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101.
102.
Jae Phil Na Kyu Chul Shin Seunghwan Kim Yoo Seok Park Sung Phil Chung In Cheol Park Joon Min Park Min Joung Kim 《Yonsei medical journal》2014,55(3):617-624
Purpose
ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains.Materials and Methods
This was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated.Results
Of the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality.Conclusion
STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary. 相似文献103.
104.
《中国现代医生》2020,58(24):162-165
目的 分析胸痛患者增强检查中增加心理护理措施的临床受益。方法 2019年4~10月收集本院因胸痛行增强检查明确病因的患者123例为观察组,116例患者为对照组。对照组采用常规护理流程,观察组在常规护理基础上增加心理护理措施。比较两组患者前后的状态焦虑量表(State Anxiety inventory,S-AI)得分情况,记录两组患者的人均检查时长、对比剂不良反应发生情况(外渗和过敏反应)、重复穿刺率以及患者满意度。结果 观察组患者自身前后比较S-AI得分差异有显著统计学意义(P0.001)。两组患者采用不同护理措施后比较S-AI得分差异有统计学意义(P0.001)。观察组患者的人均检查时长、重复穿刺率以及对比剂过敏反应发生情况均明显低于对照组,两组患者满意度比较有明显差异(观察组93.50%,对照组72.41%)。结论 胸痛患者增强检查中增加心理护理措施有助于降低患者的紧张焦虑程度,增加患者的配合度,缩短增强检查人均时间,提高患者满意度,为患者安全快速明确病因提供重要保障。 相似文献
105.
106.
目的探讨同侧肺叶切除手术后由于各种原因可能对同侧余肺再次手术切除完成不同期全肺切除与一次性完成全肺切除的临床特点。方法分析本院40年来各种原因以同侧余肺切除完成不同时期全肺切除的患者36例(距第一次肺手术时间1~420个月)。结果全部患者均完成同侧余肺切除,手术后病理检查为余肺结核(31%,11/36),余肺癌(31%,11/36),余肺支气管扩张症(8%,3/36),多发性肺囊肿(8%,3/36),余肺感染、脓肿、坏死等(22%,8/36)。余肺切除后主要并发症有手术后胸腔感染(22%,8/36),支气管胸膜瘘(14%,5/36),严重心血管并发症并导致围手术期死亡(8%,3/36,分别为急性心肌梗死、肺动脉栓塞、恶性心律失常各1例)。结论同侧余肺切除完成不同期全肺切除的主要手术适应证是:①肺结核、肺癌复发;②支气管扩张症残留症状;③治疗肺叶切除术后余肺严重并发症。手术中出血较一般全肺切除多,术后主要并发症是胸腔内感染、支气管胸膜瘘及循环系统并发症。严格手术指征、了解第一次肺手术的全过程、提高手术技巧减少手术中出血、严谨的围手术期处理是余肺切除术取得成功的关键因素,对于同侧余肺切除完成不同期全肺切除如果手术适应证正确,围手术期处理得当,其临床结果是令人满意的。 相似文献
107.
Zhu Zhang Zhen-guo Zhai Li-rong Liang Fang-fang Liu Yuan-hua Yang Chen Wang 《Thrombosis research》2014
Background and Objective
According to US Food and Drugs Administration (FDA), 2 hour recombinant tissue plasminogen activator (rt-PA) 100 mg infusion is recommended for eligible patients with acute pulmonary embolism (PE). However,there exists evidence implying that a lower dosage of rt-PA can be equally effective but potentially safer compared with rt-PA 100 mg regimen. The aim of this systematic review and meta-analysis is to assess the efficacy and safety of low dose rt-PA in the treatment of acute PE.Material and Method
We searched Pubmed, EMBASE, the Cochrane library and CBM Literature Database for randomized controlled trials (RCT) focusing on low dose rt-PA for acute PE. Outcomes were described in terms of changes of image tests and echocardiography, major bleeding events, all-cause death, and recurrence of PE.Results
Five studies (440 patients) were included, three of which compared low dose rt-PA (0.6 mg/kg, maximum 50 mg or 50 mg infusion 2 h) with standard dose (100 mg infusion 2 h). There were more major bleeding events in standard dose rt-PA group than in low dose group (OR 0.33, 95%CI 0.12-0.91;P = 0.94,I2 = 0%), while there were no statistical differences in recurrent PE or all cause mortality between these two groups. Two studies compared low dose (0.6 mg/kg, maximum 50 mg/2 min bolus or 10 mg bolus, ≤ 40 mg/2 h) with heparin. There was no significant difference in major bleeding events (OR 0.73, 95% CI 0.14-3.98;P = 0.72), recurrent PE or all cause mortality. No dose-related heterogeneity was found for all the included studies.Conclusions
The results of this meta-analysis were hypothesis-generating. Based on the limited data, our systematic review suggested that low dose rt-PA had similar efficacy but was safer than standard dose of rt-PA. In addition, compared with heparin, low dose rt-PA didn’t increase the risk of major bleeding for eligible PE patients. 相似文献108.
