缬沙坦和卡托普利对急性前壁心肌梗死后左室整体及局部收缩功能的影响

目的 对比血管紧张素Ⅱ受体拮抗剂（AⅡA）和血管紧张素转换酶抑制剂（ACEI）对急性前壁心肌梗死（AMI）后左室整体及局部收缩功能的影响.方法 将75例首次前壁AMI患者按随机数字表法分为常规治疗组15例、卡托普利治疗组30例、缬沙坦治疗组30例,并于AMI后1和28周分别行平衡法核素心室显像,测定左室整体收缩功能（LVSF）和左室局部射血分数（LrEF1～9）,了解2种药物对AMI后左室收缩功能的影响.计量资料组间及自身前后比较行t检验.结果 （1）AMI后28周时,缬沙坦治疗组与常规治疗组比较,左心室射血分数（LVEF）增加[（59.4±8.6）%与（44.9±8.4）%,t=3.87,P＜0.01],左室峰射血率（LPER）升高[（3.89±1.01）舒张末期容积（EDV）/s与（2.84±1.05）EDV/s,t=4.16,P＜0.01],LPER时间（LTPER）下降[（116±16）ms与（137±20）ms,t=2.16,P＜0.05],而与卡托普利组比较差异无统计学意义（t=1.58,1.09,1.77,P＜0.05）.（2）AMI后28周与1周比较,缬沙坦组不同部位左室局部射血分数LrEF2、LrEF4、LrEF5和LrEF6均明显升高[（71.6±18.8）%与（57.0±11.4）%,t=2.11 （78.1±16.8）%与（68.9±21.0）%,t=2.06 （70.5±16.9）%与（59.9±23.4）%,t=1.99 （58.1±9.0）%与（46.0±18.9）%,t=2.43 P均＜0.05].AMI后28周时,缬沙坦和卡托普利组LrEF2、LrEF3、LrEF4、LrEF5、LrEF6、LrEF7较常规治疗组均有所提高（t=1.96～2.27,P均＜0.05）,且2组间差异无统计学意义（t=1.06～1.77,P均＞0.05）.结论 血管紧张素Ⅱ受体拮抗剂缬沙坦能明显减轻前壁AMI后LVSF和LrEF的下降,且其效果与ACEI类药物卡托普利相近.     

急性心肌梗死患者肌钙蛋白I水平及其与室壁瘤形成关系的研究

目的 通过测定急性心肌梗死(AMI)患者早期血浆心肌肌钙蛋白I(cTnI)水平变化,结合导管法左心室造影(LVG)心室容积、压力及形态的变化,探讨cTnI在AMI后急性室壁瘤(LVA)形成患者血浆中的动态变化特点及其与LVA形成和心功能状态的关系.方法 选择首次前壁AMI患者62例,根据入院即刻LVG结果将患者分为LVA形成组29例和无LVA组33例.所有受试者于发病后12小时采血检测cTnI.所有患者于经皮冠状动脉介入治疗(PCI)完成后即刻及6个月复查时均行LVG,测定左心室舒张末期容积指数(LVEDVI)、左心室收缩未期客积指数(LVESVI)、左心室射血分数(LVEF)、室壁运动记分(WMS)、左心室舒张末期压(LVEDP).随访6个月内主要恶性心脏事件(MACE)的发生率.结果 LVA形成组自AMI发作至再灌注时间较无LVA组明显延长(9.06±5.23)hVS(6.76±4.27)h(t=2.351,P<0.05)、同时Killip Ⅲ级心力衰竭发生率明显高于无LVA组(27.6%WS 3.0%,x=7.501,P<0.01).LVA形成组血浆cTnI峰值浓度明显高于无LVA组(158.28±15.39)pg/L vs(149.15±14.62)pg/L(t:2.212,P<0.05).PCI后即刻和术后6个月时,无LVA组LVEF、LVESVI、LVEDVI、WMS和LVEDP各参数均优于有LVA形成组(均P<0.05).LVA形成组患者在6个月随访期间MACE发生率明显高于无LVA组患者[13(44.8%)vs 4(12.1%),x2=6.732,P<0.01],且cTnI峰值水平与MACE发生率显著相关(r=0.561,P<0.05).结论 血浆cTnI水平在AMI后LVA形成患者中明显高于无LVA者,且与左心室重构程度和血流动力学变化密切相关,提示心肌坏死标记物cTnI的大量释放参与了AMI后LVA的形成过程,并影响着AMI后左心室重构和LVA的进程.     

