膈肌超声指标对机械通气患者撤机结果的预测价值研究

目的比较膈肌超声相关指标膈肌动度浅快呼吸指数（DD-RSBI）、膈肌增厚浅快呼吸指数（DT-RSBI）与传统浅快呼吸指数（RSBI）在机械通气患者中预测撤机结果的价值。方法选取浙江省6家医院重症医学科连续收治的机械通气时间＞48h并行撤机自主呼吸试验（SBT）的患者131例。SBT过程中使用超声测量并计算膈肌移动度（DD）与膈肌增厚率（DTF）,代替传统RSBI中的潮气量计算出新的DD-RSBI和DT-RSBI。根据撤机结果将患者分为撤机成功组与失败组,分析两组患者各指标间的差异。采用ROC曲线比较各指标预测撤机结果的价值。结果撤机成功组患者97例,撤机失败组患者34例。撤机失败组患者的RSBI、DD-RSBI及DT-RSBI均高于撤机成功组（均P＜0.05）。RSBI、DD-RSBI及DT-RSBI预测撤机失败的AUC分别为0.796（95%CI：0.712~0.903）、0.865（95%CI：0.798~0.931）、0.872（95%CI：0.801~0.942）,以46.3次/（ml·min）、1.65次/（min·mm）、66次/min为阈值,其预测撤机失败的灵敏度分别为85.3%、73.5%、88.2%,特异度分别为56.7%、88.7%、59.8%。多因素logistic回归分析表明,高DD-RSBI（OR=5.46,95%CI：1.54～19.37）、高DT-RSBI（OR=1.06,95%CI：1.02～1.1）是撤机失败的独立危险因素（均P＜0.05）。结论膈肌超声指标DD-RSBI、DT-RSBI较传统RSBI预测撤机结果更准确,是指导撤机时机的较好指标。     

膈肌增厚分数联合浅快呼吸指数指导脓毒症机械通气患者撤机时机的价值研究

目的 探讨膈肌增厚分数（diaphragmtic thickening fraction,DTF）联合呼吸浅快指数（rapid shallow breathing index,RSBI）指导脓毒症机械通气患者撤机时机的应用价值。方法 采用前瞻性研究方法,选取2020年1月至2022年4月嘉兴市第一医院（嘉兴学院附属医院）重症医学科收治的103例脓毒症机械通气患者,所有患者均符合撤机标准,根据撤机结果将其分为撤机成功组（n=67）和撤机失败组（n=36）。两组患者均进行自主呼吸试验（spontaneous breathing trial,SBT）30min后,记录呼吸频率及潮气量,计算RSBI,通过超声测量吸气末和呼气末膈肌厚度,计算DTF,绘制受试者操作特征（receiver operating characteristic,ROC）曲线评估DTF、RSBI及联合指标对撤机时机的预测价值。结果 撤机成功组患者的DTF显著高于撤机失败组[（24.98±4.70）% vs（19.66±5.31）%,差异有统计学意义（P<0.001）;撤机成功组患者的RSBI显著低于撤机失败组[（52.67±13.65）次/（min·L）vs（70.82±20.78）次/（min·L）,差异有统计学意义（P<0.001）,DTF、RSBI及联合指标对成功撤机有预测效能,以DTF>21.20%且RSBI≤55.56次/（min·L）作为联合指标的预测效能最大。结论 DTF及RSBI能有效预测脓毒症机械通气患者的成功撤机时机,与单一DTF及RSBI相比,联合指标可显著提高成功撤机的预测效能。     

剪切波弹性成像联合膈肌增厚率及浅快呼吸指数预测机械通气患者撤机结果的临床研究

目的 探讨剪切波弹性成像技术(shear wave elastography,SWE)联合膈肌增厚率(diaphragmatic thickening fraction,DTF)及浅快呼吸指数(rapid shallow breathing index,RSBI)预测机械通气患者撤机结果的应用价值。方法选取2022年1月—2022年9月在我院住院接受机械通气治疗的52例重症患者,满足撤机条件后采用自主呼吸试验,并通过超声测量DTF、SWE技术测量膈肌剪切模量值(shear modulus,SM)对患者膈肌功能进行评估,按照撤机结果分为撤机成功组和撤机失败组,比较两组患者机械通气时间、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、呼吸频率、RSBI、氧合指数、DTF、SM等参数的差异。采用多因素Logistic回归分析影响撤机结果的因素,绘制受试者操作特征(receiver operator characteristic,ROC)曲线,评价潜在影响因素对撤机结果的预测价值。结果 撤机成...     

