经皮腔内冠状动脉成形术与冠状动脉内支架术的临床应用

目的 :评价经皮腔内冠状动脉成形术 ( PTCA)和支架置入术的临床疗效。方法 :总结 1 996年 1 1月至 2 0 0 1年 3月行 PTCA和支架置入术的冠心病患者 1 0 3例。结果 :1 0 3例冠心病患者 1 5 0支冠状动脉血管PTCA并支架置入 1 35枚 ,置入成功率 1 0 0 % ,无明显并发症发生。其中不稳定心绞痛者占 5 2 .4 3% ,既往有心肌梗死史者占 4 7.5 7%。单支病变者占 5 5 .34 % ,双支病变者占 32 .0 4 % ,3支病变者占 1 2 .6 3% ;A型病变者占 33.98% ,B型病变者占 2 6 .2 1 % ,C型病变者占 39.81 %。 PTCA所用的球囊直径平均为 ( 2 .4 8± 0 .4 3)mm,平均长度 ( 2 0 .4 0± 2 .84 ) mm,球囊所加压力平均为 ( 6 .2 3± 1 .81 ) atm。共置入支架 1 35枚 ,其直径平均为 ( 30 .96± 0 .38) mm,平均长度为 ( 2 1 .2 9± 6 .30 ) mm,释放支架时球囊所加压力平均为 ( 9.6 5± 3.0 8) atm。所用支架主要是 BX 4 5枚 ,占 33.33% ,NIR 30枚 ,占 2 2 .2 2 % ,AVE 2 7枚 ,占 2 0 .0 0 % ,MAC 1 6枚 ,占1 1 .85 % ,Jomed和其他共 1 7枚 ,占 1 2 .5 9%。支架置入 LAD内 71枚 ,占 5 2 .5 9% ,RCA内 4 8枚 ,占35 .5 5 % ,LCX和对角支 1 6枚 ,占 1 1 .85 %。结论 :PTCA和支架置入术是一种安全、有效的介入性治疗技术 ,其成功率高 ,并发     

经皮冠状动脉内支架置入术对冠脉多支病变的安全性研究

目的本文探讨经皮冠状动脉内支架置入术(PCI)治疗冠脉多支病变的疗效。方法对38例冠脉多支病变78支血管行球囊预扩张术,置入支架88枚,其中 LAD35枚,LCX22枚,RCA31枚。结果术后 CA 证实狭窄消失或残余狭窄<20%,TIMI 血流Ⅲ级。支架置入的成功率94.8%。1例出现穿刺部位出血,无其他并发症,随诊1～18个月,6例术后3～16月再发心绞痛。结论 PCI 治疗冠状动脉多支病变是一种安全有效的介入治疗技术,成功率高,临床疗效好,并发症少。     

冠心病患者冠状动脉内支架置入术的临床应用

目的 :评价冠心病患者冠状动脉内支架置入术的临床疗效。方法 :分析 2年来冠状动脉内支架置入术 94例资料。结果 :94例患者 131支冠状动脉的 15 1处病变共置入支架 112枚 ,手术和临床成功率分别为 99.1%和 97.8%。术前病变平均狭窄为 (92 .8± 4.9) % ,术后残余狭窄为 (5 .4± 8.1) %。因球囊扩张后不理想占 43.7% (4 9枚 ) ,PTCA并发夹层、急性闭塞或濒临闭塞占 2 5 .9% (2 9枚 ) ,选择性置入支架占 30 .4% (34枚 )。严重并发症 2例 (2 .1% )。结论 :冠心病患者冠状动脉内支架置入术成功率高 ,疗效好 ,并发症少。     

