静脉溶栓治疗老年急性心肌梗死疗效分析

目的探讨老年急性心肌梗死接受静脉溶栓治疗的疗效。方法60例急性心肌梗死患者分为静脉溶栓组（A组）和非静脉溶栓组（B组）,分别对两组的临床疗效进行比较。结果静脉溶栓组再通率为22例,占73．3％,非静脉溶栓组再通率为12例,占40％,静脉溶栓组30d死亡2例（6．7％）,非静脉溶栓30d死亡8例（26．7％）,（P〈0．05）具有临床统计学意义,并发症静脉溶栓组均低于非静脉溶栓组（P〈0．05）。结论老年急性心肌梗死及早行静脉溶栓治疗疗效显著,值得推广。     

急诊绿色通道溶栓救治急性心肌梗死的效果评估

目的评估急性心肌梗死患者在急诊科通过绿色通道进行静脉溶栓的效果。方法比较急性心肌梗死患者在急诊科通过绿色通道进行静脉溶栓（EICU组）和在心血管科住院后进行静脉溶栓治疗（CCU组）患者的治疗效果,对比两组开始溶栓时间、再通率、病死率、溶栓治疗后2周左室射血分数。结果EICU组平均开始溶栓治疗时间为（35±5）min;再通41例（73．2％）,急诊科住院期间死亡2例（3．8％）;溶栓后2周左室射血分数（LVEF）为（52．01±0．18）％。CCU组平均开始溶栓治疗时间为（130±15）min;再通40例（57．1％）,住院期间死亡6例（8．6％）;溶栓后2周左室射血分数（LVEF）为（43．11±0．13）％。各观察指标比较差异均有统计学意义。结论急诊科绿色通道的建立,为急性心肌梗死患者进行静脉溶栓治疗争取了宝贵的时间,显著提高了血管再通率,明显改善心肌梗死患者的心功能,降低病死率。     

急性心肌梗死溶栓治疗与介入治疗的效果对比分析

目的比较直接经皮冠状动脉介入（PCI）治疗与尿激酶（UK）静脉溶栓治疗急性心肌梗死（AMI）患者的近期临床效果。方法选取本院2009年12月～2012年12月收治的AMI患者174例,分为溶栓组68例和PCI组106例,对比两组患者梗死相关动脉血管（IRA）再通率、病死率、严重并发症发生率、平均住院时间。结果PCI组IRA再通率明显高于溶栓组,差异有统计学意义（P〈0．05）;PCI组病死率明显低于溶栓组,差异有统计学意义（P〈0．05）;PCI组严重并发症发生率明显低于溶栓组,差异有统计学意义（P〈0．05）;PCI组平均住院时间明显短于溶栓组,差异有统计学意义（P〈0．05）。结论AMI直接PCI治疗优于溶栓治疗。     

急诊重组链激酶溶栓治疗急性心梗并完全右束支传导阻滞疗效观察

目的观察急诊重组链激酶静脉溶栓治疗急性心肌梗死合并完全性右束支传导阻滞患者的疗效。方法20例AMI合并CRBBB患者按照入院距离发病时间分为2组,A组10例,在发病6h内到达急诊室,进行重组链激酶150万单位静脉溶栓;B组10例,在发病6h后到达急诊室,进行一般性内科治疗。比较2组患者入院4周内并发症发生率和病死率。结果A组患者并发症发生率低于B组（40．0％VS100．0％）,病死率也低于B组（30．0％vs80．O％）。冠状动脉造影显示均为左冠状动脉病变,74％为左前降支近端病变,26％为左主干病变,均在第一室间隔支发出之前发生梗死,狭窄程度在80—95％。结论AMI合并CRBBB患者的病死率高,急诊重组链激酶静脉溶栓是有效的治疗方法,改善近期预后。     

放宽急性脑梗死溶栓时间窗的疗效及安全性观察

目的探讨有选择地放宽急性脑梗死（ACI）的溶栓时间窗，对给予尿激酶静脉溶栓患者的疗效、安全性及对溶栓比率的影响。方法采取开放性对照临床研究，观察31例按常规溶栓时间窗（≤6h）进行治疗（A组）患者的疗效，并与17例放宽溶栓时间窗（发病后6～24h）的患者（B组）及96例具有相同条件而非溶栓治疗的患者（C组）进行疗效等指标的比较。结果A组与B组有相近的治愈率、显效率及病死率（三者均为P〉0．05），但在总有效率上，A组明显高于B组（P〈0.05），2组的治愈率、显效率和总有效率均高于C组（P均〈0．05）。结论有选择的延迟静脉溶栓对ACI是有效的，可使更多的ACI患者受益，临床应用比较安全。     

