Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index

Background: In new outpatients, blood pressure should be measured in both arms. A previous study reported that an inter-arm systolic blood pressure difference (ΔSBP) of ≥10 mm Hg is associated with an increased risk of mortality. Aim: The aim was to identify the associations with absolute values of ΔSBP (|ΔSBP|) ≥10 mm Hg. Subjects and Methods: This study included 2481 patients. Patients with a body mass index ≥25 kg/m2 were defined as obese. The group of A was defined as following: ankle-brachial index (ABI) was <0.9 or ≥1.3. ΔSBP was expressed as right arm BP minus left arm BP. |ΔSBP| ≥10 mm Hg were analyzed using multivariate logistic analysis. Results: |ΔSBP| ≥10 mm Hg was found in 6.0% of patients and |ΔSBP| < 5 mm Hg in 80.4%. In multivariate analysis, the odds ratios (ORs) of the associations with |ΔSBP| ≥10 mm Hg were significantly associated with abnormal ABI and obesity regardless of sex and age. Moreover, the OR of the combined effects of abnormal ABI and obesity was higher than that of abnormal ABI and obesity alone. Conclusion: |ΔSBP| ≥10 mm Hg was associated with abnormal ABI and obesity. In a primary care setting, blood pressure should be actively measured in both arms. This study suggests that the associations with |ΔSBP| ≥10 mm Hg may be a useful part of screening for abnormal ABI.

Analyses of Characteristics of Long-Term Monitoring of Arterial Pressure and Pulse

Long-term observations of pulse and arterial blood pressure taken from a patient＇s daily self-control diary have been analyzed in the paper. The diary was kept in the morning and in the evening. It contains regular observational data collected during over 13 years. Statistical estimates of series and their spectral responses were obtained. A difference between the morning and evening series was noted. Spectral harmonics with the period of 7 days was typical of the evening series. The morning series are characterized by a ＂lunar＂ component with the -27.35-day period. The examined series were also compared with the daily series of atmospheric pressure and daily Wolf numbers. Seasonal pulse and arterial pressure pattern and average monthly self-control tabulated data obtained during 13 years are presented in the paper.

Pulse palpation and limited joint mobility examination are better indicators than oscillometric measurement for diagnosing abnormal ankle-brachial index

Background: Peripheral artery disease (PAD) is the least recognized form of atherosclerosis and may even result in amputation if the diagnosis is delayed. Manual pulse palpation is the traditional way to diagnose PAD. Doppler ultrasonographic measurement of ankle-brachial index (ABI) is the gold standard diagnosing method but requires training and is not necessarily available as an outpatient procedure. Using automated oscillometric blood pressure devices has been suggested as an easier method for measuring the ABI. Methods: A single observer palpated the arterial dorsalis pedis, examined hand joints and measured the ABI of one hundred diabetic patients using both Doppler and oscillometric methods. The purpose of this study was to compare the oscillometric method and the manual diagnosing methods to the gold standard method of using a hand held Doppler device for measuring the ABI and detecting PAD. Results: ABI was abnormal in 24 patients (24%) (22 males, 2 females) when measured with the Doppler method. Of these 24 patients, the oscillometric method would have missed 12 giving 12 false negatives. We found that the sensitivity of the oscillometric method was 50.0% and specificity 90.8%. Clinical examination with palpation of ADP combined with limited joint mobility (LJM) scoring would have missed only four cases. Conclusions: Although the oscillometric method is easy and accessible, it is not sensitive enough to be used as the only method in measuring ABI. The simple and inexpensive ADP pulse palpation combined with testing for LMJ was able to find 20 of the 24 (83%) patients with an abnormal ABI measured by Doppler stethoscope.

Relationships of coronary artery atherosclerosis severity with blood pressure variability and ankle-brachial index in hypertensive patients

