益气活血方治疗冠心病不稳定型心绞痛临床研究

目的:探讨益气活血方治疗冠心病不稳定型心绞痛血瘀证疗效及对患者血清可溶性细胞间黏附分子1(sICAM-1)、内皮素(ET)、一氧化氮(NO)的影响。方法:选择104例冠心病不稳定型心绞痛血瘀证患者为研究对象,随机分为对照组和观察组各52例。对照组采用常规方案治疗,观察组在对照组的基础上采用益气活血方治疗,两组均治疗4周。观察两组治疗前后中医症候评分、血清sICAM-1、ET、NO水平,比较两组硝酸甘油停减率、心电图改善情况、中医症候疗效以及治疗期间不良反应发生情况。结果:两组患者治疗后血瘀证中医症状评分、血清sICAM-1、ET水平均降低(P<0.05),且观察组更低(P<0.05); 观察组硝酸甘油停减率比对照组高(88.46%与69.23%,P<0.05); 两组心电图改善总有效率相近(P>0.05); 两组治疗后血清NO水平均升高(P<0.05),且观察组更高(P<0.05); 观察组中医症候总有效率比对照组高(90.38%与75.00%,P<0.05); 两组治疗期间不良反应发生率相近(P>0.05)。结论:益气活血方联合常规方案治疗冠心病不稳定型心绞痛血瘀证患者,可改善患者的临床症状,疗效显著,提高硝酸甘油停减率,改善血管内皮功能。     

Volar locking plate: Age related outcomes and complications

BackgroundThere is no unanimity for the treatment of distal radius fractures in older people. The purpose of our study is to assess the efficacy of volar locking plate for the treatment of unstable distal radius fractures in older independent individuals.MethodsA retrospective comparative study of 105 patients. 58 patients were below the age of 55 years and 47 above the age of 55 years. Mean follow-up was 18.4 months in patients below the age of 55 years and 18.1 months above the age of 55 years. Wrist movements, complications, reoperations, grip strength, Visual Analogue Score (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH) score, and Mayo wrist score were analysed.ResultsThere was no statistical difference in the wrist movements, grip strength, complications, reoperations, VAS, QuickDASH and Mayo scores. Mean grip strength under 55 was 84.1 and above 55 was 84.5 (p = 0.87). The complication rate was 19.1% above 55 years of age and 17.2% below the age of 55years (p = 0.79). The reoperation rate above 55 years was 8.5% and below 55 years was 8.6% (p = 0.50). Mean VAS under 55 years of age was 1.6 and above 55 years was 1.7 (p = 0.58). Mean Mayo score in under 55 was 80.7 and 80.1 in above 55 (p = 0.78). Mean Quick DASH score under 55 was 20.9 and above 55 was 21.0 (p = 0.97).ConclusionOur results indicate that outcomes in older independent patients are satisfactory with a comparable complication and reoperation rate with younger individuals. We conclude that a volar locking plate is a favourable modality for the treatment of unstable distal radius fractures in older patients.     

Use of INFIX for managing unstable anterior pelvic ring injuries: A systematic review

IntroductionSubcutaneous screw rod system which is popularly known as Pelvic internal fixator (INFIX) has emerged as an alternative to external fixators in management of unstable pelvic injuries. INFIX has shown various advantages over external fixation such as reduced infection rate and patient morbidity. However, it has its own set of complications such as lateral femoral cutaneous nerve injury, heterotopic ossification, femoral nerve palsy etc. We intended to conduct a systematic review of the current literature to assess outcomes and complications with INFIX technique of fixation.MethodsA comprehensive search of literature was performed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and online database of EMBASE, PubMed, Medline and Scopus was searched for all studies in English language till March 2020. Included studies were reviewed for demographic data, fracture type/classification, radiological outcome and functional outcomes. The inclusion criteria were: 1. Studies in English language 2. Clinical studies reporting use of INFIX technique in pelvis fracture where clinical and radiological outcomes were reported.ResultsTwenty-two studies fulfilling inclusion and exclusion criteria were included in this systematic review with total of 619 patients. Radiographic parameters and outcome measures were infrequently reported. Fixation with INFIX in these fractures leads to 87% excellent to good radiological results and 84% excellent to good functional results. Complications include lateral femoral cutaneous nerve irritation (25.3%), heterotopic ossification (24.7%), infection (3%), and femoral nerve palsy (1.6%); which is likely related to placing the bar and screws too deep.ConclusionThis analysis supports the use of INFIX in management of unstable pelvis fractures where anterior fixation is required.     

