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1.
心脏型脂肪酸结合蛋白的研究进展   总被引:5,自引:1,他引:4  
近年来,在世界范围内急性心肌梗死(acute myocardial infarction,AMI)发病率持续升高,而对AMI的治疗,再灌注治疗的效果与时间呈显著负相关,早期诊断和治疗具有相当重要的意义。目前临  相似文献   

2.
cTnT在心肌梗死和不稳定性心绞痛中的应用   总被引:9,自引:0,他引:9  
在急性心肌梗死 (AMI)和不稳定性心绞痛 (UAP)的治疗中 ,患者越早接受治疗 ,获益越大 ,这就要求尽早确立AMI或UAP的诊断。目前用于诊断AMI和UAP的血清学指标中 ,以CK和CK MB为最佳 ,但它们仍因敏感性较低而使其应用受限。近年来心肌特异性结构蛋白在AMI诊断中的应用研究取得了很大进展 ,特别是cTnT ,它具有特异性高、心肌中含量高、心肌损伤后释放入血早、在血中维持阳性的时间长等优点 ,故是早期诊断AMI的良好指标 ;还可用于判断AMI再灌注治疗后血管是否再通 ,其价值优于CK和CK MB。另外 ,cTnT可用于评估UAP患者的预后 :cTnT阳性之UAP患者预后较差 ,且cTnT值越高 ,预后越差 ;但对于UAP的诊断来说 ,与CK和CK MB一样 ,因敏感性较差而诊断价值不高。  相似文献   

3.
目的 探讨心肌肌钙蛋白I(cTnI)和超敏C-反应蛋白(hs-CRP)联合检测对急性心肌梗死(AMI)的诊断价值.方法 检测192例AMI患者不同时段血清cTnI和hs-CRP水平,同时检测200例健康体检者血清cTnI和hs-CRP作对照,并对结果进行统计学分析.结果 AMI组与对照组cTnI和hs-CRP浓度比较有差异有统计学意义(P<0.01),cTnI在AMI胸痛发作12~24 h达到峰值,峰值为(9.68±2.64)μg/L;hs-CRP在AMI胸痛发作8~12 h达到峰值,峰值为(14.5±5.9)mg/L.cTnI和hs-CRP对AMI诊断灵敏度在AMI发作0~8 h和3~7 d差异均有统计学意义,8 h至3 d诊断灵敏度差异无统计学意义,cTnI和hs-CRP对AMI诊断特异度分别为98.5%和84.0%.结论 cTnI诊断AMI具有很高的特异性和较宽的诊断时间,hs-CRP对AMI的早期诊断具有很高的敏感性,二者联合检测可以更好的发挥cTnI和hs-CRP诊断AMI的优点,争取AMI早诊断、早治疗和减少对AMI漏诊、误诊,为AMI诊断提供必要的信息.  相似文献   

4.
冠状动脉疾病(CAD)无论在发达国家还是在发展中国家都是一个很常见的健康问题。急性心肌梗死(AMI)是全球死亡的主要原因之一,在美国高居第一位[1]。快速、准确的诊断AMI 对它的治疗和预后起着重要作用。在过去20年中,AMI的生物标志物的发展在诊断、治疗及预后方面已取得了巨大的进步。目前,心肌肌钙蛋白是临床实践中最常用的诊断 AMI的生物标志物。近年又发现了一种新的生物标志物 MicroR-NAs(miRNAs)能够在入院时就能可靠地排除或诊断 AMI 患者[2]。在过去的几年发现组织中 miRNAs 表达水平与心脏病有关,miRNAs 在血清、血浆、尿液以稳定的形式存在,不受RNase 的干扰。在 AMI、急性冠状动脉综合征(ACS)、稳定的冠状动脉疾病、心脏衰竭、冠状动脉粥样硬化、心律失常、心肌肥厚和心肌病患者中已发现了循环的 miRNAs 的浓度变化[3-6]。  相似文献   

