β受体阻滞剂治疗慢性心力衰竭作用机制规律的探讨

β受体阻滞剂作为一种负性肌力药物,其在慢性心力衰竭治疗中的地位于近几十年中发生了戏剧性的改变,由禁忌药转变为指南推荐的重要药。β受体阻滞剂引发了人们对慢性心力衰竭发病机制的重新思考,使人们对疾病及其治疗有了更新更全面的认识,这其中体现了哲学与自然科学间的紧密联系,提示我们运用哲学原理可以指导自然科学的发展。     

β-受体阻滞剂治疗慢性心力衰竭的哲学发展观

随着科学技术的快速发展和人们认识的不断深入,慢性心力衰竭（CHF）的发病机制处于不断嬗变的过程,CHF的药物治疗概念也发生了根本性的变化。β-受体阻滞剂在CHF的治疗策略中,经历了从禁用到必用的过程,成为了CHF药物治疗的重大突破。大量临床试验表明,β-受体阻滞剂不仅能改善患者预后,而且能明显改善左室的舒张和收缩功能,全面改善患者的血流动力学,提高患者的运动耐量和生活质量,延长生存时间。β-受体阻滞剂在CHF治疗中地位的变化,体现了哲学发展观与疾病的治疗以及药物应用的紧密联系,指导着我们的临床实践,也体现了哲学与自然科学的密切联系。本文将β-受体阻滞剂治疗CHF的新旧观念进行阐述、比较,对其作用机制以及临床用药进行介绍,并对其发展空间进行展望。随着科学的进步,人类有能力从长远的角度控制疾病。     

慢性充血性心力衰竭治疗的困惑与选择

慢性充血性心力衰竭是一种严重的临床综合征 ,是大多器质性心脏病进展的最终结局。近十年来 ,心力衰竭的治疗出现了明显的变化 ,目前的治疗主要侧重于逆转衰竭心肌的生物特性 ,β受体阻滞剂就是这种治疗模式的成功典范。在短期内应用 β受体阻滞剂治疗心衰可能会加重心力衰竭 ,因此过去这类药物被长期禁用于心力衰竭患者 ,但目前的临床研究一致证实 ,合理使用 β受体阻滞剂能明显降低充血性心力衰竭患者的死亡率而延长寿命。慢性充血性心力衰竭基础和临床研究表明 ,对立和统一始终贯穿于慢性充血性心力衰竭之中。1　诊断和治疗水平的不断前…     

β受体阻滞剂治疗充血性心力衰竭的思考

β受体阻滞剂治疗充血性心力衰竭(CHF)是一次革命,它的应用标志着随着对CHF发病机理认识的不段深入而引起CHF治疗的一次根本性转变.对CHF的治疗不仅要改善症状,还要改善CHF患者的生活质量,延长CHF患者的寿命,降低死亡率.故对β受体阻滞剂应从系统、综合及长期治疗效果作出客观评价.     

心力衰竭国内外指南浅析

近几年随着循证医学证据的不断增加,各国对心力衰竭指南进行了更新.主要是2012年欧洲心脏病学会(ESC)与心衰学会公布的心力衰竭新指南、2011年澳大利亚和新西兰慢性心力衰竭诊治指南、2010年英国国立健康与临床优化研究所(NICE)慢性心力衰竭诊治指南、2009美国心脏病学会(ACC)/美国心脏协会(AHA)实践指南工作组成人心力衰竭诊疗指南及2010年我国的急性心力衰竭指南等.各国指南对心力衰竭的诊断和治疗都提出了具体的意见和建议,其中不乏亮点,如对慢性心力衰竭患者更加重视血运重建的治疗作用、推荐心力衰竭治疗的一种新型β受体阻滞剂奈必洛尔等等.我们对以上几个指南做了浅要分析,以取长补短更规范的诊治心力衰竭患者.     

心力衰竭的药物及非药物治疗

神经内分泌激活、心室重构是收缩性心力衰竭进展的关键机制,针对上述机制的生物学治疗包括血管紧张素转换酶抑制剂、β受体阻滞剂、盐皮质激素受体拮抗剂等可显著改善心力衰竭患者预后,利尿剂、洋地黄等常规药物治疗可改善心力衰竭症状、降低心力衰竭住院风险,为神经内分泌拮抗剂的应用奠定基础;近年来,从阻断心力衰竭发生机制方面研发了很多新药,但尚没有一种能对长期生存率有显著改善.器械治疗(植入型心脏复律除颤器、心室再同步和心室再同步心脏复律除颤器)可降低特定心力衰竭患者病死风险,预防猝死发生,显著改善预后;心室辅助装置及干细胞治疗则为心力衰竭治疗带来新的曙光.     

左向右分流型先天性心脏病心力衰竭时神经内分泌失调及对策

左向右分流型先天性心脏病是引起小儿心力衰竭(心衰)主要病因之一.研究已证实神经内分泌紊乱与心衰之间有复杂的相关性.临床应用神经内分泌紊乱拮抗剂,如β-受体阻滞剂、洋地黄制剂、血管紧张素转换酶抑制剂(ACEI)能降低此类患儿心衰的病死率.就此类型先心病出现心衰时神经内分泌紊乱现象及治疗对策的综述.     

β受体阻滞剂是冠心病中的重要一线治疗药物

冠心病的治疗包括三个层面:血管重建治疗解决局部狭窄;改善生活方式是基础;全面合理的药物治疗是核心.而β受体阻滞剂又是重要的一线治疗药物,不仅能降低动脉粥样硬化及急性冠脉综合征的发生发展,还能有效预防、缓解心绞痛发生,改善梗死后左室重构和心功能;降低心肌再梗死率,降低心性猝死和病死率.临床上应用β受体阻滞剂的时机和剂量非常重要.     

