溶栓对急性心肌梗塞QTc离散度的影响

目的探讨溶栓对急性心肌梗塞(AMI)QTc离散度(QTcd)的影响。方法选择42例接受静脉溶栓治疗AMI患者,其中28例溶栓成功。分别测量溶栓成功组和失败组溶栓前后的QTcd。结果溶栓成功组溶栓后QTcd较溶栓前显著缩短[(89.9±23.2)msvs(60.5±13.6)ms,P<0.05]。溶栓失败组QTcd保持较高水平[(85.6±28.2)msvs(98.6±20.1)ms]。结论溶栓治疗成功可使AMI后的QTcd显著降低。     

院前-院内一体化急救流程在急性脑梗死患者 急诊救治中的应用效果

目的探究院前-院内一体化急救流程在急性脑梗死(ACI)患者急诊救治中的应用效果。方法选取2016年5月至2018年4月濮阳市人民医院收治的126例ACI患者。其中采用院前-院内实施一体化急救流程的63例患者作为观察组;由家属护送入院就诊,仅行院内急诊的63例患者作为对照组。比较两组救治成功率、急救时间(入院至静脉溶栓时间、入院至动脉置鞘时间、动脉置鞘至闭塞血管再通时间)、预后,对比干预前后神经功能(NIHSS评分)及日常生活能力(Barthel指数)变化。结果①救治成功率:观察组救治成功率96.83%(61/63)高于对照组80.95%(51/63),差异有统计学意义(P<0.05)。②救治时间:观察组静脉溶栓15例,对照组静脉溶栓10例,观察组入院至静脉溶栓时间短于对照组,差异有统计学意义(P<0.05);观察组急诊血管内治疗46例,对照组急诊血管内治疗41例,观察组入院至动脉置鞘时间、动脉置鞘至闭塞血管再通时间短于对照组,差异有统计学意义(P<0.05)。③预后:经Ridit检验,观察组预后优于对照组,差异有统计学意义(P<0.05),且观察组恢复良好率42.86%高于对照组25.40%,差异有统计学意义(P<0.05)。④NIHSS评分、Barthel指数:干预3周后两组NIHSS评分、Barthel指数均明显改善,且观察组NIHSS评分低于对照组,Barthel指数高于对照组,差异有统计学意义(P<0.05)。结论院前-院内实施一体化急救流程能有效提高ACI患者急救成功率,缩短救治时间,降低神经功能缺损程度,提高日常生活能力,改善预后。     

冠心病临界病变患者血管因子与冠状动脉斑块形态学特征的相关性研究

目的探讨冠心病临界病变患者血管因子与冠状动脉斑块形态学特征的相关性。方法选取2012年1月至2013年12月荆州市第一人民医院收治的120例冠心病临界病变患者为研究对象,依据冠状动脉斑块形态进行分组,不稳定型心绞痛患者40例作为A组,稳定型心绞痛患者40例作为B组,冠状动脉粥样硬化40例作为C组。并应用蛋白芯片法测定血管因子的变化,分析其血浆胎盘生长因子(PLGF)和血浆可溶性酪氨酸激酶受体2(s Tie-2)与患者冠状动脉斑块形态学特征的相关性。结果 A组PLGF显著高于B组和C组[(80.8±6.2)ng/L比(55.6±3.9)ng/L,(44.9±2.7)ng/L](P<0.05);A组和B组s Tie-2均显著高于C组[(1345±48)ng/L,(1356±45)ng/L比(1047±13)ng/L](P<0.05);A组的直径狭窄率低于B组,高于C组[(38.9±1.6)%比(43.5±3.5)%比(36.8±2.8)%](P<0.05);A组的面积狭窄率显著低于B组,高于C组[(61±7)%比(66±6)%比(58±5)%](P<0.05);A组最小管腔直径显著高于B组,低于C组[(2.15±0.27)mm比(1.94±0.23)mm比(2.23±0.16)mm](P<0.05);A组的斑块面积均显著高于B组和C组[(10.56±1.18)mm2比(9.53±0.82)mm2,(7.15±0.41)mm2](P<0.05);A组的最小管腔面积显著高于B组,低于C组[(3.2±0.2)mm2比(2.8±0.1)mm2比(3.6±0.2)mm2](P<0.05)。PLGF与最小管腔面积呈正相关(r=0.361,P<0.05);s Tie-2与最小管腔面积和最小管腔直径均呈正相关(r=0.217,0.174,P<0.05)。结论临床中检测血浆PLGF和血浆s Tie-2可以提示冠心病临界患者斑块内新生血管的生成,且两者与冠状动脉斑块形态学特征之间联系紧密。     

