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Can physicians always explain the results of clinical trials? A case study of amlodipine in heart failure

AMERICAN JOURNAL OF CARDIOLOGY 1999年第4A期84卷 1L-2L页

作者： Packer, M Miller, AB Columbia Univ Coll Phys & Surg Div Circulatory Physiol New York NY 10032 USA Univ Florida Hlth Sci Ctr Div Cardiol Jacksonville FL 32209 USA

Examines the role of physicians in explaining the results of clinical trials evaluating the effectiveness of amlodipine in the treatment of heart failure. Reluctance of physicians to prescribe beta-blockers in heart failure; Trend among physicians of prescribing amlodipine in heart failure based on its survival effects in patients with nonischemic cardiomyopathy.

关键词：氨氯地平/药理学氨氯地平/治疗应用抗高血压药/药理学抗高血压药/治疗应用钙通道阻滞药/药理学钙通道阻滞药/治疗应用存活率分析治疗结果血管舒张药/药理学血管舒张药/治疗应用人类

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VOLUME LOADING OF THE HEART BY LEG UP POSITION AND HEAD DOWN TILTING (-6-DEGREES)(HDT)

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ACTA ASTRONAUTICA 1992年第C期27卷 41-43页

作者： DIRSCHEDL, P GREGULL, A LOLLGEN, H Med.Dept. Div.Cardiol.Univ.ofBochum.

Head down tilting is widely used to increase preload and to induce intrathoracic blood pooling similar to microgravity. During daily routine, this venous pooling is performed by rising the legs up. In this study, both these approaches have been compared by invasive measurement using a right heart catheter. In patients with moderate coronary artery disease, diagnostic right heart catheterization was performed by the Swan-Ganz-techniques. All measurements were performed with head down tilting (-6-degrees) and with "leg up" position. Patients then received Nitrogycerin to countermeasure the preload changes. Pressures in the pulmonary artery as well as in the wedge position increased significantly during leg up and HDT. However, changes were significantly more pronouced in the "leg up" position than during HDT. No changes were observed for arterial blood pressure, cardiac output, stroke volume and resistances. Nitroglycerin during HDT lowered blood pressure and pressures in the pulmonary artery and in PCW-position and reduced cardiac output significantly. Both approaches of volume loading of the heart induced significant changes and increases of preload. However, changes were more pronounced during the "leg up" position than during HDT. It is questioned whether HDT with -6-degrees is appropriate to truly reflect hemodynamic alterations during simulated weightlessness.

关键词：心房功能血压/生理学冠心病/药物疗法冠心病/病理生理学体液转移/生理学心脏/生理学心脏/病理生理学硝酸甘油/治疗应用肺动脉/生理学肺楔压/生理学血管舒张药/治疗应用失重模拟/方法人类

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Treatment of heart failure with Celiprolol, a cardioselective beta blocker with beta-2 agonist vasodilatory properties

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第12期85卷 1467-1471页

作者： Witchitz, S Cohen-Solal, A Dartois, N Weisslinger, N Juste, K Darmon, JY Hop Beaujon Serv Cardiol Clichy France Hop Bicetre Serv Cardiol Le Kremlin Bicetre France Rhone Poulenc Rorer Montrouge France

Treatment with beta blockers results in improvement in functional status, and reduces mortality in patients with heart failure, A number of differences in the results noted could be due to additional properties of the specific beta blockers studied: absence of cardioselectivity, and existence of a vasodilator effect and of an associated antioxidant effect, We studied the effects of celiprolol, a cardioselective beta blocker with a stimulant effect on beta 2 receptors. One hundred thirty-two patients presenting with chronic heart failure of various etiologies, with an ejection fraction of <40% and New York Heart Association cardiac functional status grades II acid III were included in a randomized, double-blind, placebo-controlled study. The maximum dose of celiprolol (100 mg) was attained after 1 month. The study lasted 1 year. The primary evaluation criterion was functional class as evaluated using the Goldman questionnaire. There was no difference in efficacy between the 2 treatment groups in terms of functional class (p = 0.56). With regard to the secondary evaluation criteria, an improvement in DiBianco functional score was seen with celiprolol (p = 0.03), as well as a significant reduction in heart rate (p = 0.01). Ejection fraction increased in both groups (p = 0.15). There was no difference regarding improvement in left ventricular volume as determined at echocardiography or in exercise capacity. The safety profile of celiprolol was excellent. There was no difference in terms of cardiovascular mortality (2 receiving celiprolol vs 4 placebo), onset of arrhythmias (2 receiving celiprolol vs 3 placebo), worsening of heart failure (26 receiving celiprolol vs 23 placebo), or noncardiovascular adverse events (9 receiving celiprolol vs 14 placebo). The absence of a significant efficacy of celiprolol, a beta blocker with vasodilator properties, but exerting stimulation of beta 2 receptors, suggests an unfavorable role of this latter property in heart failure. However

关键词：肾上腺素能β受体拮抗剂/治疗应用塞利洛尔/治疗应用双盲法血管舒张药/治疗应用成年人女(雌)性人类男(雄)性中年人

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Dipyridamole in the treatment of a neonate with persistent pulmonary hypertension

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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 2000年第2期93卷 77-78页

作者： Worwag, S Mulla, H Luyt, D Firmin, RK Glenfield Hosp NHS Trust Dept Pharm Leicester LE3 9QP Leics England Glenfield Hosp NHS Trust Dept Paediat Cardiol Leicester LE3 9QP Leics England

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Long-term hemodynamic responses to vasodilator therapy in patients with severe left ventricular dysfunction

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第8期84卷 939-+页

作者： Mills, RM Cunningham, MS Cleveland Clin Fdn Dept Cardiol Cleveland OH 44195 USA Univ Florida Coll Med Div Cardiovasc Med Gainesville FL USA

Maximal oral vasodilator therapy resulted in long-term reduction of initially elevated pulmonary vascular resistance in 10 of 13 patients with severe heart failure who tolerated inotrope-supported uptitration of afterload reduction. Eleven patients were unable to tolerate vasodilator therapy and required inotropic support for successful cardiac transplantation.

