急性ST段抬高心肌梗死行急诊经皮冠状动脉介入术无复流影响因素探讨

目的:探讨急性ST段抬高性心肌梗死(STEMI)患者,行经皮冠状动脉介入术(PCI)时无复流现象的发生率及其相关危险因素。方法:选择本院2010年8月至2013年3月之间,STEMI行急诊PCI术的患者458例,分成无复流(慢血流)组及血流良好组,观察一般临床基线,冠状动脉造影血管病变特点等资料之间的差异。结果:63例(13.8%)患者于PCI时出现了无复流/慢血流现象。两组在性别、年龄、族别、出现症状至PCI时间,既往是否存在吸烟史、高血压史、血脂异常等高危因素以及靶血管部位、血管长度及直径等,差异均无统计学意义(P0.05),而在既往存在心肌梗死病史,糖尿病患者中,无复流/慢血流较血流正常组是增高的。在术前心肌梗死溶栓分级(TIMI)血流≤1级的AMI患者以及靶病变PCI中存在血栓负荷者出现无复流/慢血流组较血流正常组高,两组之间存在差异(P0.05)。结论:STEMI急诊PCI术后无复流现象的出现与既往存在心肌梗死、糖尿病病史,术前TIMI血流≤1的AMI患者以及靶病变PCI中存在血栓负荷者可能有关。     

D-二聚体与老年急性心肌梗死冠状动脉介入术后无复流的相关性研究

目的探讨D-二聚体水平与老年急性ST段抬高型心肌梗死(ST-elevated myocardiol infarction,STEMI)患者直接PCI后无复流的关系。方法连续性入选老年急性STEMI接受直接PCI患者124例,根据术后即刻血流TIMI分级和心肌染色分级将患者分为正常血流组84例和无复流组40例。比较2组D-二聚体水平,并探讨D-二聚体水平与术后无复流发生的关系。结果无复流组患者D-二聚体水平明显高于正常血流组[0.91(0.55,1.41)mg/L vs 0.46(0.33,0.96)mg/L,P=0.00]。多元logistic回归分析显示,D-二聚体水平是介入术后无复流发生的独立危险因素(OR=4.18,95%CI:1.18~14.7,P=0.026)。ROC曲线分析显示,术前D-二聚体界值为0.74mg/L时,预测术后无复流发生的敏感性为70.0%,特异性为72.6%。血浆D-二聚体0.74mg/L患者的无复流发生率明显高于血浆D-二聚体≤0.74mg/L患者无复流发生率(54.0%vs 17.5%,P=0.00)。结论老年急性STEMI患者接受直接PCI后,冠状动脉无复流发生与D-二聚体水平相关。     

CHA_2DS_2-VASc评分联合术前血流分级与老年急性心肌梗死术后无复流的关系

目的探讨评估CHA_2DS_2-VASc评分联合术前TIMI血流对老年急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI(PPCI)术后无复流的预测价值。方法回顾性分析行PPCI的老年STEMI患者186例;术前高血流(术前TIMI≥1级)70例和低血流(术前TIMI 0级)116例,并依据术后TIMI血流分为无复流组(TIMI≤2级)36例和复流组(TIMI=3级)150例。采用logistic回归分析危险因素。结果无复流组CHA_2DS_2-VASc评分、低血流比例明显高于复流组[(3.97±1.65)分vs(2.53±1.47)分,P=0.000;80.6%vs 58.0%,P=0.012]。CHA_2DS_2-VASc评分联合术前TIMI血流预测无复流的曲线下面积为0.776(95%CI:0.693～0.859,P0.01),低血流患者术后无复流、支架长度、血栓抽吸、术中使用替罗非斑、室性心动过速/心室颤动、起搏器置入比例明显高于高血流患者(P0.05,P0.01)。多因素分析显示,CHA_2DS_2-VASc评分、血小板计数、TC/HDL-C、低血流是术后无复流发生的独立预测因素(P0.05,P0.01)。结论 CHA_2DS_2-VASc评分联合术前TIMI血流预测老年STEMI患者PPCI术后无复流发生更有效。     

血小板-淋巴细胞聚集体和血小板/淋巴细胞比值在预测急诊经皮冠状动脉介入治疗术后心肌无复流中的作用

目的:探讨血小板-淋巴细胞聚集体(PLy A)水平和血小板/淋巴细胞比值(PLR)在预测急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后心肌无复流中的临床价值。方法:共纳入行急诊PCI的STEMI患者93例,PCI术前采集外周静脉血,应用流式细胞仪检测PLy A水平。根据PCI后是否有心肌无复流分为无复流组(n=24)和复流组(n=69)。心肌无复流定义为:在没有解剖性狭窄及血管痉挛的情况下,冠状动脉心肌梗死溶栓治疗临床试验(TIMI)血流分级≤2级。结果:24例(25.8%)STEMI患者急诊PCI术后发生心肌无复流。与复流组相比,无复流组PLy A水平明显升高(P0.05)。多因素Logistic回归分析表明,PLR是心肌无复流发生的独立危险因素(OR=2.28,95%CI:1.15~3.29,P=0.023)。受试者工作特征(ROC)曲线分析表明,当PLR大于118.4%时,PLR预测急诊PCI术后心肌无复流发生的敏感度为69.2%,特异度为63.2%,曲线下面积为0.715(95%CI:0.521~0.908,P=0.042)。结论:PLR可能是一种预测STEMI患者急诊PCI术心肌无复流发生独立而有效的指标。     

