电话传送心电图监测与常规心电图诊断心肌缺血的应用比较

目的：探讨电话传送心电图检测（Ｔｒａｎｓｔｅｌｅｐｏｍｉｃ Ｅｌｅｃｔｒｏｃａｒｄｉｏｇｒａｐｈｉｃ Ｍｏｎｉｔｏｒｉｎｇ,ＴＴＭ）心肌缺血的诊断价值。方法：同步检测９７例心肌缺血患者的常规心电图（ＥＣＧ）、电话传送心电图（ＴＴＭ）,调整后者的监测电极与ＥＣＧ的电极部位完全相同,判断二者的Ｓ－Ｔ、Ｔ缺血变化。结果：ＥＣＧ发现９７例典型Ｓ－Ｔ、Ｔ心肌缺血患者,ＴＴＭ有９０例相同变化（敏感性９２．５％     

基于跨理论模型协同护理模式在急性心肌梗死介入治疗病人中的应用

目的:探讨基于跨理论模型(TTM)协同护理模式在急性心肌梗死(AMI)介入治疗病人中的应用效果。方法:根据随机数字表法将2018年6月—2019年6月收治的88例AMI介入治疗病人分为观察组及对照组各44例,对照组实施常规护理,观察组实施基于TTM的协同护理模式。比较两组干预前及干预6个月后自我效能、疾病管理能力及生活质量改善情况,记录两组不良心脏事件发生率、再入院率及治疗依从率。结果:两组病人干预后自我效能、疾病管理能力、西雅图心绞痛量表(SAQ)总评分比较差异有统计学意义(P<0.05)。观察组病人不良心脏事件发生率(2.27%)、再入院率(4.54%)低于对照组的18.18%、20.45%,差异有统计学意义(P<0.05);观察组病人用药依从率、生活方式管理依从率分别为97.73%和95.45%,高于对照组的75.00%和72.73%,差异有统计学意义(P<0.05)。结论:基于TTM协同护理模式能有效改善AMI介入治疗病人自我效能,提高病人遵医行为及疾病管理能力,减少不良心脏事件的发生,改善病人生活质量。     

Association between body mass index and clinical outcomes of patients after cardiac arrest and resuscitation: A meta-analysis

Background

Obesity as one of the risk factors for cardiovascular diseases increases mortality in general population. Several clinical studies investigated clinical outcomes in patients with different body mass index (BMI) after cardiac arrest (CA). Controversial data regarding BMI on clinical outcomes in those patients exist in those studies. Therefore, we conducted a meta-analysis to evaluate the effect of BMI on survival condition and neurological prognosis in those patients.

Predicting long-term outcomes after cardiac arrest by using serum neutrophil gelatinase-associated lipocalin

Objectives

Neutrophil gelatinase-associated lipocalin (NGAL) is secreted by various tissues in pathologic states. Previous studies reported that post-cardiac arrest serum NGAL levels correlate with short-term neurologic outcomes and survival. The aim of this study was to examine the associations between NGAL levels post-cardiac arrest and long-term outcomes and survival.

TTM中代偿性热源的探讨

目的:探讨TTM中是否存在非病变部位的"代偿性热源".材料和方法:使用红外线热扫描技术对183例体检人员进行扫描,随机对81例耳部异常热源、88例膝关节异常热源及14例肾区异常热源进行观察,并与临床症状、体征、实验室检查、B型超声等检查结果比对.结果:大约21%～47%的病例在TTM中的异常热源仅仅出现或同时出现在病变部位的对侧(即健侧)而非病变侧.结论:在TTM图像中可能存在"代偿性热源",诊断时应结合病史注意与真正的异常热源相区别.     

An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status

Objective

To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic control measured by HbA_1c and psychological status in type 2 diabetes and to compare effects when interventions are delivered by generalist clinicians compared to psychological specialists.

Methods

We used the original review protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants, interventions, delivery methods, comparison groups and outcome measures.

Results

35 trials were reviewed and meta-analysis of 19 trials (n = 1431), reporting HbA_1c found a reduction in HbA_1c by 0.54% (−0.32; 95% CI: −0.47 to −0.16). In nine trials (n = 832) interventions were delivered by diabetes or general clinicians reducing HbA_1c by 0.51% (−0.27; 95% CI: −0.50 to 0.04). In nine trials, interventions (n = 561) were delivered by psychological specialists reducing HbA_1c by 0.57% (−0.36; 95% CI: −0.61 to 0.12). Meta-analysis of 13 trials reporting psychological status found psychological status to be lower in the intervention groups −0.56 (95% CI: 1.00 to −0.13). Trial quality for the majority of studies remained poor.

