他汀类对急性缺血性脑卒中后感染影响的临床研究

目的探讨他汀类对急性缺血性卒中后感染的影响。方法回顾性分析429例急性缺血性脑卒中患者的临床数据,依据发病前是否已使用他汀类药物分为他汀治疗组与非他汀治疗组,对比两组感染、败血症发生情况。结果两组在卒中后总体感染、死亡及各单病种感染发生率方面差异均无统计学意义（均〉0.05）。在动脉粥样硬化性血栓性脑梗死亚组,他汀治疗组败血症发生率较非他汀治疗组低（〈0.05）。结论发病前使用他汀类不会增加卒中后感染的风险,在某些卒中亚型中还起到降低败血症的风险的作用。     

他汀类药物预防心肌梗死后房颤发生的临床研究

目的:探讨他汀类药物对心肌梗死后房颤的预防作用。方法:选取2012年1月-2013年12月本院收治的80例急性心梗患者,根据随机数字表法将其分为他汀组和非他汀组各40例。他汀组入院前已规律服用他汀类药物,非他汀组入院前未服用过他汀类药物,对两组患者进行心电监测,观察心梗后房颤的发生率及阵发性房颤再发生率。结果:他汀组的房颤发生率10.0%明显低于非他汀组的22.5%,且阵发性房颤再发生率33.3%明显低于非他汀组的66.67%,差异均有统计学意义(P0.05)。结论:他汀类药物能有效降低MI后房颤的发生率,且有利于预防阵发性房颤的再发生,有效预防阵发性房颤发展为永久性房颤。     

缺血性脑卒中患者出院服药依从性与复发相关性

目的 分析急性缺血性脑卒中出院患者服药依从性与复发的关系。方法 选取 2017 年 1 月~2018年12 月我院内科收治的急性缺血性脑卒中患者 200例,比较两组患者出院后 12 个月复发情况及预后。结果 随访181例急性缺血性脑卒中患者中,复发60例,复发率为33.1%, 其中死亡10例,死亡率为5.52%;患者出院后 3、6、12 个月服用他汀类药物、抗栓药物、降糖药物、降压药物服药依从性都呈下降趋势（P＜0.05）;两组患者文化程度、糖尿病、高血压及心脏病发生率、饮酒率、吸烟率、药物认知情况、疾病认知况、TOAST病因分型比较,差异有统计学意义（P＜0.05）;出院后依从性好组患者12个月的复发率、预后不良的所占比例低于依从性差组（P＜0.05）。结论 随出院时间延长,缺血性脑卒中患者他汀类药物、抗栓药物、降糖药物、降压药物的服药依从性均呈下降趋势,且受多种因素影响,因此,医院及社区、乡镇卫生院需加强对患者二级预防药物服用的健康教育及正确指引。     

再次负荷量瑞舒伐他汀对NSTEACS患者经PCI术后心血管事件的影响

目的：观察非 ST 段抬高型急性冠状动脉综合征（NSTEACS）患者择期经皮冠状动脉介入（PCI）术前再次强化他汀治疗,能否降低围手术期心肌标志物水平及心肌梗死发生率。方法：120例患者随机分为两组,两组患者既往均长期（30 d以上）服用瑞舒伐他汀10 mg/d,入院后两组患者继续服用常规剂量瑞舒伐他汀,并接受NSTEACS其他常规治疗。强化他汀组术前24 h 服用瑞舒伐他汀40 mg,常规他汀组术前仍以瑞舒伐他汀10 mg/d 治疗。比较两组围手术期心肌梗死发生率及高敏 C 反应蛋白（hs-CRP）变化,观察随访1个月患者主要心血管不良事件（MACE）发生率。结果：强化他汀组围手术期心肌梗死发生率明显低于常规他汀组,两组比较差异有统计学意义（P 〈0.05）。PCI 术后24 h 强化他汀组hs-CRP低于常规他汀组,两组比较差异有统计学意义（P 〈0.05）。PCI 术后随访1个月,强化他汀组无MACE发生,常规他汀组发生心肌梗死5例;两组发生率差异有统计学意义（P〈0.01）。结论：既往长期服用他汀类药物治疗的NSTEACS患者,择期PCI术前再次负荷量他汀治疗能减少围手术期心肌梗死发生率,降低术后hs-CRP的升高,减少术后1月MACE发生率。     