5.
急性心肌梗死(AMI)的早期诊断对AMI患者的及时治疗十分重要.近年来,国内外都在寻找一些具有高度特异性和敏感性的AMI诊断指标,随着对血清钙蛋白I(cTnI)与心肌梗死(MI)早期诊断及预后关系的不断研究,血清钙蛋白I(cTnI)被认为是早期诊断MI的敏感而特异的血清标志物.作者通过对本院110例AMI患者和50例健康体检者血清中的cTnI、CK-MB的动态观察,探讨cTnI在心肌梗死中的诊断价值.  相似文献   

6.
通过对40例老年急性心肌梗死(AMI)患者的首发症状观察与护理,认为护士在治疗护理中,必须对AMI有较深的认识和警觉。首发症状的观察与护理对老年AMI早期诊断和治疗具有重要意义。并发症的观察与护理对减少并发症、降低病死率至关重要,尤其是发病初期。溶栓治疗及药物观察与护理是治疗老年AMI的重要环节。心理护理在解除病人顾虑、使其积极主动配合治疗方面发挥了重要作用。  相似文献   

7.
肌钙蛋白T在急性心肌梗塞中的应用   总被引:3,自引:0,他引:3  
急性心肌梗塞(AMI)的早期诊断和及时治疗是降低死亡率的关键。尤其是目前开展的溶栓治疗更要求在发病后4小时内给予确诊。目前,在AMI的生化诊断方面,血清酶CKCK-同工酶是常用的灵敏度很高的指标,尤其是CKAIB被公认为诊断AMI的金标准,但最早也要在AMI发病后4~8小时才开始升高,对早期诊断带来一定的局限.肌钙蛋白T(TnT)是近年来发展对AMI有高灵敏、高特异的生化指标。我们观察了45例AMI患者发病时TnT变件及6例AMI患者发病过程TnT的跟踪检测,并与CK、CK-MB等加以比较,探讨其临床意义.对象和方法一、对象1.对…  相似文献   

8.
邵听军  阮森林  张辉 《浙江临床医学》2008,10(11):1500-1501
急性心肌梗死(AMI)的早期诊断对AMI患者的及时治疗十分重要。近年来,国内外都在寻找一些具有高度特异性和敏感性的AMI诊断指标,随着对血清钙蛋白Ⅰ(cTnⅠ)与心肌梗死(MI)早期诊断及预后关系的不断研究,血清钙蛋白Ⅰ(cTnⅠ)被认为是早期诊断MI的敏感而特异的血清标志物。作者通过对本院110例AMI患者和50例健康体检者血清中的cTnⅠ、CK—MB的动态观察,探讨cTnⅠ在心肌梗死中的诊断价值。  相似文献   

9.
急性心肌梗塞(AMI)的急性期死亡,约半数以上在发病2~3小时内,因此早期作出诊断,及时治疗,极其重要,AMI在发病早期,血中磷酸激酶、肌凝蛋白轻链尚未增高,诊断有一定困难,这时就必须依靠自觉症状为主的临床和心电图表现,AMI的典型心电图改变为,异常Q波形成、ST弓背形抬高及T波倒置、规律性演变。但由于种种原因、心电图诊断AMI的灵敏性和特异性有限,约15~20%甚至  相似文献   

10.
急性心肌梗死(AMI)是威胁人类生命的重要疾病之一,近年来AMI在治疗上已经有了很大的进展,如经皮冠状动脉扩张术及冠状动脉搭桥术等开始在临床广泛应用.因此对于AMI的准确诊断尤其是早期诊断就显得更加至关重要.传统的诊断主要是根据典型的临床表现,特征性心电图改变及实验室酶学检查.但相当一部分心梗患者临床表现不明显,早期心电图无明显改变.  相似文献   

11.
急性心肌梗死(AMI)后,左心室重构影响患者预后及心血管事件的发生率。超声可早期检测和评价AMI患者左心室重构情况,对临床制定治疗方案、改善预后有重要意义。本文就超声新技术评价AMI后左心室重构的研究进展进行综述。  相似文献   

