外周血白细胞计数对急性心肌梗死心力衰竭的预测作用

目的　了解急性心肌梗死 (AMI)患者入院时外周血白细胞 (WBC)及中性粒细胞 (NER)计数是否与住院期心衰和死亡事件以及随访期的死亡事件有相关性。方法　对 2 0 0 0年 1月 1日～ 2 0 0 1年 12月 31日收治的因AMI住进冠心病监护病房的 12 3例患者于入院时立即取外周血查血常规 ,并连续观察其住院期和随访期的临床结果 ,分析WBC和NER与心衰及死亡事件的相关性及预测价值。结果　心衰组患者WBC计数 (P =0 0 0 3)及NER绝对值 (P =0 0 0 4 )明显高于非心衰组患者 ,而NER %两组间无显著差异 (P =0 0 94 ) ,WBC计数 (r =0 314 ,P <0 0 0 1)及NER绝对值 (r =0 2 6 1,P =0 0 0 4 )与心衰的发生呈正相关 ,而NER %与心衰发生无明显相关性 (r =0 14 9,P =0 10 0 )。WBC计数 >11 0× 10 9/L(χ2 =4 0 0 7,P =0 0 31,OR =0 2 35 ,CI=0 0 5 8～ 0 95 8)以及NER绝对值 >12 0× 10 9/L(χ2 =4 6 14 ,P =0 0 32 ,OR =2 36 1,CI=0 4 6 9～ 11 895 )为心衰的独立预测因素。住院期和随访期死亡组WBC、NER、NER %均大于非死亡组 ,但差别无统计学意义。结论　本研究证明 ,AMI发病后 6h内WBC和NER增加与住院期心力衰竭发生有关 ,是相对简单易行的预测AMI发生心衰的指标 ,NER绝对值较NER %敏感性高。同时提醒人     

增龄对大鼠腹主动脉壁连接蛋白mRNA表达的影响

连接蛋白（connexin，Cx）是一类多基因家族表达的保守蛋白。6个Cx单体在细胞膜上环绕排列形成具有6角形中空结构的寡聚体蛋白，称连接子。相邻细胞膜上的两个连接子呈30度角倾斜排列组成缝隙连接（gap junction）。缝隙连接是广泛存在于各种生物体内各个组织器官中的结构。目前在血管壁已确定的连接蛋白有：Cx37、40、43及45。大量临床资料表明，动脉粥样硬化、肿瘤及高血压等的发病率均随年龄增长而增高，其发生机制均涉及缝隙连接的作用。因此，了解Cx在不同阶段的变化具有重要的生理及病理意义。     

置入式电复律除颤器治疗恶性室性心律失常

患者男,77岁.以突发胸闷、憋气、大汗2小时来院.入院时查心电图示室性心动过速(VT),立即给予利多卡因静脉推注和静脉点滴,但是未能奏效.此时患者血压测不到,意识丧失,先后给予同步直流电复律和电除颤共8次,并给予心肺复苏成功后收入CCU.在入院过程中,再次发生意识丧失,经心外按压和电除颤后恢复.     

浅析抗高血压药物的联合应用

目的为了更好地控制血压，最大限度地取得治疗高血压的效果，临床常常采取抗高血压药物的联合应用。联合用药提倡两种不同类型的药物联用。本文就为什么要提倡两种不同类型的药物联用，如何选择两种不同类型的药物来联用等问题发表一些简单的自我看法。     

曲酸对受辐射中国仓鼠卵巢细胞的保护作用

目的： 探讨曲酸对受辐射中国仓鼠卵巢细胞(CHO)的保护作用。方法：CHO细胞分别经不同强度(0~20 Gy )60Co γ射线照射,于照射后24、48和72 h采用MTT法检测细胞存活情况;细胞经不同浓度(分别为0、0.01、0.1、1、10、100 μg/mL)曲酸作用1.5 h,采用12 Gy γ射线照射,于照射后24、48和72 h采用MTT法检测细胞存活情况;细胞经浓度为1 μg/mL的曲酸作用1.5 h,分别经不同强度(6、12、16 Gy) γ射线照射,于照射后24 h采用MTT法检测细胞存活情况。结果：与对照组比较,γ射线照射导致CHO细胞的存活率下降(P均<0.01),且随着照射强度的增加,该效应增强;曲酸在0.01～10 μg/mL浓度范围内能明显提高12 Gy辐射条件下CHO细胞的存活率,其中浓度在1 μg/mL时效应最明显;1 μg/mL曲酸均能明显提高6、12、16 Gy γ射线照射下细胞的存活率。结论：曲酸明显提高受辐射CHO细胞的存活率,以保护细胞免受辐射损伤。     

