Directional coronary atherectomy in acute myocardial infarction

Catheter-based intervention with directional coronary atherectomy (DCA) involving the surgical removal of obstructive plaque has been extensively studied in patients exhibiting stable and unstable angina. However, since no studies to date have evaluated the effectiveness of stand alone DCA as a primary treatment in the acute myocardial infarction (MI) setting, we conducted a five-year retrospective study of the early clinical and in-hospital outcomes of patients who underwent DCA within the 72-hour interval following acute MI. Our study included data obtained from a total of 30 acute MI patients treated between 1993 and 1998. Twenty-six of these patients (86%) met the criteria for angiographic success, while 11 (36%) showed less than 50% residual stenosis without the need for supplemental percutaneous transluminal coronary angioplasty (PTCA) or additional treatment for other major complications. Four (13%) of the patients exhibited negative outcomes including post-procedural MI, emergency coronary artery bypass grafting, abrupt vessel closure, hemorrhage necessitating vessel repair and transfusion, and death. Although stand alone DCA is not presently a common treatment, our results suggest it to be an effective and relatively safe procedure for acute MI. However, further studies involving a larger number of patients and a longer follow-up evaluation are needed for comparison of the relative effectiveness of this procedure with other treatments of acute MI.     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年(≥80岁)急性心肌梗死(AMI)患者行急诊与择期经皮冠状动脉介入治疗术(PCI)的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组(AMI组)和非心肌梗死组(对照组),其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者(AMI择期组)和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率(72.2%)低于非急诊组(92.2%),差异有统计学意义(P=0.036)。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义(P<0.001,P=0.039),AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高(P<0.05)。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

梗塞前心绞痛对老年急性心肌梗塞预后的影响

目的：为了研究梗塞前心绞痛（ＡＰ）对老年急性心肌梗塞（ＡＭＩ）预后的影响。方法：作者对１８６例ＡＭＩ患者（老年人１１８例,老年前期６８例）,观察ＡＭＩ前４８ｈ有无ＡＰ发作,分为ＡＰ（＋）和ＡＰ（－）组,分析两组病人的预后。结果：在〈６０岁的ＡＭＩ患者中,梗塞前ＡＰ可降低ＡＭＩ患者１月内充血性心衰（ＣＨＦ）,心源性休克和心源性死亡率;ＣＫ峰值降低,达峰时间缩短;     

Low-dose amiodarone for the prevention of atrial fibrillation after coronary artery bypass grafting in patients older than 70 years

Background Atrial fibrillation （AF） is one of the most common arrhythmia after coronary artery bypass grafting （CABG）, which not only increases the suffering of the patients, but also prolongs hospital stay and enhances cost of care, especially for patients older than 70 years. This study was designed to evaluate the efficacy and safety of low-dose amiodarone in the prevention of AF after CABG, especially for the elderly. Methods Two hundred and ten senile patients undergoing off-pump CABG were included in this prospective, randomized, double-blind and placebo controlled study. Patients were given 10 mg/kg of amiodarone （low-dose amiodarone group, n=100） or placebo （control group, n=110） daily for 7 days before surgery and followed by 200 mg of amiodarone or placebo daily for 10 days postoperatively. Results Postoperative AF occurred in 16 patients （16%） receiving amiodarone and in 36 （37.7%） patients receiving placebo （P=0.006）. AF occurred at （58.13±16.63） hours after CABG in the low-dose amiodarone group and at （45.03±17.40） hours in the control group （P=0.018）. The maximum ventricular rate during AF was significantly slower in the low-dose amiodarone group （（121.42±8.91） beats/min） than in the control group （（134.11±30.57） beats/min, P=0.036）. The duration of AF was （10.92±9.56） hours for the low-dose amiodarone group compared with （14.81±10.37） hours for the control group （P=0.002）. The postoperative left ventricular ejection fraction （LVEF） was significantly improved in the low-dose amiodarone group （from （59.9±10.3）% to （63.4±11.4）%, P=0.001）, and significantly higher compared with the control group （（58.5±10.7）%, P=-0.002）. Both groups had a similar incidence of complication other than rhythm disturbances （12.0% vs 16.4%, P=0.368）. The low-dose amiodarone group patients had shorter hospital stays （（11.8±3.2） days vs （13.8±4.7） days, P=-0.001） and lower cost of care （RMB （79 115±16 673） Yuan vs RMB （84 997±21 587） Yuan, P=0.031） than that of control group patients. The in-hospital mortality was not significantly different between the two groups （1.0% vs 0.9%, P=0.946）. Conclusions Perioperative low-dose oral amiodarone appeared to be cost-effective in the prevention and delay of new-onset postoperative AF in aged patients. It significantly reduced ventricular rate and duration of AF after CABG, decreased hospital cost and stay, as well as promoted the amelioration of left ventricular, systolic function. Furthermore, low-dose amiodarone was safe to use and well tolerated with low toxic and side effects, and did not increase the risk of complications and mortality. It is proved to be a first-line therapy and as routine prophylaxis for AF after CABG, especially for elderly patients complicated with left ventricular dysfunction.     

