冠状静脉解剖变异对左心室电极置入成功率的影响

目的 了解冠状静脉解剖形态的改变,为成功置入左心室电极提供依据.方法 128例患者,男101例,平均年龄(63.5 ±10.6)岁.其中缺血性心肌病(IHD)41例,均经冠状动脉造影诊断(狭窄≥50%),非缺血性心肌病(NIHD)87例.结果 127例完成冠状静脉造影,1例冠状窦插管失败;123例(96.09%)经静脉将左心室起搏电极导线送至心脏静脉的分支.心侧静脉及心后侧静脉异常(细小、狭窄、扭曲、缺如)占76.38%,心侧静脉细小、扭曲和累计血管变异均明显多于心后侧静脉(P<0.05～0.01),而心后侧静脉缺如则明显多于心侧静脉(P<0.05).心侧静脉和心后侧静脉同时存在变异占25.20%.男性靶静脉缺如比率多于女性(P<0.05),女性靶静脉细小及扭曲明显高于男性(P<0.05).心后侧静脉缺如、细小或双支靶静脉均有变异在IHD组明显多见(均为P<0.05),冠状静脉窦肌桥均发生在NIHD组.IHD亚组分析,左前降支及左回旋支病变主要伴心侧静脉变异.结论 心侧静脉和心后侧静脉的解剖变异发生率高,男性靶静脉缺如发生率明显高于女性,女性靶静脉细小发生率明显高于男性.IHD血管变异比率明显高于NIHD,冠状动脉病变及心肌梗死部位对静脉变异有一定的影响.     

Percutaneous coronary intervention for chronic total occlusion in 1263 patients: a single-center report

Background Coronary chronic total occlusion （CTO） remains one of the most challenging lesion subsets in interventional cardiology, even with the development of medical device and operator expertise. This study was conducted to examine the relationship between lesion characteristics and procedural success and the incidence of in-hospital major adverse cardiac events （MACE） after percutaneous coronary intervention （PCI） for CTO. Methods Clinical and coronary angiographic data of 1263 patients with CTO who underwent PCI between June 1995 and December 2005 in Shenyang General Hospital of PLA were retrospectively analyzed. Results There were 1625 CTO lesions located in 1596 vessels with a mean occlusion time of 48.9 months. A total of 1647 coronary stents were implanted to the target lesions. The overall patient and lesion success rates were 90.8 % （1147/1263） and 88.9 % （1445/1625）, respectively. The success rate of PCI was declined with long duration of occlusion, abrupt missing stump, bridging collaterals ≥15 mm in occluded length, moderate to severe calcification or tortuosity and ostial or distal location of CTO lesions （P〈 0.05）. Procedural failure occurred in 116 patients, caused by impossibility of guide-wire （81.0%） or balloon （19.0%） to pass through the occlusion. There was no death during procedure, but 2 patients suffered from acute stent thrombosis and other 9 patients had acute or late pericardial perforation. Those complications were all successfully treated. After procedure, 3 patients died, 4 experienced urgent target vessel revascularization because of subacute stent thrombosis and 1 underwent coronary bypass graft surgery due to coronary ftstula during in-hospital period. The overall in-hospital MACE rate was 0.6% （8/1263）. Drug-eluting stents were used in 198 patients without in-hospital MACE. Conclusions In an experienced heart center, it is possible to obtain a relatively high success rate of PCI and favorable clinical outcomes for patients with coronary CTO lesions.     

