ST段抬高型急性心肌梗死直接PCI时机与预后的关系

将160例ST段抬高急性心肌梗死（STEMI）患者根据胸痛发作到开始介入治疗的时间分为三组：A组（＜4h）40例,B组（4～6h）53例,C组（＞6～12h）67例.比较三组术后心肌梗死溶栓试验（TIMI）血流3级率、ST段无回落率、出院前左室射血分数和住院期间主要不良心脏事件发生率.结果A组术后TIMI血流3级率和出院前左室射血分数显著高于B组和C组,ST段无回落率和住院期间主要不良心脏事件发生率均显著低于B组和C组.B组和C组比较,以上四项指标均无显著差异.认为STEMI 4h内介入治疗开始可显著提高术后TIMI血流3级率,改善心肌组织再灌注、心功能和近期预后;4h后介入治疗则无明显的时间依赖性.     

Diver CE血栓抽吸装置在急诊冠状动脉介入治疗中的应用

目的 评价急性ST段抬高心肌梗死(STEMI)患者急诊冠状动脉介入治疗(PCI)中应用Diver CE血栓抽吸装置的效果与安全性.方法 选择抚顺市中心医院2006年7月至2007年6月接受直接PCI的STEMI患者46例,分成血栓抽吸组与直接PCI组,比较两组间2 h胸痛缓解率、ST段回落率、TIMI 3级血流、肌酸磷酸激酶(CK)及其同功酶(CK-MB)峰值、左室射血分数(LVEF)及术后1个月内心脏不良事件发生率.结果 血栓抽吸组的2 h胸痛缓解率、ST段回落率、TIMI3级血流、CK及CK-MB峰值、LVEF值明显优于直接PCI组(P＜0.05),术后1个月内心脏不良事件发生率两组差异无显著性意义(P＞0.05).结论 PCI中应用Diver CE血栓抽吸装置能明显减少冠状动脉血栓及远端栓塞,有效地改善心肌灌注.     

替罗非班联合替格瑞洛对STEMI患者行急诊PCI术后TIMI分级、心肌灌注、主要心脏不良事件发生的影响

目的探讨替罗非班联合替格瑞洛对ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入术(PCI)患者术后TIMI分级、心肌灌注、主要心脏不良事件发生的影响。方法选取本院100例行PCI治疗的STEMI患者,随机分为对照组给予替格瑞洛治疗,观察组给予替罗非班联合替格瑞洛治疗,两组各50例。比较两组术后TIMI血流分级、心肌灌注、主要心脏不良事件发生的情况。结果观察组TIMI血流分级3级比例与术后ST段回落高于75%比例均明显高于对照组(均P0.05),且无复流发生率低于对照组(P0.05);观察组术后主要心脏不良事件发生率明显低于对照组(P0.05),且左心室射血分数明显高于对照组(P0.05),左心室舒张末期内径低于对照组(P0.05)。结论替罗非班联合替格瑞洛可有效改善行PCI治疗的STEMI患者心肌灌注,有助于保护患者心脏功能,降低无复流发生率,能够明显减轻主要心脏不良事件的发生率。     

冠脉内逆向应用重组人尿激酶原溶栓联合PCI对急性ST段抬高型心肌梗死患者预后的临床研究

目的:探讨冠状动脉(冠脉)内逆向应用重组人尿激酶原联合经皮冠脉介入治疗(PCI)对ST段抬高型心肌梗死(STEMI)患者预后的影响。方法:选择心内科行急诊PCI的STEMI患者120例,随机分为直接PCI组(A组)、血栓抽吸+PCI组(B组)、PCI+冠脉内正向溶栓组(C组)及冠脉内逆向溶栓+PCI组(D组),每组各30例。比较4组基线资料、术后TIMI血流分级、校正TIMI帧数计数(CTFC)、2 h ST段回落率(STR)≥50%的比例、无复流/慢血流(NR/SF)发生率、左心室射血分数(LVEF)、肌钙蛋白I(cTnI)和B型利钠肽(BNP)峰值。记录随访3个月的LVEF、主要不良心血管事件(MACEs)及TIMI出血情况,对相关指标进行比较。结果:(1)D组与A、B、C组比较,术后TIMI血流≤2级发生率、CTFC、NR/SF发生率、cTnI及BNP峰值显著降低,术后2 h STR≥50%的比例、LVEF显著升高(P<0.05);(2)随访3个月D组心力衰竭再住院发生率显著低于A、B、C组,且LVEF显著升高(P<0.05);(3)随访3个月,4组TIMI出血发生率...     

