高原心脏病心力衰竭机制探讨

目的：评价冬眠心肌在高原心脏病心力衰竭中的作用。方法：经胸壁小剂量多巴酚丁胺负荷超声试验观察左室局部心肌收缩功能及心功能指标。结果：轻中度心衰患者左室心肌对逐渐增加剂量的多巴酚丁胺负荷呈明显的收缩双相反应。结论：冬眠心肌是高原心脏病心力衰竭患者普遍存在的现象,它直接导致左室功能受损及泵衰竭的发生。     

高原人体左心室收缩间期的观察

高原环境是否引起人体左心功能的改变及如何进行生理评价,认识尚不一致,但对这一问题的阐明,有助于对高原心血管适应机理的认识。为此,我们于1984-1986年对不同海拔高度的健康人群应用心机图测定久居和世居高原者的左心室收缩问期(STI),并与甲原组对照,以探讨其变化规律及产生机理。     

高原Fen挖掘活动的观察

本文通过自制高原Ｆｅｎ鼠挖掘行为观察箱,以直接观察法和摄录像系统观察在模拟不同土壤坚实度条件下,高原Ｆｅｎ鼠的挖掘行为、掘土速度,掘土持续时间以及在每一掘土回合内的掘土量,结果表明,高原Ｆｅｎ鼠的掘洞活动主要由掘土、扒土、踢土、推土,以拱土组成;掘土速度和掘土持续时间与土壤坚实度有关;在相同土壤条件下,虽然雄,雌Ｆｅｎ鼠的掘土速度相似,但雄性Ｆｅｎ鼠在每回合内的掘土量明显地高于雌鼠。     

高原鼢鼠挖掘活动的观察

本文通过自制高原鼢鼠挖掘行为观察箱,以直接观察法和摄录像系统观察了在模拟不同土壤坚实度条件下,高原鼢鼠的挖掘行为、掘土速度、掘土持续时间以及在每一掘土回合内的掘土量。结果表明,高原鼢鼠的掘洞活动主要由掘土、扒土、踢土、推土、以及拱土组成;掘土速度和掘土持续时间与土壤坚实度有关;在相同土壤条件下,虽然雄、雌鼢鼠的掘土速度相似,但雄性鼢鼠在每回合内的掘土量明显地高与雌鼠。     

高原鼠兔地面活动观察

应用耳标法标记动物,用Sharp pc-1500计算器作为事件记录器,对高原鼠兔的地面活动进行了研究。寒冬,鼠兔的日活动为9小时,4月为11—12小时,夏季地面实际活动时间较短。夏季日活动明显地具有两个峰期;进出洞频次,1月,日进出洞20—30次,4月,雄体日进出洞97—161次;地面活动以取食为主,取食时间在草盛期远短于草返青和枯黄期;取食行为次数占全部洞外活动记录次数的44.5％。8月,日实际取食时间为200—240分钟。对行为格局的分析表明,幼体花费在坐、移动、自我修饰等非社会行为方面的时间明显多于成体。     

贝氏高原鳅脑垂体显微结构观察

贝氏高原鳅的垂体由神经垂体和腺垂体构成,属于背腹型,但神经垂体稍偏向背部.腺垂体从前到后又依次分为前外侧部(RPD)、中外侧部(PPD)和中间部(PI).前外侧部由ACTH细胞和PRL细胞组成,中外侧部由GH细胞和大小两种嗜碱性细胞组成,中间部分布有MSH细胞和另一种嗜碱性细胞.神经垂体分枝丰富,遍布于腺垂体的各个部分,在中间部尤为丰富.垂体内血管发达.     

