急性冠脉综合征高龄患者PCI术后影响预后危险因素临床分析

目的:分析影响急性冠脉综合征高龄患者PCI术后预后的危险因素。方法:选取3年来我科住院72例接受PCI术的急性冠脉综合征患者,按年龄分为:高龄组,年龄≥75岁,共36例;低龄组,年龄<75岁,共36例。分析高龄患者PCI术后的HbA1c、NT-proBNP、血小板聚集率(PAGR)与随访1年后LVEF、LVEDd值的相关性。比较两组的主要不良心脏事件(MACE),即再梗塞率及死亡率之间的差异。结果:高龄患者的NT-proBNP、PAGR与LVEF值呈负相关关系,相关系数为-0.891和-0.901,与LVEDd值呈正相关关系,相关系数为0.857和0.924。而HbAlc与LVEF、L-VEDd值无明显相关性。两组的MACE(再梗塞率及死亡率)部存在差异性,P值分别为0.0148与0.0254。结论:急性冠脉综合征高龄患者PCI术后MACE较低龄患者发生率高,且心脏功能与NT-proBNP及PAGR有相关性。     

Elevated Glycated Albumin in Serum Is Associated with Adverse Cardiac Outcomes in Patients with Acute Coronary Syndrome Who Underwent Revascularization Therapy

Aims: The associations between increased glycated albumin (GA) in the serum and diabetic complications and mortality have been revealed in the general population. However, less is known regarding the prognostic value of GA in patients diagnosed with acute coronary syndrome (ACS). Methods: In this study, all patients admitted for ACS who underwent a successful percutaneous coronary intervention (PCI) at our center from January 2018 to February 2019 were retrospectively examined. Clinical characteristics, laboratory results (e.g., serum GA levels), and procedural details were collected. The primary outcome included a composite of major adverse cardio-cerebral events (MACCE), such as death, myocardial infarction, stroke, and unplanned revascularization. The association between serum GA levels and clinical outcomes was tested in three multivariable models using Cox proportional hazard analysis. Subgroup analysis was performed in patients who were diagnosed with diabetes versus patients without diabetes. Results: A total of 1,806 ACS patients (mean age of 59.4 years; 77.8% were men; 44.9% were diagnosed with diabetes) were enrolled in this study, where the majority exhibited unstable angina (81.6%) and showed preserved left ventricular systolic function. Patients in the high GA level group were commonly female and were more likely to have metabolic disorders and to exhibit severe CAD (all p ＜0.05). MACCE occurred in 126 patients (7.0%) during a mean follow-up time of 17.2 months. The cumulative risk of MACCE at the 18-month follow-up visit significantly increased in a stepwise fashion along with increased GA levels (log-rank p =0.018) in the serum. The association between serum GA levels and MACCE was further determined after adjusting traditional risk factors and hemoglobin A1c (HbA1c) (GA, per 1% increase: hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.06–1.13; GA, higher vs. lower tertial: HR 1.92, 95% CI 1.01–3.67). In a subgroup analysis, the prognostic role of serum GA only existed in diabetic patients, even when adjusting for traditional risk factors and HbA1c levels. Conclusions: Elevated GA levels in the serum were associated with poor intermediate-term outcomes in low-risk ACS patients who underwent PCI, especially in patients with preexisting diabetes.     

Drainage percutané de l’abcès du psoas: Notre expérience et revue de la littérature. Percutaneous drainage of psoas abscess. Our experience and literature review

IntroductionPsoas abscess is a rare retroperitoneal infection and is often difficult to diagnose. It affects debilitated subjects. The aim of our study is to report our experience with percutaneous minimally-invasive drainage in the treatment of this condition.Patients and methodsWe report on a retrospective series of 22 patients followed at the Urology service, Military Hospital Moulay Ismail in Meknes (Morocco) over a period of seven years from January 2005 to January 2012. All patients underwent percutaneous drainage of the abscess under guidance of ultrasound or CT, together with appropriate antibiotics.ResultsAll patients had constitutional symptoms, 10 (45%) were diabetic. The postoperative course was consistently favorable. Recurrent abscess was noted in two patients (9%) and was favorably treated by percutaneous drainage. Diagnostic, clinical, biological and radiological characteristics of the disease are described.ConclusionPercutaneous drainage is an easy and reliable technique. It is minimally invasive, can be repeated if necessary, and is convenient in generally debilitated patients.     

经皮冠状动脉介入治疗改善高龄冠心病患者生活质量的效果

目的 探讨经皮冠状动脉介入(PCI)对高龄冠心病患者生活质量的影响.方法 行PCI治疗高龄冠心病患者(年龄≥80岁)64例(PCI治疗组),选择同期具有PCI适应证,但因冠状动脉病变复杂、合并其他疾病、有抗凝禁忌证、经济原因或本人意愿等原因而未行PCI高龄冠心病患者93例(单纯药物组)作为对照.出院时、出院后90 d采用中文版简明健康状况调查表(SF-36)评定患者生活质量.结果 两组患者性别、年龄、糖尿病患病率、ST段抬高型心肌梗死比例比较,差异有统计学意义(P＜0.05);其他基础临床资料比较,差异无统计学意义(P＞0.05).统计分析结果显示,用多元协方差分析控制基础临床资料的差异后,出院后90 d PCI治疗组的SF-36总得分及生理职能、躯体疼痛、健康状况得分改善情况优于单纯药物组(P＜0.05).结论 PCI治疗能改善高龄冠心病患者的生活质量.     

