急性心肌梗死患者梗死部位和冠状动脉病变与预后的关系

摘要：目的探讨急性心肌梗死合并低血钾患者梗死部位、冠状动脉病变及预后的关系。方法将212例急性心肌梗死患者发病后血钾水平分为两组：A组（低血钾组,血钾〈3．5mmol／L）;B组（血钾正常组,血钾3．5～5．5mmol／L）。将两组的梗死部位、并发症、预后及冠状动脉造影结果进行比较分析。结果急性心肌梗死患者低血钾者97例（占45．8％）,梗死相关血管近端病变53例（占59．8％）、梗死相关血管为前降支的45例（占46．4％）、严重心律失常41例（占42．3％）、心力衰竭27例（占27．8％）梗死后心绞痛32（占33％）,与血钾正常组分项比较差异显著（均为P〈O．05）。结论急性心肌梗死合并低血钾的梗死相关血管多为近端病变,梗死相关血管多为前降支,预后较差。     

低钾型周期性瘫痪伴肌酸激酶升高26例临床分析

目的探讨低钾型周期性瘫痪血清肌酸激酶（CK）水平与低血钾的关系。方法回顾性分析26例伴有CK水平升高的低钾型周期性瘫痪患者的临床和辅助检查资料,观察其血清CK水平与低血钾的关系。结果 26例患者的CK水平均有不同程度的升高,血清钾水平最低者（钾浓度〈2.0mmol/L）CK水平升高最为明显。总体上CK水平与血清钾浓度呈负相关。结论部分低钾型周期性瘫痪患者确实可伴有血清CK水平的升高,特别以重度低血钾者为明显。     

急性心肌梗死低血钾与校正QT离散度及室性心律失常的关系

目的　探讨急性心肌梗死 (AMI)早期血钾浓度与校正QT离散度 (QTcd)及室性心律失常之间的关系。方法　选择确诊为AMI的患者 82例 ,于入院即刻抽血测血清钾浓度 ,记录体表心电图 ,测量QTcd ,同时行 2 4小时动态心电图检查 ,检测室性心律失常发生情况。结果　 82例AMI患者血钾浓度平均为 (3.5 1± 0 .6 5 )mmol/L ,低血钾共 36例 ,占 43.9%。低血钾组QTcd平均为 (6 1.3± 15 .1)ms,正常血钾组QTcd平均为 (34 .1± 15 .3)ms。室性心律失常发生率在低血钾组为 80 .5 6 % ,正常血钾组为 19.5 7%。结论　AMI后早期血钾浓度降低者QTcd明显增大 ,更易发生室性心律失常 ,不利于预后。     

原发性醛固酮增多症中低血钾对糖代谢的影响

目的 探讨低血钾在原发性醛固酮增多症[包括肾上腺醛固酮分泌腺瘤（APA）、特发性醛固酮增多症（IHA）]患者糖、胰岛素代谢中的作用。方法根据有无低血钾将178例原发性醛固酮增多症患者（APA 103例、IHA 75例）分为低血钾组和正常血钾组,2组均行3h口服葡萄糖耐量试验和卧立位醛固酮试验,观察血糖、胰岛素变化与血钾之间的关系。结果低血钾组血钾曲线下面积、胰岛素曲线下面积、空腹胰岛素水平均低于正常血钾组（P〈0．05,P〈0．01）;低血钾组血糖曲线下面积、卧位醛固酮水平均高于正常血钾组（P〈0．05）;低血钾组糖耐量异常者为75．3％,正常血钾组为48．5％,两组比较差异具有显著性（P〈0．01）。APA和IHA中代谢综合征的患病率分别为38．8％、57．3％,两者比较差异具有显著性（P〈0．05）。结论低血钾是导致原发性醛固酮增多症患者中胰岛素分泌下降的可能原因之一;应警惕原发性醛固酮增多症患者合并代谢综合征的情况,并及时纠正其可能存在的代谢紊乱。     

血钾含量与急性心肌梗死早期梗死部位的关系

低血钾是诱发室速和室颤的危险因素之一。有人报道在冠心病监护单位中，发现77％的室颤患者血钾浓度低于3.8mmol／L^[1]。但是人们对急性心肌梗死（AMI）早期的一过性低血钾导致严重心律失常尚认识不足，而且，血钾水平与AMI部位之间尚有一定联系。为此，笔者通过对22例AMI患者早期血钾测定，观察其与梗死部位的关系。     

