Socioeconomic differences in mortality in Rome, 1990-1995

Population groups with a lower socioeconomic status (SES) have a greater risk of disease and mortality. The aim of this study was to investigate the relationship between SES and mortality in the metropolitan area of Rome during the six-year period 1990-1995, and to examine variations in mortality differentials between 1990-92 and 1993-95. Rome has a population of approximately 2,800,000, with 6,100 census tracts (CTs). During the study period, 149,002 deaths occurred among residents. We compared cause-specific mortality rates among four socioeconomic categories (SES) defined by a socioeconomic index, derived from characteristics of the CT of residence. Among men, total mortality and mortality for the major causes of death showed an inverse association with SES. Among 15-44 year old men, the strong positive association between total mortality and low SES was due to AIDS and overdose mortality. Among women, a positive association with lower SES was observed for stomach cancer, uterus cancer and cardiovascular disease, whereas mortality for breast cancer was higher in the groups with higher SES. Comparing the periods 1990-92 and 1993-95, differences in total mortality between socioeconomic groups widened in both sexes. Increasing differences were observed for tuberculosis and lung cancer among men, and for uterus cancer, traffic accidents, and overdose mortality among women. The use of an area-based indicator of SES limits the interpretations of the findings. However, despite the possible limitations, these results suggest that social class differences in mortality in Rome are increasing. Time changes in life style and in the prevalence of risk behaviors may produce differences in disease incidence. Moreover inequalities in the access to medical care and in the quality of care may contribute to an increasing differentials in mortality.     

Gender differences in the treatment of patients with acute myocardial ischemia and infarction in England.

We conducted a retrospective cohort study based on a case note review to determine whether there are differences in the treatment pathways followed for men and women admitted with acute myocardial ischemia and infarction after adjusting for differences in case mix. Women were as likely as men to receive thrombolysis, but were less likely subsequently to undergo exercise testing (adjusted odds ratio, 0.58; 95% CI, 0.40-0.84) or angiography (adjusted odds ratio, 0.62; 95% CI, 0.39-0.99). Coronary anatomy was the strongest predictor of revascularization regardless of sex. Women with diagnosed cardiac pain are less likely than men to be placed on the investigative pathways that lead to revascularization. Those women who are investigated are as likely as men to undergo revascularization. These findings are independent of the effects of age, angina grade, comorbidity, or cardiac risk factors. Clinicians' and patients' beliefs and preferences about treatment require investigation.     

院前急救护理对急性心肌梗死患者院前急救的影响

目的:探讨院前急救护理对急性心肌梗死患者院前急救的应用效果.方法:选取我院中心急救车送入医院的急性心肌梗死患者64例作为观察组,由家属直接送入医院的患者64例作为对照组.对照组实施常规护理方法,观察组实施院前急救护理措施,分析实施前后患者的急诊抢救时间、患者存活率及住院时间.结果:与对照组相比较,患者的存活率显著高于对照组,差异具有统计学意义(P<0.05).结论:院前急救护理值得临床推广及应用.     

Prehospital delay and independent/interdependent construal of self among Japanese patients with acute myocardial infarction

Reducing the time from symptom onset to reperfusion therapy is an important approach to minimizing myocardial damage and to preventing death from acute myocardial infarction (AMI). Previous studies suggest that certain ethnic or national groups, such as the Japanese, are more likely to delay in accessing care than other groups. The aims of this paper were the following; (1) to examine whether culture (defined as independent and interdependent construal of self) is associated with delay in accessing medical care in Japanese patients experiencing symptoms of AMI; (2) to determine if the relationship between independent and interdependent construal of self and prehospital delay time is mediated by cognitive responses and/or emotional responses; and (3) to determine if independent and interdependent construal of self independently predicts choice of treatment site (clinic vs. hospital). A cross-sectional study was conducted at hospitals in urban areas in Japan. One hundred and forty-five consecutive patients who were admitted with AMI within 72 h of the onset of symptoms were interviewed using the modified response to symptoms questionnaire and the independent and interdependent construal of self scale. The interdependent construal of self scores were significantly associated with prehospital delay time, controlling for demographics, medical history, and symptoms (p<.001). However, the relationship between independent and interdependent self and prehospital delay times was not mediated by cognitive or emotional responses. In multiple logistic regression analysis, patients with high independent construal of self were more likely to seek care at a hospital rather than a clinic compared to those with lower independent construal of self. In conclusion, cultural variation within this Japanese group was observed and was associated with prehospital delay time.     

