血压的生物节律与高血压的时间治疗学

人体血压的昼夜节律现象具有重要临床意义,高血压病更尤为如此.不同降压药物或不同时间用药对血压的昼夜节律产生不同的影响.高血压时间治疗学是根据疾病发生或发作的昼夜节律特征,通过调整投药时间及/或剂量、或应用特殊制剂,调整血液或组织中的药物浓度,从而增加疗效并减少或避免不良反应的发生.时间治疗学方法有助于以最小的医疗经济学及毒副反应代价获取最佳的治疗效果.     

根据血压昼夜节律选择服药时间控制血压晨峰

根据血压昼夜节律,观察给药时间对血压晨峰的影响。256例原发性高血压患者,经24h动态血压监测分为超杓型（n＝49）、杓型（n＝127）和非杓型（n＝80）3组;各组再分为清晨服药组和晚上服药组。用药6周,比较用药前后血压昼夜节律及血压晨峰的变化,发现在改变血压昼夜节律及降低血压晨峰方面,超杓型组清晨服药优于晚上服药,非杓型组晚上服药优于清晨服药;杓型组清晨服药与晚上服药均能降低晨峰值,提示根据个体血压昼夜节律选择服药时间能更好地控制血压晨峰。     

高血压患者家庭自测血压的探讨

高血压患者家庭自测血压有利于准确判断患者的血压水平,排除"白大衣现象",增加患者降压治疗的自信心.也使医生能够有效、正确地运用时间治疗学合理应用药物控制血压.但是对于心理因素较重的人不主张家庭内过多测量血压.     

生物钟与心律失常关系的研究进展

心律失常的发生具有昼夜节律,这种节律由生物钟产生。生物钟包括中枢生物钟和外周生物钟,通过一系列基因转录与翻译的负反馈调节,对机体生理与病理生理活动的昼夜节律产生广泛的影响。目前,我们已经认识到生物钟可以通过自主神经影响心脏电生理活动,也可以影响心肌细胞膜离子通道的表达,从而对心律失常发生的昼夜节律性产生影响。研究生物钟与心律失常之间的关系,对心律失常的预防、药物研究具有重要的意义。     

正常高值血压者血压昼夜节律与靶器官损害的相关性研究

探讨正常高值血压昼夜节律与靶器官损害的相关性。入选正常高值血压者150例,其中杓型组72例,非杓型组78例,60例正常血压者为对照组。检测尿白蛋白排泄率（UAE）、颈动脉内膜中层厚度（IMT）和左心室重量指数（LVMI）。杓型组和非杓型组UAE、IMT、LVMI高于对照组（P＜0．01）。非杓型组UAE、IMT、LVMI高于杓型组（P＜0．05）。正常高值血压人群已出现靶器官损害,血压昼夜节律异常与早期靶器官损害密切相关。     

重视对病前状态的临床研究

用矛盾转化理论探讨病前状态的发生发展规律及治疗策略。常见的病前状态包括亚健康、血压升高及糖尿病前期等状态。亚健康是人体介于健康与疾病之间的过渡环节,采用非药物干预及中医辨证论治可以使亚健康状态向健康状态转化。血压升高是血压正常和高血压的过渡状态,对于血压正常人群、血压升高及高血压的病人分别实施平衡进盐、低盐及限盐干预措施,使血压升高及高血压的发展方向逆转。糖尿病前期是处于糖代谢正常和糖尿病的中间状态,根据糖调节受损不同状态分别采取自由平衡、保持平衡和控制平衡策略,促进血糖调节异常向血糖正常转化。     

临床麻醉中常用中效肌肉松弛剂的比较

为了更准确在临床麻醉过程中使用中效肌肉松弛剂,用比较治疗学的理念及方法对目前国内报道的中效肌肉松弛剂阿曲库铵、顺式阿曲库铵、维库溴铵、罗库溴铵的应用方法进行比较和分析。结果发现：插管起效时间罗库溴铵最短,临床时效顺式阿曲库铵最长,阿曲库铵有组胺释放的作用,阿曲库铵和顺式阿曲库铵药物代谢主要是霍夫曼消除。比较治疗学方法有助于临床麻醉肌松剂的抉择。     

女性不同时期高血压的临床特征与治疗原则

女性因在不同时期内分泌的变化使其血压变化规律与男性有异,本文阐述了女性不同时期血压的临床特征和治疗原则;妊娠前及妊娠期慢性高血压的治疗及降压药物的选择;妊娠高血压综合征的处理原则及授乳期安全哺乳方法。     

女性不同时期高血压的临床特征与治疗原则

女性因在不同时期内分泌的变化使其血压变化规律与男性有异,本文阐述了女性不同时期血压的临床特征和治疗原则;妊娠前及妊娠期慢性高血压的治疗及降压药物的选择;妊娠高血压综合征的处理原则及授乳期安全哺乳方法.     

