冠状动脉直接支架术应用评价(摘要)

目的 :探讨冠状动脉直接支架术的应用价值。方法 :1999年 12月至 2 0 0 2年 3月 13 7例冠心病患者入选该研究。男 10 1例 ,女 3 6例 ,年龄 5 3 .2± 10 .7岁。稳定性心绞痛 48例 ,不稳定性心绞痛 5 9例 ,急性心肌梗死 (AMI)3 0例。选择性冠脉造影 (SCA)示病变狭窄 (78.6± 9.5 ) %。入选病例无下列病变 :重度钙化 ;长度 >3 3mm ;近端严重迂曲或病变成角≥ 12 0 0 ;慢性完全闭塞。患者随机分为 :A组 69例 79处病变 ,接受无预扩冠脉直接支架术 ;B组68例 80处病变 ,接受预扩后冠脉支架术。两组间临床情况和SCA结果差异无显著性。观察两组成功率、费用和术后 6个月心脏事件 (死亡、AMI、再次血运重建术、心绞痛、心衰 )发生率。统计学处理 :数据用±s表示 ,采用t检验。计数资料用 χ2 检验。结果 :A组成功率 97.10 % ,B组成功率 10 0 % ,残余狭窄分别为 0 .3 8± 2 .11%、0 .3 6± 2 .42 % ,仅各有 1例发生轻度内膜撕裂 ,P >0 .0 5。X -线曝光时间、造影剂用量、医疗费用A组明显低于B组 ,分别为 :9.2 0± 1.5 0min和 14 .10± 2 .80min ,13 6± 5 4ml和 15 8± 49ml,3 10 60± 5 10元和 40 980± 490元 ,P均 <0 .0 1。随访期末 ,复发心绞痛A组 8.7%、B组 7.4% ;A组再次置入支架 1例、PTCA4例 ,B组置入支架 1     

经皮冠状动脉腔内成形术及支架置入46例临床体会

1目的　探讨经皮冠状动脉腔内成形术 ( PTCA)及支架置入 ( ICS)术的临床效果与体会。 2方法　选择 46例冠心病患者 ,其中 32例先预扩张后放支架 ,14例未扩张而直接置入支架 ;3结果　 46例中共扩张 72处病变 ,置入支架 6 7个 ,支架置入前血管狭窄程度为 ( 89.6± 6 .7) % ,支架置入后血管腔残余狭窄为 ( 0 .45± 1.7) % ( P<0 .0 0 1) ,支架长度为 ( 14 .6± 4.8) mm,直径 ( 3.0± 0 .4) mm,成功率为 10 0 % ,无任何并发症 ,随访率 96 .2 % ,2 6例接受造影 ,未见再狭窄形成 ;4结论　 PTCA及支架置入是治疗冠心病最为有效和最可靠的方法 ,其成功率达 98%以上 ,安全可靠 ,基本上无并发症 ,特别是对某些轻度钙化或无钙化者可直接置入支架 ,既节省时间 ,又省钱 ,并可减少 X线曝光时间。     

冠状动脉介入治疗急性心肌梗死35例临床分析

目的 :了解 3 5例急性心肌梗死 (AMI)患者经皮腔内冠状动脉介入治疗 (PCI)的疗效、适应证及并发症。方法:对 3 5例 AMI患者行 PCI治疗 ,其中男性 3 4例 ,女性 1例 ,年龄 3 9～ 72 (5 4.8± 8.6)岁。其中 2 1例患者为急诊 PTCA,均在发病后平均 (7.4± 6.6) h内直接进行 PTCA;3例为溶栓失败后补救性 PTCA;11例为延迟PTCA。 结果 :PCI成功率为 10 0 % ,术前梗塞相关血管平均狭窄 (93 .2± 5 .9) % ,术后残余狭窄为 (10 .6± 6.3 ) %。结论:AMI时行急诊 PTCA成功率高 ,残余狭窄少 ,对溶栓失败或并发心源性休克者应积极行 PTCA,可获得较高的梗塞相关血管再通率和较低的心梗复发率和死亡率 ,同时可减少梗塞面积 ,保护心功能     

小型C臂行经皮冠状动脉腔内成形术107例经验

目的 :总结回顾小C臂X光机在经皮冠状动脉腔内成形术 (PTCA)中的应用价值。方法 :10 7例患者中 ,男 97例 ,女 10例 ,平均年龄 (5 5 .3± 8.9)岁 ,患者均有心肌缺血的临床症状和客观证据。单支病变 68例 ,双支病变3 6例 ,左主干病变 3例。需扩张病变 14 9处 ,A型病变 3 7处 ,B型病变 89处 ,C型病变 2 3处 ,前降支病变 73处 ,回旋支病变 2 6处 ,右冠病变 5 0处。结果 :10 7例患者中择期PTCA5 4例 ,冠脉造影后即刻 2 5例。无球囊预扩张直接置入冠状动脉内支架 16例 ,直接PTCA 5例 ,补救性PTCA 2例。PTCA术病例成功率为 95 .3 % (10 2 10 7) ,病变成功率 93 .2 % (13 9 14 9) ,A型病变成功率 10 0 % (3 7 3 7) ,B型病变成功率 93 .2 % (83 89) ,C型病变成功 69.5 % (16 2 3 )。结论 :应用小C臂X光机开展经皮冠状动脉腔内成形术 ,经济、安全 ,成功率高 ,值得在中下级医院推广。     

