[The hemodynamic and oxygen dynamic effects of mechanical ventilation in chronic cor pulmonale]

Observation by using Swan-Ganz catheter on hemodynamic and oxygen dynamic changes before and after assisted volume controlled mechanical ventilation (MV) was carried out in 11 cases of chronic cor pulmonale complicated with pulmonary encephalopathy. Pulmonary vascular resistance and pulmonary artery pressure were significantly decreased by the relief of hypoxia pulmonary vasoconstriction after MV. Because of the relax of sympathetic tension, the heart rate, arterial blood pressure, pulmonary capillary wedge pressure and central venous pressure reduced simultaneously. Left and right ventricular stroke work decreased after MV, without significant change in cardiac output. Venous admixture (Qs/Qt) was markedly reduced by MV and oxygen supply-demand ratio raised. It is thus shown that marked improvement of hemodynamic and oxygen dynamic status can be induced by mechanical ventilation at an opportune moment.

[A clinical study of aortic dissecting]

The clinical features, etiologies, pathogenesis, treatment and prognosis of 70 patients with aortic dissecting were studied. Patients with age ranging from 31 to 70 years consisted 93% of the total. The proportion of proximal to distal types is 0.8: 1. Hypertension was present in 67% and Marfan's syndrome 18% of the patients. The pathologic finding was scattered rupture with myxomatous and cystic necrosis of the mecial elastic fibers. 80% of the patients suffered from the disease without any inducing cause. Of the 76% patients had chest pain, it was very severe in 69%. Chest X-ray, ultrasound, computed tomography and magnetic resonance imaging together with clinical manifestations may accurately diagnose the disease. The sensitivity and specificity of the ultrasound are 97% and 94% respectively. The mortality in hospital with surgical and medical therapy of the proximal type was 14% and 22% respectively, while that of the distal type was 63% and 27% respectively. Rupture of the aneurysm was the cause of death in 68% of the patients.

[Changes in oxygen delivery and consumption in different stages of chronic cor pulmonale]

To observe the changes of oxygen dynamic status in the development of chronic cor pulmonale, we studied early chronic cor pulmonale (group A, 13 cases), late chronic cor pulmonale in remission stage (group B, 15) and late chronic cor pulmonale in acute exacerbation stage (group C, 10) with Swan-Ganz thermodilution catheter and arterial and mixed venous blood gas analysis for detecting the oxygen delivery (DO2) and consumption (VO2). In group C, amrinone was given intravenously (15 micrograms.kg-1/min) and the examinations were repeated. DO2 (465 +/- 72 ml.min-1/m2) and VO2 (114 +/- 11 ml.min-1/m2) were at low level of normal range. No correlation was noted between them (r = 0.282, P > 0.05) in group A. It is suggested that the patient of early stage was in low oxygen delivery and consumption and no tissue oxygen deficit existed. In group B, DO2 and VO2 increased (592 +/- 111 and 145 +/- 32 ml.min-1/m2 respectively, P < 0.05 versus group A) but no significant correlation was found (r = 0.189, P > 0.05). Hence, the body of the patient was in high metabolic status and no tissue oxygen deficit existed in remission stage. DO2 and VO2 in group C (622 +/- 150, 139 +/- 44 ml.min-1/m2 respectively) were similar to those in group B (P < 0.05). After amrinone administration, a significant correlation was found between DO2 and VO2 (r = 0.39, P < 0.05). It is suggested that in the exacerbation stage, the patient's body was in highly metabolic status, the oxygen delivery-consumption compensation mechanism failed, and tissue oxygen deficit existed.

