接诊心脏事件的季节和时间分布分析

对2001年急症科接诊的心脏病患者的发病季节、时间进行了统计分析。结果显示高发季节为3～4月份和10～11月份,高峰就诊时间多为19时8分至23时8分。认为了解心脏事件发生的季节和昼夜规律,有利于医护人员提前向患者提供必要的预防保健措施,适时安排抢救物品,以提高抢救成功率。     

接诊心脏事件的季节和时间分布分析

对2001年急症科接诊的心脏病患者的发病季节、时间进行了统计分析。结果显示高发季节为3～4月份和10～11月份,高峰就诊时间多为19时8分至23时8分。认为了解心脏事件发生的季节和昼夜规律,有利于医护人员提前向患者提供必要的预防保健措施,适时安排抢救物品,以提高抢救成功率。     

接诊心脏事件的季节和时间分布分析

对2001年急症科接诊的心脏病患者的发病季节、时间进行了统计分析。结果显示高发季节为3～4月份和10～11月份,高峰就诊时间多为19时8分至23时8分。认为了解心脏事件发生的季节和昼夜规律,有利于医护人员提前向患者提供必要的预防保健措施,适时安排抢救物品,以提高抢救成功率。     

乘机旅客死亡28例临床分析

目的　探讨乘机旅客的适航性和急症特点 ,以提高危重患者的救治成功率。方法　回顾性分析 1996- 0 1～ 2 0 0 4 - 0 1在北京首都国际机场候机楼和飞机上急救的 2 8例死亡乘客的临床资料。结果　 2 8例院前死亡患者在医护人员赶到现场时 ,呼吸和心跳均已停止 10min以上 ,虽现场抢救 30～ 6 0min ,但无一例复苏成功。结论　乘机心跳骤停患者抢救成功与否与急救反应时间、到现场时间、开始抢救时间及患者原发病是否可逆等因素密切相关。     

224例急性心肌梗塞发病时间的分析及其临床意义

观察224例急性心肌梗塞（AMI）的发生与时间、日期、季节之间的关系。按年龄划分为两组。Ⅰ组年龄＜60岁，Ⅱ组年龄≥60岁。观察显示：两组病人均在上午6～9时发病率最高，Ⅰ组在7～8时出现高峰，Ⅱ组在6～7时出现高峰，两组病人发病率均在星期日最高。Ⅰ组1月份发病率略高于其它月份，Ⅱ组1～2月份发病率最高。结果表明：了解急性心肌梗塞发生的时间规律，将有助于在心脏事件出现高峰之前采取有效措施，从而减少和降低急性心肌梗塞的发生率和死亡率。     

小儿急性氟乙酸钠中毒46例临床分析

鼠药中毒是小儿急性中毒的常见中毒类型,约占我院小儿急性中毒病例的37．4％（46／123）。我科自1993年1月～1998年2月收治46例急性氯乙酸钠中毒患儿,针对中毒机理,制定规范化抢救措施取得良好效果。现报告如下。1资料分析1．1性别与年龄男34例（73．9％）,女12例（26．1％）。年龄最大8岁,最小13个月,平均3．5岁。1．2中毒至八院时间05～46h,平均8．sh。1．3中毒原因均为误食毒鼠食饵（其中油条12例,花生米20例,爆米花5例,其他9例）。1．4中毒发生季节全年都有发生,以春夏季节问～8月份）为高,30例,占65．5％。而秋冬季节（8…     

钩虫感染122例所致初期综合症状分析

一、材料来源:全组患者中有59年某县委机关干部13人、某农学院学生65人及60年某公社两个生产队社员44人,共计122人。二、发病季节,时间与气候的关系:全组三个单位患者均系集体劳作时感染,计六月份受染44人,七月份受染78人。由此看出发病多在六、七月份,因此时正是农忙季节,又值雨季,人们多赤足下田,给感染造成有利的机会。发病时间:全组略记忆:上午8—10时109例,下午3—5时13例。全组均在大雨后下田施肥、刨土豆受染,因此时正是钩幼虫活动的时间,最易于感染。     

