胸痛中心持续改进对急性ST段抬高型心肌梗死患者救治效果及短期预后的影响

目的 探索胸痛中心持续改进对急性ST段抬高型心肌梗死(STEMI)患者救治效果及短期预后的影响.方法 纳入九江市第一人民医院2016年7月至2019年6月共收治的484例直接经皮冠状动脉介入治疗(PPCI)的急性STEMI患者为研究对象.其中2016年7月至2017年12月收治的198例为A组、经胸痛中心持续改进后2018年1月至2019年6月收治的286例为B组.对比两组患者首次医疗接触(first medical contact,FMC)-球囊扩张(FMC-to-balloon,FMC-to-B)时间、入门到球囊扩张(D-to-B)时间、D-to-B达标率、住院天数、人均住院费用、人均药品费用、药占比.同时对比两组患者短期预后情况,包括院内新发心力衰竭发生率、全因死亡率、大出血事件发生率.结果 通过胸痛中心的持续改进,B组患者的FMC-to-B 119±44.37min vs 156.34±65.21min、D-to-B 75.16±35.05min vs 82.58±45.72min、住院天数7.01±3.52 vs 7.96±5.02d、人均住院费用36143.99±11225.65元vs38964.23±18925.83元、人均药品费用5456.23±945.35元vs5974.94±1325.18元、药占比15.09％vs15.33％均较A组要降低,差异有统计学意义(P<0.05).D-to-B达标率86.71％vs 79.80％较改进前有所提升,差异有统计学意义(P<0.05).B组患者院内新发心衰发生率10.49％vs 16.67％较改进前的A组明显降低,差异有统计学意义(P<0.05).B组全因死亡率4.19％vs 5.05％、大出血事件发生率0.70％vs 1.01％较A组有所降低,但差异无统计学意义(P>0.05).结论 胸痛中心持续改进机制能显著缩短急性STEMI患者FMC-to-B、D-to-B、减少住院天数、降低人均住院费用、人均药品费用、药占比等指标,提高D-to-B达标率,同时能够改善患者短期预后,因此,持续改进是胸痛中心规范化建设的主要手段和努力方向.     

胸痛中心持续改进对急性ST段抬高型心肌梗死患者救治效果及短期预后的影响

目的 探索胸痛中心持续改进对急性ST段抬高型心肌梗死(STEMI)患者救治效果及短期预后的影响.方法 纳入九江市第一人民医院2016年7月至2019年6月共收治的484例直接经皮冠状动脉介入治疗(PPCI)的急性STEMI患者为研究对象.其中2016年7月至2017年12月收治的198例为A组、经胸痛中心持续改进后2018年1月至2019年6月收治的286例为B组.对比两组患者首次医疗接触(first medical contact,FMC)-球囊扩张(FMC-to-balloon,FMC-to-B)时间、入门到球囊扩张(D-to-B)时间、D-to-B达标率、住院天数、人均住院费用、人均药品费用、药占比.同时对比两组患者短期预后情况,包括院内新发心力衰竭发生率、全因死亡率、大出血事件发生率.结果 通过胸痛中心的持续改进,B组患者的FMC-to-B 119±44.37min vs 156.34±65.21min、D-to-B 75.16±35.05min vs 82.58±45.72min、住院天数7.01±3.52 vs 7.96±5.02d、人均住院费用36143.99±11225.65元vs38964.23±18925.83元、人均药品费用5456.23±945.35元vs5974.94±1325.18元、药占比15.09％vs15.33％均较A组要降低,差异有统计学意义(P<0.05).D-to-B达标率86.71％vs 79.80％较改进前有所提升,差异有统计学意义(P<0.05).B组患者院内新发心衰发生率10.49％vs 16.67％较改进前的A组明显降低,差异有统计学意义(P<0.05).B组全因死亡率4.19％vs 5.05％、大出血事件发生率0.70％vs 1.01％较A组有所降低,但差异无统计学意义(P>0.05).结论 胸痛中心持续改进机制能显著缩短急性STEMI患者FMC-to-B、D-to-B、减少住院天数、降低人均住院费用、人均药品费用、药占比等指标,提高D-to-B达标率,同时能够改善患者短期预后,因此,持续改进是胸痛中心规范化建设的主要手段和努力方向.     