银杏达莫注射液治疗冠心病不稳定心绞痛的效果观察

目的探讨银杏达莫注射液治疗冠心病不稳定型心绞痛治疗效果及应用价值。方法选择我院治疗的冠心病不稳定心绞痛患者118例作为研究对象,采取数字表法将患者分为两组,每组各59例,对照组给予西医常规治疗,观察组在对照组基础上给予银杏达莫治疗,观察两组治疗情况。结果观察组治疗总有效率高于对照组,组间对比,差异有统计学意义(P<0.05)。观察组患者血脂改善幅度优于对照组,组间对比,差异有统计学意义(P<0.05)。结论银杏达莫注射液治疗冠心病不稳定心绞痛疗效可靠,能够有效降低患者血脂水平,值得在临床上大力推广使用。     

丹参多酚酸盐对老年不稳定型心绞痛患者血液流变学及内皮功能的影响

目的 探讨丹参多酚酸盐对老年不稳定型心绞痛患者血液流变学及内皮功能的影响.方法 将我院收治的老年不稳定型心绞痛患者84例随机分为观察组和对照组,每组42例,两组均给予常规治疗,观察组在此基础上给予丹参多酚酸盐注射液200 mg/d,静脉滴注,疗程为2周.治疗前后测定患者血液流变学、血清一氧化氮（NO）、内皮素（ET）水平.结果 观察组总有效率为95.24%,对照组总有效率为80.95%.治疗后两组全血低切粘度、全血中切粘度、全血高切粘度、血浆粘度、红细胞聚集指数均有所降低,与治疗前比较差异有统计学意义（P〈0.05）,观察组上述指标明显优于对照组（P〈0.05）.治疗前两组血清NO与ET水平比较差异无统计学意义（P〉0.05）,治疗后两组患者血清NO明显升高,ET水平明显降低,与治疗前比较差异有统计学意义（P〈0.05）,观察组上述指标改善明显优于对照组（P〈0.05）.结论 丹参多酚酸盐可以有效地改善老年不稳定型心绞痛患者血液流变学和血管内皮功能,提高治疗效果.     

NT-proBNP对基层不稳定型心绞痛患者危险分层的价值

目的观察NT-proBNP对基层不稳定型心绞痛(UA)患者危险分层的价值。方法选择60例UA患者,检测血浆NT-proBNP与cTnI浓度,同时观察心电图ST段压低数值,并根据Gensini法进行冠状动脉病变积分计算。结果 60例患者中低危患者40例,高危患者20例。低危与高危患者血浆NT-proBNP浓度、ST段压低程度、cTnI浓度以及Gensini积分差异均有显著性(P<0.05)。将患者分为NT-proBNP>1 219 pg/mL组与≤1 219 pg/mL组,两组患者cTnI浓度、ST段压低程度与Gensini积分差异均有显著性(P<0.05)。此外,NT-proBNP与ST段压低程度、cTnI浓度与Gensini积分存在明显正相关(P<0.05)。结论 NT-proBNP能够作为UA患者早期危险分层的重要指标,对临床治疗有指导意义。     

