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Objective: To investigate the effect of Chinese drugs (CD) that invigorate Spleen to remove Dampness and activate the blood circulation to eliminate Turbid for retarding progression of chronic renal failure (CRF). Methods: Thirty-nine patients with CRF were divided into two groups at random: the 18 patients in group A (the control group) were treated with low protein diet and controlling blood pressure and 21 patients in group B (the treatment group) were treated similarly with that of the control group and additional CD. Levels of serous creatinine (SCr), blood urea nitrogen (BUN), blood albumin (Alb), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and hemoglobin (Hb) were checked every two months and the rate of progression of CRF was estimated by slope of the creatinine reciprocal (1/SCr) with time (months). Results: Levels of SCr and BUN in group B were lower and HDL higher than those in group A significantly, P<0.05. Mean slopes of the creatinine reciprocal with time in the two groups were markedly different, P<0.01. Conclusion: Additional CD treatment based upon the low protein diet and controlling blood pressure could retard the rate of progression of CRF evidently.
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Astragalus (AS), a traditional Chinese tonic medicine, refers to the dry root of perenial herbaceous plants Astragalus membranaceus (Fisch) and Astragalus mongolicus Bge of leguminosae family, which was first recorded in "Shen Nong's Herbal Classic" (神农本草经). The herb is sweet in flavor, slightly warm in nature and acts on the Spleen and Lung channels. It was described that AS possesses the effects of "invigorating Qi to elevate Yang,consolidating superficies to stop sweating, inducing diuresis to remove edema and promoting healing of sore to regenerate tissue". Its chemical components have been discovered to be AS-saponins (ASS), AS-general flavone (AGF), AS-polysaccharides (APS), amino acid and microelements. During the past two decades, the effects of AS, the prescriptions containing AS and its active components on cardiovascular system have been widely studied(1,2). Its effects of positive inotropic action,reducing blood pressure, and in protecting myocardia against injuries caused by ischemia and ischemia/reperfusion or virus infection have been well documented. The underlying mechanisms of the effects have also been deeply studied. This paper summarizes the pharmacological studies on the effects of AS on cardiovascular system conducted in recent years.
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There are three principles which need to be grasped in the clinical use of Chinese drugs in the treatment of hypertension: Combination of syndrome differentiation in TCM with disease-differentiation in western medicine; combination of the theory of TCM with the results of modern pharmacological researches; and combination of symptom improving, blood-pressure reducing with complications preventing measures.Use of Chinese Drugs Based on the Western Medical Stages of Hypertension Patients should be classified for clinical stages of hypertension according to western medical criteria before TCM treatment program is made. For instance, in hypertension patients, apart from high blood pressure, there may also be other symptoms such as headache, dizziness, distending sensation in the head, stiff sensation in the neck, dim eyesight, tinnitus, poor memory, inability to concentrate the mind, insomnia, disphoria, general weakness, numbness of the four limbs, and palpitation. In some patients, these symptoms may not always be directly related to hypertension. In these cases, treatment for reducing blood pressure may not be taken into consideration, and the treatment based on general differentiation of the symptoms may serve the purpose. Only after the differential use of Chinese drugs shows no obvious improvement of the symptoms and high blood pressure, the treatment will be aimed at hypertension per se. When Chinese drugs alone can not reduce blood pressure, western medicine is often used in combination to reduce blood pressure, blood lipids and uric acid, correct water-electrolyte metabolism, and improve blood rheology. The combined Chinese and western medical treatment can make up each other's deficiencies so as to give better therapeutic effects.
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Case History Song××, a male middle school teacher aged 58 years, paid his first visit on August 7, 2000, with the chief complaint of pain in the left hypochondrium for 20 days. The patient stated that he suddenly got a sharp burning pain in the left hypochondrium in mid July. The pain gradually radiated to the upper abdominal area, meanwhile red herpes appeared in the hypochondriac region. He had been diagnosed as having herpes zoster, and treated in several nearby hospitals with fluid infusion and medication. As a result, the herpes partly disappeared. But the sharp burning pain still remained, which could not be relieved by administration of analgetics. The patient was then recommended by his friends for treatment here. The patient used to be in a anxious state of mind, and had a wiry pulse and disorder of the liver-qi. The patients had been disturbed by problems of his students and worried about his aged mother's illness, and had poor sleep. Physical examination showed that the patient had a slightly fat figure and sickly complexion, but was in a clear mind. His blood pressure was 140/90 mmHg, and heart rate 75 times/min. No abnormal signs were found in the heart and lungs. Prominent dark red herpes with obvious local tenderness was found on the skin surface of the left hypochondrium and upper abdome.
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人重复肢体缺血对血压、心率及组织氧饱和度的影响
"远程缺血预适应(remote Ischemic Precondition,rIPC)"对远隔脏器缺血/再灌注(Ischemia/Reperfusion,I/R)损伤的保护作用逐渐受到重视[1-2].
