymphocytes using the fluorescent probe furaptra in response to different catecholamines. We also made an ex-vivo study of the changes in intracellular ionized magnesium in lymphocytes in 20 subjects with essential arterial hypertension, 10 treated with 120 mg/d of propranolol and 10 with placebo. Norepinephrine and isoproterenol significantly decrease Mg _i ²⁺ and this effect is blocked by β-blockers but not by α-blockers. The EC ₅₀ of the effect of norepinephrine is within the range of concentrations physiologically present in plasma. The substitution of extracellular sodium with choline blocks the decrease in intracellular ionized magnesium induced by norepinephrine, which leads us to suppose that the magnesium-reducing effect of catecholamines is a result of the activation of a Na⁺-Mg²⁺ exchanger. We were not able to demonstrate any change in intracellular ionized magnesium after 1 and 17 days of active treatment in essential hypertensives. The impossibility of demonstrating ex vivo the mechanism of catecholamine-mediated regulation that is evident in vitro is perhaps due to our experimental conditions or to substances which in vivo inhibit the action of the catecholamines on magnesium, such as insulin and/or glucose.     

不同鼠龄的人多巴胺D5^F173L突变基因转基因高血压小鼠血压及心脏结构与功能分析

目的通过对不同年龄多巴胺D5^F173L突变基因及D5正常基因转基因小鼠的血压和心脏结构与功能进行分析,了解多巴胺D5受体在高血压发生发展过程中的作用。方法利用无创血压测量仪和高分辨率小动物超声系统检测两种转基因小鼠的血压和左心室壁厚度、左心室内径、左心室容积、射血分数、短轴缩短率和左心室质量等心脏功能指标。结果 D5^F173L转基因小鼠4月龄、6月龄、16月龄时收缩压、舒张压都明显高于D5转基因小鼠;4月龄、6月龄的D5F173L转基因小鼠与D5转基因小鼠相比舒张期和收缩期左室壁厚度均明显增大、左室内容积均明显变小、左心室重量增加;16月龄的D5^F173L转基因小鼠与D5转基因小鼠相比左心室前壁增厚、心腔内径缩短,心腔容积下降、心室重量增加、射血分数提高、短轴缩短率提高;在18月龄时D5^F173L转基因小鼠相比于D5转基因小鼠左心室收缩期前壁厚度增加,后壁厚度减少,舒张期前壁厚度增加,后壁厚度减少;另外在18月龄时D5^F173L转基因小鼠与其16月龄时相比,射血分数、短轴缩短率明显降低,收缩期左心室容积明显增大。结论 D5^F173L转基因小鼠的血压及心脏功能与结构的分析结果符合原发性高血压的特征。D5^F173L转基因小鼠可作为原发性高血压动物模型。     

Unconventional Chemiosmotic Coupling of NHA2, a Mammalian Na+/H+ Antiporter,to a Plasma Membrane H+ Gradient

Human NHA2, a newly discovered cation proton antiporter, is implicated in essential hypertension by gene linkage analysis. We show that NHA2 mediates phloretin-sensitive Na⁺-Li⁺ counter-transport (SLC) activity, an established marker for hypertension. In contrast to bacteria and fungi where H⁺ gradients drive uptake of metabolites, secondary transport at the plasma membrane of mammalian cells is coupled to the Na⁺ electrochemical gradient. Our findings challenge this paradigm by showing coupling of NHA2 and V-type H⁺-ATPase at the plasma membrane of kidney-derived MDCK cells, resulting in a virtual Na⁺ efflux pump. Thus, NHA2 functionally recapitulates an ancient shared evolutionary origin with bacterial NhaA. Although plasma membrane H⁺ gradients have been observed in some specialized mammalian cells, the ubiquitous tissue distribution of NHA2 suggests that H⁺-coupled transport is more widespread. The coexistence of Na⁺ and H⁺-driven chemiosmotic circuits has implications for salt and pH regulation in the kidney.