静态心电图正常的冠状动脉闭塞患者24例临床分析

目的探讨静态心电图正常的冠状动脉闭塞患者的临床特征。方法选取2010年10月—2014年10月24例心电图正常、至少1支冠状动脉闭塞患者的临床资料。分析冠状动脉造影结果,包括闭塞血管部位及侧支循环情况、合并冠状动脉狭窄、冠状动脉病变综合评价(Gensini评分法)等,并就可能原因进行讨论。结果(1)冠状动脉血管闭塞部位:单支闭塞21例(87.5%),其中左前降支(LAD)9例,左回旋支(LCX)4例,右冠状动脉(RCA)8例;双支闭塞3例(12.5%),其中LAD、LCX闭塞1例,LCX、RCA闭塞2例;无侧支循环4例,少量侧支循环4例,良好侧支循环16例。(2)合并狭窄:24例心电图正常的冠状动脉血管闭塞中合并其他冠状动脉狭窄者20例(83.3%),其中合并1支狭窄10例,2支狭窄10例,未合并其他冠状动脉狭窄者4例(16.7%)。(3)Gensini评分法评分:<41分5例(20.8%),41~64分6例(25.0%),>64分13例(54.2%)。结论冠状动脉闭塞而心电图正常与血冠状动脉管本身多支复杂病变、心肌梗死情况、闭塞血管部位、病变范围与检查时间、侧支循环保护、危险因素等有关。     

雷帕霉素洗脱支架在冠心病的临床疗效

目的　观察雷帕霉素洗脱支架 (Cypher)治疗冠状动脉病变的临床效果。　 方法　 17例冠心病患者植入Cypher支架 ,治疗 2 3处病变 ,包括左前降支 (LAD) 15处、左回旋支 (LCX) 3处、右冠状动脉 (RCA) 5处 ;5例支架内再狭窄病变分别为LAD 4例和RCA 1例。术前病变狭窄程度 75 %～ 95 %。　结果　 17例患者共治疗 2 3处病变 ,植入Cypher支架 2 3个 ,手术即刻成功率 10 0 % ;术后残余狭窄 <5 % ,血流TIMI 3级。所有患者术中无并发症 ,术后临床随访 3～ 16个月 ,无心脏事件发生。 4例患者术后 6个月复查冠状动脉造影示病变血管支架植入处管腔通畅 ,无内膜增生征象。　结论　Cypher支架植入成功率高 ,可通过抑制血管内膜增生及支架本身拮抗病理性血管重塑的作用 ,有效降低再狭窄的发生 ,近中期疗效满意 ,安全性较高。     

不同年龄组急性心肌梗死患者病变血管特点分析

目的:了解不同年龄组急性心肌梗死(AMI)患者病变血管情况。方法:采用C型臂X光机和电生理记录仪行冠脉造影及PCI术,分析81例AMI患者的病变血管情况。结果:中年组34例,单支血管病变14例,双支病变9例,3支血管病变4例;冠脉正常为2例,冠脉病变狭窄<50%者5例(占15%),前降支病变最多,34例患者共计植入支架22枚。老年组为47例,单支血管病变12例,双支血管病变13例,3支血管病变21例;病变狭窄<50%1例(占2%),前降支病变最多,47例患者共计植入支架35枚。结论:两组病人,中年组单支血管病变最多,老年组多支血管病变最常见。两组病人均以前降支病变最多见。     

血管内超声在冠状动脉支架置入中的应用

目的：研究探讨血管内超声在冠状动脉支架置入中的应用。方法：选取我院收治的需行冠状动脉支架置入的患者31例作为研究对象,经冠状动脉造影显示,患者均为单支病变。分别在支架置入之前和之后,采用血管内超声现象的发放对患者动脉血管的管腔直径、管腔面积以及靶血管的斑块性质、斑块面积、血管壁的形态结构进行观察和测量,同时测定支架置入之后的支架对称指数和贴壁程度,由主治医师对患者的支架展开满意度进行评测和对比。结果：31例患者冠脉置入支架37枚, LAD （20支）、RCA（8支）和LCX（6支）分别有23枚、9枚和7枚。患者的冠状动脉行支架置入之前,血管内超声显像显示共有软斑11块,钙化斑块和纤维斑块各有4块,混合斑块3块;平均斑块面积为13．12±2．11 mm2;支架置入之后,平均斑块面积为6．57±1．32mm2,斑块面积显著缩小,与置入前相比P＜0．05。支架置入前后最小血管腔径分别是1．74±0．25mm、3．52±0．41mm;最小腔面积分别是3．34±0．28mm2、7．02±1．01mm2。2组数据的比较有显著差异,且P＜0．05,具有比较意义。患者的支架对称度、贴壁度、扩张度都取得了满意效果。结论：血管内超声显像可以清晰的观察到需行支架置入的靶血管的斑块性质、面积、偏心程度,血管壁的形态结构以及管径和管腔面积,从而指导支架大小的选择,同时,通过血管内超声可以对置入支架的对称度、贴壁度、扩张度、内膜增生等指标进行评估,对冠状动脉支架手术具有重要的意义。     

