1例急性心肌梗死合并三尖瓣修补术患者的抗栓治疗及药学监护

目的 探讨急性心梗经皮冠状动脉介入治疗（PCI）支架术后合并三尖瓣修补术患者的抗栓治疗方案。方法 评估患者出血和栓塞风险，查阅相关资料、利用药学专业知识，参与整个治疗过程，为患者制定个体化用药方案。结果 通过实施药学监护，对患者进行用药教育，取得较好的治疗效果。结论 临床药师开展抗栓药物方面的药学监护，可提高患者安全用药水平，为临床合理用药提供参考。     

1例PCI术后并发消化道出血患者的药学监护

摘 要消化道出血为冠状动脉介入治疗（PCI）术后较为常见的出血并发症,它会延长患者住院时间,增加心血管事件的发生率及死亡率,并且由于治疗矛盾可引起支架内血栓,进一步增加患者的死亡率。临床药师对1例PCI术后消化道出血患者实施药学监护,协助医师制定用药方案,针对患者消化道出血后抗栓与止血治疗矛盾及时调整用药方案,通过全程药学监护保障患者药物治疗的有效性和安全性,降低了冠脉血栓形成的风险,成功治愈了患者的消化道出血。     

1例恶性梗阻性黄疸患者围术期营养支持的案例分析

目的 探讨临床药师在恶性梗阻性黄疸患者围术期营养支持中发挥的作用,为营养支持在围术期患者中的临床应用提供参考。方法 临床药师应用营养风险筛查工具对1例恶性梗阻性黄疸患者进行术前营养风险筛查,并制订营养支持计划。根据病情变化,对围术期营养支持方案进行调整,将30%长链脂肪乳剂250 ml调整为20%中/长链脂肪乳剂250 ml,同时加用经口肠内营养补充剂,并对患者实施药学监护。结果 患者于围术期内由肠外营养支持过渡至肠内营养支持,手术创伤恢复较好,无并发症发生,黄疸情况较前改善。结论 临床药师应协助医师制订和调整营养支持方案,加强药学监护,改善患者营养状态。     

颌骨大型囊性病变开窗减压术12例疗效

目的 评价开窗减压术治疗大型颌骨囊性病变的疗效。方法 选取2009年10月至2014年10月行开窗减压术治疗的12例大型颌骨囊性病变患者,术后定期复诊,通过临床检查及影像学资料分析治疗效果。结果 12例患者通过开窗减压术3~18个月后,4例开窗术后囊腔完全消失,未行Ⅱ期手术治疗,8例患者在囊腔明显缩小后,Ⅱ期手术刮除病变,随访期间所有患者均无感染、复发。结论 开窗减压术治疗大型颌骨囊性病变是具有微创、效果良好的优点。     

无痛胃镜下食管胃底静脉曲张套扎术的护理配合

目的 总结无痛胃镜下套扎术治疗食管胃底静脉曲张的护理措施及效果。方法 选取2014年1月至2016年6月于芜湖市第二人民医院行胃镜下套扎术治疗食管胃底静脉曲张患者56例,在围手术期进行全面护理（术前、术中、术后护理）,观察并发症发生情况,评价护理效果。结果 56例患者均术后静脉曲张减轻,出血停止;术中有7例（12.5%）患者出现血氧饱和度下降;术后共有10例（17.8%）患者出现胸骨后疼痛不适,2例（3.5%）患者在术后2周内再次出现少量呕血及黑便,均经对症支持治疗后痊愈;术后无感染、栓塞等并发症出现。结论 胃镜下套扎术围手术期良好的护理配合有利于手术的实施,减少并发症的发生。     

急性心肌梗死患者Gensini评分及PCI术对Tp-Te间期的影响及意义

目的 ①探讨急性心肌梗死患者冠状动脉病变严重程度Gensini评分与Tp-Te间期的关系;②分析冠状动脉介入治疗(PCI)对Tp-Te间期及室性心律失常(VA)的影响。方法 选取174例临床诊断急性心肌梗死患者,其中行PCI术的患者102例为观察组,未行PCI术的患者72例为对照组,计算观察组患者Gensini评分,测量观察组和对照组入院时、治疗后第2天的Tp-Te间期并随访1周内的VA发生情况。结果 ①观察组患者随Gensini评分增加,Tp-Te间期相应增大(相关系数r=0.332,P=0.001),VA的发生率也有所提高。②与入院时比较,观察组和对照组治疗后第2天Tp-Te间期均较前降低(P<0.05),观察组治疗后第2天Tp-Te间期降低更明显(P<0.05)。③观察组1周内VA发生率较对照组降低。结论 Tp-Te间期对急性心肌梗死严重程度具有较好的预测价值,急诊PCI术能显著降低Tp-Te间期,减少VA的发生率。     