老年患者高同型半胱氨酸高血压与不稳定型心绞痛的关系研究

目的探讨老年患者高同型半胱氨酸（HcY）高血压（H型高血压）与不稳定型心绞痛（UA）的相关性。方法选择2011年1o月～2013年4月我院心内科收治的原发性高血压合并心绞痛的老年患者210例,根据HcY水平将其分为H型高血压组（n=103例）和单纯高血压组（n=107例）,所有患者均进行冠状动脉造影检查,HcY水平通过酶法测定,比较两组患者血清HgY水平的差异。结果H型高血压组不稳定型心绞痛的发生率为46．6％,高敏C反应蛋白（hsCRP）水平为（4．4±1．9）μg／L,冠状动脉病变积分为（45．3±20．1）,显著高于单纯高血压组患者uA发生率25．2％,hSCRP水平（2．1±1．8）和冠状动脉病变积分（31．5±17．6）,且差异有统计学意义。H型高血压组中,UA和稳定型心绞痛（SA）血清Hcy水平差异有统计学意义;单纯高血压组中,UA与SA比较,血清Hcy和总胆固醇水平差异有统计学意义,老年患者H型高血压是老年UA的独立危险因素。结论老年患者H型高血压与UA密切相关,在老年患者uA的发病和治疗中,既要控制患者血压,又要控制血清Hey水平。     

阿托伐他汀与瑞舒伐他汀分别联合波立维治疗不稳定型心绞痛的疗效观察

目的：对比观察阿托伐他汀与瑞舒伐他汀分别联合波立维（硫酸氢氯吡格雷）治疗不稳定型心绞痛的疗效。方法将122例不稳定型心绞痛患者随机分为研究组和对照组各61例。研究组采用阿托伐他汀联合波立维治疗,对照组采用瑞舒伐他汀联合波立维治疗。比较2组临床疗效、心电图改善和不良反应发生率。结果2组临床疗效、心电图改善情况、不良反应比较差异均无统计学意义（P＞0．05）。结论阿托伐他汀联合波立维与瑞舒伐他汀联合波立维治疗不稳定型心绞痛均能够有效改善患者的症状,临床疗效较好,不良反应率低,安全有效,值得临床推广和应用。     

通心络对不稳定型心绞痛患者血管内皮功能的影响

目的观察通心络对不稳定型心绞痛患者血浆内皮素（ET）和一氧化氮（NO）含量的影响。方法将119例不稳定型心绞痛患者随机分为两组,常规治疗59例作为对照组,同时加服通心络胶囊的60例患者为治疗组,分别在住院和治疗后3个月检测ET和NO。采用高分辨率超声法检测肱动脉血流介导的内皮依赖性血管舒张功能（FMD）。结果与治疗前相比,两组治疗前后ET水平均明显下降（P〈0．01）,NO均明显升高（P〈0．01）;通心络组较对照组ET水平下降（P〈0．05）,NO和FMD水平升高（P〈0．01）。结论通心络可通过抗凝、降脂、减少黏附分子、降低ET、提高NO水平等途径改善血管内皮功能,保护微血管的完整性。     

Prognostic significance of multiple-detector computed tomography in conjunction with TIMI risk score for patients with non-ST elevation acute coronary syndrome

Risk stratification among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) has been made by clinical scoring. Recently, multiple-detector computed tomography (MDCT) appeared to provide noninvasive coronary angiography (CAG). To clarify the prognostic significance of MDCT, we aimed to evaluate the clinical utility of MDCT in the early management and in predicting the long-term prognosis of NSTE-ACS with low to intermediate risk. Among 84 consecutive patients with NSTEACS, risk stratification using a TIMI risk score was done. A total of 48 patients were categorized as low to intermediate risk. Multiple-detector CT was performed in 30 patients using 16-slice MDCT. MDCT detected coronary stenoses in 18 patients. Compared to invasive CAG, MDCT successfully depicted the coronary stenosis (P < 0.005), with sensitivity of 100% and specificity of 86%. The incidence of in-hospital major adverse clinical events (death, subsequent myocardial infarction, revascularization) was significantly higher in patients with a positive MDCT than in those with a negative MDCT test (44% vs 0%, P < 0.005). Moreover, a Kaplan-Meier analysis showed a significant difference in the event — free survival between MDCT positive and negative groups (33% vs 100%, respectively, P < 0.0001) during the mean follow-up period of 9.9 ± 7.5 months. Sixteen-slice MDCT in conjunction with a TIMI risk score appeared to demonstrate prognostic significance in patients with NSTE-ACS.