急性心肌梗死优化介入治疗的临床研究

目的探讨经皮冠状动脉介入治疗（PCI）联合尿激酶静脉溶栓（即优化介入治疗）治疗急性心肌梗死（AMI）的有效性和安全性。方法128例发病时间≤12h的首次AMI患者随机分为溶栓治疗＋PCI组（74例）和直接PCI组（54例），对两组患者介入治疗前梗死相关血管（IRA）通畅率、介入治疗成功率、出血并发症发生率、住院期间急性心脏缺血事件发生率及出院前左心室功能（LVEF）进行比较。结果冠状动脉介入治疗前溶栓治疗＋PCI组IRA通畅率（65．7％）显著高于直接PCI组（24．3％）（P〈0．05），前者介入治疗成功率为100％；两组IRA通畅率分别为96．9％和94．6％；住院期间两组均元严重出血及急性心脏缺血事件发生；出院前经超声心动图测得LVEF在溶栓治疗＋PCI组为64．8％，明显高于直接PCI组的57．5％（P〈0．05）。结论静脉溶栓联合PCI治疗AMI早期再通率高，更有利于保护左室功能，不增加出血并发症。     

经皮冠状动脉介入治疗急性心肌梗死疗效观察

目的对急性心肌梗死（AMI）患者实施直接经皮冠状动脉介入治疗（PCI）和单纯静脉溶栓治疗的临床效果进行对比。方法选择2011年3月一2013年3月驻马店市第一人民医院收治的56例急性心肌梗死患者,随机分为观察组和对照组各28例。观察组给予直接PCI,对照组给予单纯的静脉溶栓治疗,对照两组患者的近远期治疗效果。结果观察组再通率为88．46％,住院时间为（14．80±1．37）d,对照组再通率为57．69％,住院时间（22．21±1．65）d,两组比较差异显著（P〈0．05）,但两组患者死亡率差异无统计学意义（P〉0．05）。结论对AMI患者实施PCI的血管再通率高,能够有效改善心肌缺血的状态,改善心功能,减少死亡例数,还能显著缩短住院治疗时间,预后较好,患者生命质量得到保障。     

静脉溶栓与PCI在急性心肌梗死患者中的效果比较

目的观察及比较静脉溶栓与PCI在急性心肌梗死患者中的效果。方法选取2012年4月至2014年5月于本院进行诊治的56例急性心肌梗死患者为研究对象,将其根据治疗方式的不同分为A组(静脉溶栓治疗组)28例和B组(PCI治疗组)28例,然后将两组患者的再通率、住院时间及治疗前后的心功能相关指标进行分别统计及比较。结果 B组的再通率高于A组,住院时间短于A组,治疗后的心功能相关指标均好于A组,P均<0.05,均有显著性差异。结论静脉溶栓与PCI在急性心肌梗死患者中的效果差异较为明显,PCI在效果评估的各个方面中更具优势,因此临床应用价值相对更高。     

急性心肌梗死患者溶栓后ST段回降程度的临床意义

目的探讨急性心肌梗死患者溶栓后12导联心电图梗死相关导联抬高ST段回降程度的影响因素及其临床意义。方法将冠心病监护病房收治并接受静脉溶栓治疗且符合梗死相关血管再通标准的61例首发急性心肌梗死患者，根据溶栓后60min内12导联心电图梗死相关导联抬高ST段回降程度（以回降≥50％为标准）分为两组，A组（ST段快速回降组）36例，B组（ST段缓慢回降组）25例，比较两组间梗死相关血管再通率、心功能（Killp分级）不全的发生率、住院恶性室性心律失常的发生率、住院病死率。所有患者均于3周内做冠状动脉造影。结果A、B两组患者比较，B组心功能（Killp分级）不全发生率（48％）、住院恶性窒性心律失常发生率（64％）、住院病死率（16％）较高，梗死相关血管再通率（56％）较低，两组比较差异有统计学意义（P〈0．01）。B组多支血管病变发生率（80％）较高（P〈0．01）。结论溶栓治疗后ST段缓慢回降患者，其心功能不全发生率、住院心律失常发生率、住院病死率较高，血管再通率较低，原因可能与冠状动脉存在多支病变及梗塞血管狭窄程度较重有关。     

