目的 探讨长疗程体外反搏及短疗程体外反搏对稳定型心绞痛的疗效及炎症因子的影响.方法 将90例稳定型心绞痛患者随机分为Ⅰ组(常规治疗组)、Ⅱ组(短疗程反搏组)及Ⅲ组(长疗程反搏组),每组30例.Ⅰ组接受常规治疗,Ⅱ组接受常规治疗及15 d体外反搏治疗,Ⅲ组接受常规治疗及35 d体外反搏治疗.治疗35 d后对三组的治疗效果进行评价,用免疫比浊法测定治疗前后血中CRP水平.结果 Ⅰ组有效率55.2％,Ⅱ组有效率90.0％,Ⅲ组有效率93.1％.Ⅰ组治疗前后对比,CRP水平无明显变化;与治疗前对比,Ⅱ组、Ⅲ组治疗后CRP水平明显下降,且差异有统计学意义(P＜0.05),但两组组间比较差异无统计学意义(P＞0.05).结论 长疗程体外反搏与短疗程体外反搏在治疗稳定型心绞痛方面疗效相近,均优于单药治疗.

目的 观察左西孟旦治疗慢性充血性心力衰竭(CHF)的临床效果.方法 选取慢性CHF病人156例,随机分为实验组及对照组各78例.在常规治疗的基础上,实验组给予左西孟旦治疗,对照组给予多巴酚丁胺治疗.治疗2周后,观察比较两组NYHA心功能分级、左心室射血分数(LVEF)、每搏心输出量(SV)、血清N末端脑钠肽(NTpro-BNP)、尿素氮(BUN)、肌酐(Cr)、电解质等的变化.结果 与对照组比较,实验组治疗前后心功能分级、NTpro-BNP、LVEF、SV的变化差异有显著意义(Z=3.02,t=2.62～232.13,P＜0.05).结论 左西孟旦治疗慢性CHF,可显著改善心功能,提高LVEF和SV,降低NTpro-BNP水平.

Objective To discuss the curative effect and safety of olmesartan on chronic heart failure (CHF). Methods The CHF patients (n=120, male 50 and female 70) were chosen from the Cardiovascular Hospital affiliated to Qingdao University Medical College from Nov. 2011 to Oct. 2013. All patients were divided into groupⅠand groupⅡ(each n=60) according to random digits table. All groups were treated with routine therapy (individualized administrations of cardiotonics, diuretics, aldosterone receptor antagonist andβ-receptor blockers), and group Ⅰ was additionally given olmesartan, and group Ⅱ, valsartan for 8 w. The changes of LVEDd and LVEF, level of N-terminal pro brain natriuretic peptide (NT-proBNP), blood pressure (BP) and renal function were detected in 2 groups before and 8 w after treatment. Results After treatment, LVEDd decreased in groupⅠ[(58.5 ±6.4) mm vs. (52.2±6.0) mm] and groupⅡ(58.2±5.9) mm vs. (52.8±5.8) mm], and LVEF increased in groupⅠ[(39.2±5.2)%vs. (52.1±3.8)%] and groupⅡ[(39.8±6.0)%vs. (50.6±2.7)%, all P<0.05]. After treatment, NT-proBNP decreased significantly in groupⅠ[(934.0±217.7) pg/ml vs. (184.7±66.6) pg/ml] and groupⅡ[(935.0 ±224.6) pg/ml vs. (191.6±70.2) pg/ml, all P<0.05]. After treatment, BP decreased significantly in groupⅠand groupⅡ(all P<0.01). Conclusion Olmesartan can improve heart function and reduce level of NT-proBNP in CHF patients, and its curative effect is not worse than that of valsartan.

目的 探讨体外反搏(EECP)对女性慢性心力衰竭(CHF)患者PCI术后的疗效及安全性.方法 选择53例CHF 行PCI术的绝经后女性患者,随机分为EECP组和药物治疗组.EECP组在常规药物基础上加做EECP 8周,药物治疗组只进行常规药物治疗.两组患者治疗前、后均检测6 min步行距离及Tei指数.结果 两组6 min步行距离(m)(589.00±47.17、556.00±48.17)及Tei指数(0.38±0.11、0.45±0.12)与治疗前(465.50±41.80、467.75±40.76,0.57±0.12、0.56±0.13)相比差异均有统计学意义(P＜0.01),两组之间比较差异有统计学意义(P＜0.05).结论 EECP可提高女性CHF患者PCI术后的心肌缺氧能力,改善心功能,提高运动耐量,值得临床推广.