低钾血症致心律失常的观察护理

目的：探讨低钾血症致心律失常的临床症状及心电图特点以及补钾疗效。方法：观察68例低钾血症致心律失常患者的临床表现、血清钾浓度、心电图特点、心律失常类型以及补钾疗效及其不良反应。结果：对68例低血钾患者按常规静脉补钾,2—3d低血钾纠正后心律失常减少或消失。结论：对低血钾引起各种快速式缓慢型心律失常,如房室传导阻滞、心室停搏、心室颤动等严重心律失常,危及患者生命,应及时有效补静脉补钾,随着血清浓度恢复至正常范围,各种心律逐渐减少或消失。     

低血钾与急性心肌梗死的梗死部位关系及预后的临床观察

目的:探讨低血钾与急性心肌梗死的梗死部位及预后的关系。方法:106例患者根据心肌梗死早期血钾水平分为低血钾组、正常血钾组,对比两组的梗死部位及并发症的发生。结果:急性心肌梗死患者低血钾35例(33.0%),其中广泛前壁心肌梗死16例(45.7%),下壁10例(28.6%),故正常血钾组相比更容易合并低血钾(P<0.01)。低血钾组泵衰竭、心律失常、梗死后心绞痛、死亡等心脏事件明显高于正常血钾组(P均<0.05)。结论:急性心肌梗死合并低血钾预后相对较差。     

S—T段抬高型心肌梗死患者早期血钾水平的检测及其监护

目的：研究S—T段抬高型急性心肌梗死（AMI）患者早期低钾血症的发生情况及其监护。方法：对123例S—T段抬高型AMI患者于入院时抽血测定血钾、肌酸激酶同工酶（CK—MB）、肌钙蛋白I（cTnI）,根据血钾水平分为低血钾组（血K^＋〈3．5mmoL／L）和正常血钾组（血K^＋3．5—5．5mmoL／L）,同时在1周内严密加强监护,观察住院期间室性心动过速、心室颤动和猝死等严重不良事件的发生情况。结果：低钾血症的总发生率为30．1％,低血钾引起严重不良事件发生率（32．9％）明显高于正常血钾组（10．8％）。结论：低钾血症对AMI患者的预后影响较大,加强临床监护具有重大的意义。     

低钾血症患者QT离散度的改变及意义

目的：探讨低血钾患者QT离散度的改变及临床意义。方法：观察90例低血钾病人，依其血钾水平分为轻中重三组，分析QT离散度与心电图其他表现及临床症状的关系以及治疗前后的变化。结果：90例病人均出现下肢或四肢肌无力，严重者出现呼吸肌麻痹，呼吸无力，2例出现心跳呼吸停止，39例患者出现室性心律失常，26例为Ⅲ级以上室性心律失常。血钾越低，QT离散度越大，室性心律失常发生的比例愈大。结论：低血钾病人QT离散度改变，血钾越低，QT离散度改变越大。QT离散度增大与恶性心律失常的发生及临床预后有一定关系，QT离散度改变也是低血钾病人发生室性心律失常的机制之一。尽早诊断，快速足量补钾，纠正血钾的同时能改善症状及QT离散度。     

不同血钾水平原发性醛固酮增多症患者健康状况评估

目的: 研究不同血钾水平原发性醛固酮增多症(简称原醛症)患者的整体健康状况。方法: 入选原醛症患者359例，根据血钾水平分为正常血钾组和低血钾组，比较两组患者一般临床资料、相关血生化指标、超声心动图检查指标，采用社区人群功能状态测定量表COOP/WONCA评估两组原醛症患者的健康状况。 结果： 低血钾组血浆醛固酮浓度显著高于正常血钾组（P<0.01）；两组间左室收缩末期直径（LVSD）、左心室舒张末期直径（LVDD）、左室后壁厚度（LVPW）、室间隔厚度（IVS）、左室射血分数（LVEF）无显著差异（P>0.05）;而低血钾组左心室质量指数（LVMI）显著高于正常血钾组（P=0.032）；以LVMI为因变量行多元回归分析显示，收缩压、血浆醛固酮浓度、血钾对LVMI的影响具有统计学意义（P<0.05）。统计COOP/WONCA功能状态测定量表分数显示， 低血钾组体能、日常活动、健康变化、整体健康的得分显著高于正常血钾组（P<0.01），而情绪、社交活动、疼痛得分与正常血钾组无明显差异（P>0.05）。结论： 低血钾原醛症患者整体健康状况低于正常血钾原醛症，需要重视对原醛症尤其伴低血钾患者早期积极药物及手术干预治疗。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

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…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.     

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.