急性心肌梗死患者医院感染危险因素分析与预防

目的分析急性心肌梗死患者发生医院感染的部位、病原菌分布和危险因素,提出预防措施,减少医院感染。方法回顾性分析医院2012年6月-2014年12月收治的816例急性心肌梗死并发医院感染的患者临床资料,调查其医院感染率、感染部位、病原菌分布,并对其危险因素进行单因素分析。结果 816例患者发生医院感染93例,医院感染率为11.4%,感染部位依次为:下呼吸道38例、泌尿道22例、消化道17例、上呼吸道9例及皮肤及黏膜7例,分别占40.9%、23.6%、18.3%、9.7%及7.5%;感染病原菌以革兰阴性菌为主,占73.5%,其次为革兰阳性菌占23.5%和真菌占3.0%;急性心肌梗死患者医院感染与患者的年龄、住院时间、合并糖尿病、心功能Ⅲ和Ⅳ分级、介入手术、气管插管和呼吸机使用等因素相关(P<0.05)。结论急性心肌梗死患者医院感染率较高,医院感染以呼吸道感染为主,大多数感染由革兰阴性菌引起,感染相关因素较多,临床应加强感染监测,并制定合理干预措施,减少医院感染发生。     

急诊时间对突发急性心肌梗死预后效果的影响

目的探讨突发急性心肌梗死的急诊时间对治疗方法与预后效果的影响。方法根据入院顺序将60名左室突发急性心肌梗死患者随机分为治疗组与对照组(n=30),对治疗组患者在急性突发急性心肌梗死出现症状出现12h内实施介入治疗,对对照组患者在突发急性心肌梗死症状出现12h后实施介入治疗。结果治疗后,两组的EDV、ESV、LVEF都有明显改善,差异有统计学意义(P﹤0.05),但是治疗组的改善程度优于对照组,差异有统计学意义(P﹤0.05)。经过观察与3个月随访,治疗组胸痛与再梗死的发生率明显少于对照组(P﹤0.05)。另外,治疗组没有出现死亡病例,对照组有3例死亡,差异也有统计学意义(P﹤0.05)。结论早期急诊介入治疗突发急性心肌梗死能有效改善超声心动图指标,同时对预后结果有积极影响,值得推广应用。     

急性心肌梗死Q-T离散度的临床分析

目的:为了解急性心肌梗死Q-T离散度的动态变化,以及与恶性室性心律失常、左房负荷(PTFV1)的关系。方法:测量80例急性心肌梗死病人包括死亡前)住院期间Q-T离散度,比较急性心肌梗死(AMI)入院与出院时Q-T离散度(Q-Td)及校正Q-T离散度(Q-Tcd),比较Q-Td与PTFV1及恶性室性心律失常的相关性。结果:80例AMI住院期间Q-Td动态变化揭示了Q-Td与恶性室性心律失常、PTFV1的密切关系,62例急性心肌梗死Q-Td及Q-Tcd入院时较出院有非常明显延长(P<0.05)。结论:Q-Td可作为预测恶性室性心律失常及心功能不全的一项敏感指标,不失为无创性评估急性心肌梗死预后的手段之一。     

急性心肌梗死患者近期预后的危险因素分析

目的探讨影响急件心肌梗死患者近期预后的危险因素,为改善急性心肌梗死患者的预后提供科学依据。方法选取2003-2008年山东省菏泽市牡丹区中医院419例急性心肌梗死患者作为研究对象,对相关危险因素进行单因素和多因素Logistic回归分析。结果2003-2008年笔者所在医院共收治419例急性心肌梗死患者,其中抢救无效死亡19例,病死率为4.53％。高龄、心肌梗死面积大、未及时溶栓、糖尿病、高血压、高血脂是影响心肌梗死患者近期预后的主要危险因素,OR值分别为1.462、3.205、2.390、2.401、2.133和1.650。结论影响急性心肌梗死患者近期预后的原因很多,及时给予尿激酶进行溶栓治疗,有效控制患者的血压、血糖和血脂浓度,可以改善急性心肌梗死患者的近期预后,降低病死率。     