牛樟芝提取物对四氯化碳致大鼠肝纤维化的保护作用

目的探讨牛樟芝提取物对四氯化碳(CCl4)致大鼠肝纤维化(HF)的保护作用。方法将SD雄性大鼠随机分为正常对照组、模型组、牛樟芝提取物低、中、高剂量组和秋水仙碱组,采用CCl4诱导和高脂饲料喂养构建HF模型,造模同时分别予不同浓度的牛樟芝提取物和秋水仙碱进行干预,连续8周。观察大鼠一般情况和体质量,计算各组大鼠的肝系数,检测血清肝功能指标中谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TB)、乳酸脱氢酶(LDH)和肝纤维四项指标中血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(ColⅣ)含量,Western blot法检测肝脏TGF-β1蛋白表达,采用HE染色、Masson染色法进行肝脏病理学观察。结果与模型组比较,牛樟芝提取物中、高剂量组大鼠血清ALT、AST、TB、LDH、HA、LN、PC-Ⅲ、ColⅣ含量均显著下降(P<0.05,P<0.01),TGF-β1蛋白表达明显降低;肝组织胶原纤维明显减少,肝纤维化及肝脏损伤程度减轻。结论牛樟芝提取物对CCl4所致大鼠纤维化具有明显的保护作用,其机制可能与减轻肝细胞变性和纤维化,抑制相关炎症因子的释放有关。     

急性前壁心肌梗死伴心力衰竭患者急诊经皮冠状动脉介入治疗围手术期应用重组人B型钠尿肽的心肾保护效应

Objective To evaluate the protective effect of recombinant human B-type natriuretic peptide (rhBNP) on cardiac and renal functions in heart failure (HF) patients as a result of acute anterior myocardial infarction (AAMI) in peri-operative period of primary percutaneous coronary intervention (pPCI).Methods One hundred and twenty-six patients with AAMI-HF were enrolled into this study.All patients undertaken pPCI were randomly assigned to the rhBNP group (n=62) or the control group(n=64).rhBNP or nitroglycerin was intravenously administered on the basis of conventional treatment from first day of admission to 24 hours after pPCI in both groups.Heart rate (HR), systolic blood pressure (SBP), B-type natriuretic peptide (BNP), estimated lomerular filtration rate (eGFR) and heart function were observed.All patients were followed up for 30 days for the observation of main adverse cardiac events (MACE).Results The HR was significantly decreased compared with that at admission in rhBNP group, but such condition was not found in the control group.The SBP was reduced obviously in both groups.The plasma level of BNP, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVEDD) were improved significantly at different time points compared with those before administration in both groups.The improvement of above parameters in rhBNP group was more significant than that in the control group[BNP (ng/L) 30 hours after pPCI: 303.5±128.4 vs.354.0± 133.6, 14 days after pPCI:157.8±78.6 vs.201.1±91.7; LVEF 1dayafter pPCI: 0.420±0.052 vs.0.378±0.055, 14 days after pPCI:0.444±0.050 vs.0.393±0.055, 30 days after pPCI: 0.469±0.053 vs.0.413±0.052; LVEDD (mm) 1 day after pPCI: 53.5±4.4 vs.57.6±4.4, 14 days after pPCI: 49.6±5.1 vs.53.4±4.6, 30 days after pPCI: 46.5±4.4 vs.50.2±4.8, P＜0.05 or P＜0.01].The eGFR was reduced obviously 1 day after pPCI than that at admission in both groups, and eGFR recovered to baseline 3 days after pPCI.The level of eGFR was significantly increased 7 days and 14 days after pPCI than that at admission, but there was no difference between rhBNP group and control group.The incidence of contrast-induced nephropathy showed a lowering tendency in the rhBNP group than that in the control group[19.4% (12/62) vs.29.7% (19/64),P=0.178].The incidence of ventricular arrhythmias was obviously lowered 7 days after pPCI in the rhBNP group than that in the control group[48.4% (30/62) vs.75.0% (48/64), P＜0.01].The rate of MACE was lower in rhBNP group than that in control group in 30 days[12.9% (8/62) vs.26.6% (17/64), P＜0.05].Conclusion Administration of rhBNP can effectively improve the heart function in AAMI-HF patients undergoing pPCI, and it lowered the incidence of MACE in 30 days, without influence on renal function, and it can reduce the incidence of contrast-induced nephropathy.     