性治疗的道德

治疗者和病人之间的性关系 让我们来谈谈治疗者与其病人间的性关系这个敏感的问题。虽然我只涉及精神治疗学家,尤其是性治疗学家,但病人与其它专业人员诸如咨询人员,律师、牧师及各种雇员的性关系也是常发生的,这种极不道德的现象     

降压达标治疗中的个体化原则与优化治疗

为了提高高血压患者的降压达标率、最大程度地降低靶器官损伤,一方面应强化生活方式的改变,包括戒烟限酒、低盐饮食、减轻体重和适量运动,另一方面,由于原发性高血压的发病是由多种复杂因素的不同组合引起,应根据不同个体的高血压发病机制及病因的差异,在指南的指导下,应用不同种类抗高血压药物(单用或联合用药),采用针对个体的优化治疗,才能更有效地使降压治疗达标。     

Diurnal expression of period 2 and urocortin 1 in neurones of the non-preganglionic Edinger-Westphal nucleus in the rat

Period 2 (Per2) is an important clock gene involved in the regulation of the major circadian clock in the mammalian central nervous system, the suprachiasmatic nucleus. In addition, Per2 is expressed in many other stress-sensitive brain structures. We have previously showed that the non-preganglionic Edinger-Westphal nucleus (npEW) is the main site of the corticotropin-releasing factor peptide family member urocortin 1 (Ucn1) and that this peptide undergoes conspicuous expression changes in response to various stressors. Here, we hypothesized that in the rat npEW both Per2 and Ucn1 would be produced in a diurnal, rhythmical fashion. This hypothesis was tested by following this expected rhythm on two days in rats killed at four time points each day (Zeitgeber times 0, 6, 12, and 18). We showed the co-existence of Per2 and Ucn1 in the npEW with double-label immunofluorescence and demonstrated with quantitative RT-PCR and semi-quantitative immunocytochemistry diurnal rhythms in Per2 mRNA expression and Per2 protein content, each on a single different day, with a minimum at lights-off and a maximum at lights-on. We furthermore revealed a diurnal rhythm in the number of Ucn1-immunopositive neurones and in their Ucn1 peptide content, with a minimum at night and at the beginning of the light period and a peak at lights-off, while the Ucn1 mRNA content paralleled the Per2 mRNA rhythm. The rhythms were accompanied by a diurnal rhythm in plasma corticosterone concentration. Our results are in line with the hypothesis that both Per2 and Ucn1 in the rat npEW are produced in a diurnal fashion, a phenomenon that may be relevant for the regulation of the diurnal rhythm in the stress response.     

Abnormal diurnal pattern of cortisol secretion in patients after aneurysmal subarachnoid hemorrhage

Substantial evidence suggests that impairment of the hypothalamus?pituitary system can occur following an aneurysmal subarachnoid hemorrhage (aSAH). Given that the diurnal cortisol rhythm is primarily controlled by the hypothalamus?pituitary system, this study examined whether changes in diurnal cortisol rhythm occurred after aSAH. Cortisol concentrations were measured in the saliva samples collected from patients after aSAH and other types of cerebral hemorrhage (non-aSAH) in the post-awakening period and at night (21:00?h), and the cortisol awakening response (CAR) and diurnal cortisol decline were determined. The area under the cortisol curve from immediately after to 45?min after awakening (CARauc) in the aSAH patient group was comparable to that in the non-aSAH or healthy control groups. However, an obvious cortisol peak was not found after the awakening period, and the morning/nighttime cortisol ratio in the aSAH patient group was significantly lower than that in other examined groups due to higher nighttime cortisol concentrations. In aSAH patients, the CARauc and nighttime cortisol concentrations were negatively correlated with the Fisher CT grade. These results indicate that the diurnal cortisol rhythm is not regulated normally after aSAH, and cortisol secretory activity decreases as the volume of subarachnoid bleeding increases. Our findings will be helpful to understand altered hypothalamus?pituitary?adrenal axis function after aSAH.     

