人血清卵泡抑素样蛋白1与急性心肌梗死患者左室重构相关性的研究

目的:探讨急性心肌梗死(AMI)患者及健康体检者血清人卵泡抑素样蛋白1(FSTL-1)水平的变化及其与急性心肌梗死后左室重构的相关性。方法:选取急性心肌梗死患者48例(AMI组)和健康对照患者48例(对照组)。AMI组均在发病72 h内就诊,采集外周静脉血,采用酶联免疫吸附法检测血清FSTL-1水平。超声心动图测定左室重构指标:左房内径、左室舒张末内径、射血分数。通过统计学分析FSTL-1在两组间的表达水平及其与左室重构的相关性。结果:AMI组FSTL-1表达水平明显高于对照组(P<0.05);FSTL-1与AMI后左房内径(r=0.54,P<0.05)、左室舒张末内径(r=0.58,P<0.05)呈正相关;与左室射血分数(r=-0.64,P<0.05)呈负相关;与性别、年龄、是否吸烟及饮酒、身体质量指数、血脂、高血压、糖尿病无相关性,与脑钠肽呈正相关。结论:FSTL-1在急性心肌梗死患者中高表达,并且与急性心肌梗死后左室重构相关。     

急性心肌梗死联合检测血尿酸、cTnI、cTnT、BNP对后期心力衰竭诊断的临床意义

目的 探讨血尿酸、心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、B型钠尿肽(BNP)联合检测在急性心肌梗死后期心力衰竭诊断的应用价值.方法 急性心肌梗死患者88例根据接受急性心肌梗死治疗后2年内是否发生心力衰竭分为心力衰竭组(n=36)和非心力衰竭组(n=52).观察2组患者血尿酸、cTnI、cTnT、BNP水平,并对心力衰竭患者不同killip分级的血尿酸、cTnI、cTnT、BNP水平进行比较,同时对观察指标与病情严重程度进行相关性分析,并对上述指标进行相关性分析及敏感性、特异性、阳性预测值和阴性预测值的研究.结果 心力衰竭组血尿酸、cTnI、cTnT、BNP水平均显著高于非心力衰竭组,差异有统计学意义(P<0.05).心力衰竭患者killip分级Ⅲ级血尿酸、cTnI、cTnT、BNP水平明显低于Ⅳ级,差异有统计学意义(P<0.05).血尿酸、cTnI、cTnT、BNP表达水平与后期心力衰竭是否发病呈正相关(r值分别为0.995、0.919、1.000、0.976,P<0.05).血尿酸、cTnI、cTnT、BNP水平与心力衰竭患者不同killip分级呈正相关(r值分别为0.602、0.582、0.524、0.641,P<0.05).联合检测敏感性、特异性阳性预测值和阴性预测值均显著高于尿酸、cTnI、cTnT、BNP单指标检测,差异有统计学意义(P<0.05).结论 AMI发病时血尿酸、cTnI、cTnT、BNP联合检测对预测AMI后期心力衰竭发作有重要参考价值,血尿酸、cTnI、cTnT、BNP的升高可能导致后期心力衰竭的发作.     

急性心肌梗死患者心力衰竭时血B型利钠肽水平的检测意义

目的探讨急性心肌梗死患者心力衰竭时血B型利钠肽(BNP)水平意义。方法分析2009年6月至2012年6月本院诊治的116例急性心肌梗死患者为研究对象,其中76例行经皮冠状动脉介入治疗(PCI),40例行药物治疗。比较PCI治疗与药物治疗者血清BNP水平。结果与入院时相比,入院1周后行PCI治疗患者BNP水平显著降低(P<0.05),而药物治疗患者BNP水平显著升高(P<0.05);116例患者血清BNP水平随着Killip分级的升高及LVEF的降低而显著升高(P<0.05)。结论 BNP水平与急性心肌梗死患者治疗方法相关,同时是心肌梗死后发生心力衰竭的预测因子。     

冠心病患者中B型钠尿肽与冠状动脉病变程度的相关性研究

目的：探讨冠心病患者中B型钠尿肽(BNP)与冠状动脉病变程度的相关性。方法选择2013年1~12月在本院心脏介入中心行冠状动脉造影检查诊断为冠心病的90例患者,将其分为稳定性心绞痛组(SAP)40例、不稳定性心绞痛组(UAP)35例和急性心肌梗死组(AMI)15例,根据造影结果进行Gensini评分,分析不同组别患者的BNP水平。结果SAP、UAP、AMI组BNP水平均较对照组高(P<0.05);AMI组较UAP、SAP组BNP水平更高,差异有统计学意义(P<0.01);BNP水平随Gensini积分增加依次增大(P<0.05),两者呈直线正相关(P<0.01)。结论血浆BNP水平可作为冠心病患者冠状动脉粥样硬化严重程度的预测指标。     