大剂量肾上腺素在心肺复苏中的应用价值

关于肾上腺素对心脏骤停患者的应用剂量 ,近年来一直存在争议。 1993、1995年 ,我院采用大剂量肾上腺素 (HDE)抢救心脏骤停患者 2 4例 ,与用常规剂量肾上腺素 (SDE)抢救的42例患者比较 ,抢救成功率高 ,现将结果报告如下。资料与方法 :HDE组 2 4例 ,男 18例 ,女 6例 ;抢救时心脏停跳时间 0～ 13分钟 ,平均 3.6分钟 ;心脏骤停一旦诊断 ,肾上腺素的初始用量为 2 mg,此后每 4～ 6分钟追加 5 m g。SDE组 42例 ,男 2 7例 ,女 15例 ;抢救时心脏停跳时间 0～ 18分钟 ,平均 3.2分钟 ;肾上腺素的剂量按常规方法应用 ,首剂1mg,以后每 4～ 6分钟静…     

安徽当涂县2003年急性血吸虫病感染情况

当涂县2003年共发生急性血吸虫病感染病例(下称急感)35例,现具体报告如下。35例急感的病例特征,年龄最小9岁,最大55岁,集中在25～35岁,其次是7～14岁,分别占57.14%和31.43%;其中男性31例,女性4例,分别占88.57%和11.43%;农民16例,学生15例,分别占45.71%和42.86%,其它职业4例。感染方式主要以游泳戏水为主,占54.29%,其它感染方式有养蟹、捕鱼等以及抗洪救灾、生活用水等。病例接触疫水时间最早为5月初,7、8月份为接触疫水最集中的季节;发病时间最早为7月份,高峰发病时间为8～9月份,8月份发病16例,9月份发病17例,从病人接触疫水到发病时间最短…     

急诊心肌梗死患者应用优化急诊护理流程的临床抢救效果

目的探讨优化急诊护理流程在急诊心肌梗死患者临床抢救中的效果。方法随机选取2013年3月到2015年3月我院急诊科收治的80名急性心肌梗死患者分为对照组和观察组,对照组给予常规的急诊抢救措施,观察组给予优化后的急诊抢救措施,比较两组患者的抢救效果。结果观察组进出急诊室时间、急救时间、抢救成功率以及住院时间与对照组相比,明显较低,P0.05,差异具有统计学意义。观察组复发患者有2名,复发率为5.0%,对照组有8名患者复发,复发率为20.0%,两组相比差异具有统计学意义(χ2=10.324,P0.01)。结论优化急诊护理流程能够提高急性心肌梗死患者的生存率和抢救的效果,进而改善急性心肌梗死患者的预后。     

Circadian variation of tissue plasminogen activator and its inhibitor, von Willebrand factor antigen, and prostacyclin stimulating factor in men with ischaemic heart disease.

OBJECTIVES--To determine whether plasma concentrations of tissue plasminogen activator antigen, von Willebrand factor antigen, and prostacyclin stimulating factor and plasminogen activator inhibitor activity show circadian variation in men with ischaemic heart disease. DESIGN--Blood samples were obtained every four hours for 24 hours from 10 men with ischaemic heart disease. The men were ambulant from 08:10 until 00:00 when they went to bed and they remained in bed until 08:00 the following morning. PATIENTS--Ten men with positive diagnostic exercise tolerance tests with no significant past history, who were not regularly taking any medical treatment except for glyceryl trinitrate. RESULTS--There was significant circadian variation in plasminogen activator inhibitor activity (p = 0.001) (peak value 04:00 and trough value 20:00), but not in plasma concentrations of tissue plasminogen activator antigen, von Willebrand factor, or prostacyclin stimulating factor. CONCLUSION--Men with ischaemic heart disease showed a significant circadian variation in fibrinolysis. The combination of peak values of plasminogen activator inhibitor activity and failure of plasma concentrations of tissue plasminogen activator antigen to increase in the early morning must predispose to thrombosis at this time. The circadian variation in fibrinolysis may contribute to the increased incidence of myocardial infarction in the morning.     