Background Numerous trials showed that blood pressure variability （BPV） plays an important role in triggering acute cardiovascular and cerebrovascular events. However, few studies have clarified the relationship between the coronary artery atherosclerosis severity with BVP and ankle-brachial index （ABI）. There are few studies in which have investigated BPV, ankle-brachial index （ABI）, brachial ankle pulse wave velelocity （baPWV） and severity of coronary angiography（ CAG ） at the same time. Methods Totally 188 hypertensive patients from January 2012 to March 2015 were enrolled in this study. All the cases underwent 24h ambulatory blood pressure monitoring （ABPM）, CAG and ABI. The extent of coronary artery disease was assessed by the Gensini score system. The subjects were divided into four groups： A（ Gensini score=0）, B（Gensini score≤20）, C（ 20〈Gensini score 〈50）, D（Gensini score≥50）. Pearson correlation and stepwise multiple regression were used for analyses. Results Compared with the A and B group, most of blood pressure standard deviation and average ABI of D group were higher （P 〈 0.05）. Correlation analysis indicated that Gensini score was positively correlated with 24h systolic blood pressure standard deviation （24hsbpsd）, day systolic blood pressure standard deviation （dsbpsd） and night systolic blood pressure standard deviation（nsbpsd）; But it was reversely correlated with ABI. ABI was reversely correlated with 24hsbpsd and nsbpsd. Gensini score was positively correlated with 24hsbpsd（P=0.02） and dsbpsd（P〈0.05）, while reversely correlated with ABI（P〈0.05） by multiple linear stepwise regression analysis. Conclusion BPV and ABI are closely related to severity of coronary artery atherosclerosis. They are predictors in patients with coronary artery disease with hypertension.

咽喉部高频喷射通气调节各参数对狗肺通气效率的影响

用相关和回归处理方法,研究了8条正常狗咽喉部高频喷射通气时,调节驱动压、呼吸比和频率对喷气量、吸入气氧浓度、动脉血气及气道内压的作用。结果显示,驱动压和呼吸此对各观察指标几乎有同等重要的作用,频率的影响很小,喷气量与吸入气氧浓度、动脉血气、气道内压间存在显著的正相关关系。说明调节参数的意义主要在于改变了喷气量。

冠状动脉旁路移植术患者术后早期运动耐量改善的影响因素

目的 探讨冠状动脉旁路移植术 (CABG)患者术后早期运动耐量改善的影响因素 ,以提高手术疗效。方法 随机选择 30例行 CABG患者 ,术前和术后 1～ 3个月进行平板运动试验 (TET) ,以手术前后运动功量的差值为应变量 ,各项临床指标与手术情况为自变量 ,进行 L ogistic多元回归分析。 结果 无手术死亡。术后运动功量等运动耐量指标及心肌缺血指标有明显改善 (P<0 .0 0 1) ,术前左心功能、心肌梗死史、心绞痛、高血压和乳内动脉 (IMA)移植是影响手术疗效的主要因素。 结论 CABG能显著提高运动耐量 ,改善心肌缺血 ,了解并重视这些影响因素将有助于更好地选择手术病例 ,预测手术疗效。

血压常数的取值范围及其与压力比的关系

根据准线性弹性腔模型，从理论上证明了血压常数ｋ值的取值范围在１／４～１／２之间。ｋ的取值取决于血压测量部位的压力比α以（α＝Ｐｓ／Ｐｄ）。由于压力比α随测量部位而变化，因此血压常数也随之变化。测量位置距主动脉瓣越远，血压常数越小，且ｋ值不是唯一的，对于主动脉，血压常数为０．４６±０．０３，接近１／２，对于肱动脉，ｋ值为０．４０±０．０２，对于手指动脉，ｋ植为０．３４±０．０４。

活动平板运动试验收缩压恢复比对冠心病的诊断价值

目的 探讨活动平板运动试验中收缩压恢复比 (rSBP)对冠心病的诊断价值。方法 选择 198例患者进行活动平板运动试验 ,与冠状动脉造影结果作对照。结果 rSBP >0 .91诊断冠心病的敏感度、特异度、诊断符合度分别为 5 3.6 %、83.7%、6 6 .7% ,而传统指标分别为 91.1%、5 5 .8%、75 .8% ;rSBP >0 .91在冠状动脉单支、双支和多支 3组病变中的诊断特异度均高于同组传统指标的诊断特异度 (P <0 .0 5 )。结论 运动试验中rSBP异常可预测冠状动脉疾病及其病变严重程度。

血液透析治疗中泵前动脉压与泵控血流量比值的临床研究

目的 调查血液透析过程中泵前动脉压与泵控血流量比值的正常范围并探讨其临床意义.方法 纳入2家三甲医院的血液透析患者527例,收集透析治疗过程中每个小时的泵前动脉压、静脉压、跨膜压等压力检测指标及泵控血流量情况,并分析泵前动脉压(pre-pump arterial pressure,PreAP)绝对值与泵控血流速(blood flow rate,BFR)的相关性及其比值的95%参考值范围. 结果 泵前动脉压绝对值与泵控血流量呈显著正相关性(b=10.09,t=65.241,Ptrend<0.001);PreAP绝对值与BFR比值的水平为(0.43±0.12),95%参考值范围为(0.20,0.66).结论 明确PreAP与BFR比值的参考范围可以早期发现和预防内瘘狭窄的发生,为临床护理提供快速筛查的手段,为持续监测和早期干预提供理论依据.当比值持续超出95%参考值范围,提示血管通路功能可能欠佳,需要仔细评估血管通路是否存在狭窄.