替罗非班在急性心肌梗死介入治疗中的疗效及安全性

目的观察替罗非班在急性ST段抬高性心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)中的有效性及安全性。方法选择2011年5月~2014年5月我院接受急诊冠状动脉介入治疗的急性ST段抬高性心肌梗死患者180例作为研究对象,随机分为替罗非班组和对照组,各90例。比较两组患者术后7天心电图ST段回落情况、左室射血分数、术后梗死相关血管开通后血流TIMI分级、术后30天内出血并发症及主要不良心脏事件的发生情况。结果术后7天内心电图ST段回落情况,替罗非班组所占比例高于对照组、替罗非班组TIMI血流3级高于对照组、替罗非班组左室射血分数高于对照组、30天内主要不良心脏事件的发生率替罗非班组低于对照组,差异有统计学意义(P0.05),而两组术后30天内出血并发症比较,差异无统计学意义(P0.05)。结论在急性STEMI介入治疗中,盐酸替罗非班的应用,能明显改善心肌再灌注、改善梗死相关血管的TIMI血流、提高心脏射血分数而改善心脏功能、减少心脏不良事件的发生,且不增加临床出血风险,临床应用价值高。     

再灌注时间对急诊冠状动脉介入治疗心肌灌注的影响

目的:分析再灌注时间对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌灌注及近期预后的影响。方法:101例首发STEMI并行急诊PCI的患者按症状发作至再灌注的时间(t)分为3组:t≤3h为A组,37例;3h0.05)。B组及C组PCI术后MBG0/1(58.06%、57.58%)和ST段回落不全(STR<50%)的比例(51.61%、54.55%)均高于A组(32.43%和27.03%,P<0.05),B组与C组间MBG、STR无统计学差异(P>0.05)。B组及C组在30d随访期间的死亡率、Killip分级和心源性休克发生率均显著高于A组(P<0.05)。结论:在STEMI急诊PCI中,12h内不同时间组获得TIMI 3级血流的比例相同,但再灌注时间<3h的患者心肌组织灌注水平提高,近期预后较好。     

择期PCI大面积STEMI患者术前应用IABP临床预后观察

目的研究择期行经皮冠状动脉介入治疗(PCI)的大面积急性ST段抬高型心肌梗死(STEMI)患者早期应用主动脉内气囊反搏术(IABP)对临床预后的影响。方法选取发病12～72 h的STEMI患者100例,随机分为两组,IABP组52例、对照组48例,对照组给予规范的药物治疗,IABP组在规范药物治疗的基础上床旁应用IABP 3～5 d。两组均于10～14 d后行冠脉造影及PCI术。评价梗死相关血管PCI术前及术后冠脉血流(TIMI)和术后4周心功能及主要不良心脏事件的发生情况。结果 IABP组PCI术前、术后TIMIⅢ级高于对照组,PCI术后4周主要不良心脏事件的发生率低于对照组,左心室射血分数高于对照组,P均<0.05。结论对于大面积STEMI患者择期行PCI,早期应用IABP能改善梗死相关血管的TIMI血流,减少术后4周主要不良心脏事件的发生率,改善心功能,临床应用安全有效。     