社区健康教育对急性心肌梗死患者院外时间延误和住院转归的影响

目的 探讨社区健康教育对急性心肌梗死患者院外时间延误和住院转归的影响.方法 从2012年7月开始对山东省临沂市人民医院周边社区进行为期4个月的健康教育,指导患者胸痛后及时到医院就诊.健康教育后1年内（2012年11月1日至201 3年10月31日）收治的社区内ST段抬高型急性心肌梗死患者为观察组,共89例;健康教育前1年内（2011年7月1日至2012年6月30日）收治同一社区内ST段抬高型急性心肌梗死患者为对照组,共81例.记录两组患者的院前延误时间、溶栓与急诊介入治疗例数、住院期间严重并发症发生率、死亡率.计数资料比较采用x2检验或Fisher确切概率检验;计量资料正态分布数据比较采用t检验,偏态分布数据比较采用Wilcoxon秩和检验.结果 观察组患者院外延误时间中位数为80 （47～ 150）min,短于对照组的90（60 ～255） min（WilcoxonW值=6 912.00,Z值=-2.182,P=0.029）;观察组患者再灌注治疗比例为54％（48/89）,高于对照组的38％ （31/81）（x2=4.181,P=0.041）;观察组患者住院期间总的恶性并发症发生率为24％（21/89）,低于对照组的42％（34/81）,差异有统计学意义（x2=6.732,P=0.009）.结论 社区健康教育可有效缩短急性心肌梗死患者的院外时间延误,增加再灌注治疗的比率和减少总的恶性并发症发生率.     

阿托伐他汀对急性心肌梗死患者血清高敏C反应蛋白的影响

目的 观察阿托伐他汀对急性心肌梗死（AMI）患者血清高敏C-反应蛋白（hs-CRP）的影响,探讨阿托伐他汀在急性心肌梗死炎症反应中的作用.方法 选取AMI患者65例,按发病前是否因心绞痛、血脂异常服用过阿托伐他汀分为两组.治疗组30例,服用阿托伐他汀（20 mg/d）5周;对照组35例,未服用阿托伐他汀.采用放射免疫法测两组患者血清hs-CRP水平.结果 治疗组血浆hs-CRP水平低于对照组,差异有统计学意义（P〈0 05）.结论 阿托伐他汀可抑制炎症反应,稳定粥样斑块,缩小心肌梗死范围.     

Mortality and temperature in Oslo,Norway, 1990-1995

The associations between temperature and daily mortality was studied among the citizens of Oslo, Norway, 1990–1995. Data on daily mortality were linked with daily temperatures, relative humidity, wind velocity and air pollution. At temperatures below 10 °C, a 1 °C fall in the last 7 days average temperature increased the daily mortality from all diseases by 1.4%, respiratory diseases 2.1%, and cardiovascular diseases 1.7%. Above 10 °C, there was no statistically significant increase in daily mortality, except for respiratory mortality, which increased by 4.7% per 1 °C increase in the last 7 days average temperature. Daily mortality in Oslo increases with temperatures falling below 10 °C. The increase starts at lower temperatures than shown in warmer regions of the world, but at higher temperatures than in regions with even colder climates. As well insulated and heated dwellings are standard in Norway today, more adequate clothing during outdoor visits is probably the most important preventive measure for temperature related mortality.     