Objective To explore the relationship between plasma adiponectin concentration(APN) and the ankle brachial index(ABI) 、the pulse wave velocity(PWV),the severity of coronary artery lesion in coronary heart disease(CHD).Methods A total of 98 subjects who attended the cardiovascular department of the affiliated hospital of Qingdao university medical college from Aug 2007 to Jun 2008 were enrolled.The subjects were divided into normal control group(n=23)、ACS group(acute coronary syndrome,n=53) and SAP group(stable angina pectoris,n=22) by angiography.Serum APN concentration was evaluated by ELISA system,ABI and PWV were tested by the non-invasive vascular screening device.Results APN was significantly lower in ACS group than that in control group(P0.01) and SAP group(P0.05).Compared to control group,APN was significantly lower in CHD group(P0.01).APN was significantly lower in patients with three vascular lesions than that in the control group and in those with one vascular lesion(P0.05).There was no difference in APN between three vascular lesions and two vascular lesions.PWV was higher in CHD group than in control group(P0.05),and PWV was higher in those cases with three vascular lesions than in control group and in those with one vascular lesion(P0.01).ABI was higher in those cases with three vascular lesions than in control group(P0.05).Conclusions The plasma APN level is significantly lower in patients with CHD.The plasma APN level has close relationship with the severity of coronary artery stenosis,the stability of atherosclerotic plaque.APN might be as a new risk factor of CHD,and APN combined with ABI and PWV could provide a new and convenient way for revaluating and diagnosing the severity of coronary artery disease.

Objective To compare the therapeutic effect and safety of Ramipril,Irbesartan and Ramipril combined with Irbesartan for treatment of heart failure and angina pectoris.Methods 90 patients with heart failure and stable angina pectoris treated with conventional therapy were randomly assigned to group A(treated only with Ramipril)、group B(treated only with Irbesartan) and group C(treated with both Ramipril and Irbesartan) for 8 weeks to observe the therapeutic effect and safety.The changes of NYHA class、blood electrolytes、liver and renal function、12-lead electrocardiogram and echocardiography were examined before and after treatment.Results The angina pectoris attacks、Nitroglycerin dosage、ST segment move down、brain natriuretic peptide(BNP)、the indexes of echocardiography were improved more significantly after treatment in group C than the two other groups(P0.05),the frequency of adverse reaction of three groups was similar(P0.05).Conclusions Not only does the therapeutic effect of Ramipril combined with Irbesartan for treatment for heart failure and angina pectoris surpass that of Ramipril or Irbesartan alone,but also it is a safe medicine.

Objective To Observe the efficacy and safety of Ramipril combined with valsartan in treating hypertensive patients with diabetic nephropathy.Methods 97 hypertensive patients with diabetic nephropathy under the well control of blood glucose were included in this study.All cases were randomly divided into two groups: treatment group included 48 cases given Ramipril combined with valsartan;control group included 49 cases only given Ramipril.Urinary albumin excretion rate(UAER),blood urea nitrogen(BUN),serum creatinine(SCr),systolic blood pressure(SBP) and diastolic blood pressure(DBP)were measured for all cases before and after 24 weeks' therapy.Results According to ABP and OBP,all cases' blood pressure in both two groups was significantly lowed after treatments(P0.01).There was no significant difference between two groups(P0.05).UAER,BUN and SCr in both groups were markedly reduced after treatment(P0.05).Furthermore,UAER and SCr were reduced more in treatment group than in Control group(P0.05).Conclusions It is an effective and safe way to treat hypertensive patients with diabetic nephropathy to use Ramipril combined with valsartan.The protective effect on kidneys is independent from the influence on blood pressure.

Objective To study the effects of valsarta combined with atorvastatin on intima-media thickness(IMT)of common carotid artery of patients with mild to moderate essential hypertension. Methods Eighty-six patients with mild to mo-(derate essential) hypertension and normal lipidemia were randomly divided into two groups. Group A was given Valsarta 80 mg qd; Group B, Valsarta 80 mg qd combined with atorvastatin 10 mg qd. Both were treated for 12 weeks. IMT, TC, TG,LDL-C were evaluated before and after the treatment. Results There was no difference in BP, TC,TG, LDL-C or IMT between the two groups before treatment. BP decreased significantly (t=11.10-24.00, P0.01)two weeks after administration and decrease till the end of experiment in both groups. TC, TG, LDL-C, IMT were decreased significantly(t=2.83-14.10,P0.01)in Group B and IMT were decreased significantly (t=2.04,2.65; P0.01) in Group A after 12 weeks. The difference was significant between the two groups (t=2.53-7.34, P0.05). Conclusion Valsarta combined with atorvastatin is more effective than Valsarta alone in IMT of the common carotid artery in the treatment of patients with mild to moderate hypertension.

