Clinical depression among patients after acute coronary syndrome: a prospective single-tertiary centre analysis

INTRODUCTIONClinical depression is a known consequence of acute coronary syndrome (ACS) and is associated with an adverse outcome among these patients, although this is often under-recognised. Through this study, we investigated the incidence of depression in post-ACS patients and its associated factors.METHODSWe conducted a prospective cohort study in 95 patients with ACS admitted to University Malaya Medical Centre, Malaysia. Clinical depression was assessed during the index admission and at 30 days after discharge, using the Patient Health Questionnaire-9 (PHQ-9). Data was analysed using IBM SPSS Statistics, and binary logistic regression was used to determine the independent factors associated with depression, after adjusting for significant demographic variables and clinical characteristics. The strength of this association was presented as odds ratio and 95% confidence interval, and the significance level was set at 0.05.RESULTSThe mean age of the study population was about 60 years, and 72.6% of the patients were male. Symptoms of depression were present in 88.4% of the patients at baseline. Depression at 30 days was more likely in female patients, patients with diabetes mellitus and patients on dialysis (p = 0.024, p < 0.001, p = 0.008, respectively). Patients with baseline moderate to severe depression were more likely to have moderate to severe depression at 30 days (p < 0.001). Baseline depression was the strongest predictor of depression at 30 days. An increment of one unit in PHQ-9 baseline score increased the risk of developing severe depression at 30 days by 31%.CONCLUSIONDepression was prevalent in our post-ACS patients. The associated factors were female gender, diabetes mellitus and dialysis treatment.     

Kounis syndrome: allergic acute coronary syndrome

Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospastic or nonvasospastic angina,and even as acute myocardial infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome.Instant treatment decisions need to be made once it happens.Here,we defined a case of severe Kounis syndrome,culminating in acute coronary syndrome,as a result of an acute allergic reaction,which was likely related to iodinated contrast media or dextran-40 use.     

三级医院在改善农村卫生人力资源中的路径探讨

通过对我国卫生资源配置现状中存在的卫生资源总量不足、配置不合理、使用效率低等问题进行分析,探讨三级医院在改善农村卫生人力资源中的可行性路径,并用实证研究加以论证.建议加强城乡医疗卫生资源的整合,加强大医院和中、小医院之间的人员交流.     

消化道胶囊内镜——从三级医疗中心到初级保健

1907年，布鲁日开始应用第一台内镜来观察人的上消化道，最初是硬的直管内镜，需要全身麻醉。40年后，可屈式内镜诞生，只需要局部麻醉或轻度镇静就可以进行内镜检查。随后20年的技术进步催生了第一台肠镜的出现。1999年，又实现了一个巨大的飞跃，胶囊内镜可以全面观察整个小肠。胶囊被咽下后，在肠道的蠕动推进下经过所有肠道，胶囊内镜具有成像装置，可将肠道内的影像传输给腹部的接收装置。     

大型公立医院支援社区卫生服务意愿调查与研究

通过对某大型公立医院相关医务人员意愿调查,找出了"发展、薪水和名声"是他们不愿意去社区的主要原因;提出了"病人跟着医生走"的核心理念是政府制定大型医院支持社区卫生服务政策、调配医疗卫生资源和建立长效机制的依据;建立大型公立医院及其医务人员利益机制是支持社区卫生服务长效机制的基础和动力.     

急性冠状动脉综合征介入治疗4670例近期疗效的评价

目的分析过去15年经皮冠状动脉介入(PCI)治疗急性冠状动脉综合征(ACS)患者的近期临床疗效。方法1989年8月至2004年10月沈阳军区总医院心血管内科对4670例住院的ACS患者行PCI治疗,其中发病30d内的急性心肌梗死(AMI)患者1750例(37.5%),不稳定心绞痛患者2920例(62.5%)。评价PCI的成功率、合并症及住院期间近期临床疗效。结果PCI总的病例成功率为98.1%(4579/4670),AMI行急诊PCI者梗死相关动脉开通率98.2%(825/840)。住院期间共死亡52例(总病死率1.1%),其中术中死亡2例(术中病死率0.04%)。总的PCI相关并发症发生率为6.5%(304/4670)。从入院至PCI时间为3.5d±2.1d,平均住院12d±8d。结论PCI治疗ACS成功率高,术中、术后死亡率和手术相关并发症发生率低,近期疗效好。     