急性心肌梗死并发心房颤动与冠状动脉病变的相关性

目的: 探讨急性心肌梗死(acute myocardial infarction,AMI)并发心房颤动(房颤)与冠状动脉病变的相关性。方法: 在AMI发病后连续3~7天心电监护中,18例新出现房颤(房颤组),20例无房颤出现(非房颤组)。根据房颤发生的时间将房颤组又分为房颤早发亚组(8例,房颤发生于AMI发病24 h内)和房颤迟发亚组(10例,房颤发生于AMI发病24 h后),比较两组间及两亚组间的冠状动脉造影结果。结果: 房颤组冠状动脉多支病变的发生率较高(P<0.05)。房颤早发亚组梗死相关动脉以右冠状动脉近端阻塞为主,而房颤迟发亚组梗死相关动脉以左冠状动脉前降支阻塞为多(P<0.05)。结论: AMI并发房颤的患者有较严重的冠状动脉病变,房颤出现的时间与梗死相关动脉有关。     

Clinical characteristics of acute ischemic syndrome in China

目的：研究分析中国地区急性心肌缺血综合征病人的临床特点和治疗现状。方法：此项研究为国际多中心关于急性心肌缺血综合征登记经验（OASIS）的一部分。采用填写加拿大心血管合作协会统一设计的病例记录表（CRF）的方法,自1999年4月开始,收集了各中心因急性心肌缺血入院病人的资料,记录了病人主要临床特征和院内事件。结果：共注册急性心肌缺血综合征（包括不稳定心绞痛及非Q波心肌梗死）病人1509例,来自全国范围内34所医院。病人平均年龄62.3岁,其中男性62.2％,就诊时持续胸痛47.8％,心电图异常89.5％,入院诊断不稳定心绞痛91.3％,非Q波心肌梗死8.7％。住院期间溶栓3.3％,冠状动脉造影35.0％,经皮冠状动脉腔内成形术（PTCA）16.8％,冠状动脉旁路移植术（CABG）4.1％,应用硝酸酯制剂96.8％,抗血小板治疗95.5％。院内发生重要并发症18.8％,其中死亡1.2％,主要原因为严重心律失常或猝死。结论：中国地区急性心肌缺血病人以不稳定心绞痛就诊居多。我国病人住院期间PTCA治疗率相对较高,CABG治疗率较低。院内死亡最主要的原因为严重心律失常或猝死。     

