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1.
Objective: To obtain epidemiological data on Traditional Chinese Medicine (TCM) therapeutic status of acute myocardial infarction (AMI) and to determine TCM characteristics and advantages to improve the level of TCM prevention and treatment of AMI. Methods: Clinical epidemiology methods were used to register and survey the TCM therapeutic status of hospitalized AMI patients. In 2001, the Chinese Association of Integrative Medicine surveyed the therapeutic status of 3308 AMI patients hospitalized in 30 hospitals in Beijing and Shanghai from 2000-2001. The Beijing Collaborative Study Group on Therapeutic Status of Acute Myocardial Infarction (the Study Group) then conducted a 10-year-long register survey on hospitalized AMI patients in Third-grade A-Level TCM hospitals in Beijing. After 2002, the Study Group further surveyed the treatment conditions of AMI-hospitalized patients in 10 Second-grade A-Level TCM hospitals. The therapeutic status in 8 Third-grade A-Level Western medicine hospitals was surveyed in 2001 and 2005 as a control. In 2008, in cooperation with the China Association of Chinese Medicine, the Study Group further performed a survey at 26 Third-grade A-Level TCM hospitals nation-wide. Approximately 5000 cases were investigated to obtain authoritative data on the therapeutic status of AMI patients in TCM hospitals in China. Results: We found that Chinese herbal intravenous preparations may be beneficial in reducing the mortality of AMI. Major complications of AMI, such as heart failure and arrhythmia, were significantly less during the 10-year survey period. The mortality of hospitalized AMI patients showed a decline. TCM treatment was helpful for AMI patients in improving their quality of life. Ten-year dynamic monitoring showed that the ability to perform reperfusion and to use drugs appropriately, as well as an effort to carry out the Clinical Guidelines has made great progress in TCM hospitals. However, TCM hospitals still have some problems in treating AMI, including a lack of standardized TCM syndrome diagnosis, the need for syndrome differentiation and treatment standardization, and clinical skills in reperfusion and standardized drug treatment still need to be further improved. Compared with AMI patients in Western medicine hospitals during the same period, those in TCM hospitals had the following characteristics: they were admitted to hospital later; they were older when they had a heart attack; there were more females, they had more problems in their medical history, and they had more concomitant illnesses and complications. Therefore, the demographic baseline data were significantly different between AMI patients in TCM hospitals and those in Western medicine hospitals. This indicated that patients in TCM hospitals were more critical than those in Western medicine hospitals. Conclusions: TCM has special advantages in treating AMI. TCM hospitals are making continuous progress in standardized treatment of AMI, but further improvement is still required. AMI patients in TCM hospitals have some special characteristics, and their condition may be more critical. Further clinical research on TCM treatment of AMI is required.  相似文献   

2.
Background Ambulance use expedites the definitive treatment of acute myocardial infarction (AMI). The aim of this study was to evaluate the effect of ambulance use on the administration of early reperfusion therapies for patients with AMI in Beijing, China. Methods Data were prospectively collected from 498 patients with ST-elevation myocardial infarction (STEMI) who were admitted within 12 hours of symptom onset to 19 hospitals in Beijing between November 1,2005 and December 31, 2006. The baseline characteristics of and the initial management of the ambulance users and the non-ambulance users were compared. Results Only 186 (37.3%) patients used an ambulance as transportation to the hospital. Ambulance users were, on average, older and at relatively higher risk on presentation than the non-ambulance users. After adjustment for patient and hospital characteristics, ambulance use was associated with a greater early reperfusion rate, mainly because of a greater incidence of primary percutaneous coronary intervention. In addition, ambulance users had a significantly shorter median door-to-balloon (120 compared with 145 minutes, P 〈0.001) and symptom onset-to-balloon (223 compared with 300 minutes, P 〈0.001) time than non-ambulance users. Conclusions Ambulances are underused by AMI patients in Beijing. Ambulance use may lead to more frequent and faster receipt of early reperfusion therapies. New public health strategies should be developed to facilitate an increased use of ambulances by AMI patients.  相似文献   

3.
Objective The mechanism through which platelet activating factor (PAF) induces cardiac electrical activity and arrhythmia is not well understood and previous studies have suggested a potential involvement of ion channels in its action. The present study was aimed to clarify the role of PAF in fatal arrhythmias following acute myocardia infarction (AMI) and the underlying mechanism. Methods (1) Blood PAF levels were measured among 72 AMI patients at the time of diagnosis with AMI and 48 h later, and their electrocardiogram (ECG) was recorded continuously. (2) Ischemia simulation and surface electrocardiogram were conducted in 20 pigs and their PAF levels were measured. (3) PAF perfusion and standard microelectrode recording were performed on guinea pig papillarymuscles. Results In both humans and pigs, elevated PAF levels were detected in AMI and simulated ischemia, respectively, and even higher PAF levels were found when fatal arrhythmias occurred. In guinea pig myocardium, PAF induced a shortening of action potential duration at 90% level of repolarization (APD 90 )under non-ischemic conditions and a more pronounced shortening under early simulated ischemic conditions. Conclusion AMI and ischemia are associated with increased PAF levels in humans and pigs, which are further raised when fatal arrhythmia follows. The effects of PAF on the myocardium may be mediated by multiple ion channels.  相似文献   