RDW、PLR及动脉血气分析在慢性阻塞性肺疾病急性加重期合并肺动脉高压中的临床意义

目的探讨红细胞分布宽度(RDW)、血小板与淋巴细胞比值(PLR)、动脉血氧分压(PaO2)及动脉血二氧化碳分压(PaCO2)在慢性阻塞性肺疾病急性加重期(AECOPD)合并肺动脉高压(PH)中的临床意义。方法选取2017年2月至2019年2月郑州大学第一附属医院收治的140例AECOPD患者为研究对象。根据心脏彩色多普勒超声所测得的肺动脉收缩压(SPAP),将入选患者分为A组(SPAP<40 mm Hg)80例和B组(SPAP≥40 mm Hg)60例,B组又分为轻度PH组42例和中重度PH组18例。所有入选患者于入院后24 h内留取静脉血标本,应用血细胞分析仪测定RDW、PLR值;于入院后2 h内静卧不吸氧或者停止吸氧30 min后,抽取桡动脉血行动脉血气分析,记录PaO2、PaCO2值,并比较不同组别间的RDW、PLR、PaO2、PaCO2水平及各指标间的相关性。结果 B组的RDW、PLR、PaCO2高于A组,差异有统计学意义(均P<0.05);B组的PaO2低于A组,差异有统计学意义(P<0.05)。中重度PH组血清RDW、PLR、PaCO2高于轻度PH组,中重度PH组PaO2低于轻度PH组,差异有统计学意义(均P<0.05)。相关性分析结果示,SPAP与RDW(r=0.437,P<0.001)、PLR(r=0.590,P<0.001)、PaCO2(r=0.400,P=0.002)之间存在正相关关系;SPAP与PaO2(r=-0.450,P<0.001)间存在负相关关系。结论 RDW、PLR、PaO2、PaCO2与AECOPD患者合并PH的发生及病情严重程度相关,为及早明确AECOPD患者合并PH及合并PH的病情严重程度提供了简便快捷的检测指标。

中医综合疗法对子宫动脉血流异常导致的复发性流产临床疗效观察

目的观察中医综合疗法治疗子宫动脉血流异常导致的复发性流产的临床疗效。方法因子宫动脉血流阻力异常而导致流产的复发性流产患者100例，随机分成2组，观察组予中医综合治疗，对照组予阿司匹林口服，共治疗2个月，观察组患者阴道出血、下腹坠胀痛、腰酸痛、肛门坠胀等症状改善情况及早期妊娠结局情况，B超测量子宫动脉血流阻力指数（IR）、子宫动脉收缩压与舒张压的比值（S／D）的变化。结果观察组总有效率88％，对照组总有效率64％，两组比较差异有统计学意义（P〈0．05）。观察组治疗后症状总积分改善明显优于对照组（P〈0．01）。两组治疗后子宫动脉血流RI及s／D值均有降低，随着治疗时间延长下降越明显，差异均有统计学意义（P〈0．05），且观察组优于对照组（P〈0．01）。结论中医综合治疗能够改善先兆流产症状，并能降低子宫动脉血流阻力，改善子宫局部血供，提高妊娠成功率，是一种有效的治疗复发性流产的方法。

子痫前期孕妇尿液中sFlt-1/PLGF比值与动态血压、子宫动脉血流变化的关系

目的探讨子痫前期孕妇尿液中可溶性酪氨酸激酶受体(sFlt-1)/胎盘生长因子(PLGF)比值检测及其与动态血压、子宫动脉血流变化的相关关系。方法收集2013年7月-2016年2月该院收治的孕中期子痫前期患者90例,其中轻度子痫前期52例作为轻度组,重度子痫前期38例作为重度组。另取同期在该院进行常规产检的孕中期正常孕妇50例作为正常对照组。对比各组孕妇尿液sFlt-1/PLGF比值、动态血压指标及子宫动脉血流参数水平。结果轻度组、重度组孕妇尿液中sFlt-1/PLGF比值显著高于正常对照组孕妇,且重度组孕妇尿液中sFlt-1/PLGF比值高于轻度组(P<0.05)。轻度组、重度组孕妇的动态血压指标24 h平均收缩压(SBP)、24 h平均舒张压(DBP)、白天平均收缩压(dSBP)、白天平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)水平,子宫动脉血流参数子宫动脉搏动指数(PI)、阻力指数(RI)、子宫动脉收缩期与舒张期流速比(S/D)水平均高于正常对照组孕妇,且重度组孕妇的升高程度较轻度组更明显(P<0.05)。子痫前期孕妇尿液中sFlt-1/PLGF与动态血压指标、子宫动脉血流参数水平呈正相关。结论尿液中sFlt-1/PLGF比值可辅助诊断子痫前期,且其比值与孕妇动态血压、子宫动脉血流参数水平均直接相关,可作为病情严重程度判断的间接指标。

