【摘要】 目的 探讨肺动脉高压患者药物靶向治疗的效果与耐受性。 方法 回顾分析2008年1月〖CD3/5〗2009年8月期间8例肺动脉高压患者分别接受波生坦及西地那非治疗的临床资料,评估其临床表现、WHO肺动脉高压功能分级、6 min步行距离及肺动脉收缩压在基线及治疗3个月后的变化。 结果 治疗后3个月,患者均能耐受药物治疗,无严重不良反应发生。WHO肺动脉高压功能分级在治疗前平均(31±04),治疗后为(23±09),明显得到改善(Plt;005)。肺动脉收缩压在治疗前平均(695±112 ) mm Hg(1 mm Hg=0133 kPa),治疗后为(483±124) mm Hg,明显降低(Plt;005)。6 min步行距离在治疗前平均(324±48) m,治疗后为(400±43) m,明显延长(Plt;005)。 结论 肺动脉高压患者药物靶向治疗的疗效显著,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.
ObjectiveTo summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion.MethodsWe retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation.ResultsThe mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism.ConclusionCTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.
Objective To analyze the protective effects of heat-shock response on the retinae of the rats after retinal ischemic reperfusion injury.Method Twenty Wistar rats (20 eyes) were divided into 4 groups: intracameral perfusion group (group P), intracameral perfusion after quercetin injection group (group P+Q), intracameral perfusion after heat shock group (group P+H), and in tracameral perfusion after quercetin injection and heat shock group (group P+Q+H ). According to the standard program established by International Society for Clinical Visual Electrophysiology, we recorded the results of the dark-adapted electroretinogram (D-ERG ),oscillatory potentials (OPs),and light-adapted ERG (L-ERG) of the rats with intraocular hypertension after induced by heat shock response. The expressions of HSP 70 of the rats in all groups were observed by Western blotting.Results The expression of HSP 70 of the rats in group P+H was the highest in all groups, but the expressions of HSP70 in group P+Q and P+Q+H were inhibited significantly. The amplitudes of a and b wave of ERG and O2 wave of OPs decreased, and the delitescence of them were delayed significantly in rats after intracameral perfusion. The amplitude of b wave of D-ERG and O2 wave of OPs in group P+H were higher than which in group P. Zero hour after perfusion, the amplitudes of all waves in group P+H increased significantly (Plt;0.05). Twenty-four hours after perfusion, the retinal functional resumption of the rats in group P+H was better than which in group P. In group P+Q and P+Q+H, the delitescences of all waves of ERG and O2 wave of OPs were the longest and the amplitudes were the lowest, and some waves even disappeared.Conclusions The heat-shock response may improve the recovery ability of the retinal cells after injury of ischemic reperfusion.(Chin J Ocul Fundus Dis，2003，19：117-120)
ObjectiveTo investigate impact of splenectomy plus pericardial devascularization on liver hemodynamics and liver function for liver cirrhosis patients with portal hypertension. MethodsThe internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of portal vein and hepatic artery of 42 cases of liver cirrhosis with portal hypertension were measured by Doppler ultrasonic instrument on day 1 before operation and on day 7 after operation. The free portal pressures at different phases (after open abdomen, after splenic artery ligation, after splenectomy, and after devasculanrization) were read from the disposable pressure sensor. Twenty-four healthy people through physical examination were selected as control. Results① The free portal pressure of liver cirrhosis patients with portal hypertension was decreased from (29.12±1.40) mm Hg after open abdomen to (22.71±1.21) mm Hg after splenic artery ligation, and further decreased to (21.32±1.12) mm Hg after splenectomy, but increased to (22.42±1.15) mm Hg after devasculanrization, the difference was statisticly different (all P < 0.01). ② Compared with the healthy people, for the liver cirrhosis patients with portal hypertension, the internal diameter, maximum velocity, minimum velocity, and flow volume of portal vein were significantly enlarged (all P < 0.01), which of hepatic artery were significantly reduced (all P < 0.01) on day 1 before operation; On day 7 after operation, the internal diameter of portal vein was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, and mean velocity of portal vein were significantly enlarged (all P < 0.01), but the internal diameter of hepatic artery was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01). For the liver cirrhosis patients with portal hypertension, compared with the values on day 1 before operation, the internal diameter and the flow volume of portal vein were significantly reduced (all P < 0.01) on day 7 after operation; the internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01) on day 7 after operation. ③ The Child-Pugh classification of liver function between before and after surgery had no significant difference (χ2=1.050, P > 0.05). ④ No death and no hepatic encephalopathy occurred, no thrombosis of splenic vein or portal vein was observed on day 7 after surgery. Conclusionsplenectomy plus pericardial devascularization could decrease portal vein pressure and reduce blood flow of portal vein, while increase blood flow of hepatic artery, it doesn't affect liver function.