12.
Acute myocardial infarction (AMI) is one of many causes of ST-segment elevation (STE) in emergency department (ED) chest pain (CP) patients. The morphology of STE may assist in the correct determination of its cause, with concave patterns in non-AMI syndromes and non-concave waveforms in AMI. OBJECTIVES: To determine the impact of STE morphologic analysis on AMI diagnosis and the ability of this technique to separate AMI from non-infarction causes of STE. METHODS: The electrocardiograms (ECGs) of consecutive ED adult CP patients (with three serial troponin I determinations) were interpreted in two-step fashion by six attending emergency physicians (EPs): 1) the determination of STE by three EPs followed by 2) STE morphologic analysis (either concave or non-concave) in those patients with STE. The impact of STE morphology analysis was investigated in the identification of AMI and non-AMI causes of STE. Acute myocardial infarction was diagnosed by abnormal serum troponin I values (>0.1 mg/dL) followed by a rise and fall of the serum marker; STE diagnoses of non-AMI causes were determined by medical record review. Interobserver reliability concerning STE morphology was determined. Study inclusion criteria included at least three troponin values performed in serial fashion no more frequently than every three hours, initial ED ECG, ED diagnosis, and final hospital diagnosis. RESULTS: Five hundred ninety-nine CP patients were entered in the study, with 171 (29%) individuals having STE on their ECGs. Of the 171 patients who had STE, 56 had AMI, 50 had unstable angina pectoris (USAP), and 65 had non-coronary final diagnoses. Forty-nine patients had non-concave STE, 46 with AMI and three with USAP; no patient with a non-coronary diagnosis had a non-concave STE morphology. The sensitivity and specificity of the non-concave STE morphology for AMI diagnoses were 77% and 97%, respectively; the positive and negative predictive values for non-concave morphology in AMI diagnoses were 94% and 88%, respectively. Interobserver reliability in the STE morphology determination revealed a kappa coefficient of 0.87. CONCLUSIONS: A non-concave STE morphology is frequently encountered in AMI patients. While the sensitivity of this pattern for AMI diagnosis is not particularly helpful, the presence of this finding in adult ED chest pain patients with STE strongly suggests AMI. This technique produces consistent results among these EPs.  相似文献   

13.
AMI remains a diagnostic and therapeutic challenge for the critical care nurse. As research and technology progress, a thorough understanding of the pathophysiology of AMI is necessary to appreciate and apply advances in the treatment of this condition. Likewise, if reductions in the morbidity and mortality of AMI are to be achieved, the nurse must be aware of potential complications, especially those related to ischemia, myocardial dysfunction, and dysrhythmia. Prompt diagnosis and treatment of the complications of AMI are the best approaches for minimizing fatalities, reducing hospital stays, and providing the best prognosis for patients with AMI.  相似文献   

14.
目的 分析我院心脏中心8年来收治5720例急性心肌梗死(AMI)患者的临床特点和院内死亡原因.方法 2002年1月1日至2009年12月31日期间我院心脏中心收治AMI患者5720例.根据年龄分为≤45岁组、46~75岁组和>75岁组,统计分析其发病率、死因、是否接受PCI介入治疗及接受介入治疗后的死亡情况以及性别对死因的影响.结果 2002-2009年不同年龄组AMI发病率男性均高于女性,>75岁组女性发病率显著升高,但仍低于男性.所有AMI患者接受介入治疗的比例明显升高,接受介入治疗患者每年病死率明显下降.死亡原因前三位是急性心力衰竭、心源性休克及急性心力衰竭合并心源性休克,且在女性和>75岁患者急性心力衰竭导致的死亡明显增加.结论 我院AMI住院人数逐年增加,接受介入治疗能降低病死率,>75岁老年人血运重建治疗仍然是可行及安全的.
Abstract:
Objective The study aimed to analyze the clinical features and the causes of hospital death among the 5720 acute myocardial infarction(AMI)patients from Cardiology Center,Beijing Chao-Yang Hospital during the last 8 years. Methods A total of 5720 AMI patients received treatment in the Cardiology Center from January 1st ,2002 to December 31th ,2009 were retrospectively reviewed. All patients were classified according to age into 3 groups of ≤45,46 -75,and > 75 years old. The morbidity,cause of death ,whether they had the PCI therapy,mortality after PCI and the impact of gender on the cause of death were observed respectively. Results The morbidity rate of male was significantly higher than female in all three groups,and the study also found that the morbidity rate of female was significantly higher in the group of > 75 years old,which however was still lower than that of male. The AMI patients were more likely to accept PCI therapy,which could significantly reduce the mortality rate. The top 3 causes of death included acute heart failure(AHF),cardiogenic shock(CGS)and AHF combined with CGS. In addition,AHF caused significantly more death in female and older(> 75 years old)patients. Conclusions The morbidity rate of AMI patients in Beijing Chao-Yang Hospital increased year by year. And PCI therapy could reduce the mortality rate of all groups. Revascularization treatment seems to be feasible and safe for the patients older than 75 years old.  相似文献   

