非典型急性心肌梗死的诊断

心肌梗死是严重危害人们生命安全的心血管疾病，典型的心肌梗死根据临床表现、心电图、实验室检查等诊断并不困难，但对非典型急性心肌梗死，则易误诊或漏诊。为提高对非典型急性心肌梗死的认识，本文回顾性分析了我院2000年至2006年50例非典型急性心肌梗死的临床资料，现报告如下：     

非典型急性心肌梗死50例诊断分析

典型的心肌梗死根据临床表现、心电图、实验室检查等，诊断并不难。但对非典型急性心肌梗死，则易误诊或漏诊^[1]。为提高对非典型心肌梗死的认识，本文就我院1994～2003年10年来收治的50例非典型急性心肌梗死病例进行诊断分析。     

非典型急性心肌梗死30例临床分析

急性心肌梗死是常见的危重综合征。一般都有典型症状、体征和心电图表现，但是非典型急性心肌梗死，给诊断带来一定困难，并会延误救治时间。为了提高对非典型心梗表现和特征的认识，并进行有效的诊治，现将我院自1995—2002年共收治的非典型心肌梗死30例报道如下。     

急性心肌梗死患者的心电图表现及临床应用研究

目的 探讨急性心肌梗死的心电图表现以及临床应用价值.方法 选取2014年7月-2015年8月在我院使用心电图进行诊断的78例急性心肌梗死患者,分析急性心肌梗死患者的心电图表现并评价其应用价值.结果 典型急性心肌梗死所占比例为74.35％,与非典型急性心肌梗死所占比例25.64％相比明显较多.ST段抬高是典型急性心肌梗死的心电图主要表现,非ST段抬高是非典型急性心肌梗死的心电图主要表现.结论 心电图在急性心肌梗死的诊断中具有显著的应用价值,对于非典型患者要辅助其他诊断方法进行检查,可以进一步提高临床诊断的准确性.     

非典型急性心肌梗死21例误诊原因分析

目的：加强认识提高诊断准确率避免误诊误治。方法：对21例非典型急性心肌梗死误诊病例进行临床分析。结论：非典型急性心肌梗死因其疼痛不明显或无疼痛,或疼痛的部位、性质等与心绞痛不相符而易引起漏诊或误诊。结论：加强对非典型急性心肌梗死的认识,提高警惕性,提高诊断准确率是避免误诊误治的有效方法。     

老年人非典型急性心肌梗死的临床诊疗分析

目的：探讨、分析老年人非典型急性心肌梗死患者的临床特点和诊治体会。方法：对1999-2004年入院诊疗的60例老年人非典型急性心肌梗死患者的临床资料进行回顾性分析。结果：经临床确诊后立即积极治疗，及时处理合并症，临床治愈41例，好转10例，因合并症死亡9例。结论：对老年人非典型急性心肌梗死患者在初诊时快速作出诊断，积极治疗及时处理合并症，对提高存活率，改善预后具有十分重要意义。     

症状不典型急性心肌梗死的早期诊断

急性心肌梗死（心梗）临床上并不少见，因其病情凶险、病死率高，长期以来一直是急诊内科医师重视的问题。及时、正确的诊断并采取有效的治疗对降低死亡率、改善预后至关重要。典型心肌梗死的诊断并不困难，但非典型心绞痛患者延误诊断亦非罕见。非典型心肌梗死占急性心肌梗死1/6～1/3。     

非典型急性心肌梗死28例误诊反思

急性心肌梗死（AMI）有典型临床表现者仅占70％～80％。一部分AMI患者缺乏典型症状和特征,尤其是首发症状不典型者,早期常延误诊治,非典型急性心肌梗死误诊率高,病死率高。现对1993年10月～2008年10月间28例非典型急性心肌梗死误诊进行反思,分析误诊漏诊原因,以期提高对AMI的诊断水平,减少误诊漏诊。     

不典型心肌梗死19例诊治分析

急性心肌梗死是常见心血管危重症，一直是急诊内科医师在急诊工作中重视的问题，及时正确地诊断并采取有效的治疗对降低病死率，改善预后至关重要。典型心肌梗死表现为胸骨后疼痛，结合心电图诊断并不困难，但非典型心绞痛患者因临床表现形式多样，若警惕性不高，极易引起误诊，延误治疗。在老年急性心肌梗死病例中，非典型者占18．5％，现将在急诊室工作中收集的19例非典型心肌梗死患者诊治情况分析如下。     

非典型直线形小q波有QS波起始部挫折伴正常ST段对急性心肌梗死的诊断价值

近年来，非典型急性心肌梗死的心电图表现越来越多样化，给临床心电图诊断带来一定的困难。本文就3例直线型小q波及QS波起始部挫折伴正常ST-T说明非典型图形对诊断急性心肌梗死的重要意义。     

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…     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.