摘要:目的：觀察厄貝沙坦治療非杓型高血壓患者降壓效果及其杓型血壓晝夜節律恢復情況,并觀察治療后血漿醛固酮水平的影響。方法:對杓型和非杓型兩組原發性高血壓患者分別給予150300 mg/d,觀察降壓效果及對血壓晝夜節律的影響,并監測用藥前后血漿醛固酮水平的變化。結果:所有高血壓患者應用厄貝沙坦治療前后收縮壓及舒張壓均有不同程度的下降,非杓型組夜間收縮壓及舒張壓的下降值與杓型相比有統計學差異,出現了明顯的晝夜節律,血漿醛固酮水平出現了明顯差異。結論:厄貝沙坦對非杓型高血壓患者有良好的降壓作用,并能恢復非杓型高血壓患者的晝夜節律,向杓型血壓變化。Abstract: Objective: To investigate the effect of blood pressure control and circadian variability of dipper blood pressure induced by irbesartan in patients with nondipper essential hypertension and to observe levels of aldosterone.after treatment.Methods:The patients were divided into dipper and nondipper groups. All patients were treated with irbesartan (150300 mg/d). The variability of circadian blood pressure were observed, and the levels of plasma aldosterone were monitored before and after treatment Results: After the treatment with irbesartan, the blood pressure in all patients were evidently reduced. The night blood pressure of the patient with nondipper essential hypertension had more significant improvement . The circadian variability was appeared. The levels of aldosterone had a significant difference between day and night. Conclusion:Irbesartan has significant effects for the patients with nondipper essential hypertension. It can induce a circadian variability and recover the dipper blood pressure from nondipper blood pressure.
Objective To evaluate the effect of triplex operations (splenopneumopexy, portal azygous devascularization and ligation of splenic artery) for children with extrahepatic portal hypertension. Methods From March 1993 to November 1998, 7 children with extrahepatic portal hypertension underwent triplexoperations. The diagnosis for these patients were confirmed by gastroscopy, barium meal and Doppler ultrasonography. The number of WBCand platelet and the hepatic function were checked before and after operations.And the free portal pressures were checked before and after ligations of the splenic artery. All patients were followed up for 2 to 8 years (5.6 years on average). The episodes of upper gastrointestinal bleeding were recorded. The degrees of varices of distal esophagus and proximal stomach were assessed by barium mealand gastroscopy. The diameters of the splenic and portal veins were obtained byBultrasound. The portopulmonary shunt and portal blood flow were evaluated by color Doppler flow image. The indices of hemorheology such as hematocrit, viscosity of whole blood and plasma, and the index of deformability and aggregability of RBC were obtained through viscometer (R-20 Seerle, Beijing). Results There was no operative fatal case in this group. Postoperatively, hemorrhage from the esophagus and gastric varices was completely controlled. Although the diameter of spleen reduced progressively, no patient’s spleen recovered to normal size during the follow up period. The degree of varices was mitigated and the free portal pressure was significantly decreased to （34.48±5.71） cm H2 O from the preoperative one （42.62±6.72） cm H2 O (P＜0.05). The rate of portal flow was alsodecreased. The direction of portal vein was bidirection (one part was away from the liver and the other was toward the liver). The number of WBC and platelet and the viscosity of whole blood and hematocrit were increased to normal value after operation. Conclusion The triplex operation is an effective procedure for the control of hemorrhage from varices in children with extrahepatic portal hypertension.