术前血小板-白细胞聚集体水平与STEMI患者急诊PCI术后心肌无复流的相关性

目的:研究术前血小板-白细胞聚集体(PLA)水平与ST段抬高型心肌梗死(STEMI)患者急诊介入术后心肌无复流发生风险的关系。方法:共纳入83例行急诊PCI的STEMI患者,PCI术前采集外周静脉血,应用流式细胞仪检测PLA水平。PLA具体分为血小板-中性粒细胞聚集体(PNA)、血小板-单核细胞聚集体(PMA)和血小板-淋巴细胞聚集体(PlyA)。无复流定义为在没有解剖性狭窄及血管痉挛的情况下,冠脉TIMI血流分级≤2或TIMI 3级且心肌呈色分级(MBG)≤2级。结果:共计19例STEMI患者(23%)发生无复流。与复流组相比,无复流组术前PNA(76.5±13.3)和PMA(90.3±5.2)水平显著升高(P0.001)。多因素分析表明血清PNA(OR=1.179,95%CI:1.035~1.342,P=0.013)和PMA(OR=1.248,95%CI:1.040~1.498,P=0.017)是无复流的独立预测因素。受试者工作特征曲线(ROC)表明PNA(AUC=0.881,95%CI:0.809~0.952,P0.001)、PMA(AUC为0.794,95%CI:0.699~0.889,P0.001)对无复流的发生具有重要的预测价值。结论:术前高水平的PNA和PMA可能是急诊PCI术后无复流发生的独立预测因子。     

组蛋白去乙酰化酶3用于急性心肌梗死经皮冠状动脉介入治疗后慢血流或无复流风险评估

目的 探讨术前组蛋白去乙酰化酶3(HDAC3)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后慢血流/无复流风险的评估价值。方法 选取2020年6月至2022年6月在唐山市工人医院接受PCI的AMI患者280例,根据PCI术后心肌灌注分级(TIMI)血流分级分为慢血流/无复流组(TIMI≤Ⅱ级)54例和正常血流组(TIMI>Ⅱ级)226例。比较2组人口学特征、基础疾病、入院时基线资料、术前冠状动脉造影结果及术前实验室指标。采用多因素logistic回归分析确定AMI患者PCI术后慢血流/无复流的影响因素,绘制ROC曲线分析相关指标对慢血流/无复流的预测价值。结果 慢血流/无复流组吸烟史、Killip分级Ⅱ级比例、心率、再灌注时间、血清低密度脂蛋白胆固醇、中性粒细胞计数/淋巴细胞比值(NLR)、D-二聚体及HDAC3水平高于正常血流组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,再灌注时间、NLR、HDAC3是AMI患者PCI术后慢血流/无复流的影响因素(P<0.05,P<0.01)。再灌注时间+NLR预...     

术前负荷量替格瑞洛对急性ST段抬高型心肌梗死急诊介入治疗术中心肌灌注的影响及安全性研究

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术前给予负荷量替格瑞洛对术中心肌灌注的影响及安全性。方法:将12 h内发病并接受急诊PCI的STEMI患者共105例分为替格瑞洛组(58例)和氯吡格雷组(47例)。分别于术前给予替格瑞洛180 mg或氯吡格雷600 mg嚼服。比较两组临床基线情况、PCI术中心肌梗死溶栓治疗临床试验(TIMI)血流分级、校正的TIMI帧数(CTFC)、心肌灌注分级(TMPG)、无复流/慢血流情况。结果:两组临床基线情况差异无统计学意义(P0.05)。两组患者术前TIMI血流分级差异无统计学意义(P0.05)。与氯吡格雷组相比,替格瑞洛组术中梗死相关动脉(IRA)开通后TIMI 3级血流、TMPG 3级患者比例明显增加(分别为94.8%vs 80.9%,89.7%vs 72.3%;P均0.05),CTFC明显改善[(20.0±4.9)帧vs(31.8±3.9)帧,P0.001],无复流/慢血流发生率较氯吡格雷组低(P=0.016),术后6个月出血事件较氯吡格雷组无明显增加(P0.05),主要心血管不良事件减少(P0.05)。结论:在STEMI患者急诊PCI术前给予负荷量的替格瑞洛,可减少术中无复流/慢血流的发生率,改善心肌灌注且较安全,可减少术后主要心血管不良事件发生率。     

重组人尿激酶原在STEMI患者PCI治疗中的应用价值

目的 分析重组人尿激酶原对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后血流灌注的影响.方法 选取148例STEMI患者,均行PCI治疗,对照组冠脉内注射替罗非班;观察组给予重组人尿激酶原+替罗非班,测定两组术后冠脉TIMI血流分级、TIMI心肌灌注分级(TMPG),统计两组无复流发生率;同时测定...     