中国与澳大利亚心肌梗死患者冠状动脉病变特点的比较研究

目的：比较中国和澳大利亚部分心肌梗死（MI）患者心血管病危险因素和冠状动脉造影（CAG）结果的差异。方法：对中澳两国临床诊断MI的977例患者行选择性CAG检查，并对年龄、性别和CAG结果进行对比分析。结果：中国组CAG阳性（直径狭窄50％以上）550例，占95．16％，澳大利亚组CAG阳性376例，占94．24％，中国和澳大利亚MI患者比较，〈40岁患者2．08％vs6．02％（P〈0．05），男性患者85．6％vs79．7％（P=0．015），高血压、高脂血症患者分别为58．65％vs28．57％和11．59％vs68．42％（P〈0．01），糖尿病患者为17．30％傩16．29％（P〉0．05），3支病变及完全闭塞病变分别为32．87％vs24．31％和45．50％vs32．33％（P〈0．01），两组冠状动脉（CA）病变累及的血管，均依次为左前降支（LAD）、右冠状动脉（RCA）、左回旋支（LCX）和左冠状动脉主干（LM）。中国MI患者70—79岁年龄段发病率最高，为29．58％，澳大利亚人发病年龄段主要集中在50—59岁，为32．08％。结论：与澳大利亚人相比较，中国MI患者年轻人较少，高血压发生率高，高脂血症发生率低，CA病变中以多支病变及完全闭塞更为多见。     

性别差异对急性冠脉综合征患者介入治疗后的影响

目的探讨急性冠脉综合征(ACS)患者经皮冠脉介入治疗(PCI)预后的性别差异。方法比较2004年11月~2005年6月间行PCI治疗的ACS患者(女性61例,男性113例)的临床及冠脉病变特点、即刻手术成功率、住院期间及3个月主要心脏不良事件(MACE)发生率。结果女性组合并高龄、高血压病的比例高于男性组,而主动吸烟、外周血管疾病发生率较低(均P<0.01)。冠脉造影显示,女性组冠脉病变累及前降支者较男性多(50.6%vs36.1%,P<0.05),其他病变两组间未见显著性差异。女性组PCI即刻成功率为93.7%,与男性组(94.1%)无统计学差异(P>0.05)。住院期间MACE发生率两组无显著性差异(11.4%vs8.8%,P>0.05);3个月时MACE发生率女性组高于男性组(39.8%vs21.0%,P<0.05);经多元回归分析校正年龄等因素后,性别不是预测ACS患者PCI治疗临床预后的独立危险因素(P=0.32)。结论ACS患者临床和冠脉病变特征存在性别差异,但性别不是影响ACS患者介入治疗后短期预后的独立危险因素。     

74例老年急性呼吸窘迫综合征肺内和肺外源性因素分析

目的比较老年患者中肺部原因诱发的急性呼吸窘迫综合征（acute respiratory distress syndrome of pulmonary origin,ARDSp）和肺外原因诱发的ARDS（ARDS of extra-pulmonary origin,ARDSexp）临床特征差异性。方法回顾性研究本院2000年1月-2012年6月收治的符合2012年ARDS柏林定义且年龄〉60岁的老年患者临床资料。结果 ARDSp患者以肺炎最多见,占肺部原因的77.6%;ARDSexp最多见的是脓毒症,占43.8%。ARDSp与ARDSexp组入选时APACHEⅡ评分分别为20.4分和20.7分（P=0.898）,肺损伤评分分别为2.7分和2.5分（P=0.385）,序贯性器官功能衰竭（sequential organ failureassessment,SOFA）评分分别为6.1分和8.4分（P=0.013）,住院病死率分别为58.6%及43.8%（P=0.289）。两组主要死亡原因均为多器官功能障碍综合征和严重呼吸衰竭。结论老年ARDS患者中,尽管ARDSexp组器官功能衰竭重于ARDSp组,但两组在APACHEⅡ评分、肺损伤评分、住院病死率以及主要死亡原因等方面无显著差异。     