AMI急诊静脉内溶栓疗法应用延迟时间相关因素

目的 探讨急性心肌梗死急诊静脉内溶栓疗法应用延迟时间的相关因素.方法 对204例进行急诊静脉内溶栓治疗的急性心肌梗死病人的临床资料进行回顾性分析.结果 本组204例中在院前和急诊科进行溶栓治疗者分别占11.3%和88.7%.全部病人总平均延迟时间为(203.1±92.9)min,其中进行院前溶栓的延迟时间明显短于在急诊科进行溶栓治疗者.溶栓治疗延迟时间与病人年龄呈正相关(r=0.308,P<0.05).在发病后3 h内进行溶栓的病人63例,其院内严重并发症的发生率低于3 h后开始溶栓者(χ2=2.886,P<0.05).结论 急性心肌梗死急诊溶栓治疗的延迟时间与病人年龄及院内严重并发症的发生有一定的关系,院前进行溶栓治疗可显著缩短溶栓开始时间.     

应用尿激酶溶栓急诊治疗急性心肌梗死患者64例临床疗效观察

目的:探讨尿激酶溶栓急诊治疗急性心肌梗死(AMI)患者的临床疗效。方法:选取接受治疗的128例AMI患者,随机分为溶栓组和对照组,对照组给予常规治疗,溶栓组在常规治疗基础上加用尿激酶溶栓治疗,并比较两组疗效。结果:溶栓组治疗90 min、120 min后的冠脉再通率分别为53.1%、71.9%,均明显大于对照组,差异有统计学意义(P<0.05),治疗4周后的并发症发生率和死亡率分别为3.1%、0,均明显小于对照组,差异有统计学意义(P<0.05)。结论:尿激酶溶栓治疗在急性心肌梗死治疗中可明显提高患者血管再通率,减少并发症发生,降低死亡率。     

院前静脉溶栓治疗急性心肌梗死18例疗效观察

目的:观察院前静脉溶栓治疗急性心肌梗死(AMI)的疗效。方法:在常规抢救治疗AMI的基础上,用尿激酶静脉溶栓,治疗组18例与对照组15例作比较。结果:再通率:治疗组83.3%,对照组60%,P<0.05,有显著性差异。结论:开展院前静脉溶栓治疗急性心肌梗死可明显提高冠脉再通率。     

瑞替普酶静脉溶栓治疗急性心肌梗死的效果及安全性分析

目的分析瑞替普酶静脉溶栓治疗急性心肌梗死(AMI)的效果及安全性。方法选取AMI患者80例,按照随机数表法分为对照组和观察组,各40例。溶栓辅助治疗基础上对照组接受尿激酶治疗,观察组接受瑞替普酶治疗。比较两组溶栓再通率、病死率及药物不良反应发生情况。结果溶栓后30 min,两组溶栓再通率比较,差异无统计学意义(P>0.05),溶栓后60、90、120 min观察组溶栓再通率分别为45.0%、77.5%、87.5%,高于对照组的17.5%、47.5%、55.0%,差异有统计学意义(P<0.01);溶栓后120 min,两组发病距溶栓≤6 h的患者溶栓再通率均高于发病距溶栓6~12 h的溶栓再通率,差异有统计学意义(P<0.01),且发病距溶栓≤6 h观察组溶栓再通率高于对照组,差异有统计学意义(P<0.05);两组溶栓后心血管事件发生率和死亡率比较,差异无统计学意义(P>0.05),观察组出血并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论瑞替普酶对AMI患者溶栓再通率高,安全性好,且发病时间越短,溶栓效果越好。     