急性心肌梗死患者血浆脑钠肽水平与心肌梗死面积及预后的关系

目的探讨血浆脑钠肽(BNP)浓度与急性心肌梗死面积的关系,研究血浆脑钠肽浓度与患者短期预后相关性。方法选择该院收入的急性心肌梗死患者共102例作为观察对象,患者根据梗死部位不同分为前壁心梗组(67例)及下壁心梗组(35例),入院后计算心肌梗死面积,观察早期心血管事件。结果两组不同心肌梗死部位的BNP浓度及心梗面积对比中显示,前壁心梗组BNP显著高于下壁心梗组,两组对比差异有统计学意义,P0.05。BNP水平与AMI面积具有一定的相关性,AMI的面积越大,BNP表达水平就越高。本组患者发生心力衰竭21例、死亡7例,发生心力衰竭、死亡患者的BNP浓度显著高于未发生组患者,结果对比有统计学意义,P0.05。结论 BNP水平与AMI面积具有一定的相关性,AMI的面积越大,BNP表达水平就越高,BNP浓度是心肌梗死后早期心血管事件的预测因子。     

B型尿钠肽对急性冠状动脉综合征患者预后判定的意义

目的探讨和分析B型尿钠肽对急性冠状动脉综合征患者预后判定的意义。方法甲组为急性心肌梗死患者组,30例;乙组为不稳定型心绞痛患者组,30例;丙组为稳定型心绞痛患者组,30例。无心脏疾病的健康人组,设为对照组,30例。结果甲组BNP水平明显高于乙组、丙组和对照组(P<0.01),乙组BNP水平明显高于丙组和对照组(P<0.01),丙组和对照组BNP水平无明显差异(P>0.05)。结论患者冠心病类型不同则血浆中的BNP水平不同,BNP已经作为心力衰竭独立的诊断标准用于临床,同时急性冠状动脉综合征患者血浆BNP水平也可用来预测急性心肌梗死患者预后情况,有助于重症医师及早做好防护救助措施。     

PCI对AMI患者血浆BNP水平的影响及价值

目的探讨PCI对AMI患者血浆BNP水平的影响及临床价值。方法选取2010年6月至2012年6月我院收治的急性心肌梗死(AMI)患者80例进行回顾性分析,随机分成观察组和对照组两组,每组40例,观察组采用经皮冠状动脉介入治疗(PCI),对照组采用静脉溶栓治疗,观察两组治疗前后血浆B型脑钠肽(BNP)水平变化以及PCI对预后的影响。结果两组治疗后BNP水平显著下降,且观察组下降水平明显高于对照组,存在统计学意义(P<0.05);观察组再发心肌梗死和心力衰竭率、心脏性病死率明显低于对照组,存在统计学意义(P<0.05);BNP升高是心血管疾病发生的独立危险因素(P<0.05)。结论 PCI治疗AMI患者能够有效降低患者的BNP水平,改善患者的预后状况,具有重要的临床价值,值得临床推广。     

急性心肌梗死临床诊断中检验B型钠尿肽的应用价值分析

目的研究B型钠尿肽(BNP)检测对于诊断急性心肌梗死的价值。方法选取2015年1月~2016年12月来深圳市人民医院心内科就诊的急性心肌梗死患者130例为观察组,选取同期来深圳市人民医院体检中心体检的健康人130例为对照组;两组受检对象均进行B型钠尿肽的检测。结果观察组AMI患者的BNP水平显著高于对照组健康人(P<0.05);经过治疗,观察组患者的BNP水平明显低于治疗前(P<0.05);随着年龄的增长,观察组AMI患者的BNP水平变化不明显(P>0.05);随着病情的加重,BNP水平明显提高(P<0.05)。结论 B型钠尿肽在急性心肌梗死的诊断中具有较高的敏感性,随着心肌受损程度加重,BNP水平明显提高,可以将其用于急性心肌梗死的诊断和预后评判中。     

脑钠肽和高敏C反应蛋白在急性心肌梗死中的意义研究

目的探讨急性心肌梗死患者中脑钠肽(BNP)与高敏C反应蛋白(hs-CRP)联合检测的临床意义。方法收集我院近年诊治的急性心肌梗死患者35例,检测BNP与hs-CRP水平,并与稳定性心绞痛患者和健康体检者比较。结果稳定心绞痛组及急性心肌梗死组BNP与hs-CRP水平较健康组明显升高,差异均有统计学意义(P<0.01);急性心肌梗死组BNP与hs-CRP水平较稳定心绞痛组明显升高,差异有统计学意义(P<0.05)。结论 BNP、hs-CRP与冠心病病情严重程度相关,联合检测可以预测病情程度。     

脑钠素与急性心肌梗死心室重构的关系

目的:探讨脑钠素(BNP)与急性心肌梗死(AMI)心室重构的关系。方法:应用酶联免疫法测定49例患者AMI后5～7d血浆N末端脑钠素原(NT鄄ProBNP)水平,随访检查AMI后1,3个月的超声心动图。建立大鼠AMI模型,给予咪哒普利治疗4周,测定血浆BNP。结果:AMI患者血浆NT鄄ProBNP较正常对照组显著升高(P<0.01);血浆NT鄄ProBNP在下壁与前壁、下壁与下壁 正后壁( 右室)AMI者间差别有统计学意义(均P<0.05)。下壁AMI心功能Ⅱ级者血浆NT鄄ProBNP较Ⅰ级者显著升高。AMI后5～7d的血浆NT鄄ProBNP与心梗后7d、1个月、3个月时左室射血分数(LVEF)、室壁运动积分(WMS)及左室面积缩短分数(FAC)相关。大鼠AMI4周后血浆BNP较假手术组显著升高(P<0.01);咪哒普利组血浆BNP较模型对照组显著降低(P<0.01)。结论:血浆BNP与AMI范围、心功能分级密切相关,是反映心室重构的敏感指标。     

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.