[Changes of immunologic function in patients with COPD induced chronic cor pulmonale]

We determined the counts of lymphocyte subpopulation CD3+, CD4+, CD8+ and CD16+ in PBL by using APAAP method and some humoral immunological parameters (HIP) in patients with COPD induced chronic cor pulmonale. The results showed: (1) In cases during exacerbation stage, the counts of CD3+, CD4+, CD16+ and the CD4+:CD8+ ratio decreased remarkably (P < 0.001). There was significant correlation between the counts of CD3+, CD4+, the CD4+:CD8+ ratio and PaO2 (P < 0.01). No marked change in serum IgG, IgA and IgM level was observed. Serum IgE and CIC level was significantly higher and C3 level lower than those in controls (P < 0.01). After treatment the counts of CD3+, CD4+, CD16+ and the CD4+:CD8= ratio went up notably (P < 0.01), but no significant change was found in the HIP. (2) In cases during remission stage only the CD4+ level was low (P < 0.05) and no remarkable difference was observed in the HIP. After treatment with thymopeptide the counts of CD4+ increased (P < 0.05), CD8+ decreased (P < 0.01) and the CD4+:CD8+ ratio increased (P < 0.01). The serum IgA and CIC level also went up significantly (P < 0.05). This indicated that thymopeptide played a role in regulating the immunologic function.

Therapeutic effects of an androgenic preparation on myocardial ischemia and cardiac function in 62 elderly male coronary heart disease patients

The elevated estradiol/testosterone (E2/T) ratio had been proved to be a risk factor for coronary heart disease (CHD) in elderly men. We conducted a randomized placebo controlled crossover study on the effects of a new androgenic preparation "Andriol" in 62 elderly men with CHD over a period of 2.5 months. The results showed significant differences between Andriol- and placebo-treated groups at the end of this period: in the former, serum T level was elevated significantly (P < 0.001), E2 level was unchanged (P > 0.05), E2/T ratio was reduced (P < 0.05), angina pectoris (AP) was relieved (total effective rate, 77.4%), and myocardial ischemia in ECG and Holter recordings were improved (total effective rate, respectively 68.8% and 75%). Doppler echocardiography showed that 12 parameters of cardiac function were unchanged in both groups. No obvious side effect was found in those who took Andriol.

[Antianginal and lipid lowering effects of oral androgenic preparation (Andriol) on elderly male patients with coronary heart disease]

Sixty-two elderly men with coronary heart disease (CHD), 54 of them also suffering from hyperlipidemia, were treated with a new oral androgenic preparation (Andriol) through crossover study. The results showed that after oral Andriol administration for one month, serum estradiol/testosterone (E2/T) ratio was reduced, (P < 0.05) symptom of angina pectoris was relieved (total effective rate, 77.4%), signs of myocardial ischemia in ECG and Holter monitoring were improved (total effective rate, 68.8% and 75% respectively), serum total cholesterol (TC) and triglyceride (TG) levels were reduced dramatically (both P < 0.001) and the serum level of high density lipoprotein cholesterol (HDL-ch) was increased (P < 0.05), but the blood levels of apolipoprotein-AI (APO-AI) and B (APO-B) remained unchanged. No significant side effect of Andriol was observed.

[The changes of right ventricular function in the course of COPD induced cor pulmonale]

A study on pulmonary hemodynamics, radionuclide right ventricular ejection fraction and blood gas analysis in 62 cases of COPD induced cor pulmonale at different stages showed the following results: 1. In early stage of cor pulmonale, stroke volume could not increase after exercise, it proved that cardiac reserve has been reduced; 2. With the progression of the disease, cardiac stroke volume reduced but cardiac output increased gradually, it could be considered as the evolutionary characteristic of cardiac function in chronic cor pulmonale; 3. The right ventricular stroke work was normal and could increase with the rise of after-load, reflecting the relatively effective functional compensation; 4. In acute exacerbation of cor pulmonale, the cardiac failure should be attributed to hyperdynamic type with hypervolemia; 5. Correlation analyses suggested that cardiac output decreased along with the increase of right ventricular afterload only in acute exacerbation of late cor pulmonale; PaO2 and PaCO2 have only slight influence on right ventricular function.