区域一体化心电诊断网络在急性ST段抬高型心肌梗死救治中的作用研究

目的:探讨区域一体化心电诊断网络在急性ST段抬高型心肌梗死(STEMI)救治中的作用。方法:回顾性分析2016年7月—2020年6月在我院就诊且行急诊经皮冠状动脉介入(PCI)治疗的STEMI患者200例，其中将2016年7月—2018年6月区域一体化心电诊断网络建立前在我院就诊且PCI治疗的STEMI患者纳为对照组(n=90),行传统救治流程；将2018年7月—2020年6月区域一体化心电诊断网络建立后在我院就诊且行急诊PCI治疗的STEMI患者纳为研究组(n=110),行区域一体化心电诊断网络救治流程。观察两组的关键救治时间节点、救治效果、住院费用及住院时间。结果:与对照组相比，研究组的发病至首次医疗接触时间(S-to-FMC)、首次医疗接触至首次心电图完成时间(FMC-to-ECG)、首次心电图完成时间至球囊扩张时间(ECG-to-B)、进医院大门至球囊扩张时间(D-to-B)均更短(P<0.05);研究组的主要心血管不良事件(MACE)总发生率更低，左心室舒张末期内径(LVEDd)更低，左心室射血分数(LVEF)更高；研究组的住院费用更低(P<0.05),住院时间更...     

基于微信平台构建的城乡一体化胸痛中心对STEMI患者救治效果的影响

目的:探讨基于微信平台构建的城乡一体化胸痛中心对ST段抬高急性心肌梗死(STEMI)患者救治质量及临床结局的影响。方法:建立以中山市人民医院为核心,中山市120急救系统及市人民医院周边9家不具备PCI能力的网络医院参与的胸痛中心,中心医院与网络医院及120急救系统通过微信群沟通,对STEMI患者的基本临床资料如:症状、体征、心电图等资料进行共享和实时传输,比较建胸痛中心前(2016年9月1日～2017年1月31日)和建立胸痛中心后(2017年6月1日～2018年1月31日)两组患者首次医疗接触到球囊扩张的时间(FMC to B),入门至球囊扩张(D-to-B)时间、住院死亡率、住院费用、住院天数的差异;结果:基于微信平台的胸痛中心建立前,行PPCI患者103例,胸痛中心建立后,行PPCI患者165例,两组患者住院期间死亡率、住院费用比较,差异均无统计学意义(均P0.05),但胸痛中心建立后住院时间缩短(7.50±4.03 vs 6.04±3.04,P=0.034);胸痛中心建立后FMC-to-B时间[(126.69±43.42)min vs(115.57±38.79)min,P=0.02]和D-to-B时间[(97.15±46.41)min Vs(77.78±38.61)min,P0.01]均较胸痛中心建立前患者显著缩短,差异均有统计学意义。结论:基于微信平台构建的城乡一体化的胸痛中心,明显缩短了FMC-to-B和D-to-B时间,缩短住院时间,提高了STEMI患者救治效率。     

胸痛中心建设前后急性ST段抬高型心肌梗死院前急救配合介入治疗的疗效

目的:分析胸痛中心建设前后急性ST段抬高型心肌梗死院前急救配合介入治疗的疗效。方法:选取某院于2016年7月1日～2017年7月1日收治的349例患者作为对照组,将2017年7月1日～2018年7年1月收治的526例患者作为观察组,比较两组患者治疗后FMC时间、D-to-B以及首份心电图确诊时间。结果:两组患者在治疗后均取得一定效果,但观察组患者的效果(时效性及预后)明显优于对照组,差异具有统计学意义(P0.05)。结论:胸痛中心的有效建设能够缩短急性ST段抬高型心肌梗死患者的D-to-B时间,降低其相关的住院费用,改善其预后,有较高的应用价值,值得有效推广。     

胸痛中心网络医院转诊急性ST段抬高型心肌梗死患者的救治体会

目的研究网络医院转诊急性ST段抬高型心肌梗死患者的救治情况。方法选取2018年9月～2019年8月汕尾市第二人民医院胸痛中心网络医院转诊的急性STEMI患者111例,按时间顺序分为胸痛中心建设前组及胸痛中心建设后组,比较两组患者的救治情况。结果两组患者进入首诊医院到转出时间、院内心衰发病率、院内病死率比较,差异无统计学意义(P 0.05)。建设后组入门至导丝通过时间、绕行急诊比例、直接PCI比例与建设前组比较,差异有统计学意义(P 0.05)。结论胸痛中心区域协同救治体系的建设,网络医院转诊急性STEMI患者明显增加,救治效率提高。但网络医院的救治时间因各种因素并未明显改善,需要注重胸痛中心区域协同救治体系的质量持续改进工作。     