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影响产前孕妇血压及胎心率的心理社会因素
本文应用胎心率监护的方法,探讨心理社会因素对产前孕妇血压和胎儿心率的影响,通过量化的方法找到两者之间的联系.
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急性重型颅脑损伤时内皮表和降钙素基因相关肽含量变化及其对动脉压的影响
内皮素(endothelin, ET)是一种具有极强生物活性的血管收缩因子,而降钙素基因相关肽 (calcitonin gene-related peptide, CGRP)则是一种具有极强活性的血管舒张因子,二者是极具代表性的血管活性多肽.我们用放射免疫法测定急性重型颅脑损伤(ASBI)患者血浆中ET及CGRP的含量变化,同时监测其平均动脉压(mean arterial blood pressure, MABP ),并对三者间的相互关系进行探讨.
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高血压病运动疗法的进展
高血压病目前以药物治疗为主,非药物治疗只作为其辅助疗法.然而,药物的各种副作用使患者的生活质量下降[1].高血压患者舒张压(diastolic blood pressure,DBP)降低过分或不足均可导致死亡率的上升,并认为这和药物的毒性作用有关[2].血压轻度下降的高血压患者死亡率低,而用非药物方法治疗也能取得这样的效果,而且停止用药后患者的生活质量都有所提高[1].因此近年来,非药物治疗普遍受到重视,运动作为高血压患者的一种非药物治疗的主要方法之一,不仅有助于控制体重、降低血脂、促进机体代谢,还能产生明显的降压效果.
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97例休克患者有创血压与无创血压监测的相关性研究
血压是反映人体循环系统机能的重要指标之一.近年来随着危重病医学的发展及各种先进医疗仪器的临床应用,有创血压(Arterial Blood Pressure,ABP)和无创血压(Noninvasive Blood Pressure,NBP)逐步取代了传统的汞柱血压计和听诊器测压法.理论上讲,有创血压比较准确,可靠,无创血压接近于正常值.[1]Campbell等人概述了休克状态NBP可能提供不可靠的、较高的血压值,而ABP却能更准确地反映患者的血压状态.[2]国内有人曾对血压正常和高于正常的患者进行了ABP和NBP的比较,[3]其结果与我们监测的结果是悖离的.我们自1995年2月至1998年6月收集了97例患者412次测压结果,并进行了其相关性研究.现报道如下.
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依托咪酯和咪唑安定对不停跳冠状动脉旁路搭桥手术气管插管期间心率和血压影响的比较
Objective To compare the effect of etomidate and midazolam on heart rate and blood pressure during tracheal intubation in off-pump coronary artery bypass graft. Methods Sixty patients scheduled for coronary artery bypass graft surgery without cardiopulmonary bypass shunt were randomly and double-blindly divided into etomidate group ( Group E, n = 30) and midazolam group ( Croup M, n = 30 ) based on the anesthetic used for induction. Electrocardiogram, systolic blood pressure (SBP) , diastolic blood pressure ( DBP) , heart rate ( HR) and pulse oximetry saturation ( SpO-2 ) were measured and recorded continuously, as well as the value of rate-pressure product ( RPP). The time used for tracheal intubation was also recorded. Results In Group M,compared with pre-tracheal intubation,the SBP and DBP of all patients decreased remarkably at the beginning of tracheal intubation ( P < 0.05 ). At 1 minute post-trachealintubation,the SBP,DBP and HR increased remarkably (P <0.01) ; meanwhile, the values of RPP were increased significantly than those at the beginning of tracheal intubation and pre-tracheal intubation (P<0.01). Compared with the values in Croup E,at the beginning of tracheal intubation,the values of SBP and DBP in Group M were significantly decreased ( P < 0.05 and P < 0.01,respectively) , while the values of SBP,DBP and RPP at 1 minute after tracheal intubation were significantly increased ( P < 0. 05 and P <0. 01,respectively). Conclusions Compared with midazolam, etomidate used in anesthetic induction for coronary artery bypass graft surgery without cardiopulmonary bypass shunt may more effectively alleviate the cardiovascular responses to tracheal intubation.
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探讨运动血压反应的临床价值
虽然正常人运动中收缩压(SBP)均会升高,然而不少研究证明运动中SBP过度增高也是异常的反应.超强的增压反应(exaggerated blood pressure response to exercise,exBPR)提示血管内皮功能障碍可作为血管硬化的早期指标,并能预示靶器官损害、新发高血压和心血管事件的危险,因此值得关注[1-4].
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肾动脉狭窄支架术对肾功能、血压的作用
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降压药物初始治疗时机及收缩压降低水平的审慎再讨论
本文为刚刚发表的一篇有关降压药物初始治疗时机及收缩压降低水平的综述文章,以下为主要结论.