降压治疗的决策思考

尽管降压药物有了很大发展,高血压的控制率仍很低下。降压治疗中还存在包括医生和患者两方面的许多误区。目前已取得的共识是:降压治疗的益处主要来自血压控制。因此,非常重要的是要达到血压的有效和长期稳定的降低。根据患者的年龄、基线血压、伴随的临床状况等,因人而异地选择副作用小、降压效果好的药物,提高顺应性是改善高血压控制率的关键。     

Psychopharmacology and conditional reflexes

Drugs may be used in several ways to investigate their role in behavior. (1) The placebo effect is usually connected with the relation of the person to the drug. (2) Using the drug as an unconditional stimulus, its action may help to analyze the role of peripheral vs. central stimuli in the formation of conditional reflexes; our work has shown that the effect of drugs which act solely at the peripheral nerve endings without the involvement of the central nervous system cannot become conditioned. (3) The action of drugs on the conditional reflex (CR) compared with their action on the unconditional reflex (UR) explains some of their behavioral effects. (4) Schizokinesis is often prominent in the action of drugs. Although a drug may increase the level of the heart rate, for example, it can, on the other hand, diminish the reactivity shown in the CR. Meprobamate and mescaline affect differently the cardiac and the motor components of the CR, illustrating a schizokinesis. (5) The type of individual is an important factor in the action of drugs; the same drug may have opposite effects on different individuals. This leads to the conclusion that a drug should fit the individual as well as the disease. (6) Autokinesis is often seen in drug action. Therefore a single dose of some drugs, such as acetylcholine, epinephrine or LSD, may permanently change the relationships between excitation and inhibition, in the direction of improvement or deterioration (positive or negative autokinesis).     

We have a prejudice against ourselves—Sentiment,ethics, and reason

Briefly stated my point is that the well-being of each person in a community conceived abstractly may be all too easily sacrificed for the sake of the abstraction. Physicians may offer critically ill patients places in programs of experimental treatment, but there is commonly a catch to the offer. To take part in a program of clinical experiment a patient must not only risk a possible failure of a fresh drug and the chance of destructive side effects from the drug, but the patients must risk only getting the traditional treatment along with a placebo rather than the experimental drug. Placebo control, double blind critical protocols for testing effects of fresh drugs on critically ill patients are a commonplace. I question the scientific objectivity of the protocols and the underlying ethic, and suggest use of alternate protocols. Experimental tests in the treatment gram-negative bacteria blood infections, muscular dystrophy, and AIDS and AIDS-related diseases are examples.     

Effective obesity treatments

To curb the epidemic of obesity in the United States, revised Medicare policy allows support for efficacious obesity treatments. This review summarizes the evidence from rigorous randomized trials (9 lifestyle trials, 5 drug trials, and 2 surgical trials) on the efficacy and risk- benefit profile of lifestyle, drug, and surgical interventions aimed at promoting sustained (= 2 years) reductions in weight. Both lifestyle and drug interventions consistently produced an approximate 7-lb (3.2-kg) weight loss that was sustained for 2 years and was associated with improvements in diabetes, blood pressure, and/or cardiovascular risk factors. Surgical interventions have a less solid empirical base but offer promise for the promotion of significant and sustained weight reduction posttreatment in the morbidly obese but with possible significant short-term side effects. In summary, there is strong and consistent support from rigorous randomized trials that lifestyle or drug interventions result in modest weight loss with minimal risks but disproportionate clinical benefit. Combinations of lifestyle, drug, and, where appropriate, surgical interventions may be the most efficacious approach to achieving sustained weight loss for the widest diversity of patients.     

Drug effects: Agonistic and antagonistic processes

The research presented here has shown that tolerance to drugs can be accelerated by conditioning processes. Placebo effects may be considered the opposite of tolerance, and we have shown that placebo effects may be objectively recorded by physiological measures (electromyography, skin conductance responses, and event‐related potentials), as well as by behavioral and subjective methods. The placebo response, or more precisely, the expectation of drug effects, can add to the effect of the drug. Drug antagonistic expectations can also reverse the effect of the drug. There is some evidence that placebo effects are strongest when expectations are reinforced by administration of an active drug. Expectations have graded effects and may affect symptoms to a smaller or larger degree. Although drug effects can be considered stimuli, the investigation of the role of classical conditioning in drug use and drug effects involves special issues that must be carefully considered.