急性脑梗死早期尿激酶静脉溶栓治疗临床观察

目的　评价在急性脑梗死 (ACI)病后 6h尿激酶 (UK)静脉溶栓的临床疗效。方法　 76例ACI随机分成两组 ,UK组和对照组。UK组UK2 5万单位静脉推注 ,续以UK15 0万U 60min内静滴 ,对照组采用通常的治疗方案 ,评价治疗前和治疗后 2 4h、1周、2周、4周的神经功能缺损评分。结果　 ( 1)治疗后 2 4h、2周、4周时UK组与对照组比较改善均非常显著 (P <0 0 1) ;1周时UK组改善比较显著 (P <0 0 5 )。 ( 2 )UK组用药前与用药后 2 4h比较、1周与 2周比较、2周与 4周比较 ,神经功能缺损评分改善均非常显著 (P <0 0 1) ,用药后 2 4h与 1周比较 ,差异显著 ( P <0 0 5 )。 ( 3 )UK组用药后 2 4h时显效率 2 4 3 % ,1周时 5 7 1% ,2周时 81 3 % ,4周时 90 6% ,均高于同期对照组结果 (P <0 0 1,<0 0 1,<0 0 1,<0 0 5 )。结论　早期ACIUK溶栓治疗比常规治疗起效快、作用强、效果好 ,并且安全、简便和可靠     

尿激酶静脉溶栓治疗6小时内急性脑梗死

目的　评价尿激酶 (UK)对 6小时内急性脑梗死的疗效及其安全性。　方法　符合溶栓标准的病人118例随机分为溶栓组和非溶栓组。溶栓组 6 0例 ,首先予尿激酶 70万U ,再予常规治疗 14日。非溶栓组 5 8例 ,只予常规治疗。应用中国脑卒中临床神经功能缺损程度评分标准进行评估神经功能恢复。　结果　溶栓组神经功能缺损评分迅速减少。溶栓组和非溶栓组在治疗后 1日、15日、30日总有效率分别为 70 %、85 %、90 %和 2 0 %、72 %、83% ,经Ridit分析 ,P <0 0 1或P <0 0 5 ,具有非常显著性差异。颅内非症状性出血率 3% (溶栓组 ) ,2 % (非溶栓组 ) ;脑实质出血率 3% (溶栓组 ) ,0 (非溶栓组 )。　结论　UK用于治疗 6小时内急性脑梗死有效且相对安全。     

不稳定性心绞痛尿激酶溶栓治疗的临床疗效——多中心随机对照研究

目的　对比尿激酶 (UK)与肝素在治疗不稳定性心绞痛 (UA)中的疗效。方法　采用单盲 ,有对照的完全随机化方法。UK溶栓组中按UK使用剂量分为高剂量组和低剂量组 ,后者在溶栓前增加静脉推注 3 0 0 0U肝素。研究以 3 0天病死率和急性心肌梗塞 (AMI)发生率为终点指标。结果　总共入选UA患者 5 3 4例 ,高剂量UK组 14 8例 ,低剂量UK组 113例 ,相应肝素作为对照组各为 15 5和 118例。在心脏事件 (死亡 AMI例数 )的发生率上 ,高剂量UK组高于肝素对照组 ( 10 1%与5 2 % ,P >0 0 5 ) ;而低剂量UK组低于肝素对照组 ( 3 5 %与 5 1% ,P >0 0 5 ) ,但均未达到统计学差异 ,而溶栓组间比较 ,低剂量UK组的心脏事件发生率明显低于高剂量UK组 ( 3 5 %与 10 1% ,P <0 0 5 ) ,并达到统计学显著性差异。在心脏事件的发生时间上 ,高剂量UK组心脏事件大多发生在溶栓治疗首日 ,其中发生在UK治疗的头 2个小时内占 4 6 7% ,而对照组大多数发生在入选治疗的 2 4小时后 ( 80 %与 12 5 % ,P <0 0 0 5 )。结论　高剂量UK组溶栓首日AMI发生率明显增加 ,提示该溶栓治疗方案不适于不稳定性心绞痛的治疗 ,降低UK剂量 ,溶栓前加强抗凝血酶治疗 ,虽可明显减少AMI的发生率 ,但是否优于对照组仍需进一步探讨。     