冠状动脉造影及介入治疗60例临床分析

目的 总结冠心病和风湿性心脏病60例冠状动脉造影及经皮冠状动脉介入治疗(PCI)的经验和临床疗效.方法 研究对象为2007年4月至2008年10月在笔者所在科室及所在医院胸外科住院的病例60例.均行冠状动脉造影或冠状动脉介入治疗.结果 冠状动脉造影正常26例,肌桥3例,单支病变15例,双支病变13例,三支病变3例.发现病变50处,处理29处其中置入支架20枚.结论 经皮冠状动脉介入治疗是治疗冠心病有效的方法之一.但更应该对患者做好健康教育并有效控制危险因素,降低心脑血管事件的发生率.     

冠状动脉造影定量分析对冠状动脉内支架置入术即刻疗效的评价

目的 :采用冠状动脉造影定量分析法评价冠状动脉性心脏病 (简称冠心病 )患者冠状动脉内支架置入术的即刻临床效果。　方法 :在 10 0例冠心病患者的靶病变处置入 14 7枚人工支架 ,通过冠状动脉造影定量分析法分析冠状动脉内支架置入前、后靶病变血管内径和横截面积的变化。　结果 :支架置入后靶病变处血管内径和横截面积的即刻增益分别为 1.4 4～ 3.74 (2 .4 7± 0 .4 9)mm、2 .6 2～ 12 .18(6 .4 7± 1.87)mm2 ,直径和面积残余狭窄率分别为 - 11.2 8%～ 14 .17% (3.5 0± 0 .0 4 ) %、- 2 1.2 8%～ 2 6 .3% (6 .6 2± 6 .74 ) % ,患者的症状得到改善。　结论 :冠状动脉造影计算机定量分析冠状动脉内支架置入前、后即刻疗效是一种可靠而简易的方法。     

雷帕霉素洗脱支架应用于冠状动脉超长病变的PCI

目的探讨雷帕霉素洗脱支架(SES)在冠状动脉超长病变介入治疗中应用的安全性和有效性。方法32例冠心病患者,其中男23例,女9例,年龄47-83岁,其中稳定性心绞痛11例,不稳定性心绞痛17例,急性非ST段抬高性心肌梗死4例,有陈旧性心梗病史者6例,Junkins法行冠脉造影示:冠脉两支病变或三支病变,全部患者均有一支病变属于趨长病变(38-78mm),狭窄程度>70％,靶病变为前降支14例,回旋支6例,右冠12例。结果所有32支超长病变血管中串联植入2-3枚SES,共植入CypherTM49枚,Firebird7枚,1例患者为前降支近中段长病变,串联植入2枚支架(CypherTM3．5 mm×28 mm,3．0 mm×33 mm),于术后3 h胸痛,心电图示STV1-V4上抬,立即回导管室冠脉造影证实远端支架出口处夹层伴血栓,远端血流1-2级,于远端再植入1枚支架(CypherTM2．75 mm×13 mm)后血流恢复3级,症状消失,心电图未出现病理性Q波,CTn-I阴性,无1例心脏性死亡发生。结论药物洗脱支架治疗冠状动脉超长病变安全有效。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…