Incidence of newly diagnosed heart failure in UK general practice

AIM: To estimate the incidence rate of heart failure in the general population and to assess risk factors associated with the occurrence of newly diagnosed heart failure. METHODS: From the source population that was derived from the UK General Practice Research Database, we identified patients aged 40--84 years newly diagnosed with heart failure in 1996, and estimated incidence rates. We sent questionnaires to a random sample of heart failure patients (N=1200) and performed a nested case-control analysis to assess risk factors for heart failure. RESULTS: The overall incidence rate for heart failure was 4.4 per 1000 person-years in men and 3.9 per 1000 person-years in women. The incidence increased steeply with age in both sexes. The relative risk of heart failure was 2.1 (95% C.I.: 1.7--2.6) among men compared with women less than 65 years old and 1.3 (95% C.I.: 1.2--1.4) above the age of 65. Slightly more than half of the cases were categorized in NYHA III--IV at the time of the first diagnosis. Within one month of initial diagnosis 62% of the men and 50% of the women were referred to specialists and/or hospitalized for heart failure. Smoking, hypertension, diabetes, obesity were independently associated with heart failure as well as history of distant dyspnoea. Coronary heart disease was the most common cause of heart failure with a greater relative prevalence in men than women. CONCLUSION: Incident heart failure cases mainly comprised elderly men and women frequently burdened with several diseases in general practice. Women had a lower incidence of heart failure than men. However, traditional risk factors such as smoking, hypertension, obesity, diabetes and dyspnoea appeared to confer the same relative increase in heart failure risk among women and men.     

老年急性心肌梗死146例临床特点与近期预后分析

目的:分析老年急性心肌梗死（AMI）患者临床特点与近期预后。方法: 对2005年1月~2010年5月在我院住院治疗老年（年龄≥65岁）AMI患者电子病例数据146例进行回顾性分析。包括年龄、性别、梗死部位、发病时间、发病月份、就诊时间、临床症状和30 d心血管事件等进行分析。结果: 共计146例患者入选。其中男性57例（39.0%）、年龄（72±6）岁;女性89例（61.0%）、年龄（77±9）岁（均P<0.05）。男性以前壁心肌梗死较多（40例,27.4%）（P<0.05）。女性以下壁、右室壁、侧壁较多（65例,44.5%）（P<0.01）。老年AMI患者在早上05:00～08:59时段发病人数最多53例（36.3%）、17:00～20:59时段最少为9例（6.2%）（P<0.01）。发病月份以10月（23例,15.8%）、1月（21例,14.4%）及3月（23例,15.8%）较多,5月份最低（3例,2.0%）（P<0.01）。发病12 h内就诊人数为44例（30.1%）、12～48 h时段最多为88例（60.3%）（P<0.01）。就诊时间延迟。 首发胸痛、胸闷典型症状29例（19.9%）、其他不典型症状117例（80.1%）（P<0.01）。30 d心血管终点事件:老年AMI患者严重缓慢心律失常和联合终点事件病死率、心力衰竭、Ⅲ度AVB和心室停搏致死性心律失常发生率,女性组高于男性组（均P<0.05）。心室颤动病死率、心室颤动和持续性室速致死性心律失常发生率,男性组高于女性组（均P<0.05）。结论: 老年AMI患者在构成比、年龄、梗死部位、心力衰竭、致死性心律失常和病死率类型存在性别差异。在早上05:00～08:59时段发病人数最多。发病月份以10月、1月、3月较多。发病在12～48 h时段就诊人数最多。发病后不典型临床症状人数较多。     

Influence of Age on Linear and Nonlinear Measures of Autonomic Cardiovascular Modulation

Background: Age has been identified as an independent risk factor for cardiovascular diseases. In addition, autonomic imbalance toward sympathetic preponderance has been shown to facilitate the occurrence of heart disease. Here, we aimed to assess autonomic modulation of cardiovascular parameters during normal ageing applying well‐established linear and novel nonlinear parameters. Methods: Linear and nonlinear measures of heart rate variability and complexity as well as measures of QT interval variability and baroreflex sensitivity were obtained from a total of 131 healthy, medication‐free participants from a continuous age range between 20 and 90 years, who were allocated to three different age groups. Results: Heart rate variability and complexity significantly decreased with age, while regularity of heart rate time series increased. In addition, QT interval variability linearly increased with age, while baroreflex sensitivity showed a pronounced decrease. Overall, concerning effects of ageing, linear and nonlinear parameters showed equal differentiation between groups. Conclusion: These data indicate a shift of autonomic balance toward sympathetic predominance in higher age groups, limiting the reactiveness of the cardiovascular system to adjust to different demands and increasing the risk for developing tachyarrhythmias. Ann Noninvasive Electrocardiol 2010;15(2):165–174     

Nephropathy, but not retinopathy, is associated with the development of heart disease in Type 1 diabetes: a 12-year observation study of 462 patients.