他汀类药物对缺血性卒中患者血脂和预后的影响

目的探讨他汀类药物对缺血性卒中患者血脂和预后的影响。方法将发病l周内入院的110例脑梗死伴高脂血症患者分为他汀治疗组和对照组,治疗组在入院后给予他汀类药物,对照组除不给予他汀类药物,其余治疗同治疗组。观察两组血脂变化情况和脑梗死的再发率。结果他汀治疗组血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和对照组比较差异有统计学意义（P〈0．05）,两组半年再发率和1年再发率相比差异均有统计学意义（P〈0．05）。结论他汀类药物不仅能调节血脂,而且能使缺血性卒中风险再发率显著降低,应在缺血性卒中治疗中使用常规剂量的他汀类药物。     

不同类型和不同部位急性脑卒中心电变化特点

目的 探讨缺血性脑卒中与出血性脑卒中及其不同部位发生心电图（ECG）改变的特点.方法 对123例脑梗死和89例脑出血患者的资料进行统计分析.结果 缺血性卒中组中传导阻滞和心房扩大的发生率较出血性卒中组明显增高（P〈0.05）,而出血性卒中组中心肌缺血、心动过速和房性早搏明显高于缺血性卒中组（P〈0.05）.脑叶卒中ECG改变明显高于基底节组和其它部位组（P〈0.05）.结论 急性脑卒中早期心电图异常与卒中部位、病情严重程度有关,缺血性脑卒中与出血性脑卒中发生ECG改变的类型有明显差异,脑叶卒中患者的心电图异常发生率高.     

他汀类药物对门诊冠心病患者心律失常的防治效果

目的探讨他汀类药物对门诊冠心病患者心律失常的防治效果。CHADS2评分是否与其存在相关性。方法回顾性分析门诊就诊235例冠心病患者,根据患者用药情况分为他汀组141例,非他汀组94例,3-6月内行holter评价,观察各组间心律失常的发生率是否存在差异。根据CHADS2评分分为低危中危高危3组,其中低危组CHADS2评分为0分76例,中危组CHADS2评分为1~2分98例,高危组CHADS2评分为3~6分61例。结果CHADS2评分越高的冠心病患者的房颤及室速的发病率越高,差异有统计学意义(P0.05),室早负荷未见途径差异;冠心病患者服用他汀类药物后,CHADS2评分≤2新发房颤的发病率远低于未服用他汀类药物的患者,差异有统计学意义(P0.05),而CHADS2评分≥3的患者中,差异无统计学意义(P0.05);中危组CHADS2评分1-2的冠心病患者服用他汀类药物后,新发室速显著低于未服用他汀类药物的患者,差异有统计学意义(P0.05),另两组差异无统计学意义(P0.05)。结论他汀类药物对门诊冠心病患者心律失常有预防效果。CHADS2评分可作为冠心病患者心律失常的危险分层评价。     

心房颤动患者心脏导管射频消融术后急性缺血性脑卒中发病率及其影响因素研究

目的 探讨心房颤动患者心脏导管射频消融术（RFCA）后住院期间急性缺血性脑卒中的发病率及其影响因素。方法 回顾性分析2012年1月-2015年12月北京安贞医院心内科出院诊断中包括"阵发性或持续性心房颤动"并实施RFCA的住院患者4 573例,根据RFCA后住院期间是否发生急性缺血性脑卒中分为卒中组及对照组,记录患者的性别、年龄、既往史和合并症、心房颤动类型、手术次数、住院时间、院内病死率、入院及出院时日常生活能力（ADL）评分。结果 4 573例发生急性缺血性脑卒中患者22例（卒中组）,发病率为0.48%,其中脑梗死19例（0.41%）,短暂性脑缺血发作（TIA）3例（0.07%）;其余4 551例未发生急性缺血性脑卒中患者为对照组。对照组与卒中组患者性别、年龄、既往高血压、糖尿病、高脂血症、冠心病、心脏瓣膜病发病率、手术次数比较,差异均无统计学意义（P＞0.05）;对照组与卒中组患者既往缺血性脑卒中、心功能不全发病率、心房颤动类型比较,差异均有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示,既往缺血性脑卒中病史〔OR=21.342,95%CI（6.549,69.546）〕、心功能不全〔OR=8.782,95%CI（3.173,24.308）〕、持续性心房颤动〔OR=2.990,95%CI（1.137,7.860）〕是心房颤动患者RFCA后住院期间并发急性缺血性脑卒中的独立危险因素（P＜0.05）。卒中组患者住院时间长于对照组〔13（24）d与5（2）d〕,院内病死率高于对照组〔9.09%（2/22）与0.13%（6/4 551）〕,出院时ADL评分低于对照组〔（89.8±14.6）分与（99.1±4.1）分〕（P＜0.05）。结论 心房颤动患者RFCA后住院期间急性缺血性脑卒中总体发病率较低,但并发急性缺血性脑卒中延长了住院时间,增加了院内病死率,影响患者生活能力;既往缺血性脑卒中病史、心功能不全、持续性心房颤动是RFCA后住院期间并发急性缺血性脑卒中的独立危险因素,术前筛选和严格掌握适应证有助于减少RFCA后并发急性缺血性脑卒中。     

