目的 探讨老年综合评估(C GA)指导下的综合干预对慢性心力衰竭患者心功能及不良心血管事件发生率的影响.方法 选取2019年9月至2021年9月上海市第八人民医院收治的年龄≥65岁慢性心力衰竭患者180例,按照随机数字表法分为常规组(90例)、CGA干预组(90例).干预组在常规药物治疗的前提下,根据C GA结果进行针对性综合干预,包括躯体功能训练、多重用药干预、营养状态管理等.比较2组患者治疗6个月后血浆脑利钠肽、N端脑钠肽前体水平、6 min步行距离及超声心动图结果.比较2组干预后不良心血管事件发生情况.结果 干预组治疗6个月后的左心室射血分数、心排血量、6 min步行距离较前上升(P<0.05).与常规组相比,干预组脑利钠肽(BNP)水平下降,差异有统计学意义(P<0.05).CGA干预组心脏不良事件发生率为10.0％,低于常规组的18.9％(P<0.05).结论 对于慢性心力衰竭患者通过CGA评估并在其指导下进行有效综合干预措施能够改善患者的心功能,减少不良心血管事件发生.

缺血性脑血管病在临床上较为常见,主要是因为患者脑部血液供给存在严重异常导致的脑缺血或者坏死现象,该疾病具有较高的发病风险和死亡风险,对患者的健康造成了严重的威胁[1].随着临床对脑血管病症研究的不断深入,对于该疾病的治疗方法较多,主要包括内科治疗、药物治疗、神经介入治疗等[2].药物治疗在临床中应用广泛,如何选择安全、有效的药物一直以来都是临床研究的重点.

目的 分析前列地尔脂微球载体制剂在心肾综合征患者治疗中的应用效果.方法 上海市第八人民医院2016年10月-2017年10月期间接收并治疗的心肾综合征患者中随机选取58例作为研究对象,依照患者治疗方式将其分成两组,对照组29例患者实施常规治疗,观察组29例患者在此基础上加前列地尔脂微球载体制剂和羟苯磺酸钙治疗,对比两组患者治疗前后的血肌酐(Scr)、内生肌酐清除率(Ccr)、尿素氮(BUN)和血清B型脑钠肽(BNP),并统计分析两组患者在治疗前后的肾动脉及分支收缩期峰值血流速度(PSV)、波动指数(PI)、阻力指数(RI)和左室射血分数(LVEF)改善效果.结果 两组患者治疗后的血浆Scr、BUN和BNP与治疗前相比均有明显下降,同时Ccr则有明显提高,差异对比显示P＜0.05;两组患者治疗后的PSV、LVEF和治疗前相比有显著提升,同时PI和RI出现显著下降,差异对比P＜O.05;治疗后,观察组患者的血浆Scr、BUN、BNP、Ccr、PSV、LVEF、PI和RI与对照组相比,其改善效果具有明显优势,差异对比P＜0.05.结论 在心肾综合征患者临床治疗中,对患者实施前列地尔脂微球载体制剂治疗,有助于显著改善患者的心肾功能,改善患者治疗效果,值得推广.

心肾综合征（ CRS ）狭义的概念是指慢性心力衰竭（ CHF ）患者出现的进行性肾功能损害，并导致肾功能不全，并且心力衰竭的治疗由于肾功能的进一步下降而受到限制。以往研究证明CHF患者血浆中氨基末端脑钠肽前体（ NT－proBNP ）代偿性升高，与纽约心脏病协会（ NYHA ）分级、左心室射血分数（ LVEF）、心肺运动实验中峰耗氧量等多个CHF 的独立预测因子有良好的相关性〔1〕。 NT－proBNP 亦能很好地体现CHF 的严重性，可广泛用于评价各种心血管疾病〔2，3〕，NT－pro－BNP 的清除机制依赖于肾脏，在慢性肾脏病（ CKD）前期NT－proBNP可升高〔4〕，说明NT－proBNP升高是多因素影响的结果〔5〕。本研究进一步分析NT－proBNP在老年CRS患者中的价值。

Objective In this study group of 180 patients randomized,single-blind divided into:BNP group and control group.Methods Through the continuous 2 years observing two groups of patients with cardiovascular endpoint events:any cardiovascular death,cardiovascular events in hospital(heart failure,acute coronary syndrome and cerebrovascular accident any need to increase the drug outside of the onset of decompensated heart failure)Results No difference in all-cause mortality between the two groups,the BNP group decreased significantly due to heart failure hospitalization rate(P0.05),BNP group lobbying uses the proportion of patients with heart failure drugs resistance was higher than that of the control group(P0.05),BNP group,the incidence of cerebrovascular accident was lower than that of the control group(P0.05),BNP ACS disease incidence was lower than that of the control group(P0.05).Conclusion Under the guide of BNP in elderly patients with chronic heart failure management model in terms of readmission for heart failure is better than that of the conventional management mode,and has certain advantages in prevention of ACS cerebrovascular accident,is worthy of reference for clinical.

Objective To observe the relationship between the level of serum uric ucid and the degree of hypertension. Methods The value of serum uric ueid was measured in 61 cases with essential hypertension (grade Ⅰ,Ⅱ,Ⅲ were 6,21 and 34 cases respectively)and in 53 in-patients without hypertension in the same period. Results Serum uric ueid levels,as well as the rate of hyperurieemia,in eases with essential hyperten- sion was higher than that in non-hypertension eases( P < 0. 05 ). Comparison with group non-hypertension, group grade Ⅰ and Ⅱ hypertension, group grade Ⅲ hypertension showed longer duration, higher levels of serum uric ueid( P <0.01 ). Conclusion The level of serum uric ueid and the rate of hyperuricemia in essential hyperten-sion increased significantly, and the higher of the degree, the longer of the duration, the more significant the in-creasing was.

Objective To analyze the correlation and mechanism between the level of serum uric acid and carotid artery atherosclerosis in patients with essential hypertension(EH).Methods A total of 61 patients with EH(divided into gradeⅠ,Ⅱ and Ⅲ)and 53 patients without hypertension were enrolled.The value of serum uric acid was measured and carotid ultrasound was performed.Results The mean value of serum uric acid in patients with or without EH was(339.3±121.3)μmmol/L and(295.1±89.8)μmmol/L,respectively(P0.05),and hypertension grade Ⅲ was significantly higher than that of grade Ⅰ and Ⅱ(P0.01).The detection rate of carotid atherosclerosis with ultrasound in cases with EH(52.46%)was higher than that in non-hypertension group(35.85%,P0.05).The rates of hyperuricemia and carotid atherosclerosis were not had statistical different among grade Ⅰ,Ⅱ and Ⅲ(P0.05).The rate of carotid atherosclerosis in group hypertension with hyperuricemia was higher than that either in group hypertension without HUA(P0.05)or in group non-hypertension with hyperuricemia(P0.05).Conclusion The patients with EH have high level of serum uric acid and will easily suffer hyperuricemia and carotid atherosclerosis.Hypertension with hyperuricemia increases the risk of carotid atherosclerosis.