青年急性心肌梗死住院患者的20年趋势及性别差异

老年人发生急性心肌梗死(AMI)存在性别差异已众所周知。但青年AMI发生率和相关危险因素在性别分布上是否存在差异的研究却很少。Arora等在美国4个社区开展的动脉粥样硬化风险(ARIC)研究,对AMI入院情况进行监测并分类评估。其研究人群为35至54岁年轻患者,并从患者病历中提取诊疗信息。结果显示:1995至2014年,共抽取了28732份加权AMI住院患者,其中8737人(30%)是年轻人。年轻AMI入院患者总体比例从1995—1999年的27%上升到2010—2014年的32%(P=0.002),其中年轻女性的增幅最大。在年轻AMI患者中,有高血压病史的比例从59%上升至73%(P<0.001),有糖尿病病史的比例从25%上升至35%(P<0.001)。与年轻男性相比,发生急性心肌梗死的年轻女性多为黑人,并且有更大的共病负担。年轻女性接受基于指南治疗的概率更低,包括降脂、非阿司匹林抗血小板治疗、β受体阻滞剂治疗、冠状动脉造影和冠状动脉血管重建。研究提示,需要更好地了解这些性别差异的潜在因素,以改善对年轻AMI患者的护理。     

介入治疗急性心肌梗死的术后护理

目的：对介入治疗急性心肌梗死患者术后实施科学的护理,改善病人的预后生活质量。方法：以80例急性心肌梗死住院病人为研究对象,其中男性60例,女性20例,年龄38～82岁,对患者手术后实施了有针对性的护理,对并发症进行密切观察与护理。结论：术后根据介入治疗急性心肌梗死的手术特点与要求做好相应的术后护理,对并发症进行积极的观察与预防。     

急性心肌梗死合并高血压患者的临床研究

目的探讨急性心肌梗死（acutemyocardialinfarction,AMI）合并高血压患者的临床特点。方法选择90例AMI患者分A组（伴高血压史）、B组（无高血压史）。观察AMI前后血压变化、LVH情况,AMI后2周内UCG测定LVEF、E／A比值、泵功能,血清心肌酶峰CPK、CK—MB测定,血浆AngⅡ、β-EP和CGRP水平的测定,及梗死后心脏事件等。结果A组血压下降明显,并与基础血压、LVH、泵功能有关;A组发生AMI后AngⅡ、β-EP、降钙素基因相关肽（CGRP）及CPK、CK—MB水平均高于B组;血压下降者LVEF及E／A显著低于血压无下降者,A组泵功能Ⅲ～Ⅳ级发生率高于B组,心脏事件及死亡率也高于B组。结论高血压是冠心病的重要危险因素,高血压发生AMI后71．1％血压下降,这与心功能恶化、LVH、梗死面积大以及血浆AngⅡ、β-EP、CGRP水平更高有关。     

老年病人急性心肌梗死溶栓治疗的护理

随着生活水平的提高,人口老龄化越趋严重,老年心血管病的发病率将逐渐升高,采用安全有效的方法来救治老年心血管急症越来越成为社会的焦点.2007年1月～2008年1月我院共收治急性心肌梗死的高龄患者18例,采用溶栓治疗和护理,效果良好.     

Sex differences in preinfarction characteristics and longterm survival among patients with myocardial infarction

The prevalence of primary risk factors, previous medical history, and physical activity were assessed among 262 women and 1259 men who suffered a first nonfatal myocardial infarction between 1968 and 1977 in G?teborg, Sweden. The probability of suffering a myocardial infarction based on the conventional factors cholesterol level, systolic blood pressure and smoking habits was estimated in both sexes by means of a multiple risk function. Comparisons between sexes were made with age alone and age and estimated primary risk as confounders. Survival rate and reinfarction rate were calculated for a 5-year period of follow-up. Women with infarctions had higher serum cholesterol levels (p less than 0.001) and higher blood pressure values (p less than 0.001) but were less often smokers than men (p less than 0.001). The female patients also reported chest pain and dyspnea on exertion, and low physical activity both at work and during leisure time significantly more often than men; these differences remained after controlling for estimated primary risk. An overrepresentation of hypertension and diabetes prior to myocardial infarction was found among women below 45 years of age compared with men. A high frequency of women in this age group was also on sick leave or disability pension at onset of myocardial infarction, suggesting that mainly women with several risk factors including socioeconomic factors suffer an infarction at this age. No similar and consistent differences were found between women and men of older ages. The cumulative 5-year survival rate was 80% in women and 81% in men. Below age 45 the survival rate was lower among women than men (p less than 0.01). No sex difference was found in the recurrence rate of nonfatal reinfarctions. This indicates that once women have suffered a myocardial infarction they are exposed to at least as high a risk as men.     

