养心散瘀方治疗冠心病PCI术后心绞痛临床观察

目的观察养心散瘀方治疗冠心病PCI术后心绞痛临床治疗效果。方法选取2018年10月—2019年5月辽宁中医药大学附属第一医院心内科冠心病PCI术后再发心绞痛患者80例,按照随机对照原则分为对照组和观察组各40例。对照组予常规西医治疗方案,即抗血小板,降脂,降压等。观察组在常规西医治疗方案上加养心散瘀方治疗。观察2组治疗效果,两周为一个疗程,共治疗两个疗程。通过西雅图心绞痛量表、心电图疗效、硝酸甘油用量、心功能,比较2组患者的临床情况。结果观察组患者西雅图心绞痛量表指标较对照组明显改善,差异具有统计学意义(P<0.05),观察组心电图疗效总有效率较对照组改善明显,差异具有统计学意义(P<0.05),观察组硝酸甘油用量较对照组明显降低,差异具有统计学意义(P<0.05),观察组心功能较对照组明显提高,差异具有统计学意义(P<0.05)。结论养心散瘀方治疗冠心病PCI术后心绞痛明显优于单纯常规西医治疗,值得临床广泛运用。     

硝酸甘油介入99mTc-MIBI+门控心肌断层显像在心肌干细胞移植中的临床应用研究

[目的]探讨硝酸甘油(NG)介入99mTc-MIBI 门控心肌活力显像在冠心病心梗后病变区心肌细胞是否成活及梗塞灶在干细胞移植治疗后的疗效.[方法]对16例冠心病移植前和移植后的心肌活力 门控心肌断层显像,对心肌灌注活力评分,左室射血分数、移植前移植后心肌梗死区摄取比值测定、心肌灌注缺损指数的观测比较.[结果]干细胞移植后心肌灌注活力评分从57.1%增加到84.2%,左室射血分数从42.1±3.6增加到50.2±2.7、移植前移植后心肌梗死区摄取比值测定22.4±7.3增加到39.7±9.7、心肌灌注缺损指数10.9±2.3减少到8.0±2.5.[结论]心肌活力 门控心肌断层显像, 对临床决策冠心病心肌梗死后是否进行干细胞移植和移植后是否成功提供了较有价值的手段和客观依据.     

硝酸甘油联合盐酸替罗非班治疗经皮冠状动脉介入术发生无复流现象时的临床疗效研究

目的 探讨硝酸甘油注射液联合GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班注射液对治疗经皮冠状动脉介入术(percutaneous coronary intervention,PCI)过程中发生无复流时对TIMI血流的影响.方法 2005年1月至2011年10月我院收治的PCI时发生无复流病例40例,随机分成2组.A组:发生无复流时即刻冠脉内注射硝酸甘油注射液200～ 300μg,观察TIMI血流恢复情况,如无效再给予盐酸替罗非班注射液5 μg/kg冠脉内注入(设为A+B组).B组:发生无复流时即刻冠脉内注射盐酸替罗非班注射液5 μg/kg,观察TIMI血流恢复情况,如无效再给予硝酸甘油注射液200 ～ 300μg冠脉内注入(设为B+A组). 结果 血流恢复情况B组疗效优于A组(P＜0.01),A+B组与B+A组比较无明显差异(P＞0.05),但联合用药(A+B组或B+A组)两组患者均恢复TIMIⅢ级前向血流,联合用药对TIMI血流恢复情况明显优于单用硝酸甘油注射液(A组)或盐酸替罗非班(B组)(P＜0.05). 结论 PCI术中发生无复流时即刻冠脉内注入硝酸甘油注射液联合替罗非班注射液后明显恢复TIMI前向血流,明显减少不良心血事件(MACE)的发生,提高心肌灌注,并改善临床预后.     

Efficacy of management algorithm for reducing need for sphincterotomy in chronic anal fissures

Background Lateral internal sphincterotomy is the most effective treatment for chronic anal fissure (CAF), but carries a risk of faecal incontinence. We aimed to analyse efficacy and acceptance of a treatment algorithm in reducing the rate of necessary sphincterotomies. Method Patients with CAF seen from 2001 to 2010 were retrospectively analysed. All patients were offered all steps of the algorithm nitroglycerine (NTG) → Botox (BTX) → surgery, unless symptoms or patient preference demanded a more aggressive treatment. Patients were followed up in clinic, and treatment was advanced if a step either failed or caused intolerable side effects. Results Two hundred and nine patients were included in the analysis. Mean duration of symptoms was 25.6 months and mean follow up 16 months. One hundred and 41 patients started on NTG, 36 on BTX, and 31 went straight to surgery. One patient opted for no treatment. Symptoms persisted in 58 (41.1%) of 141 NTG patients. Forty‐five (31.9% of NTG subset) were advanced to BTX and 13 (9.2% of subset) to surgery. Of the 81 (36 primary + 45 secondary) BTX patients (38.8% of the total), only 11 (13.6% of subset) required surgery. A total of 55 (31 primary + 24 secondary; 26.3%) patients needed surgery: two (3.6%) fissures did not heal, one patient developed an abscess, 14 (25.5%) had prolonged wound healing and two (3.6%) developed a recurrent fissure after the sphincterotomy had healed. Conclusion Our algorithm is effective in CAF and the majority of patients respond to conservative management. Only 26.3% of all patients require surgery, which is effective but also carries some temporary morbidity.     

