Objective To explore the influence of carvedilol combined with diuretics on BNP and cardiac function of patients with mild to moderate cardiac insufficiency.Methods87 cases of patients with mild to moderate cardiac insufficiency treated in Zhejiang Greentown Cardiovascular Hospital from June 2014 to June 2016 were divided into the groups randomly.The control group of 44 cases were given carvedilol treatment, and the study group were combined with spironolactone treatment on the basis of the control group, with the total course for a month.Clinical effects were contrasted after a month of treatment in the two groups, in order to explore the influence of carvedilol combined with diuretics on BNP and cardiac function of patients with mild to moderate cardiac insufficiency.ResultsBefore treatment, there was no significant difference in serum BNP level between the control group and the study group.After treatment, serum BNP level significantly decreased when compared with those before treatment in the two groups (P< 0.05), which of the study group was significantly lower than that in the control group(P< 0.05).Before treatment, there were no significant differences in the levels of cardiac function indexes, and after treatment, heart rate, EF (%), FS (%), LVEDD (mm) the four indicators significantly improved when compared with those before treatment, and heart rate, LVEDD (mm) levels were significantly lower than those in the control group(P<0.05), and EF (%), FS (%) levels were significantly higher thatn those in the control group(P<0.05).After treatment, the significant effective rate (73.91%) and total effective rate (95.35%) in the study group were significantly higher than that of (56.82%) and(86.36%) in the control group (P<0.05).After treatment, body function, life satisfaction, mental health, social adjustment the four parts of quality of life index scores were significantly higher than those in the control group(P<0.05).ConclusionIt has obvious improvement effect of carvedilol combined with diuretics on BNP and cardiac function of patients with mild to moderate cardiac insufficiency.It is worthy of clinical application.

Objective To discussion the clinical study of milrinone injectionon on acute heart failure with poor effect of digitalis and diuretics.Metheds 90 cases of acute heart failure with poor effect of digitalis and diuretics patients from September 2014 to May 2016 in our hospital were selected,according to the random number table method is divided into control group and study group,45 cases in each groups,the control group was treated with conventional heart failure intervention program,the study group given milrinone injectionon on the basis of control group,two groups were treated for seven days.Serum neurohormonal factors,inflammatory factors and blood pressure were measured before and after treatment,and the clinical efficacy and complications were compared between two groups.Results Compared with before treatment,serum NT-proBNP,NE and ET-1 levels were decreased in two groups,NO content increased,the levels of serum TNF-α,IL-6 and Hs-CRP were decreased,the levels of LVEF and CI were increased,the levels of LVEDD and CTR were decreased,the differences were statistically significant(P<0.05).Compared with the control group,the levels of serum NT-proBNP,NE and ET-1 in the study group were lower,NO were higher,the levels of TNF-α,IL-6 and Hs-CRP in serum were lower,LVEF and CI were higher,LVEDD and CTR were lower,the differences were statistically significant(P<0.05).The effective rate of the study group was 86.67％,which was significantly higher than that of the control group(66.67％,P<0.05).All the patients were followed up and no cases were reported.There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Milrinone injectionon has a significant effect on acute heart failure with poor effect of digitalis and diuretics,can significantly reduce the neurotrophic factor and inflammatory factors,improve heart function,promote prognosis.

Objective:　To study the changes and clinical significance of arginine vasopressin (AVP) and angiotensin II (AT-II) in patients with acute moderate and severe cerebral injury. 　　Methods:　The early plasma concentration was checked by radioimmunoassay in 47 cases of acute moderate and severe cerebral injury, 30 cases of non-cerebral injury and 30 healthy volunteers. 　　Results:　The early plasma concentrations of AVP (50.23 ng/L±15.31 ng/L) and AT-II (248.18 ng/L±82.47 ng/L) in cerebral injury group were higher than those in non-cerebral injury group (AVP for 30.91 ng/L±11.48 ng/L and AT-II for 120.67 ng/L±42.49 ng/L, P<0.01). The early plasma concentrations of AVP and AT-II in cerebral injury group were also obviously higher than those of the volunteers (AVP for 5.16 ng/L±4.23 ng/L and AT-II for 43.11 ng/L±16.39 ng/L, P<0.001). At the same time, the early plasma level of AVP (58.90 ng/L±18.12 ng/L) and AT-II (292.13 ng/L±101.17 ng/L) was higher in severe cerebral injured patients than moderate cerebral injured ones (AVP for 36.68 ng/L±12.16 ng/L and AT-II for 201.42 ng/L±66.10 ng/L, P<0.01). The early level of AVP and AT-II was negatively related to the GCS scales in acute cerebral injury. The early plasma concentrations of AVP (45.98 ng/L±13.48 ng/L) and AT-II (263.28 ng/L±80.23 ng/L) were lower in epidural hematoma group than those of subdural hematoma and cerebral injury group (AVP for 64.12 ng/L±15.56 ng/L and AT-II for 319.82 ng/L±108.11 ng/L, P<0.01). 　　Conclusions:　 AVP and AT-II may play an important role in pathophysiologic process in the secondary cerebral injury. The more severe the cerebral injury is, the higher the early level of AVP and AT-II will be. The early plasma level of AVP and AT-II may be one of the severity indexes of cerebral injury.