雾化吸入不同剂量重组人干扰素α1b治疗小儿急性毛细支气管炎的疗效比较

目的 对比雾化吸入不同剂量重组人干扰素α1b治疗小儿急性毛细支气管炎的疗效.方法 选择我院儿科2014年10月至2016年8月收治的120例毛细支气管炎患儿为研究对象,根据随机数表法将患儿分为A、B、C三组,每组40例.A组予常规治疗,B组和C组分别在常规治疗基础上联合雾化吸入重组人干扰素α1b,剂量分别为2μg/kg、4μg/kg,疗程7 d.疗程结束后,比较两组患儿喘息缓解时间、哮鸣音消失时间、咳嗽消失时间及住院时间以及治疗有效率.结果 治疗后,B组、C组患儿喘息缓解时间、哮鸣音消失时间、咳嗽消失时间及住院时间分别为(3.24±1.32)d、(5.42±1.34)d、(6.36±1.40)d、(5.62±1.29)d和(5.37±1.28)d、(5.37±1.28)d、(6.21±1.32)d、(5.41±1.23)d,均明显短于A组的(4.51±1.47)d、(6.79±1.62)d、(7.91±1.57)d、(7.92±1.91)d,差异均有统计学意义(P<0.05);B组、C组患儿的治疗有效率分别为92.50%、95.00%,明显高于A组的75.00%,差异均有统计学意义(P<0.05);而B组和C组患儿的上述各项指标比较差异均无统计学意义(P>0.05).三组患儿均未见未见发热、皮疹等药物相关不良反应,治疗期间血常规及肝肾功能检查均正常.结论 常规治疗基础上联合雾化吸入低剂量(2μg/kg)的重组人干扰素α1b治疗小儿急性毛细支气管炎具有确切的临床疗效,安全性较高.     

Comparison of drug-eluting stents with bare metal stents implantation for the treatment of acute ST-elevation myocardial infarction: 2-year clinical outcomes from single-center registry

Background  Some larger scale, randomized studies have demonstrated the superiority of drug-eluting stents (DES) over bare metal stents (BMS) for the treatment of acute myocardial infarction (AMI). This study aimed to investigate the impact of DES, in comparison with BMS, on the 2-year clinical outcomes in patients with ST-elevation myocardial infarction (STEMI).

Methods  From January 2002 to December 2008, a total of 1301 consecutive STEMI patients treated with coronary stenting in Shenyang Northern Hospital were prospectively registered. Patients received BMS (n=868) or DES (n=435) implantation in the infarction related artery according to physician’s discretion. A propensity score analysis was performed and two well matched subgroups were selected (BMS, n=288; DES, n=288) to evaluate the 2-year clinical outcomes. The primary outcome was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, myocardial infarction (MI), or target vessel revascularization (TVR).

Results  Survival salvage analysis showed that 2-year cumulative hazards were not significantly different between the two groups with respect to TVR (2.8% vs. 3.1%, log-rank P=0.780), stent thrombosis (1.7% vs. 4.2%, log-rank P=0.079) and MACE (8% vs. 10.8%, log-rank P=0.236). Multivariate analysis showed that DES was an independent protective factor of MI (HR: 0.211, 95% CI: 0.049 to 0.908) and stent thrombosis (HR: 0.327, 95% CI: 0.107 to 0.994).

Conclusion  DES was associated with similar 2-year clinical outcomes to those of BMS for the treatment of STEMI in daily practice.

     

汶川地震后重灾区人群重性抑郁障碍流行病学调查

目的 了解中国汶川5·12地震后重灾区居民的重性抑郁障碍患病率、患者的人口学和社会文化特征及患病相关危险因素.方法 采用分层整群抽样方法随机抽取≥15岁人群14 503人,以一般健康问卷12项(GHQ-12)为筛选工具,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查版(SCID-Ⅰ/P)为调查诊断工具.结果 重性抑郁障碍现患180例,时点患病率为1.27%,终生患病率为1.36%;女性(OR=1.56,95%CI:1.136～2.143,P＜0.05)、合并躯体疾病(OR=4.02,95%CI:2.75～5.90,P＜0.05)、地震中受伤(OR=3.29,95%CI:1.92～5.65,P＜0.05)、财产损失(其中10万～20万元OR=2.09,95%CI:1.18～3.69,P＜0.05;＞20万元OR=2.54,95%CI:1.38～4.68,P＜0.05)、家人去世或失踪(OR=3.79,95%CI:2.08～6.89,P＜0.05)以及中年人群(OR=2.31,95%CI:1.38～3.86,P＜0.05)为危险因素.有职业为保护性因素(OR=0.60,95%CI:0.43～0.83,P＜0.05).结论 重性抑郁障碍是目前地震灾区较为多发的精神疾病.     