Tazi Mezalek Zoubida Abderahim Azzouzi Wafaa Bono Rajae Tachinante Mamoun Faroudy Lamiaa Essaadouni Chakib Nejjari 《Thrombosis research》2014
Introduction
No data are available on thromboprophylaxis use in Morocco. Our aim was to characterize patients at risk of venous thromboembolism and assess the rate of appropriate thromboprophylaxis.Materials and Methods
This was a national, observational, multicentre survey of venous thromboembolism risk and thromboprophylaxis use in hospitalized patients. Data were collected on a predefined date in three university hospitals in Morocco using a standardized pre-printed form. Thromboembolic risk was assessed according to the American College of Chest Physicians (ACCP) 2008 guidelines. Patients were classified as “thromboprophylaxis indicated” or “thromboprophylaxis not indicated”.Results
784 patients were analysed: 307 (39.2%) medical and 477 (60.8%) surgical. 421 (53.7%) were female. Medical patients were older than surgical patients (57.6 ± 11.5 vs. 46.2 ± 16.9 years, p < 0.0001) and were more likely to have risk factors for thromboembolism (50.5% vs. 45.7% of patients, p = NS). 57% of patients without contraindications or bleeding risk were at risk of thromboembolism according to ACCP guidelines and thromboprophylaxis was prescribed to 42.8% of these patients. In contrast, 7.4% of patients with no thromboembolic risk also received thromboprophylaxis (proportion agreement: 61.0%; Kappa = 0.296). Over half (54.5%) of medical patients at risk of thromboembolism did not receive thromboprophylaxis whereas 6.3% of those with no risk did receive it (proportion agreement: 76.4%; Kappa = 0.433). These figures were 57.9% and 9.2%, respectively, for surgical patients (proportion agreement: 52.7%; Kappa = 0.191). Thromboprophylaxis was given to 19.2% of patients with contraindications or a bleeding risk.Conclusions
Educational initiatives are imperative to inform doctors about appropriate thromboprophylaxis. 相似文献109.
Adriana Claudia Lunardi Denise de Moraes Paisani Clarice Tanaka Celso Ricardo Fernandes Carvalho 《Respiratory physiology & neurobiology》2013,186(1):40-44
Objective
To evaluate the effect of laparoscopic surgery on pulmonary volume distributions and inspiratory muscles activity. Respiratory consequences associated with postoperative pain were also evaluated.Methods
This study enrolled 20 patients without lung disease performed spirometry and chest wall kinematic analyses (i.e., chest wall, upper and lower ribcage and abdominal volumes), and measured the activity of inspiratory muscular before and 2 days after laparoscopic surgery. Pain was also assessed.Results
After laparoscopy, the patients demonstrated decreased volumes in all three thoracoabdominal compartments: abdomen (ABD), upper and lower rib cage (URC and LRC, respectively) compared with the pre-operative measurements: ABD = 0.38 ± 0.20 L vs. 0.55 ± 0.25 L; URC = 0.45 ± 0.18 L vs. 0.55 ± 0.21 L; and LRC = 0.31 ± 0.18 L vs. 0.41 ± 0.23 L; p < 0.05. A reduction in the inspiratory muscular activity after surgery was also observed (sternocleidomastoid: 10.6 ± 5.1 × 10−3 mV vs. 12.8 ± 6.3 × 10−3 mV; intercostals: 16.8 ± 12.4 × 10−3 mV vs. 25.1 ± 21.3 × 10−3 mV; p < 0.05). In addition, lower volumes during deep breathing were observed in patients who reported significant pain than those who did not (0.51 ± 0.17 L vs. 0.79 ± 0.29 L; p < 0.05, respectively).Conclusion
Laparoscopic surgery reduces chest wall ventilation and inspiratory muscular activity during deep breathing. The effects appear to depend on the patient's reported pain level. 相似文献110.
Haldun Akoglu Ebru Unal Akoglu Serdar Evman Tayfun Akoglu Arzu Denizbasi Altinok Ozlem Guneysel Ozge Ecmel Onur Serkan Emre Eroglu 《Injury》2013