再灌注时间对急诊冠状动脉介入治疗心肌灌注的影响

目的:分析再灌注时间对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌灌注及近期预后的影响. 方法:101例首发STEMI并行急诊PCI的患者按症状发作至再灌注的时间(t)分为3组:t≤3 h为A组,37例;3 h0.05).B组及C组PCI术后MBG0/1(58.06%、57.58%)和ST段回落不全(STR<50%)的比例(51.61%、54.55%)均高于A组(32.43%和27.03%,P<0.05),B组与C组间MBG、STR无统计学差异(P>0.05).B组及C组在30 d随访期间的死亡率、Killip分级和心源性休克发生率均显著高于A组(P<0.05). 结论:在STEMI急诊PCI中,12 h内不同时间组获得TIMI 3级血流的比例相同,但再灌注时间<3 h的患者心肌组织灌注水平提高,近期预后较好.     

PCI后TIMI血流及心电图ST段在评价STEMI患者梗死区再灌注中的价值

目的分析急性ST段抬高性心肌梗死（STEMI）患者PCI（经皮冠状动脉介入治疗）术后1周及6个月时梗死区的室壁运动情况,评价TIMI血流及ST段回落与梗死区再灌注的关系。方法选择209例行急诊PCI和56例未行急诊血运重建的急性STEMI患者（对照组）,采用二维超声心动图测定心肌梗死后1周及6个月时梗死区的室壁运动。将PCI患者分为3组,A组为PCI后TIMI血流2～3级且2h内ST段回落〉150％者;B组为PCI后TIMI血流2～3级且2h内ST段回落〈50％者;C组为PCI后TIMI血流1级且2h内ST段回落〈50％者。结果与对照组相比,A组梗死后1周及6个月梗死区的室壁运动均明显改善（P〈0．01）,B组梗死后1周梗死区的室壁运动无明显改善,6个月时梗死区的室壁运动较对照组明显改善（P〈0．01）,且与A组无统计学差异（P〉0．05）;C组梗死后1周及6个月梗死区的室壁运动均无改善（P〉0．05）。结论急性STEMI患者成功PCI后,ST段迅速回落对于判断梗死区早期再灌注具有重要的临床预测价值,而对梗死区远期再灌注的临床预测价值较小;TIMI血流对于判断梗死区远期再灌注具有重要的临床预测价值,而对梗死区早期再灌注的临床预测价值较小。     

急性ST段抬高型心肌梗死直接PCI术后ST段回落的临床研究

目的：通过观察急性ST段抬高型心肌梗塞（STEMI）直接经皮冠状动脉介入治疗（PCI）术后,梗塞相关动脉（IRA）达心肌梗塞溶栓（TIMI）血流3级患者心电图ST段回落程度,探讨ST段回落与心肌损伤及心脏收缩功能的关系。方法：选择在发病12h内接受直接PCI治疗后TIMI血流达到3级的STEMI患者115例,PCI术前、术后行心电图检查,观察ST段回落情况,术前、后测定患者肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）及肌钙蛋白T（cTnT）,术后测定左室射血分数（LVEF）;按照ST段回落幅度（∑STR）不同,患者被分为两组：A组：∑STR〈50%,21例,为心肌灌注不良组,B组：∑STD≥50%,94例,为心肌灌注良好组;分析两组患者ST段回落程度与CK、CK-MB、cTnT及LVEF的关系。结果：（1）两组患者IRA部位、病变血管支数,PCI治疗前TIMI血流分级、cTnT水平,发病到PCI时间等差异均无显著性（P〉0.05）;（2）两组患者术前、后CK、CK-MB水平差异无显著性（P〉0.05）;（3）术后A组cTnT水平明显高于B组[（1.30±0.43）μg/L∶（1.0±0.45）μg/L,P〈0.05];（4）术后A组LVEF明显低于B组[（44.13±4.83）%∶（47.93±5.23）%,P〈0.05]。结论：急性ST段抬高型心肌梗塞直接PCI术后,TIMI血流达到3级,ST段回落良好的患者,心肌组织水平灌注程度较好,心肌损伤程度轻,左心收缩功能较好。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.