Objective To study the effect of atorvastatin on intima-media thickness(ITM)of the common carotid artery and coagulative system in hyperlipidemic patierts. Methods Thirty five hyperlipidemic patients were received atorvastatin 10 mg qd for 12 weeks. TC,TG,LDL-C,HDL-C,IMT,fibrinogen(FIB),thrombin time (TT),activated partial thromboplastin time(APTT) and prothrombin time (PT) were determind in hyperlipidemic group before and after treatment. The intima-media thickness of carotid artery was measured using echography. Thirty-five normol lipidemic subjects serued as control. Results TC,TG,LDL-C,IMT,FIB were decreased significantly( P 0.01)in hyper-lipidemic group after 12 weeks. HDL-C,PT TT,APTT were increased significantly ( P 0.05). Compared with normal lipidemic group,TC,TG,LDL-C,HDL-C,IMT,FIB and PT were not significantly different( P 0.05),while TT,APTT were significantly increased ( P 0.05). Conclusion Atorvastatin treatment not only regresses the structural changes in IMT of the common carotid artery but also improve disorder of coagulation system in hyperlipidemic patients.

充血性心力衰竭(congestive heart failure)简称心力衰竭或心衰也称心功能不全(cardiac insufficincy),是指静脉回流正常的情况下,由于原发的心脏损害引起心排血量减少和心室充盈压升高,临床上以组织血液灌注不足以及肺循环和(或)体循环淤血为主要特征的一种临床综合征.依据症状的有无及治疗反应,可将心力衰竭分为三个阶段:无症状性心力衰竭(silent heart failure):系指左室已有功能障碍,左室射血分数降低(LVEF＜50%),而临床无"充血"症状.充血性心力衰竭:系指临床已出现典型的症状和体征,即通常所指的心力衰竭.难治性心力衰竭(refractory heart failure):系指心力衰竭的终末期,对一般常规治疗无效.

Objective To evaluate the efficacy of homebred and imported bisoprolol in treatment of essential hypertension and their effects on metabolism. Methods 160 patients were randomly divided into four groups: group A (n=40), group B(n=38), effects on metabolism group C (n=42) and group D (n=40). Initially all patients were treated with bisoprolol 2.5mg qd, group A and C treated groups with homebred bisoprolol, group B and D treated with imported bisoprolc. Group C and D were combined with felodipine 2.5mg qd. The dose adjusted every week according to the blood pressure to try to keep blood pressure under 135/85mmHg. All patients were treated for 8 weeks. Everyday office blood pressure (OBP) was evaluated during the treatment; ambultory blood pressure (ABP) and some biochemical parameters were evaluated before a after treatment. Results According to the total effective rate, the extent of decreased blood pressure and T/P, patients in Group C and D were remarkably superior to the patients in Group A and B (P0.01); but there was no differen between patients in group A and group B (P0.05); neither did group C a group D (P0.05). No biochemical parameter changes were observed in all groups. Conclusions Felodipine combined with bisoprolol is more effective than bisoprolol alone in the treatment for patients with mild to moderate hypertension. No adverse effects were found in patients treated with homebred homebred and imported bisoprolol.

Objective To evaluate the effects of ramipril combined with valsartan on patients with congestive heart failure (CHF). Methods One hundred and fifty patients treated with conventional therapy (digitals, diuretics, β-blocking therapy) are randomly assigned to receive ramipril 1.25～10 mg/d and valsartan 80 mg/d combination (group A n75) or ramipril 1.25～10 mg/d alone (group B n75). The changes of NYHA class, blood electrolytes, liver and renal function, electrocardiogram and echocardiography were examined. Results After eight weeks therapy, although LA atrium diameter, LV end-distolic volume(EDV), LV end-systolic volume(ESV), left ventricular ejection fraction (EF), fraction shortening(FS), cardiac output (CO), cardiac index (CI) were improved significantly in both groups(P0.05); however, LVEDV, LVESV, EF, FS, and NYHA class were ameliorated more substantially in group A than those in group B (P0.05). No significant changes of liver and renal function were found in both groups with little difference in the freguency of adverse reaction between them (P0.05). Conclusion Valsartan combined with ramipril is more effective than ramipril alone in the treatment of the patients with CHF.

①目的观察曲美他嗪治疗老年稳定型劳累性心绞痛的疗效及安全性. ②方法选择老年稳定型劳累性心绞痛患者53例,随机分为曲美他嗪组和对照组.两组用药前后观察每周心绞痛发作的次数;每周硝酸甘油含片的消耗剂量;心率及心率和收缩压的乘积;运动诱发心绞痛发作所需的时间;运动后ST段下降≥0.1 mm所需的时间;运动持续时间;血生化检验. ③结果曲美他嗪组心绞痛的发作次数、每周硝酸甘油含片的消耗剂量、运动诱发心绞痛发作所需的时间及ST段下降≥0.1mm所需的时间较治疗前有明显差异(P<0.05),与对照组比较差异显著(P<0.05),未出现不良反应.④结论曲美他嗪可提高老年稳定型劳累性心绞痛患者的心肌耐缺氧能力,改善缺血症状,从而提高患者的运动耐量,改善生活质量,且用药安全,值得临床推广应用.