非选择性β受体阻滞剂在门静脉高压患者中的应用

门静脉高压是肝硬化患者最常见的并发症,而门静脉高压所致的食管胃底静脉曲张破裂出血则是肝硬化患者最常见的死亡原因。非选择性β受体阻滞剂是目前用于降低门静脉高压以预防食管胃底静脉曲张破裂出血和再出血的一线药物,非选择性β受体阻滞剂可通过降低门脉血流量,从而降低门脉压力,然而,近年来有报道提示非选择性β受体阻滞剂可增加门脉高压患者的死亡率。本文将对非选择性β受体阻滞剂的作用及其在门静脉高压患者中临床运用做一综述。     

β受体阻滞剂是冠心病中的重要一线治疗药物

冠心病的治疗包括三个层面：血管重建治疗解决局部狭窄;改善生活方式是基础;全面合理的药物治疗是核心。而β受体阻滞剂又是重要的一线治疗药物,不仅能降低动脉粥样硬化及急性冠脉综合征的发生发展,还能有效预防、缓解心绞痛发生,改善梗死后左室重构和心功能;降低心肌再梗死率,降低心性猝死和病死率。临床上应用β受体阻滞剂的时机和剂量非常重要。     

浅谈医学院校科研现状及研究生培养管理

倡导良好的科研风尚并建立有效的研究生培养管理体制,对增强医学院校科研能力,提高研究生培养质量至关重要,也是当前高等医学教育工作者共同关心的问题。对医学院校科研现状及现行研究生培养管理模式中存在的问题进行分析,并提出若干思考及建议。     

The intervention selection bias: an underrecognized confound in intervention research

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.     

The Admissibility of Research in Emergency Medicine

The main goal in this paper is to present the legal rules connected with medical experiment on human beings in emergency medicine and to explain the scope, significance, and meaning of these rules, especially with regard to their interpretation. As the provisions about medical experiments truly make sense only if they can be observed by the whole "civilised" international community, they are presented in the context of international law with reference to Polish law. By considering the appropriate regulations of research contained in legal documents, it is possible to formulate a catalogue of doctors' duties and patients' rights. This general catalogue refers to all kinds of medical research involving human beings. In the field of emergency medicine, general provisions are sometimes involved, and they are sometimes limited. The main and most important conclusion is that a medical experiment in emergency medicine is admissible only if previously indicated conditions based on general rules of conducting research are fulfilled.     

临床思维的逻辑性

临床思维是临床能力的核心和基础,是成为一名合格医生的前提条件。临床思维是按照逻辑规律反映疾病的思维方式。在临床思维活动过程中最重要的就是医学假说的提出、验证、推理和遵守逻辑思维的过程。逻辑思维能力对于医学工作者是至关重要的,作为医学工作者应该不断加强逻辑修养,不断提升我们临床思维水准。     

现代复苏的药物应用现状的理性思考

回顾了复苏药物应用研究的现状,运用创新思维的科学方法对现代复苏药物临床应用研究中的医学和伦理难题进行了理性分析,阐明了理论,逻辑思维,哲学思考对临床实践和医学研究的重要性。     

Computerized encounter registers in primary care research: Is there a gold standard?

Computer technology as well as the need to conduct research in primary care settings, has stimulated the creation in the U.S. of information networks linking private physicians' offices and other primary care practice sights. These networks give rise to several problems which have philosophic interest. One is a “numerator problem” created by the difficulty in primary care of using the more complicated or invasive diagnostic technologies commonly employed in tertiary care research. Another is a “denominator problem” arising from the difficulties in determining which and how many patients constitute the population from which a practice is drawn. Finally, this mode of research raises questions about the social construction of medical reality and how “objective” medical truth is actually based on carefully selected patient experience. All these questions combine to challenge the “gold standard” view on medical research: the idea that some sorts of medical knowledge are epistemologically privileged and can serve as a bench-mark to determine whether new data are valid.     

医学“交叉学科”浅析

医学交叉学科是现代医学教育不可或缺的学科,医学没有交叉学科作支撑,很难成为实实在在的医学,也很难培养出适应新世纪医学发展需要的具有综合素质的优秀医学人才。在以往研究的基础上具体阐述了医学交叉学科的内涵、主要交叉形式;分析了医学交叉学科出现的意义以及未能引起足够重视的诸多原因。目的在于提高医学人才培养、医学科学研究过程中对医学交叉学科的重视程度。     

Academic Guidance in Medical Student Research: How Well Do Supervisors and Students Understand the Ethics of Human Research?

Research is increasingly recognised as a key component of medical curricula, offering a range of benefits including development of skills in evidence-based medicine. The literature indicates that experienced academic supervision or mentoring is important in any research activity and positively influences research output. The aim of this project was to investigate the human research ethics experiences and knowledge of three groups: medical students, and university academic staff and clinicians eligible to supervise medical student research projects; at two Australian universities. Training in research ethics was low amongst academic staff and clinicians eligible to supervise medical student research. Only two-thirds of academic staff (67.9 %) and students (65.7 %) and less than half of clinicians surveyed (47.1 %; p?=?0.014) indicated that specific patient consent was required for a doctor to include patient medical records within a research publication. There was limited awareness of requirements for participant information and consent forms amongst all groups. In the case of clinical trials, fewer clinicians (88.4 %) and students (83.3 %) than academics (100 %) indicated there was a requirement to obtain consent (p?=?0.009). Awareness of the ethics committee focus on respect was low across all groups. This project has identified significant gaps in human research ethics understanding among medical students, and university academic staff and clinicians. The incorporation of research within medical curricula provides the impetus for medical schools and their institutions to ensure that academic staff and clinicians who are eligible and qualified to supervise students’ research projects are appropriately trained in human research ethics.