关键词：方差分析血管紧张素转换酶抑制药/治疗应用心脏移植米力农/治疗应用肺循环/药物作用回顾性研究统计学非参数血管阻力/药物作用血管舒张药/治疗应用心室功能障碍左/药物疗法心室功能障碍左/病理生理学女(雌)性人类男(雄)性中年人

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Effect of vasoactive therapy on heart rate variability in patients with acutely decompensated congestive heart failure

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第4期84卷 476-+页

作者： Burger, AJ Aronson, D Beth Israel Deaconess Med Ctr Noninvas Cardiol Lab Div Cardiol Boston MA 02215 USA

Congestive heart failure (CHF) is characterized by generalized thought to contribute to progressive circulatory failure and influence survival.(1,2) Among the major manifestations of neuroendocrine activation are profound abnormalities in autonomic control, characterized by sympathetic overactivity(2) and parasympathetic withdrawal.(3) Analysis of heart rate variability (HRV) has been used to study autonomic function in patients with CHF, and provides independent information on the risk of death in ambulatory patients.(4-6) Moreover, HRV analysis has been used to document the beneficial modulating effect of agents such as angiotensin-converting enzyme inhibitors and beta blockers(7) on autonomic balance. Previous studies on the effect of pharmacologic therapy on HRV parameters have been performed in stable patients with chronic CHF, documenting an improvement within weeks to months. The present study examines baseline HRV parameters of patients with acutely decompensated CHF requiring hospitalization and evaluates the acute effects of medical therapy on HRV parameters.

关键词：急性病自主神经系统/药物作用自主神经系统/病理生理学强心药/治疗应用昼夜节律心电描记术便携式/药物作用随访研究心率/药物作用治疗结果血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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Cytoprotection in acute myocardial infarction

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INTERNATIONAL JOURNAL OF CARDIOLOGY 1999年第1期72卷 1-2页

作者： Doehner, W Univ London Imperial Coll Sci Technol & Med Sch Med Natl Heart & Lung Inst London SW3 6LY England

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Tailored therapy using dobutamine and nitroglycerin in advanced heart failure

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第8期84卷 941-+页

作者： Drazner, MH Solomon, MA Thompson, B Yancy, CW Univ Texas SW Med Ctr Div Cardiol Dallas TX 75235 USA St Paul Med Ctr Dallas TX USA

In 29 patients with advanced heart failure, therapy tailored to hemodynamic goals was attempted using an initial infusion of dobutamine and nitroglycerin (the latter in those with pulmonary hypertension) followed by escalating doses of oral vasodilators. In the 23 patients who were weaned from inodilator therapy, significant improvements in hemodynamic parameters and a low 90-day hospital readmission rate were documented.

关键词：血管紧张素转换酶抑制药/投药和剂量强心药/投药和剂量强心药/治疗应用多巴酚丁胺/投药和剂量多巴酚丁胺/治疗应用高血压肺性/药物疗法高血压肺性/病因学输注静脉内输注胃肠外异山梨酯硝酸/投药和剂量硝酸甘油/投药和剂量硝酸甘油/治疗应用回顾性研究治疗结果血管舒张药/投药和剂量血管舒张药/治疗应用成年人老年人女(雌)性人类男(雄)性中年人

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Metabolic treatment of myocardial ischaemia

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EUROPEAN HEART JOURNAL 1999年第16期20卷 1144-1145页

作者： Ferrari, R

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巴曲酶与血管扩张剂治疗突发性耳聋临床疗效观察

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陕西医学杂志 2017年第5期46卷 643-644页

作者：李凯包涵张潘英陈力陈阳西安市第九医院耳鼻喉科西安710054 第四军医大学西京医院耳鼻咽喉头颈外科西安710032

目的:探讨巴曲酶与血管扩张剂治疗突发性耳聋的临床疗效及安全性。方法:将96例突发性耳聋患者随机分为观察组与对照组,观察组48例给予巴曲酶治疗,对照组48例给予血管扩张剂治疗,对比两组患者治疗临床疗效,治疗前后血浆纤维蛋白原(Fg)、... 详细信息

目的:探讨巴曲酶与血管扩张剂治疗突发性耳聋的临床疗效及安全性。方法:将96例突发性耳聋患者随机分为观察组与对照组,观察组48例给予巴曲酶治疗,对照组48例给予血管扩张剂治疗,对比两组患者治疗临床疗效,治疗前后血浆纤维蛋白原(Fg)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)等,并观察两组患者不良反应发生情况。结果:与对照组相比,观察组总有效率明显升高(P<0.05);与治疗前比较,治疗后观察组与对照组患者的FG水平明显降低,TT、PT及APTT明显延长,且观察组较对照组各指标变化更显著(P<0.05);与对照组比较,观察组患者眩晕、耳鸣及听力缓解时间均明显缩短(P<0.05)。结论:巴曲酶较血管扩张剂治疗突发性耳聋疗效更显著,且能改善患者凝血功能状态。

关键词：听觉丧失,突发性/药物疗法巴曲酶/治疗应用血管舒张药/治疗应用

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