用心肌灌注显像靶心图定量分析评价AMI患者骨髓干细胞移植术疗效

目的 探讨靶心图上心肌灌注缺损区定量分析方法的可靠性、重复性及应用价值。方法 16例急性心肌梗死（AMI）行自体骨髓单个核细胞移植治疗的住院患者，于治疗前、治疗后45和90d行^99Tc^m-MIBI静息心肌灌注显像。在靶心图上勾画缺损区（在左心室靶心图中放射性计数低于40％的区域），并进行定量分析。结果 （1）不同操作者所得ROI结果之间的差异无统计学意义（t=0．52，P〉0．05）。（2）治疗后45d心肌灌注缺损区面积较治疗前缩小34．32％，差异有统计学意义（t=2．83，P〈0．05）；治疗后90d心肌灌注缺损区面积较治疗后45d缩小14．77％，差异有统计学意义（t=2．51，P〈0．05）。示自体骨髓单个核细胞移植对缺血心肌的恢复有一定疗效，能够缩小梗死面积，且自体骨髓单个核细胞冠状动脉内移植治疗AMI的疗效在移植后早期（45d内）即有体现。（3）面积百分比是观察心肌灌注变化的重要定量指标。结论 该方法对心肌病变范围及严重程度能准确定量；对评价AMI骨髓于细胞移植术疗效有一定的价值。     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

定量核素心肌显像评价骨髓干细胞移植治疗急性心梗疗效的对照研究

目的：研究定量核素心肌显像联合动态心电图监测评价急性心梗患者骨髓干细胞移植术的疗效与安全性。方法：36例急性心梗患者，病史小于4周，心功能Ⅱ～Ⅲ级行择期冠状动脉介入（PCI）术。随机分为对照组[PCI+生理盐水（NS）]与试验组[PCI+自体骨髓单核细胞（BM-MNCs）]。对照组与试验组在PCI术结束后分别通过大腔导管于梗塞相关血管注入NS与BM-MNCs。对所有患者于PCI术前、术后45天、术后90天行静息99mTc-SPECT心肌显像、ECG、24h动态心电图。结果：①术后45天试验组与对照组静息99mTc-SPECT灌注缺损区面积较术前分别缩小34.32%和23.05%（P<0.05），两组组内比较差异有统计学意义；术后90天试验组与对照组静息99mTc-SPECT灌注缺损区面积较术后45天分别缩小14.77%和3.82%（P<0.05），但两组组内比较仅试验组差异有统计学意义。②24h动态心电图监测，室性心律失常及心动过缓在术前、术后45天、术后90天同期两组间比较差异无统计学意义（P＞0.05）。结论：定量核素心肌显像评价骨髓干细胞移植治疗急性心梗疗效较有价值。该手术治疗急性心梗有一定疗效，并且不增加心律失常的发生率。     

怎样治疗严重早泄

编辑同志:我今年36岁,患有严重的早泄,每次过性生活时不到1分钟就会射精。请问,我应如何进行治疗?浙江良缘良缘读者:你可首选阴茎挤捏法、使用多个避孕套法等性行为疗法进行治疗,以增加机体对性刺激的耐     

急诊护理教学方法改革

护理临床教学是医学护理教育的重要组成部分,是课堂的深化,是学生由学校走向社会的重要过渡阶段。急诊作为急救体系中的重要环节,其工作与其他专科护理相比,有着其独特性[1]。根据急诊科的工作特点,我们规范了教学管理方法,采用科学的引导、施教,把培养护理学生观察能力、应急能力、动手能力、沟通能力作为实习带教的重点内容,指导护理学生进一步提高急救技能,     

经桡动脉介入治疗局部应用维拉帕米防治桡动脉痉挛的有效性及安全性临床观察

目的：观察经桡动脉路径介入治疗时局部应用维拉帕米防治桡动脉痉孪的有效性及安全性。方法：80例经桡动脉路径介入治疗的患者，成功置入鞘管后注入维拉帕米5mg，记录维拉帕米注入前、注入后2，5，10，30min患者心率、血压、局部及全身情况变化。结果：80例患者均未发生桡动脉痉孪，均未发现心力衰竭和传导阻滞加重，均于维拉帕米注入后出现上肢烧灼和胀麻感，但很快消失（〈30s）。维拉帕米注入前、后心率及舒张压的差异均无显著性（P〉0．05）；注入前、后收缩压的差异有显著性（P〈0．05），但注入后不同时间点组间差异无显著性（P〉0．05）。结论：经桡动脉介入治疗时，局部应用维拉帕米可以有效防治桡动脉痉孪的发生，并且对心率、传导、舒张压和心功能无明显影响。     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