15.
目的 观察冠状动脉介入治疗(PCI术)对老年(年龄≥65岁)急性心肌梗死(AMI)患者近期(3个月)左心室舒张功能的影响.方法40例老年AMI患者随机分为PCI组和单纯药物治疗的非手术组,观察治疗3个月后左心室舒张功能各指标的变化,并与治疗前进行比较,确定PCI的治疗效果.主要观察指标:左心房前后径(LA-胸骨旁左心室长轴切面);左心室舒张末期内径(LV-胸骨旁左心室长轴切面);左心室射血分数(LVEF);左心室舒张功能指标:二尖瓣口舒张早期血流最大充盈速度(E)、舒张晚期血流最大充盈速度(A),计算E/A;肺静脉心室收缩S波、心室舒张D波,计算S/D.结果PCI组治疗后左心房室内径无明显增大,而非手术组左心房室内径明显增大(P<0.05);左心室舒张功能两组均进一步受损,但PCI组明显好于非手术组(P<0.05).结论PCI治疗可延缓老年AMI患者左心室重塑的进展及舒张功能的恶化.  相似文献   

16.
Acute myocardial infarction (AMI) is one of many causes of electrocardiographic ST segment elevation (STE) in ED chest pain (CP) patients; at times, the electrocardiographic diagnosis may be difficult. Coexistent ST segment depression has been reported to assist in the differentiation of non-infarction causes of STE from AMI-related ST segment elevation. The objective was to determine the effect of AMI diagnosis on the presence of STD among ED CP patients with electrocardiographic STE. Adult CP patients with electrocardiographic STE in at least 2 anatomically distributed leads were reviewed for the presence or absence of ST segment depression in at least 1 lead and separated into 2 groups, both with and without ST segment depression. A comparison of the 2 groups was performed in 2 approaches: all STE patients and then only with STE patients who lacked confounding electrocardiographic pattern (bundle branch block [BBB], left ventricular hypertrophy [LVH], or right ventricular paced rhythm [VPR]). All patients in the study underwent prolonged observation in the ED (at least 8 hours) with 3 serial troponin T determinations and 3 electrocardiograms (ECG). AMI was diagnosed by abnormal serum troponin T values (>0.1 mg/dL); electrocardiographic STE diagnoses of non-AMI causes were determined by medical record review. There were 171 CP patients with STE were entered in the study with 112 (65.5%) individuals show ST segment depression. When considering all study patients, ST segment depression was present at statistically equal rates in AMI and non-AMI situations (P = NS). The sensitivity, specificity, positive predictive value, and negative predictive value for the electrocardiographic diagnosis of AMI were 63%, 34%, 30%, and 67%, respectively. Patients with confounding patterns (LVH 46, BBB 19, and VPR 6) were removed from the analysis group, leaving 100 patients for analysis; 38 of these patients had ST segment depression. When considering this group of study patients, ST segment depression was present significantly more often in AMI patients (P <.0001). The sensitivity, specificity, positive predictive value, and negative predictive value for the electrocardiographic diagnosis of AMI were 69%, 93%, 93%, and 71%, respectively. Clinical diagnoses were as follows: 56 AMI, 50 USAP, and 65 noncoronary syndrome. When all CP patients with electrocardiographic STE are considered, the presence of ST segment depression is not helpful in distinguishing AMI from non-AMI. If one considers only patterns which lack electrocardiographic ST segment depression caused by altered intraventricular conduction, the presence of ST segment depression strongly suggests the diagnosis of AMI. In these cases, reciprocal ST segment depression is of considerable value in establishing the electrocardiographic diagnosis of STE AMI.  相似文献   