不同时间窗重组组织型纤维蛋白酶原激活剂静脉溶栓治疗急性脑梗死合并糖尿病的疗效评价

目的：评价重组组织型纤维蛋白酶原激活剂（ recombinant tissue plasminogen activator ,rt-PA）静脉溶栓治疗不同时间窗急性脑梗死合并糖尿病患者的疗效。方法回顾性分析2013年6月至2014年6月,环湖医院神经内科十七病区收治的急性脑梗死合并糖尿病行静脉溶栓治疗的患者344例,根据发病至治疗时间（ onset to treatment time,OTT）分为＜3 h组（ n ＝152）,3～4…．5 h组（ n ＝104）,4．6～6 h组（ n ＝88）,分别观察静脉溶栓前、溶栓后24 h美国国立卫生院卒中量表（ National Institutes of Health Stroke Scale ,NIHSS）评分以及改良Rankin评分（ modified Rankin Scale,mRS）。结果静脉溶栓前及溶栓后24 h,3组患者NIHSS评分比较,差异均有统计学意义（ P ＜0．05）。发病后90 d对3组患者进行改良Rankin评分,＜3 h组152例患者中神经功能预后良好者100例（65．7％）,预后不良者52例（34．2％）,死亡0例（0％）;3～4．5 h组104例患者中神经功能预后良好者24例（23．1％）,预后不良者80例（76．9％）,死亡4例（3．8％）;4．6～6 h组88例患者中神经功能预后良好者28例（31．8％）,预后不良60例（68．2％）,死亡4例（4．5％）。3组患者神经功能预后情况两两比较差异均有统计学意义（ P ＜0．05）。结论急性脑梗死合并糖尿病患者经rt-PA静脉溶栓近期治疗效果及远期效果均随OTT延长而降低,对于急性脑梗死合并糖尿病患者在时间窗内OTT越短,患者获益越大。     

Anticholinergic prophylaxis of acute haloperidol-induced acute dystonic reactions

Young adults treated with a high potency neuroleptic such as haloperidol are at high risk of developing dystonic reactions. In this retrospective study, 15 of 16 young adult patients treated only with haloperidol had such reactions within 60 hours of beginning the drug, while none of the seven patients treated with haloperidol plus prophylactic benztropine mesylate developed dystonia. Although methodologic considerations limit the generalization of these results, they are consistent with other reports and suggest that initial anticholinergic prophylaxis is warranted in young patients treated with high potency antipsychotics. All dystonic reactions in these patients occurred within 2 1/2 days, justifying the consideration of discontinuing prophylaxis (which also causes side effects) after 1 week.     

成人急性荨麻疹与急性细菌性咽炎的关系

目的：了解急性荨麻疹发作与急性细菌性咽炎的关系。方法：选择观察组100例急性荨麻疹患者,对照组101例慢性荨麻疹患者,均进行全身体格检查及外周血全血细胞分类计数、咽拭子细菌培养,以观察荨麻疹发作与急性细菌性咽炎的关系。结果：治疗组中发现有27例有急性细菌性咽炎,而对照组中只发现有6例有急性细菌性咽炎,两组比较差异有统计学意义（χ2=14.742,P〈0.01）。结论：急性细菌性咽炎是急性荨麻疹发作的病因之一。     

急性闭角型青光眼双眼急性发作的诱因分析

目的对急性闭角型青光眼双眼急性发作的诱因进行分析以减少其发作。方法选取2008年6月～2011年6月本院收治的急性闭角型青光眼双眼急性发作的患者25例,立即对其进行降低眼内压治疗,待眼内压得到控制之后,进行滤过性手术的患者10例,进行虹膜激光透切术的患者15例。手术后进行双眼的前房深度测量以及周边前房深度测量,并测量双眼深度差,以及屈光状态。结果经数据整理,各诱因组之间P值均大于0.05,提示经治疗后,不同诱因的治愈率差异无统计学意义。结论疼痛的刺激、情绪的剧烈波动和M受体阻断剂等药物使瞳孔扩散增大,是此类疾病的最常见诱因,临床治疗护理工作中应引起足够重视。     