AIMS: To study the occurrence of heart disease and death in Type 1 diabetic patients and evaluate whether presence of microangiopathy, i.e. nephropathy and retinopathy, was associated with the outcome. METHODS: A 12-year observation study of 462 Type 1 diabetic patients without a previous history of heart disease at baseline who were treated under routine care in a hospital out-patient clinic. RESULTS: A total of 85 patients developed signs of heart disease, i.e. myocardial infarction (n = 41), angina (n = 23), and heart failure (n = 17) and 56 patients died. The mortality for patients without signs of heart disease during the observation period was 7.6% compared with 51% in patients with myocardial infarction (P < 0.001), 26% in patients with angina (P < 0.01) and 65% in patients with heart failure (P < 0.001). The relative risk for death was 9.0 (P < 0.001) and 2.5 (P < 0.05) times higher in patients with macroalbuminuria and microalbuminuria, respectively. The risk for cardiovascular death was 18.3 times (P < 0.001) higher in patients with macroalbuminuria compared with patients with normoalbuminuria. In patients with sight-threatening retinopathy, the relative risk for death was 7.0 times higher (P < 0.01) and the risk for coronary heart disease events 4.4 times higher (P < 0.05) compared with patients with no retinopathy. However, when retinopathy was adjusted for presence of macroalbuminuria, this association disappeared. CONCLUSION: This study shows a high incidence of heart disease in patients with Type 1 diabetes. The worse prognosis was seen in patients with sight-threatening retinopathy and macroalbuminuria and microalbuminuria at baseline. Macroalbuminuria and microalbuminuria were independently associated with a high risk for heart disease and death while the association with sight-threatening retinopathy only occurred in the presence of nephropathy.     

Incidence and prevalence of heart failure in elderly persons, 1994-2003

BACKGROUND: Recent analyses have presented conflicting evidence regarding the incidence and prevalence of heart failure in the United States. We sought to estimate the annual incidence and prevalence of heart failure and associated survival in elderly persons from January 1, 1994, through December 31, 2003. METHODS: We conducted a retrospective cohort study of 622,789 Medicare beneficiaries 65 years or older who were diagnosed as having heart failure between 1994 and 2003. The main outcome measures were incidence and prevalence of heart failure and survival following a heart failure diagnosis. RESULTS: The incidence of heart failure declined from 32 per 1000 person-years in 1994 to 29 per 1000 person-years in 2003 (P < .01). Incidence declined most sharply among beneficiaries aged 80 to 84 years (from 57.5 to 48.4 per 1000 person-years, P < .01) and increased slightly among beneficiaries aged 65 to 69 years (from 17.5 to 19.3 per 1000 person-years, P < .01). Although risk-adjusted mortality declined slightly from 1994 to 2003, the prognosis for patients diagnosed as having heart failure remains poor. In 2002, risk-adjusted 1-year mortality was 27.5%, more than 3 times higher than for age- and sex-matched patients. CONCLUSIONS: Although the incidence of heart failure has declined somewhat during the past decade, modest survival gains have resulted in an increase in the number of patients living with heart failure. Identifying optimal strategies for the treatment and management of heart failure will become increasingly important as the size of the Medicare population grows.     

扩张型心肌病患者心率变异性的临床分析

目的探讨心率变异性(HRV)在扩张型心肌病(DCM)患者中的变化规律及其对扩张型心肌病患者心血管事件的预测价值。方法对90例扩张型心肌病患者和50例健康人行24h动态心电图心率变异性对比分析及随访。心率变异性(HRV)分析包括正常RR间期标准差(SDNN),5min平均RR间期标准差(SDANN)等。90例扩张型心肌病患者平均随访21.2±7.3个月(10天～32个月),确定有无心血管事件发生。计算心率变异性(HRV)指标在预测扩张型心肌病患者发生心血管事件中的比值比(OR)和95%可信区间(95%CI)。结果健康人的心率变异性有明显的昼夜变化规律,心率变异性夜间>白天;扩张型心肌病患者的心率变异性明显低于健康组,昼夜节律性丧失,且与病情及心功能明显相关;11例扩张型心肌病患者发生心血管事件。心率变异性时域指标SDNN<100ms和SDANN<100ms发生心血管事件的比值比(OR)和95%可信区间(95%CI)分别为6.05和1.98～18.47及5.00和1.43～17.54。对性别和年龄进行校正后,SDNN<100ms的比值比(OR)和95%可信区间(95%CI)为3.13和1.16～8.47。结论扩张型心肌病患者在总体心率变异性显著降低的基础上,以迷走神经张力低下和心率变异性昼夜节律丧失为突出表现;扩张型心肌病合并心力衰竭患者心率变异性的变化,反映患者病情变化;24h心率变异性的SDNN可能是预测扩张型心肌病患者发生心血管事件的独立危险因素。     