贝氏高原鳅脑组织学观察

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人工饲养高原鼢鼠生长和发育的观察

1988年3月至1989年9月,笔者对高原鼢鼠(Myospalax baileyi)幼体的生长和发育进行了观察,结果简报如下。1.材料与方法高原鼢鼠捕自中国科学院海北高寒草甸生态系统定位站地区,将捕获孕鼠34只于该站人工饲养房内笼养(50×30×30厘米)。共产仔99只,先后观察10窝29只。从幼体出生日起,每5 日测定其体重、体长、尾长、前足长和后足长,并记录其形态变化和行为发育,共测100天。     

先天性心脏病患儿的观察及护理体会

我科自 1 999年 1月至 1 2月共收治 2 2例先天性心脏病患儿 ,通过输氧 ,控制感染 ,对症治疗 ,支持疗法 ,配合严密观察及耐心细致护理均无发生心力衰竭病例。现将观察护理体会报告如下。1　临床资料　　本组患儿 2 2例 ,男 1 5例 ,女 7例 ,年龄 2～6岁 ,平均住院 1 3～ 1 6天。2　观察要点　　 (1 )注意体格发育及营养状态 ,有无杵状指(趾 ) ,发绀程度及其分布 ,哭声嘶哑 ,阵发性哭闹 ,反复性呼吸道感染等。　　 (2 )注意观察有无胸廓畸形 ,心界扩大 ,心尖搏动弥散 ,心音、心率及心律情况 ,有无震颤及其部位、性质、时限 (收缩期或舒张期 ) ,…     

缬沙坦联合吲达帕胺治疗高血压的效果观察

目的:探讨缬沙坦和吲达帕胺治疗高血压的临床效果,为临床治疗提供可借鉴的方法。方法:选取2012年4月-2014年1月在我院接受治疗的87例高血压患者的临床资料,根据治疗方式的不同将所选患者分为缬沙坦组、吲达帕胺组和联合用药组,每组27例。缬沙坦组患者采用口服缬沙坦单药治疗,吲达帕胺组患者采用口服吲达帕胺单药治疗,联合用药组采用缬沙坦+吲达帕胺缓释片治疗。观察三组患者治疗前后的血压变化、治疗总有效率及不良反应的发生情况。结果:治疗后,三组患者的血压均不同程度降低(P0.05);联合用药组患者血压下降幅度明显高于缬沙坦单药治疗组和吲达帕胺单药治疗组,差异具有统计学意义(P0.05)。联合用药组患者治疗的总有效率明显高于缬沙坦单药治疗组和吲达帕胺单药治疗组,差异具有统计学意义(P0.05)。三组患者不良反应的发生率无显著差异(P0.05)。结论:缬沙坦胶囊与吲哒帕胺缓释片联合应用治疗高血压具有显著的临床意义,能够有效的控制患者的血压,值得推广采用。     

Chronopharmacology of Captopril plus Hydrochlorothiazide in Hypertension: Morning Versus Evening Dosing

Blood pressure follows a strong circadian rhythm in normotensive people and in patients with primary hypertension. This may have several implications for antihypertensive therapy, including the time of dosing. For this reason we studied the influence of different dosing times on the antihypertensive effect over 24 h using ambulatory blood pressure monitoring (ABPM). We studied 13 male patients with moderate hypertension with controlled blood pressure over 12 months under a fixed combination of captopril and hydrochlorothiazide. The dosage of the combination therapy was then halved and given as one evening and then as one morning dose, each for 3 weeks. The combination therapy given twice daily showed a good 24-h antihypertensive effect after 12 months of treatment. During the following 6 weeks the mean 24-h blood pressure did not increase under half dosage, irrespective of whether under evening or morning dosing. However, mean daytime values (systolic and diastolic) of ABPM were significantly higher with evening dosing when compared both with full dosage and with half dosage given in the morning. The mean arterial blood pressure over 24 h showed the same differences as systolic and diastolic blood pressure, whereas heart rate was not significantly different between the three therapeutic regimens. ABPM seems to be an ideal method for chronopharmacological investigations under everyday conditions. Our study demonstrated significant differences in daytime blood pressure but not in 24-h blood pressure between morning and evening dosing of a fixed antihypertensive combination therapy.     

