曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

导丝扩张钳法经皮扩张气管切开术在神经外科危重患者中的应用

目的 探讨导丝扩张钳法经皮扩张气管切开术在神经外科危重患者中的应用价值.方法 回顾性分析施行经皮扩张气管切开术的神经外科危重患者96例,其中64例直接经皮气管切开,32例气管插管后转行经皮扩张气管切开术,全部采用Griggs技术导丝扩张钳法(即Potrex法).结果 96例患者手术均顺利完成.术中、术后无严重并发症.89例病情稳定后拔除气管套管,拔管后无气道狭窄梗阻或其他并发症.5例患者拔管前呼吸循环衰竭死亡,2例患者带管自动出院.结论 掌握合适的指征、由有经验的医师操作,导丝扩张钳法经皮扩张气管切开术操作简单、快速、微创、安全,可作为神经外科在紧急情况下需行气管切开的危重患者的首选术式.     

残余肾功能对维持性血液透析患者的影响

残余肾功能对血液透析患者是一个非常有价值的指标,因此进一步提高对血液透析患者残余肾功能的认识,加强对残余肾功能的关注和保护,采取针对性的预防措施,可延缓残余肾功能的降低.     

冠心病患者血浆ET、GMP-140水平及意义

本文对冠心病患者的血浆内皮素 (Endothelin ,ET)及α -颗粒膜蛋白 (GMP - 14 0 )水平进行了检测 ,并就临床意义作了初步分析 ,现报告如下。对象和方法一、对象 :(一 )正常对照组 :30例 (男 17,女 13) ,年龄 35～ 6 3岁 ,平均 4 8 3岁。均为本院职工健康查体者 ,无高血压、心、脑、肾、肝及内分泌疾病。(二 )冠心病组 :32例 (男 18,女 14 ) ,年龄 4 0～ 76岁 ,平均5 9 4岁。均为我院心内科住院病人 ,经临床医师按照诊断标准诊断。二、方法(一 )ET测定 :采用RIA法 ,所有待测对象取静脉血 2ml,注入含 7 5 %EDTA -Na2 30 μl和抑肽酶 4 …     

hs—CRP在急性脑梗死患者动态水平及预后的临床意义

目的：观察超敏C-反应蛋白（hs-CRP）在脑梗死患者的动态水平与其病情预示作用，了解hs-CRP同脑梗死患者病情关系。方法：收集126例脑梗死患者发病后72h内，第（4—7）d和第14d的血清进行超敏免疫比浊法测定hs-CRP。应用美国国立卫生研究院卒中量表（NIHSS）及Barthel指数（BI）记分法测定神经功能缺损评分。结果：脑梗死后72h血清hs-CRP浓度即开始升高，1周左右达高峰，至14d时接近对照组水平，并发多脏器功能衰竭者CRP水平最高。结论：hs—CRP是判断脑梗死病情轻重和预后的特异性指标，适时终止或减轻炎症反应损害，可以降低脑梗死的病死率及并发多脏器衰竭的危险。     

阔韧带妊娠误诊为卵巢肿瘤1例报道

患，38岁，农民，住院号：324107。病人48d前曾因停经70d后阴道流血并流出血性块状物就医，当地医生诊为早孕、不全流产，并予以刮宫治疗；术中刮出蜕膜样组织约30g，出血不多，未见胎盘膜等组织；术后诊为完全流产，流产后阴道无流血。但白带增多，清涕样。1月前，病人在当地计划生育查体时发现尿妊娠试验阳性，到我院行B超检查示：子宫大     

肺唾液腺型肿瘤13例临床病理分析

目的探讨肺唾液腺型肿瘤的临床病理特征、诊断、鉴别诊断及预后。方法回顾性分析13例肺唾液腺肿瘤的临床病理特征及免疫表型,并复习相关文献。结果 13例临床诊断为肺肿瘤行肺切除术或楔形切除术,病理确诊为腺样囊腺癌(adenoid cystic carcinomas,ACC)最多见(6/13,46. 2%),黏液表皮样癌(mucoepidermoid carcinomas,MEC)次之(4/13,30. 8%),多形性腺瘤(pleomorphic adenoma,PA)(2/13,15. 4%)及肌上皮癌少见(1/13,7. 7%)。ACC肿瘤细胞呈筛孔状或小管状排列,由导管细胞和肌上皮细胞构成,导管细胞嗜酸性,形成真性腺腔结构。MEC可见大小不等的囊腔,囊腔衬里细胞由典型的黏液细胞构成,周边中间型细胞胞质透亮。肺肌上皮癌细胞圆形、胞质透亮,由纤维血管间隔分割,可见肿瘤性坏死。肺PA由两种细胞构成,排列成腺管样结构,腔内含红染分泌物,部分区域由梭形细胞构成,束状排列。免疫表型:肿瘤细胞不同程度的表达CK、p63、S-100、SMA等。结论肺原发唾液腺肿瘤非常罕见,诊断需综合临床资料、病理学形态及免疫表型。     

扩大中颅窝底硬膜外入路切除三叉神经鞘瘤

1999年 5月— 2 0 0 0年 8月 ,我院采用扩大中颅窝底硬膜外入路手术切除三叉神经鞘瘤 3例 ,疗效较好 ,报告如下。1　临床资料3例均为女性 ,年龄 35～ 49岁 ,2例因患侧面部麻木 ,咀嚼无力 ,反复发作性面部抽搐就诊 ,1例因头部外伤行颅脑ＣＴ扫描时发现。均行ＭＲＩ检查 ,肿瘤直径 3～ 6ｃｍ ,1例中颅窝型 ,2例哑铃型者骑跨中后颅窝 ,ＭＲＩ显示以岩骨尖为中心 ,巨大哑铃状异常信号影 ,边界清楚 ,信号不均 ,呈等及长Ｔ1长Ｔ2信号。均有三叉神经受损体征。2　手术方法与结果2 .1　手术方法　全麻仰卧位 ,垫高患侧肩部 ,头偏向健侧 ,取患侧额颞…     

高血压病的药物治疗

高血压病是许多心血管病特别是冠心病和脑血管疾病的危险因素,降压治疗对防止和减 少脑卒中、冠心病事件、心力衰竭、肾功能衰竭以及控制高血压病的进一步发展都有明显效 果,并可减少病死率。1 高血压病降压目标近期公布的高血压最佳治疗(Hypertension Optimal Treatment,Hot)试验［1］ 结 果表明,舒张压平均达到82.6 mmHg和收缩压平均达到138.5mmHg时,主要心血管 事件(包括 所有致死或非致死性心肌梗死,所有致死或非致死性脑卒中和所有其他心血管疾病死亡)的 危险性降低最明显,并且降至此血压水平以下时,亦未见主要心血管事件增…     

卵巢过度刺激综合征

<正>卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)是应用促性腺激素和人工合成类激素药物诱导排卵引起的医源性并发症。其严重者有生命危险。随着促排卵药物使用的增加,目前已成为妇产科医生十分关注的问题。