急性冠脉综合征住院风险评分及其对血运重建的评价

目的 建立中国急性冠脉综合征(ACS)患者住院不良事件的风险评分,评价血运重建对不同风险人群的疗效.方法 收集1501例中国(全球性急性冠脉事件注册研究,GRACE)研究人选患者的基线特征、诊断治疗和住院转归,通过多因素Logistic回归方法建立住院风险评分,并进行验证.以敏感度、特异度均接近70%为截点,评价血运重建对不同风险评分患者预后的影响.结果 (1)6个危险因素进入风险评分模型:包括年龄、收缩压、舒张压、心功能Killip分级、入院时心脏骤停、心电图ST段偏移;(2)拟和优度检验值为0.673,c检验为0.776;(3)将入选的1301例患者分为高风险组和低风险组(风险评分>5.5分、≤5.5分)组,血运重建明显降低ST段抬高心肌梗死患者(STEMI)[OR(95%CI)=0.32(0.11,0.94),x2=5.39,P=0.02]和非ST段抬高ACS患者(NSTEACS)[0R(95%CI)=0.32(0.06,0.94),x2=4.17,P=0.04]高风险组住院不良事件发生率,但是高风险组血运重建率均低于低风险组(STEMI:61.7%、78.3%,P=0.000;NSTEACS:42.0%、62.3%,P=0.000).结论 风险评分能够在入院早期定量预测ACS个体住院不良事件发生率,高风险组血运重建获益最大.     

Mitral isthmus ablation in patients with prosthetic mitral valves

Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mitral valves （MVs） was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs Methods Patients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium （LA） mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan. Results During the study period, a consecutive of 19 patients （male/female=12/7, mean age of （48±6） years） with prosthetic MVs （16 with metal valves, 3 with biologic valves） entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages （（2.0±1.0） vs. （3.1±1.3） mV, P=-0.002）, more fragmented potentials （19/19 vs. 20/15, P 〈0.001 ）, and higher impedance （（132±34） vs. （110±20） Ω, P=0.004）. After initial ablation, more residual gaps along the MI lesions were found in study group （2.4±0.4 vs. 1.7±0.3, P 〈0.001）. The mean length of MI （（6.2±3.3） vs. （7.1±2.3） cm, P=-0.25） was comparable between 2 groups, but the MI in study group was much thicker （（3.1±1.8） vs. （2.1±1.07） cm, P=0.01） and all were found as pouch type （19/19 vs. 2/35, P 〈0.001）. The follow-up results were comparable （65.1% vs. 72.3%, P=-0.30）. Conclusion For patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.     

合并阵发性心房颤动的急性缺血性脑卒中患者临床特征及预后研究

目的 探讨合并阵发性房颤的急性缺血性脑卒中患者的临床特征及预后情况。 方法 前瞻性收集2017年1—12月在哈尔滨医科大学附属第一医院卒中病房治疗的731例急性缺血性脑卒中患者的基本信息。根据患者的疾病史、入院心电图检查、住院期间心电监测确定有无房颤及类型。随访出院结局和3个月预后。将合并阵发性房颤组分别与无房颤组及合并持续性房颤组对比临床特征及预后。 结果 ①合并阵发性房颤与无房颤的患者相比，入院时神经功能受损更严重(P<0.001)，患者严重神经功能受损比例更高(P=0.002)。合并心力衰竭、冠心病、心肌梗死、肾功能异常的比例更高(均P<0.05)。合并阵发性房颤是出院结局及出院3个月预后的危险因素，OR(95%CI)为2.190(1.111，4.316)、3.399(1.701，6.791)。②合并阵发性房颤与合并持续性房颤的患者相比，患心脏瓣膜性疾病的比例更低(P<0.001)，住院期间病情明显缓解比例更高(P=0.017)。 结论 合并阵发性房颤相比无房颤患者起病时病情重、伴发疾病更多；相比于持续性房颤患者，仅心脏瓣膜性疾病比例更低；相比于无房颤患者，合并阵发性房颤是急性缺血性脑卒中患者出院结局及3个月预后不良的危险因素。      

Outcomes of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction in patients aged over 75 years