汉中市职业卫生现状调查分析

为认真贯彻《中华人民共和国职业病防治法》（下称《职业病防治法》），掌握汉中市职业卫生的现状及特点，为今后职业卫生监督管理提供科学依据，我们对汉中市职业卫生监督管理现状和34家企业职业卫生管理情况进行了调查，结果如下。     

云南民族地区初中生心理健康状况

目的了解云南民族地区初中生的心理健康状况,为少数民族地区中学生心理健康教育提供依据.方法采用症状自评量表(SCL-90)调查云南省几个主要民族地区初中生心理健康状况,并与中心城市昆明市初中生进行比较.结果迪庆和澜沧地区初中生SCL-90各因子分明显高于昆明、大理初中生,除个别因子外,昆明与大理初中生之间差异无显著性;云南民族地区初中生SCL-90各因子得分均高于云南其他地区初中生.结论云南省民族地区也多为贫困地区,其初中生的心理健康状况较为严峻.     

Endovascular stent-grafts for acute and chronic type B aortic dissection: comparison of clinical outcomes

Background Endovascular stent-graff treatment has emerged as an alternative for patients with type B aortic dissection （AD）, either at acute or chronic phase, in selected patients. This study aimed to investigate the results of endovascular stent-graft repair for acute and chronic type BAD. Methods From May 2002 to July 2007, 67 patients with type BAD were treated by endovascular stent-graft placement. There were 32 patients in the acute phase （AAD group） and 35 patients in the chronic phase （CAD group）. The patients were followed up from 1 to 65 months （average, 17_＋16 months）. The immediate and follow-up clinical outcomes were documented and compared between the 2 groups. Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 67 patients. Compared with patients in the CAD group, those in the AAD group had higher percentages of pleural effusion （15.6% vs 0, P=-0.02） and visceral/leg ischemia （21.9% vs 2.9%, P=0.02）. Procedure related complications, including endoleak and post-implantation syndrome occurred more frequently in AAD group than in CAD group （21.9% vs 2.9% and 31.3% vs 8.6%, respectively; P=0.02 and P=0.02）. Kaplan-Meier analysis showed no significant difference in survival rate at 4 years between the 2 groups （86.4% vs 92.3%, P=0.42 by Log-rank test）. But the 4-year event-free survival rate was higher in patients with chronic dissection than in patients with acute dissection （96.2% vs 73.9%; P=0.02 by Log-rank test）. Conclusions Endovascular repair with stent-graff was safe and effective for the treatment of both acute and chronic type BAD. However, both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection.     

中西医结合治疗小儿遗尿症38例

目的:探讨儿童遗尿症的中西医结合治疗临床疗效。方法:采用中草药遗尿汤及西药甲氯芬酯等,配合心理治疗、膀胱锻炼、推拿疗法等综合疗法治疗遗尿患儿38例。结果:显效26例,有效11例,无效1例,总有效率97.37%。结论:遗尿症大多数属于功能性遗尿,采用中西医结合疗法治疗效果显著。     

新疆维吾尔自治区8月龄～15岁人群乙型肝炎病毒表面抗原及抗体监测分析

目的了解新疆维吾尔自治区8月龄~15岁人群乙型肝炎(乙肝)病毒表面抗原(HBsAg)及抗体(抗-HBs)阳性率,评价卫生部/全球疫苗免疫联盟/儿童免疫基金(GAVI)项目实施效果。方法采用二级抽样的方法,从全疆67个县共抽取8月龄~15岁人群4 633名。用酶联免疫吸附试验(ELISA)检测血清中的HBsAg及抗-HBs。结果新疆维吾尔自治区8月龄~15岁人群HBsAg阳性率2.29%[95%可信区间CI为1.9%~2.8%],单抗-HBs阳性率45.65%(95%CI为44.2%~47.1%)。不同民族人群HBsAg和抗-HBs阳性率差异均有非常显著的统计学意义(χ2=69.146,χ2=755.694,P均<0.01)。GAVI项目干预后,8月龄~2岁儿童HBsAg阳性率从项目前的2.74%降到项目后的为0.82%,下降了70.1%;单抗-HBs从项目实施前的41.75%提高到项目实施后的64.72%,上升了55.0%。结论GAVI项目启动后取得显著效果。为保证GAVI项目的顺利开展,应提高第1针乙肝疫苗及时接种率和大力开展少数民族语言文字接种乙肝疫苗宣传工作。