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1.
Yan HB  Wang J  Li N  Zhu XL  Gao H  Ai H  Li X  Ye M  Chi YP  Zhang H 《中华医学杂志(英文版)》2007,120(7):557-561
Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device (Invatec, Italy) versus Guardwire Plus device (Medtronic, USA) before percutaneous coronary intervention (PCI) were compared in patients with acute inferior ST-segment-elevation myocardial infarction (STEMI) for less than 12 hours, thrombolysis in myocardial infarction (TIMI) flow grade 0 to 1, and total occlusion of the proximal right coronary artery (≥3 mm in diameter) in a prospective randomized single-center study.Methods The primary end point was the magnitude of ST-segment resolution (STR) (>70% ) measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume (LVEDV), left ventricle ejection fraction (LVEF) and major adverse cardiac events (MACEs) including death, myocardial infarction, target vessel revascularization and stroke at 30 days.Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age ((60±14) years vs (60±13) years), male (82% vs 84%), diabetes (31% vs 28%), previous coronary artery disease (25% vs 23%), onset-to-angiogram ((350±185) min vs (345±180) min), and use of glycoprotein IIb/IIIa inhibitor (11% vs 13%). The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution >70% (57% vs 59%; P>0.05). Similar slow flow/no-reflow rates were observed in the Diver CE group (8%) and the Guardwire Plus group (7%). TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively (P>0.05). Myocardial blush grade 3 was similar (70% vs 72%; P>0.05). Thirty-day clinical outcome was comparable (LVEF, 0.54±0.12 vs 0.53±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P>0.05, respectively). Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery (≥3 mm in diameter) compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.  相似文献
2.
Background A growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.
Methods From September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE). Results Baseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P=0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P=0.74). Aspirated thrombi were categorized as small thrombi (〈3.5 mm), moderate thrombi (3.5-7.0 mm) and large thrombi (〉7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P=0.021). Rates of dual wire utilization were 1.7% of the Diver CE and 7.2% of the ZEEK (P=0.052). There were no differences in MBG, STR and TIMI flow grade between the two groups. No differences were found in cardiac death, TLR, re-infarction, MACE, LVEDD and LVEF between the Diver CE and the ZEEK during 3-month follow-up.
Conclusions Both Diver CE and ZEEK manual aspiration catheters are effective for thrombectomy in STEMI. In clinical practice, ZEEK presents a stronger aspiration capacity for moderate to large thrombi compared with Diver CE, but Diver CE displays a trend towards better pushability and trackability than ZEEK. Differences in aspiration capacity and operability between Diver CE and ZEEK in this setting do not influence myocardial reperfusion and 3-month outcome.  相似文献
3.
近16年南京市第二医院收治传染病病种的回顾性分析   总被引:3,自引:2,他引:1  
目的:了解近16年来东南大学附属第二医院(南京市第二院,简称南京二院)传染病收治情况和流行趋势,为该院传染病的诊治提供依据。方法:回顾性分析1994至2009年南京二院每年收治的传染病总数变化、每种传染病总数的变化及具体分布情况。结果:南京二院收治的传染病总数呈现曲线上升的趋势,其中发病总数处于前5位的为麻疹、流行性腮腺炎、水痘、急性细菌性痢疾、百日咳。梅毒、艾滋病等性传播性疾病以及疟疾、狂犬病等病发率呈现上升趋势,严重急性呼吸综合征、人禽流感和甲型H1N1流感等新发传染病均有发生。结论:急性呼吸道传染病仍然是防治的重点,要加强对梅毒、艾滋病的健康宣教,时刻警惕新发传染病的入侵。  相似文献
4.
通过对河北省肿瘤医院住院癌症病人及其家属的问卷调查,了解其对该校图书馆提供文献服务的需求,调查结果显示,79.18%的病人及其家属希望在住院期间接受图书馆提供的文献信息服务。  相似文献
5.
对国内24家省级肿瘤医院图书馆为癌症患者提供文献服务情况的调查发现,仅有2家医院图书馆向癌症患者及其家属开放,其原因主要是馆舍面积小,馆员少等.据此提出肿瘤医院图书馆应利用丰富的馆藏资源,搭建网络平台为癌症患者及其家属提供网络资源服务,加强与医院各科室的合作,共同做好癌症患者及其家属的健康教育工作.  相似文献
6.
目的 探讨院前心电图对进行直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者进门至球囊扩张时间的影响.方法 对2006年1月至2006年12月间就诊于北京安贞医院抢救中心进行直接PCI的STEMI患者的临床资料进行回顾性分析.根据是否有院前心电图将患者分为2组:心电图组和无心电图组.主要分析指标:进门至球囊扩张时间.次要分析指标:住院期间病死率.结果 研究期间共入选147例患者,其中有院前心电图者92例(62.6%),进门至球囊扩张时间为(92±17)min;无院前心电图者55例(37.4%),进门至球囊扩张时间为(110±33)min,2组相比有统计学差异(P<0.01).心电图组进门至球囊扩张时间<90 min的患者显著多于无院前心电图组,分别为42%和23%(P<0.01).有院前心电图者中以抢救车就诊的患者比例显著高于无心电图者,2组分别为95%和3%(P<0.01).2组患者住院期间病死率无统计学差异(P>0.05).结论 院前心电图可以显著缩短ST段抬高心肌梗死患者进门至球囊时间,但目前院前心电图完成率较低,有待进一步改善.  相似文献
7.