Background The optimal reperfusion strategy in elderly patients with ST-elevation myocardial infarction （STEMI） remains unclear. The purpose of this study was to evaluate the safety, in-hospital and one-year clinical outcomes for patients 〉75 years of age with STEMI receiving primary percutaneous coronary intervention （PCI）, compared with those treated by conservative approach. Methods One hundred and two patients 〉75 years of age with STEMI presented 〈12 hours were randomly allocated to primary PCI （n=50） or conservative therapy only （n=52）. The baseline characteristics, in-hospital outcome and major adverse cardiac events （MACE）, including death, non-fatal myocardial infarction and target vessel revascularization at one-year clinical follow-up were compared between the two groups. Results Age, gender distribution, risk factors for coronary artery disease, infarct site and clinical functional status were similar between the two groups, but the patients in primary PCI group received less low-molecular- weight heparin during hospitalization. Compared with conservative group, the patients in primary PCI group had significantly lower occurrence rate of re-infarction and death and shortened hospital stay. The composite endpoint for in-hospital survivals at 30-day follow-up was similar between the two groups, but one-year MACE rate was significantly lower in the primary PCI group （21.3% and 45.2%, P=0.029）. Left ventricular ejection fraction was not significantly changed in both groups during follow-up. Multivariate analysis revealed that primary PCI （OR=0.34, 95% CI： 0.21-0.69, P =0.03） improved MACE-free survival rate for STEMI patients aged 〉 75 years. Conclusion Our results indicated that primary PCI was safe and effective in reducing in-hospital mortality and one-year MACE rate for elderly patients with STEMI.     

新疆某三甲医院329例急性中毒患者流行病学调查

目的：分析某三甲医院院内急性中毒的流行病学特点。方法收集2009-2014年新疆医科大学第一附属医院急救中心收治的329例急性中毒住院患者的临床资料，采用回顾性研究方法，对年龄、性别、民族、中毒谱、中毒季节、发病时间和预后进行分析。结果329例急性中毒住院患者中，男女比例为1.08：1，主要分布于20~50岁这个年龄段，男性与女性急性中毒类型构成比差异有统计学意义(χ2=17.00，P<0.01)。急性中毒以汉族居多，其次为维吾尔族与回族，其他民族所占比例较少。中毒谱构成比差异有统计学意义(χ2=506.35，P<0.01)，其中农药中毒最多，其次为食物中毒，第三位的为气体中毒。季节构成比差异有统计学意义(χ2=330.78，P<0.01)，其中以夏季最多。死亡6例，其中农药中毒5例，药物中毒1例。结论急性中毒为急诊科常见疾病，在发病早期得不到准确的诊断及有效的治疗，常可危及患者生命。本文反映了我院急诊科收治的急性中毒谱，在一定程度上反映了地域性中毒特点，具有一定的临床意义。     

急性心肌梗死后新发心房颤动的临床特征及其对预后的影响

目的探讨急性心肌梗死患者急性期新发心房颤动（以下简称房颤）对患者预后的影响。方法回顾性分析2017年7月—2019年1月在上海市浦东新区公利医院住院并接受冠状动脉介入治疗的急性心肌梗死患者。根据急性期是否发作房颤分为房颤组（n=25）和非房颤组（n=168）,比较两组的临床特征以及预后。随访终点为心血管不良事件,包括心源性死亡,再发非致死性心肌梗死,非计划性血运重建,因心肌缺血症状再次住院,缺血性脑卒中及心力衰竭。结果房颤组患者较非房颤组年龄更大（P<0.001）、男性及吸烟比例更高（P=0.018,P=0.006）,且中性粒细胞百分比、超敏C反应蛋白、脑利钠肽前体水平更高（P=0.006,P<0.001,P<0.001）,发病至接受冠脉介入治疗时间更长（P=0.035）,而使用替罗非班药物比例、Killip分级水平更低（P=0.022,P=0.012）。Kaplan-Meier生存曲线发现房颤组较非房颤组发生心血管不良事件的时间更短（P<0.001）,Cox回归分析显示急性心肌梗死患者急性期新发房颤与患者发生心血不良事件相关（P=0.017）。结论急性心肌梗死患者急性期新发房颤是发生心血管不良事件的独立危险因素。     