基于120系统的急性脑卒中救治体系应用效果

目的研究基于120系统构建的的急性脑卒中救治体系应用效果。方法选择2015年1月~2016年12月我院卒中中心收治的急性脑卒中患者180例为观察对象。2016年1~12月救治体系实施后的90例患者设为观察组,2015年1~12月救治体系实施前的90例患者设为对照组,对照组采取传统院前转运和院内急救,观察组则基于120系统的急性脑卒中救治体系进行急救。分别对比两组患者接诊至确诊时间、确诊至专科治疗时间、入院到开始静脉溶栓的时间(DNT)、并发症发生情况、致残率及死亡率。结果观察组接诊至确诊时间、确诊至专科治疗时间、患者入院到开始静脉溶栓的时间(DNT)分别为(17.7±1.9)min、(27.1±7.2)min和(57.0±6.3)min,均显著低于对照组的(29.3±4.4)min、(45.8±6.1)min和(89.0±7.2)min,差异有统计学意义(P0.05)。观察组并发症发生率为7.78%(7/90),显著低于对照组的22.22%(20/90);观察组致残率、死亡率分别为8.89%(8/90)和4.44%(4/90),显著低于对照组的31.11%(28/90)和16.67%(15/90)。结论基于120系统与急诊科的数据传输和预警体系建设的急性脑卒中救治体系,可显著缩短院前延误时间、DNT时间,利于降低并发症发生率、致残率及死亡率。     

急性心肌梗塞溶栓治疗与经皮急诊及延迟冠脉介入治疗近期疗效分析

目的:比较急性心肌梗塞(AMI)药物溶栓治疗与急诊直接经皮冠脉介入治疗(PTCA)及延迟冠脉介入治疗(PCI)在住院期间的临床效果。方法:在137例AMI中,73例接受PCI治疗,其中28例行即刻PCI(即刻治疗组),45例在肝素或溶栓7d后行介入治疗(延迟治疗组),64例接受药物溶栓治疗。结果:溶栓治疗组再通的患者47例,开通率73.4%,PCI开通率94.5%,其中直接PTCA成功开通26例,开通率92.8%,延迟PTCA开通43例,开通率95.6%。住院期间,左室射血分数(LVEF)值:溶栓组52.1%±12.2%,PTCA组64.3%±9.2%(其中即刻组67.4%±10.1%,延迟组61.2%±9.2%),差异有显著性(P<0.05)。病死率分别为7.8%和1.4%(其中即刻组为0,延迟组2.2%)。进一步分析两组间临床疗效,前者再闭塞或缺血发作行择期PTCA者比率明显高于PTCA组(9.4%,VS0,P<0.05)。结论:PTCA与溶栓治疗AMI患者,前者可使IRA充分有效的开通,能更好地改善患者心功能,减少死亡率,其中即刻PTCA较延迟PTCA对心功能的改善更好。     

急性心肌梗死序贯性再灌注研究

目的:探讨经尿激酶静脉溶栓加即刻准备的支架植入治疗急性心肌梗死(AMI)的临床疗效。方法:80例AMI患者中,直接冠脉支架植入20例(直接支架组),尿激酶静脉溶栓加即刻准备的支架植入30例(溶栓支架组),尿激酶静脉溶栓30例(溶栓组)。均行急诊冠状动脉造影,以Timi血流分级判断梗死相关冠状动脉(IRA)开通、血栓、慢复流情况;记录住院期间心脏事件;出院前用二维超声心动图测定左心室射血分数(LVEF)。结果:直接支架组IRA开通率为100％,溶栓支架组开通率为96.7％,溶栓开通率为46.7％(P<0.01);直接支架组与溶栓支架组术中冠脉内血栓发生率分别为25.0％,20.0％,P>0.05;慢复流发生率分别25.0％,30.0％,P>0.05;临床事件:出血、心力衰竭、心绞痛、再梗死,脑梗死,支架纽较溶栓组发病率低,但3组间统计学上无差异(P>0.05),住院天数明显短缩(P<0.01);3组病死率分别为0％,3.3％,6.7％(P<0.05);3组LVEF分别为(65.5±11.5)、(64.0±14.5)、(54.5±13.0)(P<0.05)。结论:直接支架植入或尿激酶静脉溶栓加即刘准备的支架植入较单纯尿激酶溶栓治疗惠性心肌梗死更能充分开通IRA,改善心功能,降低病死率。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.