Chronotherapy With Valsartan/Hydrochlorothiazide Combination in Essential Hypertension: Improved Sleep-Time Blood Pressure Control With Bedtime Dosing

Administration of angiotensin receptor blockers at bedtime results in greater reduction of nighttime blood pressure than dosing upon awakening, independent of the terminal half-life of each individual medication. To obtain blood pressure (BP) target goals most patients require treatment with more than one hypertension medication. However, the potential differing effects on BP regulation of combination therapy depending on the time-of-day of administration have scarcely been investigated. Accordingly, the authors prospectively evaluated the administration-time-dependent BP-lowering efficacy of valsartan/hydrochlorothiazide (HCTZ) combination therapy. The authors conducted a randomized, open-label, blinded-endpoint trial on 204 subjects with essential hypertension (95 men/109 women), 49.7?±?11.1 (mean?±?SD) yrs of age. The BP of participants in this trial was not properly controlled with respect to published ambulatory BP criteria after initially randomized to valsartan monotherapy (160?mg/day), whether routinely ingested upon awakening by one group or at bedtime by another group for 12 wks. Thus, HCTZ (12.5?mg/day) was added to valsartan as a single-pill formulation, maintaining the original treatment-time, i.e., upon awakening or at bedtime, of participants of the two groups, for another 12 wks. BP was measured by ambulatory monitoring for 48?h at inclusion and after each 12-wk span of therapy. Physical activity was simultaneously monitored every minute by wrist actigraphy to accurately define the beginning and end of daytime activity and nocturnal sleep so that the respective BP means for every participant at each evaluation could be precisely determined. Combination therapy resulted in a similar statistically significant reduction of the 48-h BP mean from baseline for both treatment-time groups (17.0/11.5?mm Hg in systolic/diastolic BP after combination therapy on awakening; 17.9/12.1?mm Hg reduction after combination treatment at bedtime; p?>?.542 between groups). The awake BP mean was reduced to a comparable extent in both treatment-time groups (p?>?.682). However, bedtime compared to morning dosing better reduced the asleep means of systolic BP (20.1 vs. 16.0?mm Hg; p?=?.015) and pulse pressure (6.5 vs. 4.0?mm Hg; p?=?.007 between groups). Accordingly, the proportion of subjects with a baseline non-dipper BP profile was significantly reduced from 59% to 23% only after bedtime combination treatment (p?<?.001). Moreover, the proportion of subjects with properly controlled ambulatory BP after combination therapy was significantly greater with bedtime than upon-awakening treatment (55 vs. 40%, p?=?.037). The improved efficacy in lowering the asleep BP mean, increased sleep-time relative BP decline, and greater proportion of controlled patients suggest that valsartan/HCTZ combination should be preferably administered at bedtime for treatment of subjects with essential hypertension requiring combination therapy to achieve proper BP control. (Author correspondence: rhermida@uvigo.es)     

Chronopharmacology of Captopril plus Hydrochlorothiazide in Hypertension: Morning Versus Evening Dosing

Blood pressure follows a strong circadian rhythm in normotensive people and in patients with primary hypertension. This may have several implications for antihypertensive therapy, including the time of dosing. For this reason we studied the influence of different dosing times on the antihypertensive effect over 24 h using ambulatory blood pressure monitoring (ABPM). We studied 13 male patients with moderate hypertension with controlled blood pressure over 12 months under a fixed combination of captopril and hydrochlorothiazide. The dosage of the combination therapy was then halved and given as one evening and then as one morning dose, each for 3 weeks. The combination therapy given twice daily showed a good 24-h antihypertensive effect after 12 months of treatment. During the following 6 weeks the mean 24-h blood pressure did not increase under half dosage, irrespective of whether under evening or morning dosing. However, mean daytime values (systolic and diastolic) of ABPM were significantly higher with evening dosing when compared both with full dosage and with half dosage given in the morning. The mean arterial blood pressure over 24 h showed the same differences as systolic and diastolic blood pressure, whereas heart rate was not significantly different between the three therapeutic regimens. ABPM seems to be an ideal method for chronopharmacological investigations under everyday conditions. Our study demonstrated significant differences in daytime blood pressure but not in 24-h blood pressure between morning and evening dosing of a fixed antihypertensive combination therapy.     