17.
目的评价基层医院不同治疗方法对急性心肌梗死(AMI)患者预后的影响。方法将266例AMI患者根据治疗方法的不同分为药物治疗组(n=78)、静脉溶栓组(n=32)、急诊PCI组(n=38)、择期PCI组(n=118)。比较四组入院时、治疗1月后的NT-proBNP水平及心功能指标、出院1年后的主要不良心血管事件(MACE)发生情况及住院费用。结果治疗1个月后,急诊PCI组和择期PCI组的NT-proBNP水平低于药物治疗组和静脉溶栓组,LVEF高于药物治疗组和静脉溶栓组,LVEDD小于药物治疗组和静脉溶栓组(P<0.05)。出院1年后,急诊PCI组和择期PCI组MACE总发生率低于药物治疗组和静脉溶栓组(P<0.05)。药物治疗组和静脉溶栓组的住院费用少于急诊PCI组、择期PCI组(P<0.05)。结论PCI治疗应用于AMI患者中能改善患者的心功能指标,降低MACE发生率,基层医院目前已有条件开展PCI治疗,对有经济能力的AMI患者应优选PCI治疗。  相似文献   

18.
急性心肌梗死(AMI)的发生发展与心肌微循环障碍紧密相关,及时有效地评价微循环灌注情况对AMI的诊断、治疗和预后均有十分重要的意义。心肌声学造影是一种评估心肌微循环灌注的超声新技术,目前已成为临床评价AMI的重要方法。本文就心肌声学造影在AMI再灌注前后的应用、危险分层、疗效评估、存活心肌检测、造影剂安全性等方面进行综述。  相似文献   

19.
Purpose

The purpose of the study was to determine the prevalence of ischemic and alternative diagnoses and the diagnostic accuracy of CT angiography (CTA) in the setting of suspected acute mesenteric ischemia (AMI).

Material and methods

We included 959 patients undergoing CTA for the evaluation of suspected AMI. The final clinical diagnosis was used to determine the prevalence of ischemic and alternative diagnoses and to calculate the diagnostic accuracy of CTA. Prevalence of diagnoses by age, sex, and admission status was compared using Cochran–Armitage and χ 2 tests.

Results

Prevalence was 18.8% (180/959) for AMI and 61.2% (587/959) for specific alternative diagnoses. In the remaining 20.0% (192/959), no clear clinical diagnosis was established. The most frequent alternative diagnoses were small-bowel obstruction (10.4%; 61/587), infectious colitis (8.7%; 51/587), pneumonia (6.5%; 38/587), cholecystitis (6.1%; 36/587), and diverticulitis (5.6%; 33/587). Prevalence of specific alternative diagnoses varied significantly according to both age (p < .013) and admissions status (p < 0.001). CTA had a sensitivity and specificity for diagnosing AMI of 89.4%/99.5% and for alternative diagnoses of 86.7%/96.9%, respectively.

Conclusion

In the setting of suspected AMI, the prevalence of ischemic and alternative diagnoses varies significantly by age, sex, and admission status. CTA provides for rapid and non-invasive assessment of ischemic and alternative diagnoses with high diagnostic accuracy.

  相似文献   

20.
白细胞介素-18含量变化与急性心肌梗死的炎症关系   总被引:7,自引:0,他引:7  
目的:探讨IL-18在急性心肌梗死(AMI)中改变的意义.方法:用酶联免疫吸附双抗体夹心法动态检测44例AMI患者和20例健康对照者的血清IL-18含量,分析IL-18与梗死部分、面积积分、临床积分、血清肌酸激酶同工酶(CK-MB)之间的相关性.结果:AMI患者血清IL-18含量明显升高,第2 d达高峰,以后开始下降,第14 d接近正常对照组;且IL-18含量变化与血清CK-MB含量变化、临床积分、梗死面积均呈明显的正相关性(P均<0.05);死亡组IL-18含量明显高于存活组(P<0.05).结论:IL-18含量与AMI患者的病情变化相一致,其可能参与了AMI的病理生理过程,可作为AMI患者病情监测和预后的参考指标之一.  相似文献   

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