120急救转运系统对急性ST段抬高型心肌梗死患者的救治意义

目的探究在急性ST段抬高型心肌梗死(STEMI)患者的救治中应用120急救转运系统的效果评价。方法选取2016年1月至2017年1月到我院急诊科抢救STEMI的60例患者作为研究对象。根据入院方式的不同分为两组,即:研究组、参照组,每组各30例。其中研究组采用的入院方式为120急救转运系统;参照组患者均为自行入院的方式。观察两组患者治疗的时间指标、病死率、PCI术后心功能情况,并对其进行比较、分析。结果研究组患者的治疗时间指标及病死率明显少于参照组,差异具有统计学意义(P<0.05);研究组患者治疗后6个月的心功能情况明显好于参照组,差异具有统计学意义(P<0.05)。结论将120急救转运系统应用于STEMI患者的救治获得显著效果,不仅能够对患者进行及时的抢救,还能快速的恢复患者的心功能,极大地降低了病死率,对于STEMI患者的救治有着积极的现实意义。     

基层胸痛救治单元对急性ST段抬高型心肌梗死患者SO-to-FMC时间、D-to-N时间的影响

目的 探讨基层胸痛救治单元对急性ST段抬高型心肌梗死(STEMI)患者就诊率、溶栓率、发病到首次医疗接触(SO-to-FMC)时间、入门至开始溶栓(D-to-N)时间的影响。方法 124例急性STEMI患者,根据救治方法不同分为对照组和研究组,每组62例。对照组患者接受常规救治方法进行治疗,研究组患者接受基层胸痛救治单元进行治疗。对比两组患者临床指标[SO-to-FMC时间、首次医疗接触到双抗血小板(FMC-to-双抗)时间、D-to-N时间]、治疗前后希望评分,预后指标[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、脑利钠肽前体(pro-BNP)、心力衰竭发生率、住院时间]。结果 研究组患者的SO-to-FMC时间、FMC-to-双抗时间、D-to-N时间分别为(119.25±10.16)、(16.28±7.23)、(19.38±4.25)min,均短于对照组的(178.55±16.34)、(26.07±8.15)、(28.37±5.11)min,差异具有统计学意义(P<0.05)。治疗前,两组患者的对现实和未来的态度、采取积极行动的态度、与他人保持亲密关系评分及总...     

胸痛中心成立前后的急性ST段抬高型心肌梗死患者救治效果差异分析

目的比较成立胸痛中心前后对于急性ST段抬高型心肌梗死患者救治的不同效果。方法以2016年1月~2017年12月这一时间段作为研究进行时间,将2017年1月成立胸痛中心后的1年时间2017年1~12月视作观察组,选取30例患者,另外将2016年1~12月成立胸痛中心前的一年时间作为对照组,同样选取30例患者,比较两组患者救治的不同效果。结果对照组30例患者中27例患者接受直接经皮冠状动脉介入治疗,占90%;观察组30例患者中26例患者接受直接经皮冠状动脉介入治疗,占86.67%。两组伴有高血压、糖尿病、高血脂症基础疾病的患者比重,吸烟患者比重差异不大,两组PCI成功率没有差异;观察组入门-球囊扩张时间、住院时间均短于对照组,住院费用少于对照组,观察组院内病死率为3.33%,明显低于对照组16.67%;观察组出院后1、3个月生活质量高于对照组。结论成立胸痛中心后对于急性ST段抬高型心肌梗死患者的救治效果能够得到明显提升,有助于减少病死率,可推广。     

注射用重组人TNK组织型纤溶酶原激活剂溶栓治疗急性ST段抬高型心肌梗死的效果

目的 探析注射用重组人TNK组织型纤溶酶原激活剂(rhTNK-tPA)溶栓治疗急性ST段抬高型心肌梗死的效果.方法 32例急性ST段抬高型心肌梗死患者作为研究对象,以治疗方式的不同分为参照组及研究组,每组16例.参照组应用尿激酶治疗,研究组应用rhTNK-tPA治疗.对比两组溶栓治疗后90 min行冠状动脉造影患者的冠...     