缬沙坦和卡托普利对急性前壁心肌梗死后左室整体及局部收缩功能的影响

Objective To compare the therapeutic effect of angiotensin Ⅱ antagonist (Valsartan)and angiotension-converting enzyme inhibitor (Captopril) for the improvement of left ventricular systolic function(LVSF) after acute myocardial infarction (AMI) at anterior wall. Methods A total of 75 patients with initial AMI at anterior wall were enlisted in the study. Patients were divided randomly into three groups: control group (n = 15), Captopril treated (n =30), and Valsartan treated (n =30). At 1 week and 28 weeks post AMI, the LVSF and left ventricular regional ejection fraction (LrEF) were measured by equilibrium radionuclide angiography (ERNA). The t-test was used to compare the dada. Results ( 1 ) At 28 weeks, left ventricular ejection fraction (LVEF) and left ventricular peak ejection rate (LPER) in Valsartan treated group were significantly increased as compared with those of control: ( 59.4 ± 8.6 ) % vs (44.9 ± 8.4)%, t = 3.87, P ＜ 0.01 for LVEF; (3.89 ± 1.01 ) end-diastolic volume (EDV)/s vs (2.84 ±1.05) EDV/s, t= 4.16, P ＜ 0.01 for LPER). The left ventricular time to peak ejection rate (LTPER) in Valsartan treated group was significantly decreased ( ( 116 ± 16 )ms vs ( 137 ±20) ms, t =2.16, P ＜ 0.05 ) as compared with control. (2)Compared with 1-week, 28-week Valsartan treated group had a significant increase inLrEF2, LrEF4, LrEF5, LrEF6: (71.6±18.8)% vs (57.0±11.4)%, t=2.11, P＜0.05;(78.1 ±16.8)% vs (68.9±21.0)%, t =2.06, P＜0.05; (70.5±16.9)% vs (59.9 ±23.4)%, t=1.99, P ＜ 0.05; and (58.1 ± 9.0) % vs (46.0 ± 18.9) %, t = 2.43, P ＜ 0.05, respectively. Conclusions Valsartan and Captopril are effective for the improvement of LVEF after AMI at anterior wall. The effects of the two drugs are similar.     

输尿管镜下气压弹道碎石术治疗泌尿系结石的临床分析

目的:探讨输尿管镜下气压弹道碎石治疗泌尿系结石的临床效果。方法:选取2014年2月至2016年6月期间在本院收治的90例泌尿系结石患者作为研究对象,随机分为对照组和观察组,各45例。观察组行输尿管镜下气压弹道碎石术治疗,对照组行输尿管镜下钬激光碎石术治疗,观察两组患者术后碎石效果、术中与术后恢复相关指标、并发症情况。结果:观察组碎石总有效率为95.55%,显著高于对照组(77.78%),组间差异p0.05。观察组术中出血量、手术时间、术后肠胃功能恢复时间、术后下床活动时间、术后双J管拔除时间、术后疼痛评分、镇痛药物使用时间、术后住院时间均显著低于对照组,组间差异p0.05,具有统计学意义。观察组术后并发症发生率(8.89%),显著低于对照组(24.44%),组间差异(p0.05)。结论:泌尿系结石采用输尿管镜下气压弹道碎石术治疗碎石效果较为可靠,且术中出血量较少、术后恢复速度快,有助于改善患者预后。     

