间歇运动对高血压患者生存质量及血浆CRAMP的影响

目的比较大强度间歇运动和中等强度持续运动对高血压患者生存质量及血浆CRAMP的影响规律。方法26名原发性高血压患者经适应性训练后随机分为两组,分别进行中等强度的持续有氧练习(CE组)和较大强度的间歇有氧练习(IE组)16周,试验开始和结束时分别进行生存质量的评价和外周血CRAMP的测定。结果运动干预后两组患者SF-36量表各维度评分中,躯体疼痛和社会功能与干预前比较无显著性差异(P>0.05);而躯体功能、躯体角色、总体健康状况、活力、情感角色和心理健康6项指标与运动干预前比较都存在显著性差异(P<0.05)。治疗后SF-36量表各维度评分,其4项指标:总体健康状况、活力、情感角色和心理健康,IE组均高于CE组(P<0.05);IE组CRAMP在运动后出现了明显下降(P<0.05),但CE组CRAMP在运动后下降不明显(P>0.05)。结论高强度间歇运动与中等强度持续均能提高高血压患者的生存质量,但间歇运动的效果更好,且可以降低高血压患者外周血衰老信号分子CRAMP水平;间歇运动是高血压患者运动干预的重要方式。     

间歇运动对自发性高血压大鼠心血管内皮细胞的保护作用

目的:探讨间歇运动对自发性高血压大鼠(SHR)胸主动脉的心血管内皮细胞的保护作用。方法:20只11周龄的自发性高血压大鼠随机分为运动组和对照组,运动组进行连续10周的间歇运动。分别于训练前后测试血压、血脂,运动10周后通过扫描电镜观察胸主动脉的内皮细胞层,测量血液中内皮细胞的数量,同时测定循环内皮祖细胞(CEPCs)的数量及增殖能力、黏附能力及凋亡情况。结果:运动组SHR胸主动脉内皮细胞层受损程度轻于对照组;运动组循环内皮细胞数量与CEPCs凋亡率低于对照组(P0.05),而CEPCs数量、CEPCs增殖能力、CEPCs黏附能力均高于对照组(P0.05)。结论:长期的间歇运动能增加SHR的CEPCs数量、提高CEPCs功能、降低CEPCs的凋亡、增强CEPCs对血管内皮细胞的修复能力,对高血压大鼠的血管内皮细胞具有保护作用。     

原发性高血压发病危险因素及防治的探讨

原发性高血压已成为危害人类健康的重要疾病,就其发病的危险因素,针对其薄弱环节采取综合防治措施,为更好的控制危险因素,防治高血压的发生和发展,提供理论依据.     

太极拳锻炼对Ⅱ型糖尿病合并高血压疗效影响的机制探讨

通过观查40例Ⅱ型糖尿病合并高血压的患者练习太极拳前后血压,血糖,胰岛素及受体的变化,研究太极拳锻炼对Ⅱ型糖尿病合并高血压患者疗效的影响以及可能的作用机制。在常规药物治疗的基础上参加规定的太极拳动作的学习及锻炼3个月。分别采集各实验组和对照组在锻炼前和锻炼12周结束后空腹状态下血液,进行如下指标的测试:血糖、胰岛素、糖化血红蛋白。结果显示运动组治疗后24小时血压、白天收缩压比治疗前有所下降,经统计学处理有显著性差异,但其他各项值虽有数量上的变化,但经统计学处理,与治疗前比较,无显著性差异。运动组血糖水平下降,胰岛素水平升高,高、低亲和力受体个数(r)和高低亲和力受体容量(R)显著升高。     

Assessment of Oxidative DNA Damage by Alkaline Comet Assay in Human Essential Hypertension

The objective of the present study was to investigate the antioxidant status and the extent of oxidative DNA damage in lymphocytes and their relation with essential hypertension (EHT). A total of 100 South Indian subjects aged 30–65 were included for the study. Of these 50 were normotensive controls (group-1) with blood pressure ≥120/80 mm Hg, 50 were newly diagnosed (group-2) and were not on any antihypertensive drugs, but had systolic blood pressure ranging between 140 and 160 mmHg and diastolic blood pressure 95–100 mmHg and 50 newly diagnosed essential hypertensive patients underwent drug therapy for 1 year was considered as group-3. Enzymatic and non-enzymatic antioxidants significantly decreased and lymphocyte DNA damage was significantly increased in newly diagnosed hypertensive patients compared with control group. The major decrease in DNA damage and significant improvement in enzymatic and non-enzymatic antioxidants were observed after 1 year of antihypertensive therapy in treated group compared with newly diagnosed hypertensive patients. Total antioxidant status and lymphocyte DNA damage showed a strong negative correlation in all the three groups. Essential hypertension associated with oxidative stress which in turn causes genotoxic susceptibility to variety of disease including cancer. In the absence of DNA repair process and DNA checkpoint mechanisms, the genomic integrity is susceptible to extensive damage. In our study, increased oxidative DNA damage and decreased antioxidant levels were frequently observed in the newly diagnosed essential hypertensive patients, suggesting that oxidative stress is important in the pathogenesis of EHT. Therefore, the present study has additional clinical implication. Further investigations with large number of patients along with antioxidant supplement are highly warranted.     