Effects of treatment history and centralized intake on drug treatment outcomes

This study assesses differences between first-time treatment clients (n=90) and repeat treatment clients (n=361), including whether entering treatment through a central intake unit affects outcomes differently for the two groups. Interview data were collected at baseline, one-month and 12-month follow-up. Study groups were similar in gender, race and age, but repeat treatment participants were more educated, more likely to primarily use heroin and more likely to have ever injected drugs. First-time treatment clients were more likely to have been required to enter treatment, but less likely to have applied to another program or to be in the program they desired. First-time treatment clients were also more likely to be in outpatient or day treatment, and less likely to be in residential treatment. Problem severity decreased for both groups over time, with no significant differences between groups. There was one significant interaction effect of study group and length of stay on social problem severity, such that longer stays in treatment led to a greater reduction in social problems for repeat treatment clients. Route of treatment entry (CIU/non-CIU) was not associated with problem severity nor change in problem severity over time for either study group.     

中西医结合治疗急性胆源性胰腺炎疗效分析

目的探索中西医结合治疗急性胆源性胰腺炎的临床疗效。方法对66例急性胆源性胰腺炎在常规西医治疗使用奥美拉唑、生长抑素的基础上加中医治疗给予中药大承气汤加减治疗急性胰腺炎治后评价疗效。结果非手术治疗治愈率87.8%,手术治愈率10.6%,死亡1例。结论中西医结合治疗急性胆源性胰腺炎患者疗效确切而且无不良反应,有较好的疗效,值得临床应用。     

Analysis of the impact of treatment setting on outcomes from methadone treatment

How methadone setting, duration of drug career, and dose impact on treatment are assessed. Two hundred fifteen participants were recruited. Analysis revealed significant reductions in drug use at 1 year within all settings, but the pattern varied. Proportions using heroin reduced in all settings, unprescribed benzodiazepines reduced in community, and general practitioner settings and cocaine use reduced in community and Government health board settings. A logistic model controlling for intake methadone dose, setting, previous treatments, and intake heroin use revealed that setting was a significant factor in predicting heroin use at 1 year but was not significant in predicting changes in health. Findings illustrate that drug outcomes improved across all settings, and health did not improve in any setting. For optimum outcomes to be achieved, opiate users must be directed to settings that best match their needs and that the “one-stop-shop for methadone” is not the most effective solution.     

Effect of treatment for nicotine dependence on alcohol and drug treatment outcomes

This study was designed to examine the effect of a policy banning smoking and a smoking-cessation intervention on alcohol and drug treatment outcomes. We compared long-term alcohol and drug treatment outcomes in two cohorts hospitalized for substance use treatment, subjected to different smoking policies and cessation interventions in two periods. The study included 314 male patients, aged 18–65. The intervention cohort was subjected to a total hospital smoking ban and concurrent drug and nicotine dependency treatment, with a requirement for nicotine abstinence during hospitalization. The control cohort was hospitalized under a policy permitting smoking in designated areas, with no specific smoking-cessation intervention. Current alcohol, drug, and tobacco use were ascertained by follow-up interview with patients 8–21 months after completion of treatment. There was a 60% response rate in the intervention group (n = 92) and a 66% response rate in the control group (n = 105). Among respondents, there were no significant differences between intervention and control groups in rates of “improvement” for alcohol, cocaine, or marijuana use, or for these drugs combined, although there was a nonsignificant trend toward less “improvement” in the intervention group. When nonrespondents were analyzed as treatment failures, the rate of “improvement” was significantly worse for cocaine users in the intervention group, but not for other drug users or for all patients combined. Ten percent of patients reported quitting smoking in the intervention group compared to 4% in the control group (difference not significant). Although patients resisted the mandatory nature of the smoking intervention, many continuing smokers requested information and referral for smoking cessation at the time of follow-up. These data suggest that concurrent intervention for nicotine dependence did not significantly harm treatment outcomes of patients using alcohol or marijuana as their drug of first choice. Due to a trend in this direction, this possibility should be investigated in randomized, controlled trials. The intervention was associated with a small increase in self-reported smoking cessation. There is considerable interest in this patient population in smoking cessation after completion of treatment.     