急性脑梗死不同时间窗静脉溶栓疗效观察

20 0 0年 1月至 2 0 0 1年 6月 ,我们对不同时间发病的急性脑梗死患者进行静脉溶栓治疗 ,以探讨其不同时间窗静脉溶栓的疗效。1　资料与方法1 .1　临床资料　本文接受溶栓治疗 5 5例 ,其中发病 <6小时 2 0例 (A组 ) ,男 1 4例、女 6例 ,年龄 48～70岁 ;发病 6～ 2 4小时 3 5例 (B组 ) ,男 2 4例、女 1 1例 ,年龄 47～ 70岁。另设 3 0例作为对照组 (C组 ) ,为同期住院脑梗死患者 ,男 2 2例、女 8例 ,年龄 48～ 70岁。三组性别、年龄、神经功能缺损评分均具有可比性 (P>均 0 .0 5 )。1 .2　治疗方法　 A组、B组用尿激酶 1 5 0万 U溶于生理…     

超早期尿激酶溶栓治疗脑梗死的临床研究

目的评价超早期应用尿激酶(UK)2.0万U/kg溶栓治疗脑梗死的临床疗效及安全性。方法采用国产UK 2.0万U/kg静脉滴注,对66例发病6h内的脑梗死患者进行溶栓治疗,比较治疗前后神经功能缺损评分(NFDI)。另设60例普通治疗病人作为对照组。结果溶栓后2h NFDI为21.39±2.81,较溶栓前25.96±3.29明显减少(P<0.001),治疗后21d溶栓组NFDI为19.01±3.35,明显低于对照组22.67±3.68(P<0.001)。治疗后21d溶栓组的治愈率、显效率、总有效率分别为30.3%、66.7%、83.3%显著高于对照组13.3%、30%、46.7%,两组比较有显著性差异(均P<0.01)。结论在严格掌握溶栓治疗适应证基础上,应用国产UK 2.0万U/kg超早期静脉溶栓治疗脑梗死临床疗效好,并发症少。     

镁对急性心肌梗死溶栓并发再灌注心律失常的抑制作用

目的 :探讨尿激酶 (U K)静脉溶栓治疗急性心肌梗死 (AMI)时再灌注心律失常 (RAs)的发生情况 ,评价硫酸镁 (MS)对 RAs的抑制作用。方法 :32 2例 AMI住院患者接受 U K溶栓治疗 ,将其中 15 1例随机分为 U M组 (UK加 MS,76例 )和 U K组 (75例 ) ,U M组在静脉滴注 U K前 15 min开始静脉注射 MS。结果 :根据临床标准判定为再灌注的患者 2 16例 (6 7.1% ) ,其中 190例 (88.0 % )于再灌注过程中出现心律改变 ,170例 (78.7% )出现RAs,其中室性 RAs 119例 (5 5 .1% )。预防性静脉注射利多卡因与否 ,对室性 RAs的发生无显著影响 (P >0 .0 5 )。U M组 RAs及严重心律失常 (SA)、室性 RAs的发生率均显著低于 UK组 (P<0 .0 1,P<0 .0 0 5 )。结论 :RAs是 AMI溶栓治疗的重要并发症 ;利多卡因不能预防室性 RAs的发生 ;MS对 RAs(尤其是室性 RAs)及严重心律失常的防治有重要作用     

尿激酶加肝素静脉溶栓治疗急性脑梗死疗效观察

1999年 10月至 2 0 0 0年 12月 ,我们对 31例急性脑梗死患者采用尿激酶加肝素静脉溶栓治疗 ,取得较好疗效 ,现报告如下。一般资料 :将 47例急性脑梗死患者 (均按 1995年全国第四届脑血管病学术会议修订的标准确诊 )随机分为两组。溶栓组 31例 ,男 2 6例、女 5例 ,年龄 41～ 6 3岁。符合下列溶栓治疗条件 :1年龄≤ 70岁 ;2发病 6小时之内 (进展性脑梗死发病 12小时以内 ) ;3头颅 CT除外颅内出血 ,且无明显与本次相关的责任病灶。有下列条件之一者不行溶栓治疗 :1有脑出血病史 ;2有未控制的高血压 (收缩压≥ 180 mm Hg,舒张压≥10 0 mm Hg,1…     