普罗布考预防对比剂肾损害的随机化临床研究

Objective Contrast induced acute kidney injury (CIAKI) is a significant clinical problem. We, therefore, performed a prospective, randomized trial to investigate the role of probueol in the prevention of CIAKI in patients with unstable angina pectoris (UAP) undergoing percutaneous coronary angiography (CAG) and interventions (PCI). Methods We studied 205 patients with UAP, who underwent CAG or PCI prospectively. Patients were randomly assigned to probucol group (n = 102) and control group (n= 103). In the probucol group, the patients received probucol tablets 500 mg b. i. d for 3 days before and after intervcntion. All the patients, after intervention, underwent hydration with intravenous saline at a rate of 1 ml per kilogram of body weight per hour for 12 hours. Results Patients were well-matched with no significant differenced at baseline in majority measured parameters between two groups. CIAKI occurred in 23 of the 205 (11.22%) patients. Multivariate logistic regression was used to identify correlates of CIAKI and clinical data. CIAKI was most strongly associated with Scr≥132.6 μmol/L (OR =21.11,95% CI 1.95-56. 06, P＜0.001), Ccr ＜60 ml/min (OR =4.19, 95%(2/1.94-9.05, P ＜0.001), heart function ＞ class Ⅱ (OR = 6.23, 95% CI 2.73-14.21, P ＜ 0.001), Diabetes (OR = 2.049, 95% CI1.19-5.25, P ＜ 0.001), age ≥ 70 yrs (OR = 3.52, 95% CI 1.66-7.43, P ＜ 0.001), coronary artery calcification shown by CAG (OR =4.29, 95% CI 1.99-9.24, P ＜ 0.001). The rate of CIAKI in probueol groups was slightly lower compared with control group (7.84% vs. 14.56%), without significant difference. The post-procedure mean peak of Scr [(101.62±42. 98) μmol/L vs. (117.67 ～68.77) μmol/L, P =0.047] and the post-procedure increasing Ser from baseline (ASer) [(13.49 ± 19. 61) μmoL/L vs.(22.50 ± 18.31) μmol/L, P =0.001] in the probucol group decreased significantly compared with that of control group. Conclusion Prophylactic treatment with probueol 500 mg b. i. d during periproeedural stage in patients with UAP has preventing role against CIAK1 after cardiac catheterization.     

急性心肌梗死PTCA及溶栓治疗的疗效及成本—效果比较

急性心肌梗死(AMI)的治疗近几十年来有了很大变化。20世纪50年其死亡率为20％～30％。自60年代以来建立了冠心病监护病房。及时发现了一些患者的心律失常,使死亡率下降到10％～15％。此时主要的死亡原因是大面积心肌坏死所致的泵功能衰竭或与其相关的致命性心律失常。而限制心肌坏死范围最有效的方法是早期恢复冠状动脉的血流。80年代世界各地广泛开展的溶栓疗法(throm-bolysis)、经皮冠状动脉腔内成形术(PTCA)使AMI的治疗进入了再灌注(reperfusion)时代。多项旨在评价该两种疗法的疗效及成本效果的研究相继开始     

普罗布考预防对比剂肾损害的随机化临床研究

Objective Contrast induced acute kidney injury (CIAKI) is a significant clinical problem. We, therefore, performed a prospective, randomized trial to investigate the role of probueol in the prevention of CIAKI in patients with unstable angina pectoris (UAP) undergoing percutaneous coronary angiography (CAG) and interventions (PCI). Methods We studied 205 patients with UAP, who underwent CAG or PCI prospectively. Patients were randomly assigned to probucol group (n = 102) and control group (n= 103). In the probucol group, the patients received probucol tablets 500 mg b. i. d for 3 days before and after intervcntion. All the patients, after intervention, underwent hydration with intravenous saline at a rate of 1 ml per kilogram of body weight per hour for 12 hours. Results Patients were well-matched with no significant differenced at baseline in majority measured parameters between two groups. CIAKI occurred in 23 of the 205 (11.22%) patients. Multivariate logistic regression was used to identify correlates of CIAKI and clinical data. CIAKI was most strongly associated with Scr≥132.6 μmol/L (OR =21.11,95% CI 1.95-56. 06, P＜0.001), Ccr ＜60 ml/min (OR =4.19, 95%(2/1.94-9.05, P ＜0.001), heart function ＞ class Ⅱ (OR = 6.23, 95% CI 2.73-14.21, P ＜ 0.001), Diabetes (OR = 2.049, 95% CI1.19-5.25, P ＜ 0.001), age ≥ 70 yrs (OR = 3.52, 95% CI 1.66-7.43, P ＜ 0.001), coronary artery calcification shown by CAG (OR =4.29, 95% CI 1.99-9.24, P ＜ 0.001). The rate of CIAKI in probueol groups was slightly lower compared with control group (7.84% vs. 14.56%), without significant difference. The post-procedure mean peak of Scr [(101.62±42. 98) μmol/L vs. (117.67 ～68.77) μmol/L, P =0.047] and the post-procedure increasing Ser from baseline (ASer) [(13.49 ± 19. 61) μmoL/L vs.(22.50 ± 18.31) μmol/L, P =0.001] in the probucol group decreased significantly compared with that of control group. Conclusion Prophylactic treatment with probueol 500 mg b. i. d during periproeedural stage in patients with UAP has preventing role against CIAK1 after cardiac catheterization.     

深化医药卫生体制改革实现人人享有基本医疗卫生服务

女士们、先生们,朋友们: 2009年世界卫生经济大会在北京召开,69个国家和地区的专家学者和政府官员齐聚一堂,共商卫生与经济和谐发展这一具有现实和长远历史意义的议题.这是一次难得的机会,我很高兴借此机会向各位朋友介绍中国卫生改革与发展的现状.     

中国卫生改革与发展的构想

1 前 言 中国是一个拥有12亿人口,具有国土面积近千万平方公里的发展中国家。80年代以来,中国经济体制发生了深刻的变化,人们开始逐步摆脱传统、僵化的计划经济观念,社会经济各领域充满活力,国民经济与社会发展取得了快速发展。中国的发展引起了世界瞩目。同时,发展中存在的问题也引起了许多政策研究者和学者的研究兴趣。 社会主义市场经济体制的确立,对于在计划经济条件下形成的中国卫生事业体制是严峻的挑战,也是良好的机遇。存在以下几方面的问题;现行卫生事业管理体制和卫生机构运行机制不适应社会主义市场经济发展,现行卫生服务组织管理方式不适应疾病谱的变化和人民群众对基本卫生服务的需求,现行医疗保障制度不适应卫生服务的发展。同时,有