急性心肌梗死患者白介素17水平与心肌无复流的相关性研究

目的探讨急性心肌梗死患者白介素17(IL-17)与经皮冠状动脉介入(PCI)术后心肌无复流的相关性。方法本研究为前瞻性队列研究。选取2014年1月至2016年1月在海口市人民医院行PCI治疗的106例急性心肌梗死患者,根据PCI术后心肌复流情况分为无复流组(TIMI血流分级≤2级)31例和复流组(TIMI血流分级3级)75例。分别测定患者PCI术前和术后肌钙蛋白I(cTnI)和IL-17的表达水平,超声心动图评估心功能,比较主要不良心血管事件(MACE)发生情况。结果 PCI术后16～18 h时,无复流组IL-17水平显著高于复流组[(58.49±1.52)μg/L比(41.24±3.12)μg/L,P<0.05]。无复流组术后cTnI水平明显高于复流组[(1.34±0.42)μg/L比(0.42±0.13)μg/L,P<0.05]。随访12个月后,无复流组的左心室射血分数明显低于复流组,而左心室收缩末期内径和左心室舒张末期内径均显著大于复流组(均为P<0.05),复流组的MACE事件发生率明显低于无复流组(5.3%比19.3%,P=0.013)。结论 IL-17对急性心肌梗死患者经皮冠状动脉介入术后无复流有一定的预测价值,可作为评估无复流的一个辅助指标。     

老年急诊经皮冠状动脉介入术后无复流的危险因素分析

【】目的：探讨老年急性心肌梗死患者急诊经皮冠状动脉介入(PCI)术后出现无复流的相关危险因素。方法：302例行急诊PCI术的老年急性心肌梗死患者根据PCI术后TIMI血流分级分为无复流组和正常血流组,比较两组患者临床基线资料,造影结果及手术相关资料的差异,应用logistic逐步回归分析老年急诊PCI术后出现无复流的影响因素。结果：老年急诊PCI术后无复流发生率为24.8%(75/302),两组患者间的症状至PCI时间,既往糖尿病人数,术前心功能Killip分级,术前收缩压,术前TIMI血流≤1级人数,病变长度,球囊扩张次数,高血栓负荷人数比较差异有统计学意义(P<0.05)。logistic多元逐步回归分析显示：症状至PCI时间>6h(OR=2.119,P=0.018),高血栓负荷(OR=1.941,P=0.022),术前TIMI血流≤1级(OR=1.718,P=0.009),球囊扩张次数(OR=1.071,P=0.015)是老年急诊PCI术后发生无复流的独立危险因素。结论：可根据老年急性心肌梗死患者临床、造影及手术时的情况来预测急诊PCI术后是否发生无复流现象。     

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     

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.     

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.     

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.     

Communicating with patients with inflammatory bowel disease

Ulcerative colitis and Crohn's disease, the two main forms of inflammatory bowel disease (IBD), are chronic illnesses that affect hundreds of thousands of Americans. Patients with IBD suffer chronically from diarrhea, abdominal pain, gastrointestinal bleeding, malabsorption, and weight loss requiring continuous medical and surgical attention. Despite recent advances in therapy, IBD follows a course of exacerbations and remissions with approximately 25-50% of patients relapsing annually. Hence, these diseases are readily encountered in primary care and gastroenterology clinics. Though medical and surgical treatment options have improved significantly, little has been written about the psychosocial aspects of IBD. Currently, there is a paucity of data concerning effective communication methods enabling physicians to develop stronger rapport with patients suffering from IBD, the care of whom requires a multidisciplinary approach involving primary care physicians, gastroenterologists, and colorectal surgeons. Because IBD has a high morbidity, it is worthwhile to further investigate those social factors that will improve patients' quality of life. In this paper, we summarize some of the common problems that emerge when taking care of patients with IBD and provide initial guidelines based on the world literature regarding the management and education of patients with IBD. Both primary care physicians and specialists (gastroenterologists, colorectal surgeons) need to be aware of the questions and concerns of IBD patients and to be capable of dispensing the information in a clear and concise manner. Using the case scenario format, we review the most common aspects of communication for health care professionals taking care of IBD patients and suggest ways to establish and maintain long-term doctor-patient relationships. The two most significant interventions that dramatically improve quality of life and patient-physician relationships are proper patient education and appropriate treatment of concurrent depression and anxiety. We hope that our review will form a framework by which different members of the medical team learn their roles in the complex management decisions affecting IBD patients.