酷似急性心肌梗塞表现的嗜铬细胞瘤一例

男患,28岁,工人。因阵发性头痛,憋气、心悸,上腹痛伴有出汗、恶心、呕吐15小时。于1990年12月12日入院。既往有阵发性心悸史3年,每次发作持续数分钟自行缓解。多由劳累、失眠、感冒而诱发。查体:T36℃、P180次/分,R30次/分Bp15/9kPa,神志清,唇微绀,颈(-),心率180次/分,心尖部闻及奔马律,肺底闻及湿(口罗)音,腹软,左上腹轻压痛,肝脾(-)。门诊ECG示室上性心动过速。入院后ECG示V_(1-3)QS波,ST段抬高。Hb 145g/L,W,BC14×10~9/L,N0.90,L0.1。入院诊断:急性心肌梗塞,急性     

中重度慢性射血分数减低心力衰竭患者下沉社区的诊疗研究

背景　心力衰竭（简称心衰）是一种慢性、进展性自发性疾病,很难根治。对中重度慢性心衰患者进行医疗管理,能提高患者生活质量,延长生命,有效减少医疗资源的消耗。目前国际公认的最有效的人群健康服务模式是社区医疗管理。目的　探讨中重度慢性射血分数减低心力衰竭（HF-REF）患者在社区医疗管理下的诊疗效果。方法　选取2017年1—12月在内蒙古科技大学包头医学院第二附属医院心内科和急诊科诊治的美国纽约心脏病协会（NYHA）分级为Ⅱ~Ⅳ级的中重度HF-REF患者115例,根据患者意愿分组,同意回到社区与社区医生签约患者52例（社区组）,无法回到社区和不愿意接受社区医生签约患者63例（区外组）。社区组医护学习《中国心力衰竭诊断和治疗指南2014》,并在技术层面和内蒙古科技大学包头医学院第二附属医院心内科、急诊科专科医生对本疾病的诊治达成一致,进行社区医疗管理模式。区外组患者如有医疗问题不在社区卫生服务中心、站诊治。两组患者出院后第6、12个月时本项目组成员对其进行电话随访,随访内容包括：一般情况〔症状加重、体征加重、药量增加、饮食减少、运动减少、社会活动减少、情感改变（烦躁/淡漠）、睡眠减少〕,“金三角”药物服药依从性及心衰不良事件（合并症增加、急性心衰再发、再次住院、手术、全因死亡）。“金三角”药物：是指血管紧张素转化酶抑制剂（ACEI）、β-受体阻滞剂和醛固酮受体拮抗剂合用,本研究主要观察这三个药物的服药依从性。结果　随访第6个月,社区组症状加重率、饮食减少率低于区外组（P<0.05）;随访第12个月,社区组症状加重率、社会活动减少率、睡眠减少率低于区外组（P<0.05）。随访第6、12个月,社区组β-受体阻滞剂、醛固酮受体拮抗剂服药依从性高于区外组（P<0.05）;随访第12个月,社区组急性心衰再发率低于区外组（P<0.05）。结论　社区医疗管理模式可以减缓中重度HF-REF疾病的进展,提高服药依从性,改善患者生活质量,减少心脏不良事件的发生。     

老年心房颤动90例临床分析

目的:探讨老年心房颤动的病因和治疗方法。方法:对我院2005年1月～2009年4月住院的90例60岁以上老年房颤患者的临床资料进行回顾分析。结果:阵发性房颤21例,持续性房颤26例,永久性房颤43例。86例老年患者存在器质性心脏病,占95.6%。有老年冠心病、高血压及高血压性心脏病、风心病、肺源性心脏病、老年退行性变风湿性心瓣膜病。心功能Ⅰ～Ⅱ级患者61例,Ⅲ～Ⅳ级者29例。结论:本组分析表明,冠心病、高血压病、风心病是老年人房颤的主要原因。对老年人房颤的治疗主要有病因治疗、控制心室率、抗凝治疗、预防脑卒中、改善心功能。