[The interaction of some active and immunological factors in blood in the development of chronic cor pulmonale]

Fourteen experimental indices were determined in 26 patients of chronic cor pulmonale due to COPD and in 32 healthy nonsmokers. It was found that elastase, TXB2, ATII, 5-HT, IgE, CTC and Ach were significantly higher whereas 6-keto -PGF1 alpha, C4 and cAMP lower in the blood from the patients. The roles played by these factors in the development of chronic cor pulmonale were discussed.

[Pulmonary vascular resistance index as parameter for detecting right ventricular afterload]

We studied the pulmonary haemodynamics in 62 cases of chronic cor pulmonale due to chronic obstructive pulmonary disease (COPD). Present criteria for pulmonary hypertension are: pulmonary arterial mean pressure greater than 20 mmHg and/or pulmonary systolic pressure greater than 30 mmHg at rest and pulmonary mean pressure greater than 30 mmHg after exercise. We found that 24 of our 62 cases did not meet these criteria even after exercise despite clinical evidence of cor pulmonale. However, in all cases the pulmonary vascular resistance index (PVRI) was increased (greater than 177 dyn.s.m2.cm-5) and significantly elevated after exercise. It is suggested that 1) it is inappropriate to set the criteria based solely on pulmonary artery pressure to define pathologically increased right ventricular overload; 2) the measurement of PVRI allows the concept of relative and latent pulmonary hypertension to be introduced; 3) PVRI is a more sensitive index of right ventricular overload than pulmonary artery pressures, especially when referring to the result of exercise test.

[Hemodynamic changes in patients with chronic cor pulmonale secondary to COPD and effect of sodium nitroprusside administration]

Pulmonary hemodynamic changes were studied with Swan-Ganz right heart catheterization in 19 patients with chronic cor pulmonale secondary to COPD. HR, RVP, PAPM, PVR, PCWP, RWI and PaCO2 were significantly higher and PaO2 and PH lower in patients with decompensated than those with compensated heart function. Nitroprusside lowered effectively pulmonary arterial pressure and pulmonary vascular resistance. Meanwhile, the drug also lowered PaO2 when the patient was breathing air but did not so or even increased it when breathing oxygen.

[Long-term prognosis after recovery from acute myocardial infarction]

754 cases of acute myocardial infarction survivors were followed up for 28 days to 14 years, the missing rate was 1.86%. The factors influencing long-term prognosis were analyzed. Single factor analysis revealed sex, occupation, age, amount of cigarette smoked, history of stroke, and COPD, complications of heart failure, and arrhythmia, stroke and COPD, heart rate higher than 110/min, lung rales, frequency of infarction, quit smoking after infarction exerted significant influence on over all and cardiac death rate. Multiple factors Cox model analysis revealed quit smoking, complications of stroke heart failure, arrhythmia and occupation were the independent predicting factors for over-all causes of death. Frequency of myocardial infarction, quit smoking, amount of cigarette smoked, occupation, stroke were the independent prognostic factors of cardiac death.

[Prognostic factors in the acute stage of myocardial infarction: analysis of 893 cases]

The prognostic factors in the acute stage of 893 myocardial infarction patients, admitted during a period from 1970 to 1986, were analysed. The overall mortality was 15.6%, including 14.4% cardiac death and 1.1% non-cardiac death. Single factor analysis indicated that age, sex, occupation, history of hypertension, chest pain during the episode, systolic blood pressure, heart rate and site of infarction at the time of admission, presence of complications such as cardiogenic shock, arrhythmias, stroke and monitoring in CCU or not were related to the overall mortality and cardiac death. Multiple factor logistic regression analysis indicated that for the overall mortality, the independent prognostic factors included presence of cardiogenic shock, heart rate and chest pain at the time of admission; for the cardiac death, the independent factors included age, occupation, history of hypertension, heart rate and chest pain at the time of admission, involvement of anterior wall and presence of cardiogenic shock and arrhythmias. Basing on the above findings we establish a risk factors predicting prognostic model of acute myocardial infarction in its acute stage.