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动态血压临床应用的研究现状
动态血压监测(ambulatory blood pressre monitoring,ABPM)能够提供24 h内多次血压测量数据,为了解患者全天的血压水平和波动趋势,提供了极有价值的信息,目前正广泛应用于临床,在高血压病的诊断、治疗效果评价及预后分析中发挥着越来越重要的作用.
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冠心病患者的血压管理:从循证证据到临床实践
冠状动脉粥样硬化性心脏病(冠心病)经常和高血压同时并存,这是因为血压的升高可促使动脉粥样硬化的发生与发展.事实上高血压患者冠心病的患病率是血压正常者的3~4倍,而全球60%~70%冠心病患者有高血压、49%的心肌梗死病例由高血压引起.因此,冠心病患者的降压问题值得充分关注.
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Clinicopathological Conference(the48th case)Adult gland pituitary hypofunction in an elderly female patient
Case presentation A female patient(a retired worker),68 years old,who complained mainly of "repeated episodes of dizziness,fatigue,vomiting in 6 years,chest tightness,chest pain for 1 year",was admitted to Heart Center,Chaoyang Hospital,Capital Medical University on February 24,2010.The patient suffered from dizziness and fatigue with unknown cause 6 years ago.She ever experienced sudden syncope and loss of conscioueness during visiting Xuanwu Hospital,when she presented with blood pressure of 62/? mmHg and slower heart rate,then her consciousness recoverd spontaneously 1-2 minutes later with no treatment.The head CT and electrocardiogram(ECG)showed no significant abnormality,and she was discharged after symptomatic treatment.Since then,the patient presented with intermittent anorexia,dizziness,nausea,vomiting,non-visual rotation,which were not affected by different body positions.All these symptoms appeared more frequently in winter,lasted for several days,relieved without any treatment.One year ago,the patient began to suffer from chest tightness and chest pain at physical activities.Each attack lasted for 3-5minutes and relieved by rest.In Xuanwu Hospital,the diagnosis of "coronary heart disease,angina pectoris " was established.After oral administration of "Wan Shuang Li" and other meidcations,chest tightness and chest pain appeared accidentally.Ten days ago,the patient experienced dizziness and vomiting(stomach contents,4-5 times a day on average).No visual rotation or tinnitus was accompanied.Twenty-nine hours before admission,the patient suffered from chest distress and chest pain again after 100 meters walking,accompanied with shoulder dispersion and sweating;the symptoms relieved after resting for 3-5 minutes.For further treatment,the patient visited Heart Center,Chaoyang Hospital.ECG showed "sinus bradycardia",and she was admittied for "arrhythmia".Since the onset,the patient displayed low blood pressure,slow heart rate,Susceptibility to coldness,frailty,poor appetite and sleep,normal stool.The body mass decreased by about 5kg over the past decade.
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第3例:阵发性心慌-肝脾肿大-腹水
诊治难点:·患者有阵发心慌、面色潮红、血压下降、腹泻、肝脾肿大及腹水等症状.腹水常见病因为肝硬化、肿瘤、结核等,系统性肥大细胞增多症为造成腹水的少见疾病之一.·阵发心慌、面色潮红等常为释放生物活性物质或激素有关,注意与类癌的鉴别.启示:·临床症状较多时,诊断上尽量用一元论解释全貌.常见病、多发病不能解释时,应考虑到少见病和罕见病的可能.·临床医生应加强对肥大细胞增生症的认识,这种疾病可有多种临床表现.
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高血压患者应当实施降压联合抗动脉粥样硬化的治疗
既往的实践证明:单纯降压治疗可以比较好地解决高血压导致的心力衰竭和卒中,特别是出血性卒中;单纯降压治疗可以减少部分冠心病事件,但往往获益不足.这一现象持续了相当长的时间.
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关注骨代谢因素对血压的影响
骨骼与心血管系统似乎是毫无关系的两个领域,但越来越多的证据显示两者间存在着密切联系,其中骨代谢对于血压的影响尤其引起了人们的极大关注.
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肥厚型心肌病猝死危险因素分层
肥厚型心肌病(HCM)是常见的遗传性心脏病.普通人群患病率1/500,以自然病史差异极大为特征.很多患者终生无症状,寿命与常人并无不同.有些患者有心力衰竭(心衰)或心房颤动(房颤)的症状,某些患者猝死.猝死者常常先前没有症状,年龄较轻.HCM是青年人和运动员常见的猝死原因.因此对猝死危险进行分层,预防猝死是一个重要的临床问题.药物治疗,包括胺碘酮治疗,已经被证明不能防止HCM猝死,而两个多中心研究已经证实,置入性心脏除颤器(ICD)防止HCM猝死非常有效.因此找到猝死高危需要置入ICD的HCM患者,成为目前学术界的研究热点.