不稳定性心绞痛介入治疗的临床疗效及费用效果比

目的不稳定性心绞痛(unstable angina pectoris,UAP)是急性冠状动脉综合征(acute coronary syndrome,ACS)的一种重要表现类型.UAP的保守治疗包括扩冠、抗凝、抗血小板及缓解冠状动脉痉挛等.     

长托宁用于口腔颌面外科肿瘤手术患者术前用药的临床观察（附40例报告）

麻醉前应用抗胆碱药物可以减少呼吸道腺体的分泌,有利于保持患者术中及术后呼吸道的通畅,减少肺部并发症。但传统的抗胆碱能药物阿托品有增快心率的作用,特别不利于老年患者及合并心血管疾病的患者使用,且阿托品作用时间较短,不能有效抑制较长时间手术患者的呼吸道分泌作用。长托宁是一种新型的具有选择性的抗胆碱能药物,对心肌M2受体无明显的作用,不增快心率,作用时间长。     

人为什么会被噩梦纠缠

人为什么做梦呢？关于梦的生理机制和心理机制问题,目前在科学上还未得到圆满的解决,但有两点是十分肯定的：其一是外界刺激可以致梦。如有的学者曾分别将冰水泼在睡眠者身上。以及用闪光、音响刺激睡眠者后,将其唤醒,结果发现。     

精制破伤风抗毒素脱敏疗法中发生过敏性休克一例

患者男,40岁。于1989—06在工作中不慎被钉子扎伤手部.急诊来我院求治。术后医嘱精制破伤风抗毒素1500单位肌肉注射,过敏试验呈阳性,给予脱敏注射。在脱敏注射中,前二次无不良反应,第三次注射后约2min,患者突然出现面色苍白,出汗、表情淡漠,血压9.3/6.8kPa,脉搏140次/min。立即嘱患者平卧,给予吸氧,皮下注射     

我国医疗机构的主要问题及其对策

指出我国医疗机构目前存在的主要问题，即医疗服务供求关系失衡，效率低下；医疗费用迅猛上涨，服务成本不断扩大；行业和内部管理松懈，社会反响强烈。在分析其产生原因的基础上提出相应的对策建议，即改革医疗机构管理体制；推行医药分业，实行医疗机构分类管理；实行从医资格认定管理，医疗机构用人实行合同聘任制。     

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.     

不同剂量氟伐他汀对急性冠状动脉综合征患者血管内皮功能及炎症因子的影响

目的探讨较大剂量与常规剂量氟伐他汀相比,对急性冠脉综合征(ACS)患者是否有进一步的改善血管内皮功能和抗炎的作用。方法收集本院ACS患者120例,常规治疗基础上随机给予氟伐他汀40mg(40mg组)或氟伐他汀80 mg(80 mg组),每晚睡前服用。治疗4周,测定治疗前后患者血清NO、Hs-CRP、IL-6、HSP60的水平,随访临床事件发生情况。结果两组患者治疗4周后血清NO水平均有所升高[40 mg组:(56.68±12.01)μmol/L比(74.49±12.38)μmol/L,P<0.05;80mg组:(51.29±14.67)μmol/L比(82.57±12.17)μmol/L,P<0.01],且80 mg组患者血清NO水平升高更明显(P<0.05)。两组患者血清Hs-CRP、IL-6、HSP60水平均有所下降[40mg组分别为:(14.79±12.68)mg/L比(6.17±4.68)mg/L,(47.96±37.54)ng/L比(36.21±20.06)ng/L,(6.36±1.24)μg/L比(3.14±1.09)μg/L,P<0.05;80 mg组分别为:(14.48±12.32)mg/L比(4.31±3.56)mg/L,(50.35±40.17)ng/L比(31.24±15.49)ng/L,(6.25±1.16)μg/L比(1.25±0.98)μg/L,P<0.01],且80mg组下降更明显(均为P<0.05)。临床事件的随访观察显示,40 mg组共有10例(16.67%)患者发生心血管事件,80 mg组仅有4例(6.67%)发生心血管事件,发生率两组间差异有统计学意义(P<0.05)。结论氟伐他汀可升高ACS患者血清NO水平,降低Hs-CRP、IL-6及HSP60水平,其改善血管内皮功能和抗炎作用在短期内呈剂量依赖性。较大剂量氟伐他汀早期强化治疗可以明显减少ACS患者近期心血管事件的发生率,且安全性良好。     

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.     

口腔颌面外科608例经鼻腔气管插管方法的临床分析

目的探讨在全麻快速诱导下行鼻腔气管插管在口腔颌面外科手术中的临床应用。方法选择从2005年1月到2006年3月在我科行清醒鼻腔气管插管的221例患者（A组）,与自2006年4月份至今在我科行全麻快速诱导下经鼻腔插管的387例患者（B组）作为对照,比较两种经鼻腔插管方法的成功率、并发症的发生率以及插管时间;观察并记录两组患者在插管前、插管时以及插管后5min的心率、血压、血氧饱和度的变化情况。结果 B组患者插管的成功率明显高于A组,并发症的发生率低于A组,插管时间较A组亦明显缩短（〈0.05）;A组患者插管时以及插管后5min心率明显增快、血压增高,与基础值比较有显著性差异（〈0.05）;血氧饱和度在插管时与基础值比较明显降低（〈0.05）,在插管后5min与基础值比较已无明显差异（〉0.05）。B组患者在各时间点心率、血压、血氧饱和度与基础值比较均无明显变化（〉0.05）。结论全麻快速诱导经鼻腔插管成功率较高,插管并发症少,循环波动小,是一种安全、可行的鼻腔气管插管方法。     

全苏社会卫生、经济与卫生事业管理科学研究所简介

全苏社会卫生、经济与卫生事业管理科学研究所,是一所直属于苏联卫生部的医学科学研究所,它建立于30年代,现以当时的主要创办人之一、苏维埃人民委员谢马氏克命名。过去该所的名称为全苏社