Predictors of atrial fibrillation after coronary artery bypass graft surgery

Objective To identify the clinical predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).Methods 322 consecutive patients who had undergone isolated CABG were reviewed. Preoperative, intraoperative and postoperative data were collected. Patients were grouped according to whether AF appeared postoperatively.Results AF occurred in 75 patients (23.3%). Most cases of AF (85.6%) appeared on or before the third postoperative day. The mean age for patients with AF was 62.5 years compared with 56.7 years for patients without AF ( P &lt;0.05). The mean aortic crossclamp time for patients with AF was 67 min compared with 60.3 min for patients without AF ( P &lt;0.05). The mean duration of cardiopulmonary bypass for patients with AF was 109.6 min compared with 97.3 min for patients without AF ( P &lt;0.05). The mean duration of mechanical ventilation for patients with AF was 19.1 h compared with 15.7h for patients without AF ( P &lt;0.05). Multivariate logistic regression analysis was used to identify the following independent predictors of postoperative AF ( P &lt;0.05): age≥65 years (OR 2.7; 95% CI 1.5 to 5.1), lesions in the right coronary artery (OR 2.5; 95% CI 1.4 to 4.5), and early postoperative withdrawal of β blocker (OR 3.9; 95% CI 2.1 to 7.7).Conclusions AF remains the most common complication after CABG. Age and lesions in the right coronary artery can influence the incidence of AF, and β blocker and magnesium may be the most economical and effective prevention for AF early after CABG.     

血栓抽吸对直接经皮冠状动脉介入治疗预后的影响

目的 观察血栓抽吸在经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者中应用的即刻及住院期间疗效. 方法 选择2007年12月至2008年11月因AMI住院行直接PCI术并于术中应用了血栓抽吸导管的患者共202例为抽吸组,而直接PCI术中未应用抽吸导管的148例患者作为对照组,比较两组术中术后并发症及住院期间临床事件的发生率. 结果 两组在年龄、性别、易患因素、病变部位及入院时的左室射血分数、IRA的分布、病变血管支数、手术操作时间等基线资料方面差异均无统计学意义,具有可比性.而抽吸组在就诊距血管再通时间[(79±12)min vs(83±15)min,P=0.007]、PCI术后无复流/慢血流(3.5%vs 8.8%,P=0.038)、急性、亚急性支架内血栓(0.5%v8 4.7%,P=0.011)、住院期间心衰(11.4%v8 19.6%,P=0.035)、再次AMI(1.0%vs6.1%,P=0.010)、病死率(3.5%v8 8.8%,P=0.038)、住院时间[(6.9±1.5)d vs(7.3±1.8)d,P=0.028]、心肌酶达峰时间[(12.8±2.2)h vs(13.3±1.9)h,P=0.023]较对照组显著减少,TnI峰值[(44.7±31.2)μg/L vs(51.9±33.6)μg/L,P=0.041]及CK-MB峰值[(152.0±73.6)U/Lvs(171.0±71.2)U/L,P=0.015]明显低于对照组,直接支架置入率(44.1%vs 24.3%,P=0.002)及术后达TIMI3级血流(90.1%vs 81.8%,P=0.027)、即刻心电图的ST段回落率(67.8%vs53.4%,P=0.008)则显著高于对照组,两组之间差异有统计学意义. 结论 直接PCI过程中应用血栓抽吸可减少PCI术中术后并发症,缩短住院期间及改善预后.     