围手术期健康教育路径对髋关节置换术患者早期功能锻炼依从性影响

目的 探讨围手术期健康教育路径对髋关节置换术患者早期功能锻炼依从性的影响。方法 选取2015年11月至2017年4月在淮南市第一人民医院行髋关节置换术患者60例,采用随机数字表法分为观察组与对照组,每组30例。对照组围手术期采用骨科一般护理常规,观察组围手术期采用专病规范化设计的健康教育路径,比较两组患者术后早期功能锻炼依从性及术后第2天、第7天及术后1个月髋关节康复水平。结果 观察组患者术后早期功能锻炼依从性优于对照组,差异有统计学意义（P<0.05）。两组患者术后第2天的Harris评分、牛津大学髋关节（OHS）评分差异均无统计学意义（P>0.05）,术后第7天的Harris评分、OHS评分差异有统计学意义（P<0.05）,术后1个月的OHS评分差异无统计学意义（P>0.05）。结论 髋关节置换术患者围手术期采用规范化健康教育路径,能加强患者及家属对疾病的认识,提高患者早期功能锻炼依从性,促进关节功能恢复,能够减少术后卧床并发症发生率,值得临床推广。     

急性冠脉综合征合并慢性肾脏病患者冠状动脉旁路移植术围术期出血与血栓治疗矛盾的平衡管理

目的评价1例急性冠脉综合征合并慢性肾功能不全患者冠状动脉旁路移植术围术期的抗栓治疗方案。方法查阅相关指南及文献综述中急性冠脉综合征合并慢性肾脏病患者冠状动脉旁路移植术围术期治疗不同阶段的抗栓处理方案。结果临床药师参与药物治疗过程,制定了安全有效的抗栓方案。结论应充分评估患者的血栓和出血风险,制定个体化抗栓方案。     

延续性护理对冠脉介入治疗术后患者再发不良心血管事件的影响

目的 探讨延续性护理对冠心病患者行经皮冠状动脉支架植入术（PCI）后再发不良心血管事件的影响。方法 选取2017年3月至2018年9月合肥市第三人民医院心内科收治的冠心病并行PCI术患者100例为研究对象,按照随机数字表法分为对照组与观察组,每组50例。对照组执行常规护理方法,观察组在常规护理方法基础上实施延续性干预护理,比较两组患者1年内发生心血管死亡、不稳定性心绞痛、急性心肌梗死、恶性心律失常、支架内再狭窄等不良心血管事件情况,以及因不良心血管事件的再入院率,两组患者生活质量、护理满意度的差异。结果 观察组PCI术后1年内发生不良心血管事件共5例,其中不稳定性心绞痛4例、心血管死亡1例,这5例患者因发生不良心血管事件再入院4例（8%）,无恶性心律失常、支架内再狭窄、急性心肌梗死等发生。对照组术后1年内发生不良心血管事件共17例,其中不稳定性心绞痛13例、支架内再狭窄2例、急性心肌梗死1例、心血管死亡1例,这17例患者中因发生不良心血管事件再入院16例（34.04%）。两组患者在生活质量、护理满意度方面差异有统计学意义（P<0.05）。结论 冠心病患者行PCI术后1年内实施延续性护理,可降低不稳定性心绞痛、支架内再狭窄等不良心血事件发生率及再入院率,还可提高患者生活质量和护理满意度。     

Solitaire AB支架机械取栓治疗急性脑梗死的围手术期护理体会

目的 总结Solitaire AB支架机械取栓治疗急性脑梗死的围手术期护理经验和方法。方法 回顾分析安徽医科大学附属六安医院神经内科2014年11月至2016年3月收治的33例行Solitaire AB支架机械取栓治疗的急性脑梗死患者临床资料，从术前、术中护理及术后并发症的护理等方面总结护理经验。结果 33例Solitaire AB支架取栓治疗的急性脑梗死患者中，成功开通率为87.88%，4例因开通困难或已超时间窗而放弃治疗，开通病例中并发脑出血率为10.34%（其中术中2例，术后高灌注1例），术中再闭塞率为6.90%，术后再闭塞发生率为6.90%。结论 术前对患者的心理疏导，术中配合医生对患者进行护理，术后对并发症及穿刺点的护理等是Solitaire AB支架机械取栓手术成功的重要保证。     

Triple antithrombotic therapy in patients with atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation

Purpose The efficacy and safety of triple antithrombotic therapy in patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI) with stent implantation are reviewed. Summary A systematic literature search of PubMed, EMBASE, and International Pharmaceutical Abstracts identified a total of 10 cohort studies and one meta-analysis investigating triple antithrombotic therapy in this patient population. With respect to efficacy, evidence from nonrandomized studies supports the superiority of triple antithrombotic therapy over dual antiplatelet therapy at preventing major adverse cardiac events and all-cause mortality. With respect to safety, the heterogeneous methodology and definitions for bleeding in the studies do not allow for easy interpretation and quantification of bleeding risk. There appears to be qualitative consistency that the rate of bleeding is higher with triple antithrombotic therapy compared with dual antiplatelet therapy. The meta-analysis, as well as a recent large registry data cohort study, demonstrated a twofold increase in the risk of major bleeding with triple antithrombotic therapy. Conclusion The heterogeneous methodology of the available studies does not allow for conclusive interpretation and quantification of the efficacy and safety of triple antithrombotic therapy in patients with AF undergoing PCI with stent implantation compared with dual antiplatelet therapy. Evidence from small cohort studies support the benefit of triple antithrombotic therapy at reducing major adverse cardiac events and all-cause mortality with higher rates of bleeding.     

1例瓣膜置换联合冠状动脉旁路移植术后患者抗栓治疗的药学监护

摘 要 目的：探讨临床药师对冠状动脉旁路移植术（CABG）合并瓣膜置换的患者实施药学监护的方法和思路。 方法：临床药师对1例CABG合并瓣膜置换术后的患者进行查房密切观察和药学教育,参与个体化抗栓方案的制定,规范患者用药问题,监测疗效与药品不良反应,给患者提供用药教育。结果：通过药师治疗全过程中细致的药学监护和医嘱干预,确定符合患者特点的抗栓方案,避免不良反应的发生,提高患者治疗的依从性和药物治疗效果。结论：临床药师积极开展药学监护,协同临床医师优化给药方案,有利于患者用药的安全性和有效性。     

一例房颤合并冠心病患者初始抗栓治疗策略及文献复习

目的 探讨房颤伴急性冠脉综合征的抗栓治疗策略。方法 1例46岁房颤合并冠心病的男性患者,房颤卒中风险低危,入院期间未给予抗凝治疗,后出现急性脑梗塞。通过提阅部分指南及文献,分析CHA₂DS₂-VAS_c评分为1分,并伴急性冠脉综合征患者的不同抗栓治疗策略方案及其优劣。结果 文献提示,CHA₂DS₂-VAS_c评分为1分出血低危患者,建议尽早服用抗凝药。双联抗栓（华法林+氯吡格雷）能够有效抗栓并且降低患者出血风险,因此需根据患者的具体情况,尽快将三联调整为双联抗栓（1~3个月内）,保证患者疗效的情况下,降低患者出血风险。结论 临床上遇到相关患者需充分评估患者的出血及血栓风险,制定个体化的抗栓治疗策略。     

冠脉造影及冠脉内支架术前后血浆肌钙蛋白I的变化

目的：研究及评估肌钙蛋白Ｉ（Ｔｎ１）对诊断冠脉内支架及冠造影相关的心肌损伤的作用,并与肌酸激酶同功酶（ＣＫ－ＭＢ）相比较。方法：连续测定１５例冠脉内支架术患者术前,术后,３０分,２４小时,４８小时血浆ＴｎＩ,ＣＫ－ＭＢ及２２例冠脉造影患者血浆ＴｎＩ及ＣＫ－ＭＢ动态变化。     

Rivaroxaban,a new,oral, direct factor Xa inhibitor for thromboprophylaxis after major joint arthroplasty

The new oral, antithrombotic drug rivaroxaban is a direct factor Xa inhibitor, which can restrict thrombin generation both in vitro and in vivo. It has a predictable dose-dependent pharmacokinetic and pharmacodynamic profile and is well tolerated. In patients undergoing total hip or knee arthroplasty, rivaroxaban, 10 mg once daily started 6 – 8 h after the operation, had a significantly better antithrombotic efficacy and a comparable safety when compared with enoxaparin. Furthermore in all studies performed the drug had no adverse influence on the liver function in comparison with enoxaparin. In conclusion, rivaroxaban is a potent and safe new compound for antithrombotic prophylaxis in orthopaedic surgery.     