Current treatment of asthma--focus on leukotrienes

Since their identification in 1979, the cysteinyl leukotrienes (cysLTs) have been shown to be prominent in many inflammatory conditions, including asthma, allergic rhinitis, rheumatoid arthritis, psoriasis, cystic fibrosis and inflammatory bowel disease. They are potent pro-inflammatory agents, as well as causing bronchoconstriction, and undoubtedly have a role in asthma. The cysLTs are products of arachidonic acid metabolism and have been shown to have effects via a cysteinyl leukotriene receptor (CysLTR1) on vascular permeability, mucus production, chemotaxis and bronchial smooth muscle. Their detection in certain body fluids in allergic, aspirin-sensitive and exercise-induced asthma is well documented and potential roles in pathogenesis, proposed. The development of agents affecting production or action offers an exciting new approach to the treatment of asthma. Two approaches to antileukotriene therapy have been developed: blocking their production by inhibiting the action of 5-lipoxygenase enzyme or blocking the CysLTR1. Both approaches have been tried in studies in asthma and overall the results are encouraging, with a decrease in both daytime and nocturnal symptoms, a decrease in additional beta 2 agonist usage and improvement in lung function. The changes, however, are small in some studies. This may be a reflection of disease severity in the study subjects, but of note is a heterogeneity of response to these treatments that may be genetically determined. Antileukotriene therapy has been shown to have an effect in specific types of asthma where the role of cysLTs seems well established--aspirin-sensitive/intolerant asthma and exercise-induced asthma. Longer term studies are needed in other areas such as severe asthma and chronic persistent asthma in both children and adults to provide evidence for the appropriate placement of antileukotriene treatment in current asthma guidelines, in comparison with other established treatments.     

新生儿黄疸治疗进展

本文探讨目前新生儿黄疸治疗常用的蓝光照射、换血疗法、酶诱导剂、微生态制剂、茵栀黄制剂等治疗方法的应用指征、临床疗效及利弊,临床工作中,新生儿黄疸的干预方案应建立在病史、病程、体检和权衡利弊的基础上,对患儿尽早给予相应的干预治疗,可有效实现降低高胆红素血症以及胆红素脑损伤患病率的目的 。     

抑郁症的药物治疗进展

抑郁症是一种常见的精神疾病,其发病率在不断上升,而且难以治愈。目前抑郁症的治疗药物主要包括:三环类抗抑郁药、单胺氧化酶抑制剂和可逆性选择性单胺氧化酶抑制药、选择性5-HT再摄取抑制剂、选择性NE再摄取抑制剂、5-HT及NA再摄取抑制药、NA及DA再摄取抑制药等。本文就抗抑郁药及特殊情况下抑郁症的药物治疗进展作一综述。     

甲状腺外科治疗研究

甲状腺良性疾病外科切除需尽可能保留器官功能;分化型Ⅰ、Ⅱ期甲状腺癌预后良好,一般可长期无病存活,甲状腺外科治疗不应拘泥于一套死板规范模式,应结合不同患者临床表现、分期、预后因素等综合评估,确定个体化治疗方案,以确保治疗效果,最大程度改善患者预后,降低对生活不良影响。     

对糖尿病神经病变治疗的思考

糖尿病神经病变变(diabetic neurophy,DN)是糖尿病最常见和最复杂的并发症之一,是引起全身神经病变的首要病因[1]。其临床表现形式复杂多样,主要包括周围神经病变、自主神经病变、颅神经病变、中枢神经系统病变等,其中周围神经病变     

Influence of radiation treatment on dobutamine

As an alternative to heat and gas exposure sterilization, ionizing radiation is gaining interest as a sterilization process for medicinal products. The aim of this work was to develop equations to describe the ESR curves versus dose and storage time after gamma irradiation of dobutamine hydrochloride. Limit of detection and limit of discrimination are, respectively, 0.5 and 1.5 kGy for dobutamine hydrochloride. Linear regression is applicable for doses lower than 20 kGy. Estimation of the number of free radicals by comparison of the second integral from radiosterilized dobutamine and DPPH standard on the linear part of the curve gives 6±2 10¹⁵ spin/g/kGy. From this result, the G value (number of radicals/100 eV) could be estimated to 0.1±0.04. Decay kinetics for radicals versus storage were considered. Nonhomogeneous kinetics with time-dependent rate appeared valid to reproduce the experimental data. Discrimination between irradiated and unirradiated dobutamine is possible after a storage longer than 2 years. The comparison of the chromatographic profiles of irradiated and unirradiated samples showed minor differences.