有晶体眼前房硅油原因分析

1961年Cibis 首次将硅油应用于复杂的视网膜脱离手术以来,已在临床上得到广泛应用[1].玻璃体腔硅油填充又伴有许多并发症,如白内障、青光眼、角膜病变[2,3],硅油进入前房也是其中之一[4],其发生率为0.66%[5,6].硅油进入前房后会引发角膜变性和角膜失代偿、高眼压、角膜水肿等,严重者可造成视力下降,视网膜再脱离,给患者造成很大的痛苦.为探讨有晶体眼前房硅油产生的机制,对我科2004年1月至2007年12月行玻切硅油填充术的255 例(272只眼)有晶体眼的临床资料进行回顾性分析,探讨如何预防有晶体眼前房硅油的发生,减少硅油填充的并发症,从而保护患者的视功能.     

缺血后适应对STEMI患者急诊PCI术后炎性因子的相关影响

目的 探讨缺血后适应对急性心肌梗死(STEMI)患者急诊冠脉介入(PCI)术后相关炎性因子的影响.方法 入组自就诊的STEMI患者,随机分为缺血后适应(IPC)组和对照(CON)组,IPC组患者术中应用缺血后适应术式.记录所有患者一般基线资料、术中资料和入院时、术后24 h和72 h炎性因子的水平.结果 2组患者基线资料差异无统计学意义(P>0.05),2组患者基线炎性因子水平差异无统计学意义(P>0.05),IPC组患者术后24 h及72 h高敏C-反应蛋白、白介素-6、肿瘤坏死因子-α等炎性因子水平均低于CON组,且各组内术后24 h炎性指标水平最高,72 h指标水平有所下降,差异有统计学意义(P<0.05).结论 缺血后适应可以降低接受急诊PCI的STEMI患者术后炎性因子的水平.     

缺血后适应对女性心肌梗死患者急诊冠脉介入后微循环障碍的预防

目的 探讨缺血后适应对女性急性心肌梗死(STEMI)患者急诊冠状动脉介入术(PCI)中心肌微循环障碍的预防作用.方法 就诊于医院诊断为首发心肌梗死的女性患者76例,随机分为缺血后适应(IPC)组和对照(CON)组,每组38例.所有患者均行PCI治疗,其中IPC组行缺血后适应术式.记录患者一般基线资料、术中资料、酶峰水平、心功能及随访不良事件.结果 IPC组三支冠脉的CTFC均高于CON组,IPC组术后TMPG 3级比例高于CON组,差异有统计学意义(P<0.05);IPC组无复流/缓血流发生率明显降低,差异无统计学意义(P>0.05).IPC组心肌坏死标记物酶峰水平低于CON组,差异有统计学意义(P<0.05).术后3 d左心室射血分数(LVEF)水平差异无统计学意义(P>0.05),院外1个月时IPC组LVEF水平高于CON组,2组患者各项不良事件IPC组发生率均低于CON组,但差异均无统计学意义(P>0.05).结论 缺血后适应可以预防接受急诊PCI的女性STEMI患者心肌微循环障碍、提高患者心功能水平.     

睾丸扭转27例的诊治分析

睾丸扭转是泌尿外科急症之一,好发于青少年,临床上并非罕见.初诊时易误诊为急性睾丸炎、附睾炎,有时误诊为嵌顿疝.睾丸扭转时间过长,常易导致睾丸坏死,也可反应性影响健侧血运,继发精系退行性变,影响生育功能.睾丸扭转诊断治疗并不复杂,关键是医务人员提高对此病的认识,尽量做到早诊断、早手术治疗.我院2001年3月至2011年10月共收治睾丸扭转27例,报道如下.