Optimal duration of antiplatelet therapy in recipients of coronary drug-eluting stents

Four weeks' therapy with clopidogrel, in addition to aspirin (acetylsalicylic acid), is currently standard care after percutaneous coronary intervention (PCI) with stent implantation. The recent availability of drug-eluting stents (DES), which dramatically reduce restenosis at the site of PCI, has again raised the issue of stent thrombosis. In clinical trials, the risk of stent thrombosis appeared unrelated to the presence of the drug eluting from the stent and was documented within the usual range of < or =1% at 9 months after DES implantation. However, these devices feature delayed strut endothelialisation and there are reports describing late DES thrombosis up to 18 months after PCI, in most cases after clopidogrel has been discontinued. Although infrequent after bare-metal stenting (0.4-2.8%), stent thrombosis is a catastrophic event. Before DES availability, adjunctive intravascular brachytherapy significantly reduced in-stent neointimal proliferation, at the price of a higher-than-expected rate of late stent occlusion (6-8%). In such setting, a 12-month aspirin plus clopidogrel regimen showed a beneficial effect on long-term adverse events. An additional consideration is that, among patients undergoing bare-metal stent PCI, combined antithrombotic therapy with aspirin and clopidogrel has been recently associated with favourable effects on cardiovascular outcome beyond stent thrombosis in two large-scale clinical trials. Therefore, we propose that prolonged combination therapy with aspirin and clopidogrel be mandatory up to 1 year after PCI in all patients receiving DES.     

二期翻修术治疗人工全髋关节置换术后感染

目的：探讨二期翻修术治疗人工全髋关节置换术后感染的疗效。方法：回顾性分析12例人工全髋关节置换术（THA）后感染患者,均采用二期翻修术治疗。采用实验室检查、影像学检查、Harris评分评价疗效。结果：12例患者感染控制率为100%,实验室检查及影像学检查满意,Harris评分明显改善。结论：二期翻修术治疗人工全髋关节置换术后感染疗效满意。     

不同助行方式在老年人工全髋关节置换患者中的应用效果

目的 探究不同助行方式在老年人工全髋关节置换患者中的应用效果。方法 选取2015年6月至2016年12月南通大学附属海安人民医院收治的给予框架式助行器辅助的老年人工全髋关节置换患者68例作为对照组，选取2017年1月至2018年5月收治的给予腋式拐杖辅助的老年人工全髋关节置换患者68例作为观察组。在干预6个月后对比两组患者假体下沉位移与松动情况发生率、髋关节功能及生活质量。结果 观察组干预6个月后，假体下沉位移小于对照组，假体松动发生率低于对照组，差异有统计学意义（P<0.05）。观察组干预前后Harris评分、生活质量各维度评分差值均高于对照组，差异有统计学意义（P<0.05）。结论 腋式拐杖辅助方式对改善老年人工全髋关节置换患者预后具有重要意义。     

加味十全大补汤对全髋置换术后隐性失血的影响

目的 研究加味十全大补汤对全髋置换术后患者隐性失血量的影响。方法 选取2013年6月-2015年3月全髋置换患者40例,随机分为2组,实验组20例服用加味十全大补汤,对照组20例不予服用。对比2组总失血量、术中出血量、术后引流量、隐性失血量、术后输血率及术后14 d的并发症。结果 2组病例中总失血量、术后引流量、隐性失血量及术后输血率的差异有统计学意义（P<0.01）,术中出血量差异无统计学意义,2组患者术后均未产生并发症。结论 加味十全大补汤可通过补益气血,纠正患者术后贫血,减少术后隐性失血和输血率,加快恢复情况,并防止重要并发症的发生。     

The effect of spironolactone on the levels of GATA4 protein and hypoxia inducible factor-1α in patients receiving coronary stent implantation

In the present study, we aimed to explore the protective effect of spironolactone on cardiac function in patients undergoing coronary stent implantation by determining the serum levels of GATA4 and hypoxia-inducible factor-1α (HIF-1α) proteins before and after the coronary stent implantation. A total of 134 patients undergoing coronary stent implantation in our hospital from March 2019 to March 2020 were retrospectively selected using the propensity score matching (PSM) method. Of the 134 patients, 67 patients taking spironolactone were used as a test group, and the other 67 patients without taking spironolactone were used as a control group. In all patients, the levels of serum GATA4, HIF-1α, and troponin I proteins were determined before as well as 24 h and 6 months after the coronary stent implantation. Left ventricular ejection fraction (LVEF) and left ventricular systolic global longitudinal strain (GLS) were determined before and 6 months after the coronary stent implantation. There were no significant differences in the HIF-1α level between the two groups before and 6 months after the operation, while the HIF-1α level was significantly lower in the test group compared with the control group at 24 h after the operation (P < 0.01). There were no significant differences in the GATA4 protein level between the two groups before and 24 h after the operation, while the GATA4 protein level was significantly lower in the test group compared with the control group at 6 months after the operation (P < 0.01). There was no significant difference in LVEF between the two groups before and 6 months after the operation. GLS was significantly improved at 6 months after the operation compared with that before the operation in both groups, while GLS was significantly better in the test group compared with the control group at 6 months after the operation (P < 0.01). Collectively, spironolactone could protect cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.