爱通立静脉溶栓治疗急性心肌梗死46例临床观察

将98例急性心肌梗死（AMI）患者随机分为观察组46例和对照组52例．分别应用小剂量（50mg）爱通立（rT—PA）和尿激酶（UK）静脉溶栓治疗。结果冠状动脉总再通率观察组为82．6％、对照组为50．0％．发病后6h内静脉溶栓治疗再通率分别为89．29％、60％，两组比较P均〈0．01；5周病死率分别为6．5％和9．6％；P〉0．05。认为小剂量rT—PA静脉溶栓治疗AMI疗效优于UK,发病后6h内治疗效果更佳，且并发症少。     

重组组织型纤溶酶原激活物静脉溶栓治疗急性脑梗死的疗效

目的探讨重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗急性脑梗死的疗效及无效率的多因素分析。方法试验组选择0⁴.5 h内发病给予溶栓的急性脑梗死患者87例,对照组选择与试验组同期发病的04.5 h内发病给予溶栓的急性脑梗死患者87例,对照组选择与试验组同期发病的0⁴.5 h内未予溶栓的急性脑梗死患者90例,试验组给予溶栓治疗外其余治疗与对照组一致。评定患者治疗前、治疗后24 h、7 d、30 d、90 d的NIHSS评分。结果试验组与对照组NIHSS评分治疗前无差别(P=0.17),治疗后各时间点比较有统计学意义(P<0.05)。两组无效率多因素回归分析试验组为大面积脑梗死(OR=22.709,95%CI 5.0194.5 h内未予溶栓的急性脑梗死患者90例,试验组给予溶栓治疗外其余治疗与对照组一致。评定患者治疗前、治疗后24 h、7 d、30 d、90 d的NIHSS评分。结果试验组与对照组NIHSS评分治疗前无差别(P=0.17),治疗后各时间点比较有统计学意义(P<0.05)。两组无效率多因素回归分析试验组为大面积脑梗死(OR=22.709,95%CI 5.019¹02.743,P=0.000)及早期症状改善(OR=0.065,95%CI 0.012102.743,P=0.000)及早期症状改善(OR=0.065,95%CI 0.012⁰.364,P=0.002),对照组为大面积脑梗死(OR=0.273,95%CI 0.0830.364,P=0.002),对照组为大面积脑梗死(OR=0.273,95%CI 0.083⁰.904,P=0.034)及基线NIHSS评分(OR=0.866,95%CI 0.0830.904,P=0.034)及基线NIHSS评分(OR=0.866,95%CI 0.083⁰.904,P=0.041)。结论 rt-PA静脉溶栓治疗急性脑梗死疗效和安全性确切,大面积脑梗死、早期症状改善为静脉溶栓治疗疗效的独立预测因素。     

院前急救与CCU室联合应用rt-PA与尿激酶治疗急性心肌梗死的对比分析

目的　观察重组组织型纤溶酶原激活剂 (rt -PA)与尿激酶 (UK)静脉溶栓治疗急性心肌梗死 (AMI)的疗效。方法　将患者随机分为rt-PA和UK两组进行对比分析。结果　rt -PA组冠状动脉 (冠脉 )总再通率为 80 % (2 4/ 30 ) ,UK组冠脉总再通率为 6 0 % (18/ 30 ) ,患者在发病 <3h溶栓治疗 ,rt -PA组冠脉再通率为88 9% ,UK组冠脉再通率为 6 8 4% ,前者明显高于后者 ,统计学处理有显著性差异 (P <0 0 5 ) ;4周住院病死率 :rt-PA组为 6 7% ,UK组为 13 3% ,前者低于后者 ,两组对比统计学处理具有明显统计学差异 (P <0 0 1)。结论　rt-PA溶栓疗效优于UK ,尤其是在患者发病后 3h内进行溶栓治疗效果更佳 ,住院病死率低。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.