胸部超声对脓毒症患者机械通气撤机结果的预测价值研究

背景　脓毒症患者机械通气撤机失败率较高,近年来超声已广泛应用于重症患者机械通气撤机评估中,如评估撤机前患者的心功能,但在脓毒症患者机械通气撤机过程中胸部超声应用不多。目的　探讨胸部超声对脓毒症患者机械通气撤机结果的预测价值。方法　采用前瞻性研究,2017年6月-2018年12月选择温州医科大学附属慈溪医院重症医学科收治的65例持续机械通气48 h以上的脓毒症患者,在其符合机械通气撤机筛查条件后采用低水平压力支持通气（PSV）进行自主呼吸试验（SBT）,于SBT前及SBT 30 min后进行胸部超声指标检测,获得肺部超声评分（LUS）、膈肌位移值（DE）、吸气末膈肌厚度（DTei）和呼气末膈肌厚度（DTee）,并计算浅快呼吸指数（RSBI）、膈肌浅快呼吸指数（D-RBSI）和膈肌增厚分数（DTF）。对符合临床撤机标准者进行撤机,根据撤机结果将患者分为撤机成功组和撤机失败组。比较两组患者各项指标的差异,采用受试者工作特征（ROC）曲线评估胸部超声对脓毒症患者机械通气撤机结果的预测价值。结果　最终纳入50例患者,其中撤机成功组35例,撤机失败组15例。撤机成功组与撤机失败组患者SBT后LUS、SBT前DTF、SBT后DTF、SBT后D-RBSI比较,差异有统计学意义（P<0.05）。撤机失败组患者SBT后LUS较SBT前上升（P<0.05）,撤机成功组和撤机失败组患者SBT后DTF均高于SBT前（P<0.05）。SBT后LUS、D-RSBI及SBT前后DTF预测脓毒症患者机械通气撤机结果的ROC曲线下面积（AUC）分别为0.819、0.895、0.738、0.891。SBT后LUS<15.5分、SBT后D-RSBI<1.41次?min-1?mm-1、SBT前DTF>22.9%、SBT后DTF>33.2%预测脓毒症患者机械通气撤机成功的灵敏度分别为0.730、0.867、0.866、0.886,特异度分别为0.800、0.829、0.667、0.867。结论　胸部超声对脓毒症患者撤机结果有预测价值,SBT后LUS<15.5分、D-RSBI<1.41次?min-1?mm-1、DTF>33.2%对撤机成功的预测价值高。     

超声评估膈肌收缩能力和做功对撤机结局的预测价值

目的 探讨超声测量膈肌增厚率和位移-时间指数（E-T指数）对机械通气患者撤机结局的预测价值。方法 本研究选取十堰市太和医院2021年7月至2022年7月重症医学科（ICU）内符合纳入标准的患者,对所有研究对象均行床旁超声检查,收集自主呼吸试验（SBT）进行30 min时的超声数据：(1)膈肌增厚率（DTF）;(2)膈肌E-T指数。采用受试者工作特征（ROC）曲线确定膈肌超声指标预测撤机成功的最佳阈值。结果 研究共纳入患者60例,其中撤机成功组42例,撤机失败组18例。成功组与失败组的一般临床资料,包括年龄、性别、体重指数（BMI）、急性生理和慢性健康评估Ⅱ评分（APACHEⅡ评分）以及是否行手术治疗等比较,差异均无统计学意义（P>0.05）,而成功组的患者撤机前机械通气时间低于失败组（P<0.05）。在SBT进行30 min时,撤机成功组的DTF及E-T指数均高于失败组（P<0.05）。以DTF≥32.5%为最佳界值预测撤机成功,其敏感性71.4%,特异性83.3%,曲线下面积（AUC） 0.824。以E-T指数≥0.99 cm·s为最佳界值预测撤机成功,为其敏感性7...     