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)
Objectives To systematically review the efficacy of polytetrafluoroethylene (PTFE) covered stent grafts vs. bare stent grafts in transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension. Methods PubMed, EMbase, The Cochrane Library, and ClinicalTrial.gov were searched online to collect randomized controlled trials (RCTs) and cohort studies of PTFE-covered stent grafts vs. bare stent grafts for portal hypertension from inception to Jan 11th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 4 RCTs and 11 cohort studies involving 2 422 patients (1 070 PTFE-covered stent grafts patients and 1 352 bare stent grafts patients) were included. The results of meta-analysis showed that compared with the bare stent grafts group, the PTFE-covered stent grafts group had higher patency rate of intrahepatic shunt (HR=0.38, 95%CI 0.31 to 0.47, P<0.000 01) and survival rate (HR=0.59, 95%CI 0.44 to 0.79,P=0.000 5), lower postoperative complications rate (including gastrointestinal bleeding and refractory ascites) (HR=0.44, 95%CI 0.33 to 0.58, P<0.000 01) and encephalopathy rate (HR=0.76, 95%CI 0.57 to 0.99,P=0.05). Conclusions Current evidence shows that compared with the bare stent grafts, the PTFE-covered stent grafts could effectively improve patency rate of intrahepatic shunt and survival rate with less postoperative complications rate and encephalopathy rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Non-drug treatment of hypertension has become a research hotspot, which might overcome the heavy economic burden and side effects of drug treatment for the patients. Because of the good treatment effect and convenient operation, a new treatment based on slow breathing training is increasingly becoming a kind of physical therapy for hypertension. This paper explains the principle of hypertension treatment based on slow breathing training method, and introduces the overall structure of the portable blood pressure controlling instrument, including breathing detection circuit, the core control module, audio module, memory module and man-machine interaction module. We give a brief introduction to the instrument and the software in this paper. The prototype testing results showed that the treatment had a significant effect on controlling the blood pressure.
Objective To analyse the changes of nitric oxide and nitric oxide synthase in rat retina under acute high ocular pressure and study the effect of nitric oxide in rat retinal damage under hypertension. Methods Sixty Wistar rats were divided randomly into five groups:Ocular hypertension 30 min,60 min,90 min and 12 h,24 h after reperfusion．Elevation of the ocular pressure in the anterior chamber of the rat eye ca used retina ischemic damage．The changes of retinal nitric oxide content were ob served indirectly by measuring NO2－/NO3－ content in retina.The distribution and changes of neuronal constitutive nitric oxide synthase (ncNOS)were studied by immunocytochemical localization of ncNOS. Results ncNOS positive neurons were distributed in the inner nuclear layer (INL),ganglion cell layer (GCL) and the inner plexiform layer of the normal and ischemic rat retina.During acute high IOP 30 min,60 min and 90 min,NO content decreased gradually and ncNOS immune activity weakens.During reperfusion,NO content increased remarkably (Plt;0.05) as compared with the groups of hypertension 90 min and decreased remarkably as compared with the normal rat retina.But ncNOS positive neurons continue to decrease compared with the groups of hypertension 90 min. Conclusion NO participates the rat retinal injury by acute elevated intraocular pressure, and nitric oxide synthetized by ncNOS may play an important role in protecting the retina from ischemic and post-ischemic injury.
OBJECTIVE The purpose of this study was to study the effect of splenopneumopexy for patients with portal hypertension in children. METHODS From March 1993 to April 1998, splenopneumopexy was performed on six children with portal hypertension. Doppler ultrasound and radionuclide were used to demonstrate the portopulmonary shunt after operation. RESULTS The bleeding from the esophageal varices was controlled and the esophageal varices were eliminated gradually. The symptoms pertaining to hypertension were disappeared. The patency of the shunt was maintained without the formation of thrombosis. No pulmonary complication was observed. CONCLUSION The results indicated that splenopneumopexy was a safe and effective procedure for patients with portal hypertension in children.
We had performed transjugular intrahepatic portosystemic stent shunt (TIPSS) in one hundred and three patients with advanced liver cirrhosis and portal hypertension from July,1993 to January, 1995. TIPSS was carried out successfully in ninty-eight out of 103 cases and the technical success rate was 95.2%. Acute variceal bleeding was immediatly controlled and portal pressure reduced by an average of 1.36±0.02 kPa after TIPSS. The disappearance of gastric cornoary and esophageal varices, the shrinkage of spleen and the reduction of ascite were observed . Three patients died of acute liver failure and one died of variceal redbleeding within 30 days of treatment. Mild encephalohthy was obserbed in 10 cases with TIPSS. At follow-up of 1～22 months, variceal rebleeding and ascite were observed in 6 patients and stenosis of shunt was evident is 12.5% of cases by the subsequent doppler sonography. According to this result, TIPSS is an effective method for the treatment of portal hypertension.