18例脑干出血临床分析

总结18例脑干出血的临床资料，发现其危险因素有：高血压、高血脂、糖尿病、吸烟、酗酒等，临床表面多样，但以意识障碍、颅神经症状、交叉性偏瘫或双侧瘫为主，CT检查有助于早期诊断及判断预后，本组治疗显示死亡率55．5％，说明干出血死亡率高，根据临床表现尽早CT检查可提高存活率，手术穿刺引流值得探索，积极防治原发病及养成良好生活习惯，可减少发病。     

Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units (ICUs). A total of 108 (76.6%) questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation (APACHE) II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure (IAP). Although the vast majority of the ICUs adopted the exclusively transvesicular method, the overwhelming majority (88.0%) only measured IAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for IAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended abdomen (92%), worsening oliguria (80%), and increased ventilatory support requirement (68%). Common causes for IAH/ACS were “third-spacing from massive volume resuscitation in different settings” (88%), “intra-abdominal bleeding”, and “liver failure with ascites” (52% for both). Though 60% respondents would recommend surgical decompression when the IAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of respondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases.     

高血压病患者用药依从性影响因素及护理干预

目的对高血压病患者用药依从性情况进行调查,根据调查结果制定相应的护理干预措施,为更好地治疗高血压病提供依据。方法对就诊于江苏省中医院被确诊为原发性高血压病的260例患者,通过问卷调查和问询,对其服药依从性情况进行调查。结果 260例高血压病患者中,服药依从性好的比例仅为22.7%,多数患者由于来自认知因素、年龄因素、治疗因素和经济因素等方面原因,导致服药依从性不高。结论通过加强健康教育、坚持个性化用药、构建伙伴式的护患关系、督导自测血压、争取家庭和社会的支持等途径,可以有效提高高血压病患者的服药依从性。     

Reversible suppression of nitric oxide system in essential hypertension

Despite enormous research in the field of hypertension, its pathophysiology still remains largely unresolved and appears to be multifactorial. In the present communication, we have analyzed the status of nitric oxide (NO) in the patients with essential hypertension and age matched controls. We have found that the levels of NO are lowered in essential hypertension. The normalization of blood pressure by administration of antihypertensive therapy causes rise in the NO level indicating that perturbed NO status in essential hypertension is reversible. Addition of antioxidant to the antihypertensive drugs causes a further, though non significant, rise in the levels of NO, suggesting that antioxidants may be combined with antihypertensive drugs as adjunct in the management of essential hypertension.     

太极拳对原发性高血压患者降压效果的系统评价与Meta分析

目的：本研究系统评价太极拳运动对原发性高血压患者血压指标的影响并进行Meta分析,以期为临床工作提供较为可靠的参酌依据。方法：收集太极拳对原发性高血压患者血压影响的随机对照试验,应用Cochrane偏倚风险评估工具对纳入研究进行方法学质量评价,Stata15.0软件进行Meta分析。结果：依据排除标准,研究共纳入15篇随机对照试验,其中低、中、高风险文献分别为6篇、8篇和1篇。纳入研究总样本量732个,其中实验组316个,对照组416个。Meta分析发现,实验组对原发性高血压患者收缩压和舒张压的改善效果优于对照组;亚组分析显示,太极拳可明显改善65岁以下患者的收缩压和舒张压;多因素Meta回归分析未能解释研究间异质性的来源,敏感性分析剔除2篇质量较差的文献后,同质性较好。Egger检验显示,太极拳影响收缩压的文献存在显著发表偏倚,影响舒张压的文献无显著发表偏倚。结论：基于现有证据,太极拳对原发性高血压患者收缩压和舒张压的干预是有效的,应在原发性高血压的治疗中得到重视和推广。