大型综合医院开展老年健康教育的实践

论述医院开展老年健康教育的必要性,以及开展老年健康教育的组织管理、方式和方法。医院的老年健康教育作为连接卫生知识和健康行为的桥梁,可以有效地提高老年人的保健知识水平和健康水平.     

加强基层培训,不断提高对非ST段抬高型急性冠状动脉综合征的诊治水平

简要介绍《非ST段抬高型急性冠状动脉综合征基层诊疗指南(2019年)》制订的背景和涵盖内容。基层医疗机构医师应熟悉心肌损伤标志物肌钙蛋白(cTn)检测在非ST段抬高型急性冠状动脉综合征早期诊断中的重要性,重视其早期评估和危险分层,规范治疗策略,以改善长期预后。     

非ST段抬高型急性冠状动脉综合征基层诊疗指南(2019年)

一、概述(一)定义非ST段抬高型急性冠状动脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)根据心肌损伤生物标志物[主要为心脏肌钙蛋白(cardiac troponin,cTn)]测定结果分为非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)和不稳定性心绞痛(unstable angina,UA),后者包括静息型心绞痛、初发型心绞痛、恶化型心绞痛和变异型心绞痛。UA与NSTEMI的发病机制和临床表现相似,但严重程度不同。     

非ST段抬高型急性冠状动脉综合征基层诊疗指南(实践版·2019)

一、定义非ST段抬高型急性冠状动脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)根据心肌损伤生物标志物[主要为心脏肌钙蛋白(cardiac troponin,cTn)]测定结果分为非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)和不稳定性心绞痛(unstable angina,UA),后者包括静息型心绞痛、初发型心绞痛、恶化型心绞痛和变异型心绞痛。UA与NSTEMI的发病机制和临床表现相似,但严重程度不同。其区别主要是缺血是否严重到导致心肌损伤,并可定量检测到心肌损伤的生物标志物。     

血栓弹力图在急性冠脉综合征中的临床应用

目的 探讨血栓弹力图在急性冠脉综合征中的诊断价值。方法 将2017年11月～2019年12月于本院就诊的50例急性冠脉综合征患者纳为研究对象,所有患者均行抗血小板治疗与经皮冠状动脉介入术,治疗后行实验室检测及血栓弹力图检测,依据冠状动脉造影检查结果分为血栓组（n=22）与无血栓组（n=28）。比较两组实验室相关指标及血栓弹力图指标,分析筛选出导致血栓病变的危险因素。结果 血栓组既往冠心病史患者比例高于无血栓组（P＜0.05）。实验室检查结果及血栓弹力图检测结果显示,两组间三酰甘油、高密度脂蛋白胆固醇、D-二聚体、MA值、G值比较,差异有统计学意义（P＜0.05或P＜0.01）。经Logistic回归分析显示,既往冠心病史、三酰甘油升高、高密度脂蛋白胆固醇下降、D-二聚体下降、MA值与G值的升高均是导致血栓弹力图在急性冠脉综合征患者形成血栓的危险因素（P＜0.05或P＜0.01）。结论 血栓弹力图在急性冠脉综合征的诊断中可较好地反映患者血液高凝状态,MA值与G值的升高可成为评估患者血栓负荷的有效指标。     

Management of patients with chronic kidney disease presenting with acute coronary syndrome

We evaluated the treatment pattern of patients with chronic kidney disease presenting with acute coronary syndromes. In a retrospective chart review of 400 patients with and without kidney disease presenting with angina pectoris we found that patients with chronic kidney disease have longer hospital stays, receive fewer diagnostic angiographies, and have a delay in therapy.