西安地区伴吞咽障碍老年急性脑梗死患者的临床特征及对住院结局的影响

目的探讨西安地区伴吞咽障碍老年急性脑梗死患者的临床特征以及吞咽障碍对院内结局的影响。 方法通过西安卒中登记研究,纳入西安市4所三级甲等医院收治的1 116例老年急性脑梗死患者,根据入院24 h内洼田饮水试验评分分为吞咽良好组（1~2级）1 004例和吞咽障碍组（3~5级）112例,比较分析2组的基线临床特征。采用多因素Logistic回归模型分析发生吞咽障碍对老年急性脑梗死患者院内结局（卒中相关性肺炎、肠外营养和预后不良）的影响。 结果与吞咽良好组相比,吞咽障碍组患者的年龄较大,心房颤动比例、入院美国国立卫生研究院卒中量表评分、入院48 h不能行走比例较高,入院心率和空腹血糖、血尿素氮、白细胞计数水平较高（P＜0.05）。吞咽障碍组院内卒中相关性肺炎发生率、肠外营养率以及预后不良率均高于吞咽良好组（26.8% vs. 4.0%,11.6% vs. 1.9%,46.4% vs. 17.8%,P＜0.001）。校正相关混杂因素后,多因素Logistic回归分析显示,发生吞咽障碍的老年急性脑梗死患者院内卒中相关性肺炎风险（OR=3.835,95%CI：2.005~7.335,P＜0.001）及肠外营养概率（OR=4.909,95%CI： 1.991~12.102,P＜0.001）显著升高。 结论西安地区伴吞咽障碍老年急性脑梗死患者院内卒中相关性肺炎风险和肠外营养概率显著升高,需引起临床医师关注和早期应对。     

连续性血液净化预防造影剂肾病的疗效观察

目的 探讨在原有肾功能不全的病人中造影后立即给予预防性血液透析滤过能否预防造影剂肾病的发生。方法 对我院1998～2003年46例有肾功能不全的病人使用造影剂(碘普罗胺)行造影后(CT、IVP、冠脉造影)进行分析。46例病人分为两组，其中一组(20例)给予常规治疗，另一组(26例)于造影后立即给予12～16h持续性静脉-静脉血液透析滤过(CVVHDF)，单次治疗，分析此两组病人造影后的肾功能的变化、需要暂时肾替代治疗的频率、造影临床相关事件(肺水肿、心肌梗死、休克)的发生率以及患者住院期间的病死率。结果 常规治疗组造影剂肾病发生率9／20(45％)，而HDF组造影肾病发生率为2／26(8％)(P＜0．01)，常规治疗组需暂时肾替代治疗(血透或血滤)的发生率为7／20(35％)，而HDF组需暂时肾替代治疗的发生率为1／26(4％)(P＜0．05)，常规治疗组造影临床相关事件(肺水肿、心肌梗死、休克)的发生率为9／20(45％)，HDF组为1／26(4％)(P＜0.01)，常规治疗组住院病死率为3／20(15％)，而HDF组住院病死率为1／26(4％)(P＜0．05)。结论 对于原有肾功能不全的病人在给予X线造影后立即给予预防性血液透析滤过可以有效地阻止造影剂对肾功能的损害，并可明显改善患者的预后。     

Embolic events in 93 elderly Chinese patients with atrial fibrillation

Objectives To evaluate the prevalence of embolic events and relevant factors in elderly Chinese patients with atrial fibrillation(AF), and to provide evidence on ways to prevent embolic events.Methods Autopsy data from ninety-three continous elderly Chinese patients with AF were analysed. The incidence of embolic events and its relationship to underlying disease, pathologic changes in the heart, and other clinical characteristics were examined.Results Embolism were observed in 27 of 93 cases, with an incidence of 29.03%. The incidence of embolic events was higher in elderly patients with rheumatic heart disease than those with coronary artery disease, hypertensive myocardiopathy and heart diseases. Patients with chronic AF,with a course of AF≥3 years, and those with heart failure or diabetes had a higher incidence of embolic events than those without these complications. There was significant difference in incidence between paroxysmal and chronic AF. Patients with left atrial or ventricular enlargement, mural thrombosis in cardiac chambers, valvular calcification and valvular vegetation also had a higher incidence of embolic events. Oral dipyridamole (75-150 mg/d) or aspirin (50-150 mg/d) showed no definite effects in preventing embolism in some patients.Conclusions There was a high incidence of embolic events in elderly Chinese patients with AF. Anticoagulation therapy should be provided to the elderly patients with AF, especially to the patients with risk factors for embolism.