超声定位在经皮肾镜取石术中的应用

目的：探讨超声定位在经皮肾镜取石术中的应用效果。方法选取我院2014年1月至2015年3月期间行经皮肾穿刺钬激光碎石术患者215例。所有患者采用超声定位引导下行经皮肾穿刺,建立通道,术中协助处理残余结石。结果所有患者均成功建立经皮肾通道,行钬激光碎石清石,其中1针穿刺成功185例,2针穿刺成功21例,多针穿刺成功9例。一步扩张法建立通道后置入内窥镜行钬激光碎石术,一期结石清除率为75.3%(162/215),二期结石清除率为92.1%(198/215)。术后出现2例继发性出血,经行超选择性肾动脉栓塞后治愈。术后住院时间6~9 d,平均7.5 d。随访全部病例2~12个月,腰部疼痛、血尿等症状均消失,无结石复发。结论超声定位引导下经皮肾穿刺具有使用灵活方便、定位准确、成功率高的优点。其可避开穿刺路径上的脏器及帮助术中寻找结石,但超声较X线直观性差,需要掌握一定的操作技巧才可灵活使用。     

冠心病介入治疗后血管闭合装置Angio-SealTM的临床应用

目的评价在肝素联合强效抗血小板制剂GPⅡb-Ⅲa受体拮抗剂应用的情况下,经皮穿刺冠状动脉介入治疗(PCI)术后使用Angio-SealTM的效果和患者的满意度.方法本组161例患者接受肝素、GPⅡb-Ⅲa受体拮抗剂和常规PCI治疗,其中术后应用Angio-SealTM(A组)105例,Femostop(B组)56例.观察两组术后止血时间、早期行走时间和血管并发症及电话随访出院后48h患者的满意度,并进行统计学分析.结果Angio-SealTM应用成功率为98.1%.两组术后止血时间分别是(1.8±2.2)min和(129±51)min(P＜O.0001);术后早期开始行走时间分别为(6.4±2.3)h和(15.2±4.8)h(P＜0.0001).A组出现2例血肿,均保守治疗;B组分别有3例血肿,2例假性动脉瘤和1例动静脉瘘,其中3例送外科手术;两组总血管并发症的发生率分别为1.9%与10.7%(P＜0.05).术后住院时间分别为(28.2±10.4)h和(58.4±10.2)h(P＜0.0001).出院后48h随访满意度两组分别为93.3%和60.7%(P＜0.001).结论在需要强效抗凝的情况下,PCI术后应用Angio-SealTM在即刻止血、早期行走和缩短住院时间方面均优于传统压迫方法,尤其是能显著降低血管并发症的发生率和提高患者的满意度.     

经皮冠状动脉介入治疗诱导的循环内皮祖细胞变化与动脉硬度的关系分析

目的探讨经皮冠状动脉介入治疗(PCI)诱导的循环内皮祖细胞(cEPCs)变化与动脉硬度和冠状动脉病变严重程度的关系。方法收集稳定性冠心病患者40例,年龄45～60岁,分为试验组:肱踝脉搏波速度(baP-WV>正常+2sd)和对照组(baPWV值<正常+1sd),每组20例。每例患者PCI术中球囊扩张和支架置入时间限制在30min以内。SYNTAX评分评价冠状动脉病变的程度。流式细胞仪计数PCI术前和术后48h CD 3+4/CD 1+33百分比。结果与对照组相比,试验组SYNTAX评分显著增加〔(9.2±13.5)vs(6.8±7.0),P<0.05〕,循环CD3+4/CD1+33细胞变化百分比显著下降〔(0.09±0.04)vs(0.04±0.03),P<0.05〕。SYNTAX评分和baPWV均与PCI诱导的cEPCs变化呈显著负相关。结论 PCI诱导的循环cEPCs水平可能预测冠状动脉病变和全身动脉硬化的严重性。结合动脉硬度和PCI围术期cEPCs的变化可能预测冠心病患者预后。     

Pressure sensors for the monitoring of diseases in surgical care

Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy.     

Auditory Neurotoxicity and Hepatotoxicity After MSMA (Monosodium Methanarsenate) High Dose Oral Intake

Context.?Human butyrylcholinesterase (huBuChE) has potential utility as a post-exposure therapy following percutaneous nerve agent poisoning as there is a slower absorption of agent by this route and hence a later onset of poisoning. Methods.?We used surgically implanted radiotelemetry devices to monitor heart rate, EEG, body temperature and locomotor activity in guinea pigs challenged with VX via the percutaneous route. Results.?Treatment with huBuChE (24.2 mg/kg, i.m.) at 30 or 120 min following percutaneous VX (~2.5 × LD₅₀) protected 9 out of 10 animals from lethality. When i.m. huBuChE administration was delayed until the onset of observable signs of systemic cholinergic poisoning, only one out of six animals survived to 7 days. Survival increased to 50% when the same dose of huBuChE was given intravenously at the onset of signs of poisoning. This dose represents approximately 1/10th the stoichiometric equivalent of the dose of VX administered (0.74 mg/kg). Intramuscular administration of huBuChE (24.2 mg/kg) alone did not produce any changes in heart rate, brain electrical activity, temperature or locomotion compared to saline control. Survival following VX and huBuChE treatment was associated with minimal incapacitation and observable signs of poisoning, and the mitigation or prevention of detrimental physiological changes (e.g. seizure, bradycardia and hypothermia) observed in VX + saline-treated animals. At 7 days, cholinesterase activity in the erythrocytes and most brain areas of guinea pigs that received huBuChE at either 18 h prior to or 30 min following VX was not significantly different from that of naïve, weight-matched control animals. Conclusion.?Percutaneous VX poisoning was successfully treated using post-exposure therapy with huBuChE bioscavenger. The opportunity for post-exposure treatment may have particular relevance in civilian settings, and this is a promising indication for the use of huBuChE.