脑卒中机械通气患者撤机前超声评估膈肌运动指标的价值分析

目的 分析超声评估膈肌运动指标对于脑卒中机械通气患者撤机成败的预测价值.方法 选取该院ICU于2016年6月至2019年5月收治的需要接受机械通气治疗的脑卒中患者96例,分为2组,研究组为40例撤机成功的患者,对照组为56例撤机失败的患者.采用超声检查,对两组患者自主呼吸试验(SBT)30 min时的呼吸频率、浅快呼吸指数(RSBI)、右侧膈肌位移(DE)、膈肌收缩速度进行检测,并分析预测价值.结果 研究组患者的呼吸频率、RSBI及膈肌收缩速度均明显低于对照组,而DE明显高于对照组,两组比较差异均有统计学意义(P<0.05).RSBI、DE及膈肌收缩速度预测撤机失败均具有较高的准确度,但DE及膈肌收缩速度的ROC曲线下面积(AUC)明显大于RSBI.单因素分析表明,RSBI、DE及膈肌收缩速度是撤机失败的相关因素.多因素logistic回归分析表明,低DE及高膈肌收缩速度均为撤机失败的独立危险因素.研究组患者的机械通气时间、住院时间等临床预后指标明显短于对照组,两组比较差异均统计学意义(P<0.05).结论 超声评估膈肌运动指标对于预测脑卒中机械通气患者撤机时机具有较高的临床价值,可有效预测患者撤机预后.     

血浆microRNA-206联合床旁超声膈肌功能预测老年机械通气患者撤机结果的价值

目的 观察血浆microRNA-206 (miRNA-206)与床旁超声膈肌功能联合预测老年机械通气患者撤机结果的价值。方法 选取2020年6月—2023年6月在南京医科大学附属淮安第一医院急诊重症监护室住院的老年机械通气患者102例,根据撤机结果分为成功组、失败组。比较两组患者血浆miRNA-206、膈肌功能指标及一般资料;采用多因素逐步Logistic回归模型分析老年机械通气患者撤机结果的影响因素;绘制受试者工作特征（ROC）曲线分析血浆miRNA-206、床旁超声膈肌功能单独及联合对老年机械通气患者撤机结果的预测价值。结果 102例患者撤机失败率为33.33%。与成功组比较,失败组膈肌增厚率（DTF）、膈肌活动度（DE）、血浆miRNA-206、白蛋白（Alb）水平降低（P <0.05）,膈肌收缩速度（DCV）加快（P <0.05）,膈肌浅快呼吸指数（DRSBI）、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分、早期气管切开百分率升高（P <0.05）,年龄增大（P <0.05）。多因素逐步Logistic回归分析结果显示：年龄[■=1.089 (9...     

膈肌超声在机械通气患者撤机中的应用

目的评价膈肌超声指标对机械通气患者撤机的指导价值。方法纳入2016年2月至2017年12月在福建省立医院诊治并接受有创机械通气治疗的患者。在患者符合临床撤机筛查条件后进行T管试验1 h,同时采用床旁超声评估患者右侧膈肌移动度(DD)及膈肌增厚率(DTF),记录呼吸浅快指数(呼吸频率/潮气量,RSBI),定义膈肌–呼吸浅快指数(呼吸频率/DD,D-RSBI)。对符合临床撤机标准的患者进行撤机,统计分析膈肌超声指标与撤机结果之间的关系,绘制受试者工作特征(ROC)曲线,评价D-RSBI和RSBI对撤机成功的预测价值。结果研究共纳入88例患者,其中撤机成功59例,撤机失败29例。成功组和失败组的撤机前指标,包括年龄、性别、收缩压、舒张压、血脂(总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯)、空腹血糖等差异均无统计学意义(P0.05),而失败组的体重指数、急性生理学与慢性健康评分系统Ⅱ评分均高于成功组(P0.05)。撤机成功组撤机前的DD、DTF显著高于撤机失败组[(13.44±3.23)mm比(10.28±2.82)mm,(32.43±12.35)%比(27.64±5.77)%,P0.05],而D-RSBI显著降低[(1.49±0.47)次·min~(-1)·mm~(-1)比(2.55±0.87)次·min~(-1)·mm~(-1),P0.05]。以DTF≥27.9%为标准预测撤机成功,敏感性98.3%,特异性62.1%,ROC曲线下面积0.873。以D-RSBI≤1.73次·min~(-1)·mm~(-1)为标准预测撤机成功,敏感性76.3%,特异性93.1%,ROC曲线下面积0.887。以RSBI≤50.9次·min~(-1)·mm~(-1)为标准预测撤机成功,敏感性91.5%,特异性86.2%,ROC曲线下面积0.927。D-RSBI与RSBI的ROC曲线下面积间差异无统计学意义(P0.05)。结论膈肌超声指标DTF、D-RSBI与RSBI预测机械通气患者撤机结果准确性相当,但更客观,可更多应用于临床。     