Objective To monitor the release of amino acids of the whole retina during and after experimental glaucoma by increasing the intraocular pressure （IOP）． Methods Experimental glaucoma was induced in one of the two eyes of rabbits by increasing IOP at 120 mm Hg for 45 min under infusion of saline in anterior chamber；then the pressure was released and the needle inserted into the anterior chamber was removed，this state was maintained for another 45 min．Every 15 min during the experiment 5 rabbits were killed and experimental eyes were enucleated．Aliquots（20 μl）of the retinal extracts（see below）were mixed with ophthaldialdehyde reagent and analysed for amino acid content by the HPLC method of Wangwei，using a 150 mm×4.6 mm,5 μm C18 column． Results A large increase in the release of glutamate，but not of the other three amino acids monitored，occurred during initial experimental ocular hypertension．It reached peak value of（111.73±17.46）10-5 mmol/g at 15 min of hypertension．15 min after release of intraocular pressure，again，immediately large and specific increase in the concentration of glutamate was reached to（102.96±51.91）10-5 mmol/g．In eyes subjected to paracentesis of anterior chamber，no difference was found between experimental eyes and controls. Conclusion These results suggest that glutamate is triggered by increasing the IOP，and it releases not only during the period of experimental ocular hypertension，but also afterwards. (Chin J Ocul Fundus Dis, 2002, 18: 146-148)
Objective To investigate the effect of prostaglandin E1 (PGE1) on serum vascular endothelial growth factor(VEGF) in patient with pulmonary hypertension secondary to congenital heart disease and its relation to different pathologic gradings of pulmonary arterioles. Methods Fifty three patients suffering from pulmonary hypertension secondary to congenital heart disease were chosen at random to undergo active tissue test of lung, including 6 patients suffering from severe cyanosis. All of them were intravenously dripped with PGE 1 for 15 days at the speed of 10 15 ng /kg·min, 12 hours a day. Venous blood was taken for study in the morning on the day before infusion, on the 5th day, the 10th day, and the 15th day after infusion. Then the concentration of VEGF was measured by enzyme linked immunosorbent assay (ELISA). Lung biopsy was taken from each patient and pathologic grading performed according to Heath and Edwards pathologic grading. Results Fifty three patients were classified into Grade Ⅴ:9 of them belonged to Grade Ⅰ, 14 to Grade Ⅱ, 19 to Grade Ⅲ, 5 to Grade Ⅳ, the other 6 with severe cyanosis belonged to Grade Ⅴ or even severe than Grade Ⅴ. Before administration of PGE 1, serum VEGF reached the peak while the pathologic grading of pulmonary arteriole was Grade Ⅲ, VEGF level markedly decreased in Grade Ⅳ and Ⅴ. After administration of PGE 1 serum VEGF in Grade Ⅰ showed no difference with that before administration of PGE 1( P gt;0.05), VEGF decreased in GradeⅡ and Ⅲ ( P lt;0.01), slightly decreased in Grade Ⅳ ( P lt; 0.05), while patients greater or equivalent to Grade Ⅴ showed no VEGF change during the course of PGE 1 administration ( P gt;0.05). Conclusions PGE 1 can lower the VEGF level, but the extent closely relates to the degree of pathologic change in pulmonary arteriole. It might be a pre operative parameter for pathologic grading of pulmonary arteriole.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.
Pulmonary arterial hypertension(PAH) is a kind of pulmonary hypertension disease. Recently, the researches of its pathogenesis have reached more and more deeply. The treatment of pulmonary arterial hypertension is individual and systematic, not only relying on medicine treatment. The treatment of PAH is as follows: common treatment, non-specific medicine treatment, targeted medicine treatment, NO breath-in treatment, gene treatment, intervention and surgery treatment.The article reviews the main treatment of pulmanory arteral hypertesion to provide new thought and evidence in clinic.
【摘要】 目的 探討肺動脈高壓患者藥物靶向治療的效果與耐受性。 方法 回顧分析2008年1月〖CD3/5〗2009年8月期間8例肺動脈高壓患者分別接受波生坦及西地那非治療的臨床資料,評估其臨床表現、WHO肺動脈高壓功能分級、6 min步行距離及肺動脈收縮壓在基線及治療3個月后的變化。 結果 治療后3個月,患者均能耐受藥物治療,無嚴重不良反應發生。WHO肺動脈高壓功能分級在治療前平均(31±04),治療后為(23±09),明顯得到改善(Plt;005)。肺動脈收縮壓在治療前平均(695±112 ) mm Hg(1 mm Hg=0133 kPa),治療后為(483±124) mm Hg,明顯降低(Plt;005)。6 min步行距離在治療前平均(324±48) m,治療后為(400±43) m,明顯延長(Plt;005)。 結論 肺動脈高壓患者藥物靶向治療的療效顯著,且耐受良好。【Abstract】 Objective To examine the effects of target medical therapy in patients with pulmonary arterial hypertension(PAH). Methods To determine the safety and efficacy of bosentan and sildenafil in eight patients with PAH.The patients’ clinical features, six minutes walking diastance, WHO functional class and systolic pulmonary arterial pressure (SPAP) were measured at baseline and at three months after initiating target medial treatment. Results At the three months followup assessments, WHO functional class was improved with 31±04 vs 23±09 (Plt;005); SPAP was significantly decreased with(695±112 ) mm Hg vs (483±124) mm Hg (Plt;005), the six minutes walking distance was significantly increased with(324±48) m vs(400±43) m (Plt;005). Target medical treatment was well tolerated. Conclusion Target medical treatment is well tolerated and has beneficial effects on PAH.
