护理干预对急性心肌梗死患者负性情绪的影响

目的总结并归纳护理干预对急性心肌梗死患者负性情绪的影响。方法本文挑选100例医院急性心肌梗死患者(2017年2月—2018年2月)为对象。按建档时间分组,对照组50例患者(常规护理),分析组50例患者(加用人文性护理)。比较两组对疾病的了解程度及护理前后焦虑、抑郁等负性情绪的评分,随访1年,比较两组复发率。结果护理后分析组对疾病了解程度高于对照组(P<0.05);护理前分析组焦虑、抑郁评分同对照组无显著差异(P>0.05),提示可比;护理后,分析组焦虑、抑郁评分低于对照组(P<0.05);护理后分析组1年内复发率(8.00%)低于对照组(24.00%)(P<0.05)。结论在急性心肌梗死患者的护理中,人文性护理干预可显著改善患者负性情绪,改善患者预后,且可有效降低患者复发率。     

Design and preliminary results of FRENSHOCK 2016: A prospective nationwide multicentre registry on cardiogenic shock

Central illustration: geographic distribution of the 49 centres participating in the FRENSHOCK registry (35 academic hospitals, 10 general hospitals and four private clinics). Inclusion per centre varied from 1 to 72 patients.

     

急性心肌梗死急诊介入治疗的临床评价

目的探讨急诊经皮冠状动脉介入治疗术(PCI)对ST段抬高型急性心肌梗死(STAMI)的治疗价值。方法STAMI46例,在发病12h内行急诊冠状动脉造影及直接冠脉支架置入术(DS)或预扩张后支架置入术(PS),观察术中心律失常发生情况,术后TIMI分级、心电图,出院前左室射血分数(LVEF)和住院期间主要不良心脏事件(MACE)等。结果DS组与PS组各项指标无差异,44例达TIMI3级,成功率达95.7%,ST段回落率67.4%,平均LVEF(49.4±9.46)%,术中心律失常发生率21.7%,无MACE发生。结论对于发病12h的STAMI患者,行急诊PCI,可开通梗塞相关动脉(IRA),改善心肌再灌注和近期预后。     

幽门螺杆菌细胞毒素相关蛋白A在脑梗死中的作用

目的探讨幽门螺杆菌细胞毒素相关蛋白A(Cag-A)与脑梗死发生的关系。方法使用酶联免疫法测定100名患者和50名健康对照者Cag-A抗体,并对脑梗死患者检测CagA-HP-IgG阳性及阴性情况下颈动脉斑块和脑梗死相关因素水平。结果脑梗死组血清CagA-HP-IgG阳性率为62%,而对照组为38%,两组相比有显著性差异(P<0.05)。脑梗死组CagA-HP-IgG阳性100%存在颈动脉斑块;而CagA-HP-IgG阴性者仅55%存在颈动脉斑块,两者之间存在显著性差异(P<0.05)。CagA-HP-IgG阳性的脑梗死患者CRP水平及血纤维蛋白原水平均显著高于CagA-HP-IgG阴性者(P<0.05)。结论Cag-A阳性菌株感染与脑梗死的发生有关,是其发病的危险因素。     

多体素1H-MRS对脑胶质瘤、转移瘤及脑脓肿的鉴别诊断研究

目的 探讨多体素氢质子磁共振波谱（^1H-MRS）在脑胶质瘤、单发转移瘤、体积较大脑脓肿鉴别诊断中的应用价值及胶质瘤瘤体周围的微观结构的改变。资料与方法 搜集脑胶质瘤26例、单发转移瘤9例、大体积脑脓肿4例，均行^1H-MRS检查。比较脑胶质瘤与单发转移瘤瘤体及瘤周胆碱（Cho）／N-乙酰天门冬氨酸（NAA）、Cho／肌酐类物质（Cr）、NAA／Cr值的差别，并做统计学分析；用HE染色、免疫组织化学、电镜检查等重点观察胶质瘤瘤周微观结构改变。结果 各个级别的胶质瘤与单发转移瘤瘤体之间Cho／NAA值分别为3．14±1．61和2．46±0．83，Cho／Cr值分别为2．57±0．93和2．90±1．93、NAA／Cr值分别为0．96±0．53和1．21±0．80，差异均无明显统计学意义（P值均〉0．05）；而瘤周之间的上述比值为1．74±0．98和0．98±0．23，1．72±0．51和1．09±0．35．1．11±0．30和1．11±0．25，除NAA／Cr外均有明显统计学意义（P值〈0．05）。脑脓肿内部出现特征性波谱，扩散加权成像（DWI）上脓腔显示为高信号。胶质瘤瘤周在光镜及电镜下发现已有瘤细胞浸润。结论 使用多体素^1H-MRS结合常规MRI可鉴别胶质瘤、单发转移瘤、不典型脑脓肿，胶质瘤的瘤细胞可以通过毛细血管转移浸润至瘤周。     