SARS临床特征分析(附56例病例报告)

目的 :归纳和探讨临床诊断SARS病例的临床特征、实验室检查及X线胸片变化规律。方法 :对 5 6例临床诊断为SARS病例的临床表现、血常规、血氧饱和度和X线胸片等资料进行收集整理、归纳总结和分析。结果 :本组病例全部以高热和全身不适、乏力和肌肉酸痛为主诉症状 ;2 0例有明确一次性接触史者的平均潜伏期为 ( 4 .70± 0 .92 )d(X±SD ) ;大部分病例有干咳 ( 71 .4% )、气短 ( 4 8.2 % ) ,少数病例在病程中有短暂的胸痛、头痛和鼻塞 ,但无 1例发生腹泻。血常规检查 ,1 0 0 %的患者有白细胞减少 ( <4× 1 0 9/L)和淋巴细胞计数减少 ( <1 .5× 1 0 9/L) ,5 3.6%的病例出现血氧饱和度降低 ( <90 % )。X线胸片异常改变中双侧云雾状阴影占 62 .5 % ,单侧病变占 32 .1 % ,单一肺叶病变的仅占 5 .4%。结论 :本组SARS病人的主要临床症状与WHO提示的有关症状基本符合 ,但未见腹泻和血小板下降者 ;X线胸片单侧病变也占相当比例 ( 32 .1 + 5 .4) %。胸片病变局限可能与及时治疗干预有关。     

经皮冠状动脉腔内成形术治疗支架内再狭窄

目的　评价用经皮冠状动脉腔内成形术 (PTCA)治疗支架内再狭窄临床疗效。方法　 2 1例患者(2 4个支架 )于冠状动脉内支架术后平均 (7.3± 5 .3)个月发生支架内再狭窄 (支架节段管腔内径减小≥ 5 0 % ) ,各例均有心绞痛症状。以标准方法行PTCA治疗。结果　 2 4个支架中 ,完全阻塞 6个 ,不完全阻塞 18个。PT CA总成功率为 95 .8% ,冠状动脉最小内径由术前 (0 .5 9± 0 .46 )mm增至术后 (2 .2 9± 0 .33)mm(P <0 .0 0 1) ;狭窄程度由术前 (79± 15 ) %降至术后 (17± 4) % (P <0 .0 0 1) ,术中无严重并发症。随访 (4.6± 3.1)个月 ,16例心绞痛明显减轻或消失。结论　用PTCA治疗冠状动脉内支架术后再狭窄安全、有效。     

经皮腔内冠状动脉成形术与冠状动脉内支架术的临床应用

目的 :评价经皮腔内冠状动脉成形术 ( PTCA)和支架置入术的临床疗效。方法 :总结 1 996年 1 1月至 2 0 0 1年 3月行 PTCA和支架置入术的冠心病患者 1 0 3例。结果 :1 0 3例冠心病患者 1 5 0支冠状动脉血管PTCA并支架置入 1 35枚 ,置入成功率 1 0 0 % ,无明显并发症发生。其中不稳定心绞痛者占 5 2 .4 3% ,既往有心肌梗死史者占 4 7.5 7%。单支病变者占 5 5 .34 % ,双支病变者占 32 .0 4 % ,3支病变者占 1 2 .6 3% ;A型病变者占 33.98% ,B型病变者占 2 6 .2 1 % ,C型病变者占 39.81 %。 PTCA所用的球囊直径平均为 ( 2 .4 8± 0 .4 3)mm,平均长度 ( 2 0 .4 0± 2 .84 ) mm,球囊所加压力平均为 ( 6 .2 3± 1 .81 ) atm。共置入支架 1 35枚 ,其直径平均为 ( 30 .96± 0 .38) mm,平均长度为 ( 2 1 .2 9± 6 .30 ) mm,释放支架时球囊所加压力平均为 ( 9.6 5± 3.0 8) atm。所用支架主要是 BX 4 5枚 ,占 33.33% ,NIR 30枚 ,占 2 2 .2 2 % ,AVE 2 7枚 ,占 2 0 .0 0 % ,MAC 1 6枚 ,占1 1 .85 % ,Jomed和其他共 1 7枚 ,占 1 2 .5 9%。支架置入 LAD内 71枚 ,占 5 2 .5 9% ,RCA内 4 8枚 ,占35 .5 5 % ,LCX和对角支 1 6枚 ,占 1 1 .85 %。结论 :PTCA和支架置入术是一种安全、有效的介入性治疗技术 ,其成功率高 ,并发     