Conclusion

Our findings suggest that psychological and general clinicians are similarly effective in delivering psychological interventions, however, effect sizes for all clinicians have reduced since the earlier review.

Practice implications

Psychological training opportunities for generalist clinicians could lead to wider availability of effective psychological care.     

体位对心电图的影响

目的观察不同体位下心电图各波段振幅的改变,并分析体位对其影响。方法50例受检者均接受12导联动态心电图(Holter)及12导联电话传输远程心电图(TTM)记录,分别比较TTM和Holter在5种不同体位下的心电图各波段振幅。结果在II导联,体位对TTM和Holter各波段振幅造成的影响均无统计学意义;TTM的V1导联T波右侧卧位振幅较平卧位大(p=0.047),V5导联P波立位较平卧位高(p=0.044);Holter的V1导联S波左侧卧位较平卧位低(p=0.045),V5导联R波左侧卧位较平卧位高(p=0.04)。结论体位改变对TTM和Holter所测各波段振幅在肢体导联没有影响,胸导联振幅受体位影响而变化。     

Development and Validation of Transtheoretical Model Measures for Bulgarian Adolescent Non-Smokers

The goal of this study was to develop, translate, and evaluate measures for decisional balance and situational temptations for Bulgarian adolescent nonsmokers and to test the predicted relationships with stages of change. Students in the last grades of high school (15–19 years old) recruited in 12 randomly selected schools participated in the study. Data from the 369 nonsmokers (61.8% female, mean age 16.4 years, 97.1% Bulgarian) were used in the measurement development. A two-factor model for decisional balance (CFI =. 94) and a hierarchical three-factor model for temptations (CFI =. 90) demonstrated the best fit. The predicted crossover pattern for decisional balance and decreasing trend for temptations across the stages of change was verified. Both measures demonstrated tau-equivalent invariance across gender, in addition to good psychometric properties. These results, with the caveat of the noted limitations, support the cross-cultural validity of these transtheoretical model (TTM) constructs and indicate that they can be used as a basis for development of smoking prevention interventions.     

前列腺素E1/目标温度控制联合干预措施对心肺复苏后大鼠微血栓形成抑制效应的初步探讨

目的 探讨前列腺素E1(PGE1)和目标温度控制(TTM)联合策略对心跳骤停后成功复苏大鼠的微血栓广泛形成的抑制效应.方法 采用经食道交流电致颤方式,建立大鼠心肺复苏模型.设立空白对照组(B组,n=14),另将56只成功复苏的恢复自主循环(ROSC)大鼠随机分为4组:ROSC对照组(R组,n=14)、PGE1干预组(P组,n=14)、TTM干预组(T组,n=14)和PGE1/TTM联合干预组(PT组,n=14).分别在0.5、4、8h3个时间点,对每组5只大鼠进行血小板计数、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、血栓调节蛋白(TM)和D-dimer的ELISA检测.每个时间点,每组处死3只大鼠,进行心肌组织苏木精伊红(HE)染色以及血管内皮钙黏蛋白(VE-cadherin) mRNA的PCR检测.实验结束时,对每组处死的大鼠进行心肌组织VE-cadherin/血管内皮生长因子受体(VEGFR)荧光双染.结果 PGE1、TTM及其联合干预措施可以不同程度地减少心肌组织微血栓的形成,缓解微血管内皮细胞VE-cadherin蛋白的破坏,并在复苏后0.5h有效抑制VE-cadherin mRNA表达水平的上升(P＜0.05),且以PT组更为明显.3种干预方式都能减缓复苏后血浆TM和D-dimer水平的陡然上升(P＜0.05),且联合干预措施较单独干预措施的抑制效应更加突出(P＜0.05).结论 PGE1和TTM能够通过不同的抗凝途径和内皮细胞保护效应来改善微血管内血栓的广泛形成,且二者联合治疗可能存在协同作用.     

电话传送心电图监测与常规心电图诊断心肌缺血的对比研究

目的 探讨单通道双极导联电话传送心电图监测(transtelephomic electrocardiographic monitoring,TTM)诊断心肌缺血的实用价值.方法 同时检测178例次心肌缺血患者的常规心电图(ECG)和TTM,调整TTM的监测电极部位与ECG的导联位置完全相同,观察两者在同一时间、相同导联的S-T、T缺血变化,并以31例正常者作对照.结果178例次ECG明确S-T、T心肌缺血改变者在TTM有相同变化者共170例次,TTM与ECG的符合率及敏感性达95.5%(P>0.05).而31例对照组ECG无S-T、T心肌缺血的患者,TTM亦无变化,特异性100%.结论TTM对心肌缺血的检测有高度敏感性及可靠的诊断价值.