归龙汤治疗老年糖尿病下肢血管病变临床研究

目的:观察归龙汤治疗老年糖尿病下肢血管病变患者的中远期疗效。方法:94例老年糖尿病下肢血管病变患者按随机数表法均分为观察组与对照组各47例。两组均采取严格饮食控制、运动治疗及常规给予胰岛素控制血糖等基础治疗。对照组口服西洛他唑片,每次50 mg,2次·d-1,连续治疗3个月。观察组在对照组治疗基础上给予归龙汤干预治疗,水煎服,每日1剂,1个月为1个疗程,连续治疗3个疗程。随访12个月,全部随访成功。比较两组临床疗效,记录治疗前及治疗3个月、6个月、12个月后血糖指标、凝血指标、踝动脉-肱动脉血压比值(ankle-branchial index,ABI),并观察不良反应发生率。结果:观察组有效率(93.62%)显著高于对照组(76.60%)(P<0.05)。两组治疗3个月、6个月、12个月后均较治疗前空腹血糖(fasting blood-glucose,FBG)、餐后2小时血糖(2-hour post-meal blood glucose,2h FBG)水平显著降低;且随时间延长,观察组FBG、2h FBG水平呈降低趋势(P<0.05)。观察组治疗后各时间点FBG、2h FBG水平均显著低于对照组(P<0.05)。两组治疗后各时间点凝血酶原时间(prothrombin time,PT)、部分凝血活酶时间(activated partial thromboplastin time,APTT)长于治疗前,D-二聚体(d-dimer,DD)、纤维蛋白原水平低于治疗前,且观察组随时间延长,PT、APTT呈升高趋势,DD、纤维蛋白原水平呈降低趋势(P<0.05)。观察组治疗后各时间点PT、APTT长于对照组,DD、纤维蛋白原水平低于对照组(P<0.05)。两组治疗后各时间点ABI均较治疗前明显升高,且观察组高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:归龙汤治疗老年糖尿病下肢血管病变疗效较好,可控制患者血糖水平,改善血液高凝状态及ABI值,且无严重不良反应。

缺血后处理对大鼠缺血-再灌注肺损伤血红素加氧酶-1表达的影响

目的观察缺血后处理（IPO）对大鼠肺缺血-再灌注损伤（IRI）期间血红素加氧酶-1（HO-1）表达的影响，探讨其保护机制。方法48只成年SD大鼠，随机（随机数字法）分成6组（n=8）,假手术组（S组）；缺血-再灌注组（I/R组）：夹闭左肺门缺血45min,再灌注105min；缺血后处理组（IPQ组）：缺血后再灌注30s,停灌30s，反复3次，再恢复灌注102min;氯化高铁血红素（Hemin）＋缺血-再灌注组（ZnPPIX＋IPO组）：术前连续2d腹腔注射Hemin40junol/（kg·d）,余同I/R组；锌原卟啉K＋缺血后处理组（ZnPPK＋IPO组）：术前24h腹腔注射ZnPPIX20mg/（kg·d）,余同IPO组；氯化高铁血红素＋假手术组（HM＋S组）。测定各组肺组织HO-1蛋白表达水平、动脉血氧分压（Pa02）、肺组织湿/干质量比（W/D）和血清丙二醛（MDA）含量，观察肺组织病理变化。组间比较采用单因素方差分析，组内比较采用配对＊检验。结果1/R组肺组织HO-1蛋白表达（0.177±0.015）与S组和HM＋S组相比差异具有统计学意义（P〈0.01,P〈0.05）,但与IPO组（0.194士0.017）及HM＋I/R组（0.209±0.013）相比差异具有统计学意义（P〈0.05,P〈0.01）o各实验组Pa02均显著低于S组（90±11）mmHg,IPO组和HM＋I/R组PaO2与1/11组相比较，差异具有统计学意义（P〈0.01）;I/R组较S组肺组织W/D、血清MDA含量升高，肺组织病理损伤严重，而IPO组和HM＋I/R组上述改变差异具有统计学意义（P〈0.05）。结论早期短时程缺血后处理能明显减轻在体大鼠肺IRI,其作用机制与其上调HO-1蛋白表达及抑制脂质过氧化的损伤作用有关。