脑梗死部位与缺血性进展性卒中的关系

目的:探讨脑梗死部位与缺血性进展性卒中的关系,为早期识别进展性卒中提供可能的影像学依据。方法:回顾性分析发病48 h内入院治疗的653例脑梗死患者的病例资料,根据缺血性进展性卒中诊断标准,将其分为进展性卒中组(进展组155例)和非进展性卒中组(对照组498例);按梗死部位分为侧脑室体旁梗死(A型)、分水岭梗死(B型)、单个脑叶或基底节或大面积脑梗死(C型)、脑干和/或小脑梗死(D型)4型,比较各型的发生率,对缺血性进展性脑卒中的相关因素进行Logistic回归分析,筛选其发生的危险因素。结果:进展组中A型进展性卒中发病率最高,其次为B型,与其他类型及对照组比较差异均有统计学意义(P0.05);同组其他类型间比较差异无统计学意义(P0.05)。进展组高血压病史和颈部血管斑块形成发生率显著高于非进展组(P0.05);进展组入院时血糖、胆固醇、甘油三酯水平显著高于非进展组(P0.05)。颈部血管斑块形成、入院时高血糖、梗死部位与缺血性进展性脑卒中的发生相关(P0.05)。结论:颈部血管斑块形成、入院时高血糖、梗死部位与缺血性进展性脑卒中的发生相关。侧脑室体旁梗死、分水岭梗死较易进展。     

血清尿酸水平对急性缺血性脑卒中后抑郁的预测价值研究

目的　探讨入院时血清尿酸水平对急性缺血性脑卒中患者6个月内出现抑郁的预测价值。方法　选取2015年8月—2016年12月于华北理工大学附属医院住院治疗的急性缺血性脑卒中患者498例为研究对象。卒中后6个月应用汉密尔顿抑郁量表（HAMD）对被评定者进行检查,总分<7分为非卒中后抑郁（PSD）组（283例）,总分≥7分为PSD组（168例）。收集两组患者一般临床资料、神经功能评价结果、实验室指标,比较两组上述指标的差异;采用Logistic回归分析急性缺血性脑卒中PSD的影响因素,分析血清尿酸水平对急性缺血性脑卒中PSD的预测价值。结果　PSD组男性所占比例低于非PSD组,平均年龄、精神疾病家族史、合并冠心病、合并高脂血症、首次发病者所占比例高于非PSD组,差异有统计学意义（P<0.05）;PSD组美国国立卫生研究院卒中量表（NIHSS）评分、日常生活活动能力量表（ADL）评分、改良Rankin量表（mRS）评分高于非PSD组,差异有统计学意义（P<0.05）;PSD组总胆固醇、三酰甘油水平高于非PSD组,血清尿酸水平低于非PSD组,两组血清尿酸水平分组构成不同,差异有统计学意义（P<0.05）。Logistic回归分析结果显示,性别、年龄、合并冠心病、脑卒中发生次数、mRS评分、血清尿酸水平是急性缺血性脑卒中PSD的影响因素（P<0.05）。结论　血清尿酸水平是急性缺血性脑卒中PSD的独立影响因素,对急性缺血性脑卒中6个月内抑郁的发生有预测作用。     

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.