川芎嗪联合缬沙坦治疗糖尿病肾病肾衰竭的临床疗效观察

目的:探讨川芎嗪联合缬沙坦治疗糖尿病肾病肾衰竭的临床疗效。方法:选择我院2011年1月至2013年1月收治的糖尿病肾病肾衰竭患者96例,并将其随机分为实验组和对照组,每组48例。两组患者均根据病情给予对症支持治疗,并严格控制血糖。在常规治疗基础上,实验组患者给予川芎嗪注射液240 mg,静脉滴注,1次/d,同时给予缬沙坦80 mg,口服,1次/d,21天为1个疗程;对照组患者给予缬沙坦80 mg,口服,1次/d,21天为1个疗程。1个疗程后观察两组患者的临床疗效、血液学指标、尿检指标等实验室检查。结果:治疗21天后,实验组的临床有效率达83.3%,显著高于对照组(60.4%),差异具有统计学意义(P0.05);两组空腹血糖、尿蛋白、尿素氮、血肌酐水平均较治疗前显著改善,且实验组以上指标及胆固醇水平的改善程度明显优于对照组,差异有统计学意义(P0.05)。治疗过程中,两组均无严重不良反应发生。结论:川芎嗪联合缬沙坦可以更有效地改善糖尿病肾病肾衰竭患者的临床疗效,有一定的临床应用价值。     

曼月乐与妇康片治疗单纯性子宫内膜增生的临床疗效比较

目的:比较曼月乐与妇康片治疗单纯性子宫内膜增生(simple endometrial hyperplasia,SHE)的临床疗效.方法:选择SHE患者102例,在患者知情同意自愿的前提下,分为妇康片组(n=46例)和曼月乐组(n=56例),妇康片组给予妇康片治疗,曼月乐组给予曼月乐治疗,比较两组患者治疗3个月后的临床疗效、PBAC评分、子宫内膜厚度、血红蛋白水平,同时记录并比较两组患者在治疗过程中不良反应的发生情况.结果:治疗3个月后,两组患者显效例数与无效例数比较,差异具有统计学意义(P＜0.05);曼月乐组患者PBAC评分、子宫内膜厚度均显著低于妇康片组,而血红蛋白水平显著高于妇康片组,差异均具有统计学意义(P＜0.05);治疗期间出现肝肾功能异常例数比较,差异具有统计学意义(P＜0.05),曼月乐组均优于妇康片组.结论:曼月乐治疗SHE的疗效较妇康片更好,并能减少不良反应.     

双歧杆菌四联活菌在预防小儿抗生素相关性腹泻的临床应用

目的探讨双歧杆菌四联活菌预防小儿抗生素相关性腹泻（AAD）的临床效果。方法132例住院患儿随机分成2组;对照组常规抗感染治疗,预防组在此基础上加用口服双歧杆菌四联活菌片。结果对照组72例发生腹泻27例（37.5%）,预防组60例,发生腹泻10例（16.7%）（χ^2=7.58,P〈0.01）;发生腹泻次数：对照组为（6.42±2.66）次/d,预防组为（3.92±1.03）次/d（t=3.29,P〈0.01）;腹泻平均持续时间：对照组为（4.97±1.20）d,预防组为（3.90±1.02）d（t=5.60,P〈0.01）,2组比较差异均有显著性。结论口服双歧杆菌四联活菌制剂可以减少小儿抗生素相关性腹泻的发生率。     