80岁以上高龄患者急性脑梗塞的临床特点分析

目的:探讨超过80岁的高龄急性脑梗塞患者的临床特点。方法:58例高龄(均≥80岁)急性脑梗塞患者,大多数行头颅MRI平扫加弥散加权成像(DWl),少数行CT检查。依影像学结果按梗塞病灶的大小分为两组:大面积梗塞(直径>1.5cm)及小面积梗塞(直径≤1.5cm,主要为腔隙性梗塞)组。回顾比较两组间发病特点;糖尿病、高血压、颈动脉硬化、冠心病、房颤的发生率;治疗方法、平均住院时间、30天病死率、日常生活活动能力(ADL)等临床指标。结果:大面积梗塞组占16例(27.6%),小面积梗塞组占42例(72.4%)。首发症状中大面积梗塞组以意识障碍(87.5%vs23.8%;P=0.018)、严重偏瘫(93.8%vs28.6%;P=0.012)、头痛(43.8%vs14.3%;P=0.026)、言语障碍等症状为主,小面积梗塞以以肢体无力、行走不稳(64.3%vs6.3%;P=0.001)、头昏、眩晕(52.4%vs25.0%;P=0.028)、言语不清、感觉障碍等症状为主。大面积梗塞组房颤高发(43,8%vs14.3%;P=0.030),小面积梗塞组高血压(88.1%vs56.3%;P=0.041)、糖尿病(54.8%vs18.8%;P=0.021)高发。在大面积梗塞组急性期用低分子肝素抗凝较多(75.0%vs40,5%;P=0.035),两组均以口服抗血小板药物为主。大面积梗塞组的并发症较多,平均住院日为小面积梗塞组的近二倍,死亡率较后者明显增高(25.0%vs4.8%;P=0.035)。结论:高龄急性脑梗塞患者以较小面积的腔隙性脑梗塞多见。小面积梗塞组高血压、糖尿病的发生较高。大面积梗塞组房颤的发生较高,有较高的死亡率,预后较差,需要更积极的综合诊治管理。常规尽早行头颅MRI加DWI有助于急性脑梗塞的早期诊断治疗。     

Prediction and Detection of Secondary Hemorrhages after Thrombolytic Therapy in Ischemic Stroke

Abstract It is well established that thrombolytic therapy increases the risk of secondary intracerebral hemorrhage in ischemic stroke patients. However, the term “intracerebral hemorrhage” (ICH) covers a wide spectrum from tiny spots of blood to massive space-occupying hematoma. We will review the etiology and clinical consequences of secondary hemorrhage after thrombolysis in ischemic stroke patients and discuss the ability of magnetic resonance imaging (MRI) to predict this phenomenon. MRI is a highly sensitive tool for detection of hemorrhagic transformation after ischemic stroke. The definitions of a so-called symptomatic hemorrhage after ischemic infarction differ considerably and will also be described. Attributing a causal relationship of a clinical deterioration to a secondary hemorrhage is not easy and should be only addressed when it exceeds at least 30% of the infarct volume. In other patients, secondary hemorrhage might be regarded as side effect of reperfusion within the region with the most severe perfusion deficit. Cerebral microbleeds (CMBs) are a frequent finding in patients with leukoaraiosis and appear to be a general marker of various types of bleeding- prone small vessel disease and a predictor of recurrent vascular events. Current data do not support the hypothesis that the detection of CMBs is a useful diagnostic criterion for the exclusion of patients with CMBs from thrombolytic therapy. However, an increased risk for the rare patients with numerous CMBs can not be ruled out.      

Kinetic modeling of PET-FDG in the brain without blood sampling

The aim in this work is to report a new method to calculate parametric images from a single scan acquisition with positron emission tomography (PET) and fluorodeoxyglucose (FDG) in the human brain without blood sampling. It is usually practical for research or clinical purposes to inject the patient in an isolated room and to start the PET acquisition only for some 10–20 min, about 30 min after FDG injection. In order to calculate the cerebral metabolic rates for glucose (CMRG), usually several blood samples are required. The proposed method considers the relation between the uptake of the tracer in the cerebellum as a reference tissue and the population based input curve. Similar results were obtained for CMRG values with the present method in comparison to the usual autoradiographic and the non-linear least squares fitting of regions of interest.     

丹参注射液治疗老年人急性脑梗塞时间窗的探讨

目的探讨丹参注射液治疗老年人急性脑梗塞的最佳时间窗.方法选择老年人急性脑梗塞患者120例,随机按发病后24～48小时、72～96小时、120～144小时初始给予丹参注射液,分成早治、中治、晚治3组,均给药4周,每日1次,其余常规治疗相同.结果4周和8周后观察疗效、神经功能缺损恢复程度,早治组均明显优于其余两组,但梗塞面积扩大或继发出血3组差异无显著性.结论丹参注射液最有效且安全的时间窗是梗塞后24～48小时内.