丹红注射液合并硝酸甘油对急性心肌梗死患者PCI治疗中无复流现象及C-反应蛋白的影响

目的:研究急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)前静脉注射丹红注射液对术中无复流血流的改善及C-反应蛋白(CRP)的影响。方法:对120例AMI患者术前均给予阿司匹林300 mg、氯吡格雷300 mg等治疗。随机分成A组与B组两组,各60例。A组PCI术前予以丹红注射液,术中出现无复流2例,再予以硝酸甘油冠脉内给药;B组直接行PCI术,术中出现无复流8例,再予以硝酸甘油冠脉内给药,对比两组患者冠脉血流恢复情况。同时两组患者均在术前及术后监测CRP。结果:A组全部冠脉血流恢复TIMI3级,B组有4例冠脉血流恢复TIMI3级,且用丹红注射液组术后CRP降低更明显。结论:PCI术前静脉注射丹红注射液可以降低AMI患者的CRP值,且联合硝酸甘油后较单一给予硝酸甘油可更有效恢复无复流血管的TIMI血流值。     

Comparison of the effects of molsidomine,nitroglycerin and isosorbide dinitrate on experimentally induced coronary artery thrombosis in the dog

Summary Platelet activation and aggregation in the coronary circulation may be important in the pathogenesis of myocardial ischemia. Molsidomine (M), isosorbide dinitrate (ISDN) and nitroglycerin (NTG) have been found to inhibit platelet aggregationin vitro. In the present study, the activity of these compounds was investigated in a model of coronary artery thrombosisin vivo. Dogs were ancsthetized, thoracotomized, and their heart was exposed. An electrode was inserted into the left circumflex coronary artery and set to rest on the intima. Electrical stimulation (9 V, 150 A) lasted for 6 h. Compounds (each in 2 dose levels) were given as an i.v. infusion starting 30 min after the beginning of the stimulation and lasting for the duration of the experiment. All control (saline-treated) animals underwent thrombotic occlusion of the coronary artery as assessed by flow measurement. On the other hand, 2/8 dogs treated with the lower M dose and 4/8 dogs treated with the higher M dose did not have a coronary occlusion. Neither ISDN nor NTG, at both doses, prevented the coronary occlusion. In control animals thrombus wet weight was 74.43±11.25 mg. M reduced the thrombus weight in a doserelated manner, while ISDN (marginally) and NTG (significantly at the higher dose) increased this parameter. Following the coronary thrombosis, all control animals developed myocardial infarcts as assessed by the tetrazolium technique. Similarly all animals treated with ISDN and with NTG (at both doses) showed infarcts. However, 3/8 M-dogs did not have a myocardial infarction in the lower as well as in the higher dose groups. The hemodynamic changes induced by the 3 compounds were similar in magnitude.Thus M but not ISDN or NTG showed in thisin-vivo study antithrombotic and consequently antiischemic activity.     

化痰活血中药治疗急性冠状动脉综合征

目的 探讨化痰活血中药治疗急性冠状动脉综合征临床效果.方法 从急诊科留观及住院患者中随机选择60例分为治疗组与对照组,各30例.对照组予西医常规治疗,治疗组在对照组治疗基础上予化痰活血中药治疗.结果 治疗后2组发作频率较治疗前均显著下降(P＜0.05),且治疗组优于对照组(P＜0.05);治疗组中医证候评分显著下降(P＜0.05);治疗后2组心肌酶相关指标水平均显著下降,P ＜0.05;且治疗组优于对照组(P＜0.05).2组均未发生不良反应.结论 西药联合化痰活血中药治疗急性冠状动脉综合征,能明显减少心绞痛发作频率,明显改善中医症状,提高患者生活质量.     

硝酸甘油软膏在痔术后应用的疗效观察

【】目的：观察硝酸甘油软膏在痔术后应用的临床价值。方法：对痔术后患者进行随机分组,实验组手术结束后即给予硝酸甘油软膏,之后每天换药时给药,其余治疗和对照组一致,观察术后3、5、7d患者疼痛情况及额外止痛药物使用情况。结果：实验组(硝酸甘油软膏组)术后3、5、7d疼痛程度低于对照组,相比较有显著差异；额外止痛药物使用量低于对照组,两组相比较有显著差异。结论：硝酸甘油软膏应用于痔术后患者,能够有效缓解患者疼痛症状,减少额外止痛药物的使用,促进创面愈合,可以加以推广应用。     

Postoperative management of Dupuytren’s disease with topical nitroglycerin

Dupuytren’s contracture remains a significant clinical challenge due to associated complications and a recurrence rate of up to 60%. Commonly, the operated skin tends to rebuild scar in the area of surgery. Assuming local ischemia as an etiological factor, two cases in which topical nitroglycerin was used following surgical treatment of Dupuytren’s disease are presented. In these patients, no raised scar formation developed during healing. At least six months after surgery, disease recurrence was not noted and the patients and surgeon reported improved skin quality. In the present study, the use of topical nitroglycerin, a local vasodilator, appeared to prevent recurrent scar formation, possibly through prevention of local ischemia. Further study and follow-up is necessary.