缬沙坦对维持性血液透析患者心脏功能和结构的影响

目的:探讨缬沙坦对维持性血液透析(maintenance hemodialysis,MHD)患者心脏功能和结构的影响。方法:100例MHD患者,随机分为治疗组(50例)与对照组(50例),对照组仅予基础治疗,治疗组加予口服缬沙坦治疗,总疗程为6个月。观察治疗前后超声心动图指标变化。结果:与治疗前及对照组同期比较,治疗组心脏结构指标左房收缩末期内径(LAD)、左室舒张末期内径(LVDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左房内径指数(LAI)、左室重量指数(LVMI)及相对室壁厚度(RWT)有所降低,心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)值有所提高,差异均有统计学意义(P<0.05)。对照组超声心动图各项指标与治疗前相比变化不明显(P>0.05)。结论:缬沙坦能延缓或逆转左心室肥厚,明显改善左室舒张功能,有助于改善MHD患者心脏重构,改善心脏功能,从而延缓慢性肾功能衰竭尿毒症期患者的左心室重塑,降低心血管疾病的发生率和死亡率。缬沙坦对MHD患者心血管疾病并发症的预防和治疗及提高MHD患者生存率有一定临床指导意义。     

复方嗜酸乳杆菌对轻中度溃疡性结肠炎诱导和维持缓解作用的临床研究

目的:观察复方嗜酸乳杆菌对轻中度溃疡性结肠炎诱导和维持缓解作用的疗效。方法:第一阶段将102例轻、中度溃疡性结肠炎患者随机分成A组(34例)、B组(34例)和C组(34例),分别服用美沙拉嗪片、复方嗜酸乳杆菌、美沙拉嗪+复方嗜酸乳杆菌治疗12周后观察3组临床疗效,缓解率及缓解时间。第二阶段将各组缓解者随访1年,观察3组维持时间及复发率。结果:3组临床疗效评价,临床缓解时间、缓解率比较无显著性差异见(P>0.05),3组患者维持临床缓解时间、复发率比较差异无显著性意义(P>0.05)。所以由中国株嗜酸乳杆菌,日本株嗜酸乳杆菌、粪链球菌和枯草杆菌等四种菌粉组成的复方片剂是值得推荐的维持治疗缓解期UC的有效药物;两者联合用药并未增效,联合使用复方嗜酸乳杆菌片和美拉沙嗪作为溃疡性结肠炎的联合维持治疗是没有必要的。结论:复方嗜酸乳杆菌对轻中度溃疡性结肠炎诱导和维持缓解作用的疗效与美拉沙嗪比较无差异,没有必要联合使用复方嗜酸乳杆菌片和美拉沙嗪作为溃疡性结肠炎的联合维持治疗。     

硫辛酸联合缬沙坦治疗早期糖尿病肾病的疗效及安全性分析

目的:探讨硫辛酸联合缬沙坦治疗早期糖尿病肾病的疗效及安全性。方法:选取了80例糖尿病肾病患者,按随机数字表法分为两组,对照组(39例)给予缬沙坦治疗,观察组(41例)给予缬沙坦和硫辛酸治疗。通过观察并记录患者治疗前后超敏C反应蛋白(hs-CRP),尿蛋白排泄率(UAER),尿β2微球蛋白(β2-MG),血清丙二醛(MDA),总抗氧化能力(T-AOC),超氧化物歧化酶(SOD)水平及治疗期间不良反应情况,评价硫辛酸联合缬沙坦治疗早期糖尿病肾病的疗效及安全性。结果:治疗前两组hs-CRP,UEAR,β2-MG差异无统计学意义(P0.05),经2个疗程药物治疗后两组各指标均明显降低。使用硫辛酸联合缬沙坦治疗的患者,治疗后上述指标降幅更明显(P0.05),治疗前,两组SOD、MDA、T-AOC水平差异无统计学意义(P0.05),治疗后两组SOD、T-AOC水平均显著增加,MDA水平显著降低(P0.05)。组间比较,观察组SOD、T-AOC水平高于对照组,MDA水平低于对照组(P0.05);治疗期间,两组不良反应率无统计学意义(P0.05)。结论:硫辛酸联合缬沙坦能显著减少糖尿病肾病患者尿蛋白水平,改善机体氧化应激状态,用药安全,值得临床推广使用。