急性ST段抬高型心肌梗死患者心电图QRS延长与心肌损伤的相关性

目的探讨急性ST段抬高型心肌梗死(STEMI)患者心电图QRS波延长与心肌损伤之间的相关性。 方法采用回顾性病例对照研究分析2017年2月至2019年11月经确诊为冠心病患者90例,根据QRS波长是否延长分为延长组(n＝52)和非延长组(n＝38),分析QRS延长与临床特征的关系,比较延长组和非延长组患者的心肌损伤指标CTnI、CK-MB、Myo及两组患者心脏功能LVEF、LVFS、LVEDd水平,分析延长时间与心肌损伤相关指标的相关性。 结果QRS延长组血清CTnI、CK-MB和Myo指标均高于非延长组,差异有统计学意义(P<0.05),QRS延长组LVEF和LVFS的水平低于非延长组,LVEDd高于非延长组,差异有统计学意义(P<0.05);QRS延长水平与血清CTnI、CK-MB和Myo指标呈正相关(P<0.05),与LVEF和LVFS的水平呈负相关(P<0.05),与LVEDd水平呈正相关(P<0.05)。 结论STEMI患者心电图QRS延长与心肌损伤程度呈正相关,监测ECG的QRS波群有助于评估STEMI患者的心肌损伤程度。     

Clinical findings,outcome and treatment in patients > or = 75 years with acute myocardial infarction

Background and objective: Treatment of acute myocardial infarction (AMI) has changed dramatically during the 1990s, and the patients are older. Our aim was to characterize current clinical course, medication and invasive treatment in elderly patients with AMI, compare treatment between sexes and also with data from 1994. Methods: The study population included all patients aged 75 years (n = 197, 68% female), who were admitted from January 1997 to December 1998 to our hospital because of AMI. Results: Sixty-six percent of both sexes had non-Q AMI. Peak creatine kinase (CK)-MB fraction values were significantly higher in men (p = 0.035). Thrombolysis was performed on 16% and coronary angiography, coronary angioplasty/cardiac surgery on 8% of patients each. In-hospital mortality was high (25%). Cholesterol-lowering agents were used for only 8% of patients. During hospitalization, 15% of patients had an infection requiring intravenous antibiotics. Multivariate analysis revealed that infection increased in-hospital mortality 2.90-fold (95% CI: 1.23–6.82) and congestive heart failure (CHF) 2.25-fold (95% CI: 1.02–4.97). Post-discharge mortality was 10% during the median follow-up of 12 months; 75% of deaths were due to re-infarction. Compared with the year 1994, the use of -blockers (84 vs. 70%, p = 0.010) and angiotensin-converting enzyme inhibitors (43 vs. 31%, p = 0.062) had increased, and digitalis (27 vs. 43%, p = 0.0065) and calcium antagonists (13 vs. 26%, p = 0.0086) had decreased. Conclusions: Treatment and hospital course of AMI in these elderly patients did not differ between sexes. Although drug treatments have become more evidence-based during the end of 1990s, in-hospital mortality was still high and more effective prevention, effective treatment of infections and CHF may be important for improving prognosis.     

急性心肌梗死心电图对梗塞相关动脉的预测价值

目的探讨急性心肌梗死患者体表心电图对梗塞相关动脉预测的价值.方法对120例急性心肌梗死患者的心电图与冠脉造影结果进行比较.结果前间壁、前壁、广泛前壁心肌梗死其左前降支病变阳性率96.6%;下壁心肌梗死其右冠脉病变阳性率83%,左回旋支病变阳性率60%;下后壁心肌梗死其右冠脉病变阳性率89%,左回旋支病变阳性率67%;右室梗死其右冠脉病变阳性率100%;下壁合并右室梗死其右冠脉病变阳性率88%;正后壁梗死3例均显示为三支病变.结论心肌梗死心电图定位与其相关冠脉病变关系密切,虽然有一定的局限性,仍不失为一项重要的评估方法.