The impact of heart failure on prognosis of diabetic and non-diabetic patients with myocardial infarction: a 15-year follow-up study

BACKGROUND: Information about the occurrence of heart failure in the acute phase of myocardial infarction (MI) in diabetic patients and its impact on prognosis are sparse. AIM: The purpose of the present study was to describe how MI patients with diabetes mellitus (DM) differed from MI patients without DM with respect to the occurrence of heart failure and with respect to the influence of heart failure on mortality during follow-up 30 days extending to 15 years. METHODS: The study is a retrospective long-term follow-up of prospectively recorded data concerning 1954 consecutive cases of MI admitted to one coronary care unit (CCU) between 1979 and 1983. DM was diagnosed in 10% (n=194), with 17% (n=33) on insulin therapy. Patients with DM comprised of a higher proportion of women (DM 36% vs. no DM 26%, P<0.001) compared with non-diabetic patients. Baseline risk factors were more prevalent in the patients with DM. The cumulative incidence of heart failure was higher among patients with than without DM (DM 54% vs. no DM 34%, P<0.001). The incidence of life-threatening arrhythmias were similar in both groups. Only 2% of patients with DM and heart failure survived 10 years of follow-up compared with 15% of the non-diabetic patients with heart failure (P<0.001). In multivariate analysis DM was not independently associated with 30 days mortality. During long-term follow-up DM was an important risk factor for mortality independent on the presence of heart failure. CONCLUSION: DM disposes to the development of heart failure. In acute myocardial infarction diabetic patients with heart failure have a worse prognosis than non-diabetic patients with heart failure.     

REM sleep and bradyarrhythmia episodes in rats

The relationship between rapid eye movement (REM) phasic events and bradyarrhythmia was investigated in five male Wistar rats. ECGs, EEGs (frontal cortex and dorsal hippocampus), and electrooculograms were monitored continuously for 6 days. Sleep states were classified as alertness, slow-wave sleep, or paradoxical sleep, and the frequency of the REM burst was measured to evaluate the REM density. Bradyarrhythmias, such as SA block or AV block, were observed in each rat and were divided into two groups: group A, bradyarrhythmias with a duration greater than 5 sec; and group B, duration less than 5 sec. For a period of 33 days, the five rats showed alertness, slow-wave sleep, and paradoxical sleep 6,481, 6,483, and 1,523 times; bradyarrhythmia incidents in each sleep stage were 0.35%, 0.03%, and 22.4%, respectively. The incidence of bradyarrhythmia episodes increased with REM density, and 78.5% of the episodes appeared related to the REM bursts. The latency between the REM bursts and bradyarrhythmia was as follows: type A bradyarrhythmias, 2.17 +/- 0.41 sec; type B, 3.78 +/- 0.63 sec. These results suggest close association of bradyarrhythmia occurrence with REM phasic events.     

Comparison Between Ischaemic and Anisomycin-Induced Preconditioning: Role of p38 MAPK

To further evaluate the significance of p38 MAPK as trigger or mediator in ischaemic preconditioning, anisomycin and SB 203580 were used to manipulate its activation status. Special attention was given to the concentration of the drugs and protocols used.The isolated perfused rat heart, subjected to either 25 min global ischaemia or 35 min regional ischaemia, was used as experimental model. This was preceded by anisomycin (2 or 5 M: 3 × 5 min; 5 M: 5 min or 10 min; 5 M: 10 min + 10 min washout or 20 M: 20 min) or SB 203580 (2 M: 3 × 5 min; before and during 3 × 5 min or 1 × 5 min ischaemic preconditioning; 10 min). Endpoints were functional recovery during reperfusion and infarct size.Anisomycin, regardless of the protocol, reduced infarct size, but did not improve functional recovery. In a number of experiments activation of JNK by anisomycin was blocked by SP 600125 (10 M). SP 600125 had no effect on the anisomycin-induced reduction in infarct size. SB 203580 when administered for 10 min before sustained ischaemia, improved functional recovery and reduced infarct size. SB 203580 could not abolish the beneficial effects of a multi-cycle preconditioning protocol, but it significantly reduced the outcome of 1 × 5 min preconditioning. In all hearts improved functional recovery and reduction in infarct size were associated with attenuation of p38 MAPK activation during sustained ischaemia-reperfusion.The results indicate that activation of p38 MAPK acts as a trigger of preconditioning, while attenuation of its activation is a prerequisite for improved recovery and a reduction in infarct size.