冠心病左心功能不全介入治疗的近期和远期疗效

目的　评价PTCA结合支架治疗冠心病左室功能不全的近期、远期疗效。方法　连续 74例冠心病合并左室射血分数≤ 4 0 %行PTCA治疗 ,其中 6 1例 (81% )在支架支持下进行 ,所有治疗成功者随诊 2 9 1± 2 2 9月。结果　PTCA结合支架治疗的病变成功率为 89 5 % (12 0 /134) ,病例成功率为 89 2 % (6 6 /74 ) 围术期病死率为1 4 % ,心肌梗塞发生率为 2 7% ,无 1例需行急诊冠状动脉搭桥术。 4 4例合并心力衰竭治疗成功者 ,2 9例 (73% )术后 6月NYHA分级下降≥ 1。长期随诊期间 ,5 8例 (87 9% )治疗成功者存活 ,其中 4 4例 (6 8 6 )无任何心脏事件存活。结论　PTCA结合支架治疗冠心病左心功能不全的成功率高 ,围手术期死亡率低 ,远期生存率高。     

溶栓及经皮冠脉腔内成形术治疗急性心肌梗死的疗效分析

目的　对比直接冠状动脉腔内成形术 (PTCA)及静脉尿激酶 (UK)溶栓对急性心肌梗死 (AMI)治疗的临床疗效。方法　采用观察性队列研究的方法 ,对 97例AMI患者采用UK溶栓 ,60例AMI患者采用直接PTCA治疗 ,比较两组住院期及随访期的超声心动图 (UCG)和临床结果。结果　住院期间UCG检查室壁运动正常者在PTCA组为 (4 6.0 0 % ) ,高于UK组 (2 4.73 % ) (p =0 .0 2 1) ,矛盾运动发生率PTCA组为 0 ,而UK组为 11.83 %。LVEF在PTCA组为 5 6.88± 10 .47,高于UK组 (5 1.5 8± 10 .97) (p =0 .0 41)。住院期心衰发生率UK组为 3 2 .5 9% ,高于PTCA组 (18.3 3 % ) (p =0 .0 2 9)。随访 13 .3 2± 6.86个月累计心衰发生率UK组为 16.2 8% ,也高于PTCA组 (5 .19% ) (p =0 .0 0 1)。住院期间的病死率UK组为 10 .3 1% ,PTCA组为 5 .0 0 % (p =0 .10 0 )。累计病死率UK组为 15 .5 6% ,明显高于PTCA组 (5 .0 0 % ) (p =0 .0 2 1)。 60岁以上年龄组累计的病死率仍然是UK组 (2 8.99% )高于PTCA组 (10 .3 4% ) (p =0 .0 49)。在随访 3、6、12及 2 4个月时PTCA组的生活质量计分各自为 :5 9.90± 14 .67、74.40± 12 .86、73 .86± 9.70、82 .47± 10 .47均高于同时期UK组的计分 (分别是 5 2 .0 8± 14 .49、65 .0 0± 14 .72、67.0 2     

河南省传染性非典型肺炎患者胸部X线表现

目的 :探讨传染性非典型肺炎的X线表现及变化规律。方法 :对河南省临床诊断的 1 5例患者发病后不同时间的系列胸片和CT进行回顾性分析。结果 :1 5例胸部X线病灶初始形态为斑片状 1 1例 (73.3% ) ,大片状 4例 (2 6 .7% ) ;双侧 9例 (6 0 .0 % ) ,单侧 6例 (4 0 .0 % ) ,均为中、下肺野 (1 0 0 % )。动态观察发现病变进展快 ,病变发展到高峰期时间为 4～ 1 4d , x±s(7.7± 3.2 )d ,双侧 1 3例 (86 .7% ) ,单侧 2例 (1 3.3% ) ,两肺叶及两肺叶以上病变者 1 4例 (93.3% )。病变开始吸收时间为 6～ 2 1d , x±s(1 1 .3± 4 .1 )d ;完全或基本吸收时间 8～ 2 6d , x±s(1 6 .4± 5 .0 )d。1 5例经治疗均痊愈出院。住院时间 1 8～ 4 2d , x±s(31 .9± 7.9)d。 结论 :传染性非典型肺炎的胸部X线特点为急性双侧或单侧多叶炎性浸润阴影 ,以中、下野常见 ,进展迅速 ,及时复查胸部X线对临床诊断及判断病情具有重要价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.