脱机试验时应用膈肌浅快呼吸指数预测脱机的临床研究

目的通过应用膈肌浅快呼吸指数(D-RSBI)是否可以预测撤机成功。方法采用前瞻性观察研究,在自主呼吸试验结束时记录患者呼吸频率(RR)和潮气量(VT),并应用M超声测量评估右侧膈肌移位(DD),记录撤机的结果、机械通气时间,重症加强治疗病房(ICU)住院时间和ICU死亡率。依据撤机结果,分为撤机成功组和撤机失败组,采用受试者工作特征(ROC)曲线分析快速浅呼吸指数(RSBI,RR/VT)及D-RSBI(RR/DD)对撤机失败预测的准确性。结果纳入110例患者,其中撤机成功组为73例(66.4%),撤机失败组为37例(33.6%),撤机失败组患者的RSBI、D-RSBI均高于撤机成功组(P<0.01)。RSBI、D-RSBI预测撤机失败的ROC曲线下面积分别为0.78(95%可信区间0.69-0.87)、0.91(95%可信区间0.85-0.97),分别以69次/(L·min)、1.5次/(min·mm)为临界值,其预测撤机失败的灵敏度分别为55%、87%,特异度分别为89%、80%。结论D-RSBI比传统指标RSBI预测撤机失败更准确。     

心肺超声对老年脓毒症患者机械通气撤机结果的预测价值

背景　老年脓毒症患者机械通气撤机失败率高,近年来超声检查广泛应用于重症患者的管理中,临床上越来越多地将超声用于评估患者机械通气撤机前的心、肺功能,但在老年脓毒症患者机械通气撤机过程中超声应用不多。目的　探讨心、肺超声对老年脓毒症患者机械通气撤机结果的预测价值。方法　采用病例对照研究方法,分析2013年1月—2018年10月温州医科大学附属慈溪医院重症监护病房（ICU）收治的60例持续机械通气后撤机的老年脓毒症患者的临床资料。记录患者基本资料,包括性别、年龄、体质指数（BMI）、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、自主呼吸试验（SBT）前心率（HR）、平均动脉压（MAP）。记录患者的基础疾病及感染部位。记录常见预测撤机指标,包括呼吸频率（RR）、最大吸气压（MIP）、吸气0.1 s口腔闭合压（P0.1）、SBT后B型尿钠肽（BNP）。计算浅快呼吸指数（RSBI）。记录患者在SBT前超声检查结果,心脏超声指标包括：左室舒张末期室间隔厚度（IVSTD）、左心室后壁厚度（LVPWTD）、左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）;舒张早期左房室瓣血流速度（E）、舒张晚期左房室瓣血流速度（A）、舒张早期左房室瓣环运动速度（E'）,计算E/A、E/E';测量收缩期左心房面积（LAA）;计算左心室射血分数（LVEF）。肺部超声指标为肺部超声评分（LUS）。根据撤机结果将患者分为撤机成功组和撤机失败组,比较撤机成功组与撤机失败组各项指标的差异,并采用受试者工作特征（ROC）曲线评估心、肺超声对老年脓毒症患者机械通气撤机结果的预测价值。结果　最终纳入60例患者,其中撤机成功组35例,撤机失败组25例。两组患者基本资料比较,差异均无统计学意义（P>0.05）。撤机失败组基础疾病中的冠心病发生率高于撤机成功组（P<0.05）;两组脓毒症感染部位比较,差异无统计学意义（P>0.05）。撤机失败组RSBI高于撤机成功组（P<0.05）。撤机成功组心脏超声指标E'高于撤机失败组,E/E'、LAA低于撤机失败组（P<0.05）,撤机成功组肺部超声指标LUS低于撤机失败组（P<0.05）。ROC曲线分析结果显示,E/E'、LUS、LAA对撤机结果有预测价值,ROC曲线下面积（AUC）分别为0.835、0.751、0.680;当临界值E/E'为8.22、BLUS为15.50分、LAA为22.85 cm2时,灵敏度分别为0.760、0.720、0.560,特异度分别为0.857、0.724、0.829。结论　心肺超声对老年脓毒症患者撤机结果有预测价值,SBT前E/E'为8.22、LUS为15.50分对老年脓毒症患者机械通气撤机成功的预测价值较高。     

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.     

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.     

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.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.