通过计算机检索中国生物医学文献数据库和中国学术期刊全文数据库(2003.1—2008.8),对近年国内公开发表的中药治疗胃食管反流病的临床随机对照试验进行科学性评价,共纳入临床随机对照试验研究论文58篇。对样本含量、随机方法、盲法采用、组间基线可比性、诊断标准、纳入和排除标准、统计方法、疗效判定标准、不良反应、随访等项进行评价。结果表明,目前国内发表的中药治疗胃食管反流病随机对照临床研究的质量还有待提高。  相似文献
8.
Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device (Invatec, Italy) versus Guardwire Plus device (Medtronic, USA) before percutaneous coronary intervention (PCI) were compared in patients with acute inferior ST-segment-elevation myocardial infarction (STEMI) for less than 12 hours, thrombolysis in myocardial infarction (TIMI) flow grade 0 to 1, and total occlusion of the proximal right coronary artery (≥3 mm in diameter) in a prospective randomized single-center study. Methods The primary end point was the magnitude of ST-segment resolution (STR) (>70% ) measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume (LVEDV), left ventricle ejection fraction (LVEF) and major adverse cardiac events (MACEs) including death, myocardial infarction, target vessel revascularization and stroke at 30 days.Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age ((60±14) years vs (60±13) years), male (82% vs 84%), diabetes (31% vs 28%), previous coronary artery disease (25% vs 23%), onset-to-angiogram ((350±185) min vs (345±180) min), and use of glycoprotein IIb/IIIa inhibitor (11% vs 13%). The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution >70% (57% vs 59%; P>0.05). Similar slow flow/no-reflow rates were observed in the Diver CE group (8%) and the Guardwire Plus group (7%). TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively (P>0.05). Myocardial blush grade 3 was similar (70% vs 72%; P>0.05). Thirty-day clinical outcome was comparable (LVEF, 0.54±0.12 vs 0.53±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P>0.05, respectively). Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery (≥3 mm in diameter) compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.  相似文献
9.
Background  Repeat percutaneous coronary intervention (PCI) is associated with unfavorable prognosis in patients with coronary artery disease, but there is a current lack of related systematic cross-sectional studies in China. The survey was to investigate a real world of repeat PCIs and their associated factors during the drug eluting stent era in a Beijing high volume center.
Methods  A comprehensive review of the institution’s database between January 2006 and July 2009 was conducted. Demographic information, concomitant diseases, peri-procedure laboratory examinations and angiographic features were collected consecutively. Multivariate Logistic regression analysis was undertaken to explore the risk factors associated with repeat PCIs.
Results  A total of 13 404 patients were included in the analysis. Of which, 1946 patients (14.5%) had prior PCI procedure. More males patients had previous PCI than the females (15.7% vs 10.9%, P <0.001). After adjustment for age, gender, concomitant diseases, angiographic and procedural factors, a multivariate model showed that male, diabetes, hyperlipidemia and previous myocardial infarction, left main disease were identified as independent risk factors of repeat PCIs. Of which, previous myocardial infarction (odds ratio: 2.58, 95% confidence interval: 2.27–2.92) was highly related with repeat PCIs.
Conclusion  The frequency of repeat PCIs was 14.5% in this cross-sectional investigation, and their associated factors included male, diabetes, hyperlipidemia and previous MI and left main disease during drug eluting stent era.
  相似文献
10.
成骢  魏洪霞  池云 《现代医学》2013,(5):307-311
目的:提高对免疫缺陷人群患弓形虫脑病的诊断水平和加强对经验性治疗的认识。方法:结合1例艾滋病合并弓形虫脑病患者的临床资料及文献复习,对本病的临床表现、实验室检查、影像学检查、诊断、鉴别诊断和治疗进行分析。结果:该患者在艾滋病基础上合并弓形虫脑病,临床症状为头痛、视物模糊、癫痫发作;实验室检查血弓形虫抗体IgG阳性;头颅MRI表现多发结节,增强后病灶呈不规则强化伴周围水肿;因难以取得病理,诊断主要依赖临床;经验性使用复方磺胺甲噁唑(SMZ/TMP)及阿奇霉素抗弓形虫治疗后,患者症状明显缓解。结论:弓形虫脑病是免疫缺陷患者常见的中枢神经系统机会性感染之一,正确诊断和及时治疗对于挽救患者的生命非常重要。  相似文献
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