Objective To investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital to enrich the epidemiological data of chronic thromboembolic pulmonary hypertension (CTEPH) in China.Methods We conducted a retrospective study to investigate the incidence and management of CTEPH in the Department of Pulmonary and Critical Care Medicine in Xijing Hospital from 2008 to 2012. Results The incidence of CTEPH was 5.24% . About 62.90% of venous thromboembolism/pulmonary embolism (VTE/PE) patients were unprovoked, and about 53.85% of CTEPH patients was unprovoked. About 38% of CTEPH patients had no history of VTE, and 62% of CTEPH patients had no history of acute pulmonary embolism. None of the CTEPH patients was treated by pulmonary thromboendarterctom (PTE) , and about 53.85% of patients were only given anticoagulant monotherapy. Conclusions The incidence of CTEPH is higher in our hospital than reported. This phenomenon may be related to the lack of awareness of risk factors of CTEPH and the insufficient thrombolytic and anticoagulant therapy to acute pulmonary embolism. It’s very urgent to standardize the diagnosis and management of CTEPH in pulmonologists.
Objective To observe the protective effects of simvastatin at different stages on monocrotaline (MCT) induced pulmonary arteral hypertension (PAH) in rats and evaluate the early preventive effect of simvastatin. Methods Twenty-four male SD rats were randomized into a control group, a PAH group, an early intervention group, and a late intervention group, with 6 rats in each group. The rats in the control group received intraperitoneal injection of normal saline (NS) on d0. The rats in the PAH group received one-off intraperitoneal injection of MCT (50 mg/kg) on d0. The rats in the early intervention group were pretreated with oral gavage of simvastatin (20 mg·kg–1·d–1)(d–7––1) before the intraperitoneal one-off injection of MCT (50 mg/kg, d0) and continued with oral gavage of simvastatin for 14 days (d1~14). The rats in the late intervention group received one-off intraperitoneal injection of MCT (50 mg/kg)(d0) and oral gavage of simvastatin (20 mg·kg–1·d–1) for the next 21 days (d15~35). Thirty-five days after the MCT injection (d36), mean pulmonary arterial pressure (mPAP) and right ventricular systolic pressure (RVSP) were measured by right heart catheter. Then the rats were sacrificed for separating the heart and lung, the right ventricular hypertrophy index (RVHI) and percentage of small pulmonary arteries media thickness (WT%), the inflammation score around the small pulmonary arterial were recorded. Results Compared with those in the PAH group, RVSP, mPAP, RVHI and WT% in two simvastatin interventiongroups got much better (P＜0.01), and the inflammation score around the small pulmonary arterial declined (P＜0.05). Compared with those in the late intervention group, RVSP, mPAP in the early intervention group improved (P＜0.05) and WT% decreased more significantly (P＜0.01). However RVHI and the inflammation score around the small pulmonary arterial were not different between two simvastatin intervention groups. Conclusions Both early intervention and late intervention with simvastatin can reduce RVSP, mPAP and WT% in MCT induced PAH rats. Compared with later intervention, early intervention can prevent PAH more remarkably.
ObjectiveTo evaluate clinical efficacy of the modified Sugiura procedure with cardia transection in treatment of recurrent portal hypertension with upper gastrointestinal bleeding. MethodsFrom January 2007 to January 2015, there were 28 cases of recurrent portal hypertension with upper gastrointestinal bleeding were treated by the modified Sugiura procedure with cardia transection in The Second People's Hospital of Yichang and The Zigui County People's Hospital, collecting the clinical data of them and then summarizing the therapeutic effect. ResultsAll cases underwent surgery successfully with no operative death. The operative time was 120-300 minutes with an average of 160 minutes. About surgical blood loss was 100-500 mL, with an average of 210 mL. Two cases suffered from postoperative gastrointestinal bleeding, 6 cases suffered from postoperative gastric dysfunction, and no one suffered from anastomotic leakage, anastomotic stenosis, and portal vein thrombosis. Three cases died in reason of liver failure and hepatic coma. There were 24 cases were followed up for 6-60 months, with the median of 33 months. No recurrence of gastrointestinal bleeding happened during the follow-up period. Sixteen cases underwent gastroscopy in 6 months after surgery, according to the results, the clinical effect was fine. For grade of varicose veinsm, there were 14 cases of grade GⅠ and 2 cases of grade GⅡ. For shape of varicose veins, there were 11 cases of grade F1 and 5 cases of grade F2. ConclusionThe modified Sugiura procedure with cardia transection is a safe and thorough operation for recurrent portal hypertension with bleeding.