Pharmacotherapy of acute lung injury and acute respiratory distress syndrome

Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Mortality from ALI/ARDS is substantial, and current therapy primarily emphasizes mechanical ventilation and judicial fluid management plus standard treatment of the initiating insult and any known underlying disease. Current pharmacotherapy for ALI/ARDS is not optimal, and there is a significant need for more effective medicinal chemical agents for use in these severe and lethal lung injury syndromes. To facilitate future chemical-based drug discovery research on new agent development, this paper reviews present pharmacotherapy for ALI/ARDS in the context of biological and biochemical drug activities. The complex lung injury pathophysiology of ALI/ARDS offers an array of possible targets for drug therapy, including inflammation, cell and tissue injury, vascular dysfunction, surfactant dysfunction, and oxidant injury. Added targets for pharmacotherapy outside the lungs may also be present, since multiorgan or systemic pathology is common in ALI/ARDS. The biological and physiological complexity of ALI/ARDS requires the consideration of combined-agent treatments in addition to single-agent therapies. A number of pharmacologic agents have been studied individually in ALI/ARDS, with limited or minimal success in improving survival. However, many of these agents have complementary biological/biochemical activities with the potential for synergy or additivity in combination therapy as discussed in this article.     

Management of acute cholecystitis and acute cholangitis in emergency setting

Acute biliary infection (acute cholecystitis and acute cholangitis) is one of the common emergency conditions which carries significant morbidity and mortality. The risk factors are often associated with gallstones, biliary stasis and bile infection. Gram-negative bacteria are frequent isolates from bile and blood cultures in infectious cholangitis. Endotoxaemia from the gram-negative microbes results in circulatory shock and organ dysfunction. Therefore, prompt diagnosis with severity stratification and recognition of its potential rapid progression to life-threatening shock and multi-organ failure ensure execution of the three fundamental interventions in the initial management strategy, namely: resuscitation to support the organ, antimicrobial therapy and biliary decompression drainage to control the infection. This is the core principle in the management of severe acute cholangitis.     

37例急性毒鼠强中毒救治及护理体会

目的 :探讨急性毒鼠强中毒的救治护理措施以及有效的控制抽搐对患者病情的影响。方法 :回顾性分析我院近年来收治的37例急性毒鼠强中毒患者应用维生维B6 静注等综合救治护理措施。结果 :维生素B6 联合鲁米那钠静注对控制抽搐确实有效 ,37例中毒患者 ,临床治愈33例 ,死亡4例。结论 :急性毒鼠强中毒是一综合救治护理过程 ,控制抽搐当属重中之重 ,脑水肿和中毒性脑病的防治也不可忽视。     

Vascular pharmacology of acute lung injury and acute respiratory distress syndrome

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) following sepsis, major trauma and surgery are leading causes of respiratory insufficiency, warranting artificial ventilation in the intensive care unit. It is caused by an inflammatory reaction in the lung upon exogenous or endogenous etiologies eliciting proinflammatory factors, and results in increased alveolocapillary permeability and protein-rich alveolar edema. The interstitial and alveolar inflammation and edema alter ventilation perfusion matching, gas exchange and mechanical properties of the lung. The current therapy of the condition is supportive, paying careful attention to fluid balance, relieving the increased work of breathing and improving gas exchange by mechanical ventilation, but in vitro, animal and some clinical research is done to evaluate the value of anti-inflammatory therapies on morbidity and outcome, including inflammatory cell-stabilizing corticosteroids, xanthine derivates, prostanoids and inhibitors, O(2) radical scavenging factors such as N-acetylcysteine, surfactant replacement, vasodilators including inhaled nitric oxide, vasoconstrictors such as almitrine, and others. None of these compounds has been proven to benefit survival in patients, however, even though carrying a physiologic benefit, except perhaps for steroids that may improve outcome in the later stage of ARDS. This partly relates to the difficulty to assess the lung injury at the bedside, to the multifactorial pathogenesis and the severity of comorbidity, adversely affecting survival.