4.
Background Acute myocardial infarction (AMI) is a common cardiac emergency with high mortality.Serum soluble ST2 (sST2) is a new emerging biomarker of cardiac diseases.The present study is to investigate the predictive value of sST2 and interleukin-33 (IL-33) for risk stratification and prognosis in patients with AMI.Methods Fifty-nine patients with AMI,whose chief complaint was chest pain or dyspnea,were selected for our study.Physical examination,chest radiograph,electrocardiograph (ECG),biomarkers of myocardial infarction,NT-proBNP,echocardiography and other relevant examinations were performed to confirm the diagnosis of AMI.Thirty-six healthy people were chosen as the control group.Serum samples from these subjects (patients within 24 hours after acute attack) were collected and the levels of sST2 and IL-33 were assayed by enzyme-linked immuno-sorbent assay (ELISA) kit.The follow-up was performed on the 7th day,28th day,3rd month and 6th month after acute attack.According to the follow-up results we defined the end of observation as recurrence of AMI or any causes of death.Results Median sST2 level of the control group was 9.38ng/ml and that of AMI patients was 29.06ng/ml.Compared with the control group,sST2 expression in the AMI group was significantly different (P〈0.001).In contrast,the IL-33 level showed no significant difference between the two groups.Serum sST2 was a predictive factor independent of other variables and may provide complementary information to NT-proBNP or GRACE risk score.IL-33 had no relationship to recurrence of AMI.Both sST2 and the IL-33/sST2 ratio were correlated with the 6-month prognosis; areas under the ROC curve were 0.938 and 0.920 respectively.Conclusions Early in the course (〈24 hours) of AMI,sST2 usually increases markedly.The increase of sST2 has an independent predictive value for the prognosis in AMI patients and provides complementary information to NT-proBNP or GRACE risk score.The IL-33/sST2 ratio correlates with the 6-month prognosis of AMI patients.However,there is no significant relationship between IL-33 and the prognosis of AMI patients.  相似文献   

5.
Objective: To assess the trends in characteristics, treatments, and outcomes of acute myocardial infarction (AMI) patients in tertiary Chinese medicine (CM) hospitals in China between 2006 and 2013. Methods: This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years (2006 and 2013). Patients admitted to the hospital for AMI were enrolled. Hospital records were used as the data source. Case data were derived regarding baseline characteristics, treatments, and outcomes of patients to assess changes from 2006 to 2013. Logistic regression was used to analyze the relationship between prognosis, general influencing factors of disease, and various treatment measures. Results: Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013 (18 were repetitive) were surveyed. A total of 2,311 patients with AMI were enrolled (1,094 cases in 2006 and 1,217 cases in 2013). From 2006 to 2013, the mean age did not significantly change, but the proportion of patients younger than 65 years increased. The prevalence of risk factors such as hypertension, diabetes, and hyperlipidemia also increased. Significant increases were observed in primary percutaneous coronary intervention [20.48% (2006) vs. 24.90% (2013)] and revascularization [36.11% (2006) vs. 52.42% (2013)]. In-hospital mortality decreased from 11.15% in 2006 to 10.60% in 2013. A mortality logistic regression analysis identified reperfusion therapy [odds ratio (OR), 0.222; 95% confidence interval (CI), 0.106–0.464], Chinese patent medicines (OR, 0.394; 95% CI, 0.213–0.727), and CM decoctions (OR, 0.196; 95% CI, 0.109–0.353) as protective factors. Conclusion: Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly, but in-hospital mortality has not significantly decreased. Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.  相似文献   

6.
Background The loss of cardiac myocytes is one of the mechanisms involved in acute myocardial infarction (AMI)-related heart failure. Autophagy is a common biological process in eukaryote cells. The relationship between cardiac myocyte loss and autophagy after AMI is still unclear. Carvedilol, a non-selective α1-and β-receptor blocker, also suppresses cardiac myocyte necrosis and apoptosis induced by ischemia. However, the association between the therapeutic effects of carvedilol and autophagy is still not well understood. The aim of the present study was to establish a rat model of AMI and observe changes in autophagy in different zones of the myocardium and the effects of carvedilol on autophagy in AMI rats. Methods The animals were randomly assigned to a sham group, an AMI group, a chloroquine intervention group and a carvedilol group. The AMI rat model was established by ligating the left anterior descending coronary artery. The hearts were harvested at 40 minutes, 2 hours, 24 hours and 2 weeks after ligation in the AMI group, at 40 minutes in the chloroquine intervention group and at 2 weeks in other groups. Presence of autophagic vacuoles (AV) in the myocytes was observed by electron microscopy. The expression of autophagy-, anti-apoptotic- and apoptotic-related proteins, MAPLC-3, Beclin-1, Bcl-xl and Bax, were detected by immunohistochemical staining and Western blotting. Results AVs were not observed in necrotic regions of the myocardium 40 minutes after ligation of the coronary artery. A large number of AVs were found in the region bordering the infarction. Compared with the infarction region and the normal region, the formation of AV was significantly increased in the region bordering the infarction (P 〈0.05). The expression of autophagy- and anti-apoptotic-related proteins was significantly increased in the region bordering the infarction. Meanwhile, the expression of apoptotic-related proteins was significantly increased in the infarction region. In the chloroquine intervention group, a large number of initiated AVs (AVis) were found in the necrotic myocardial region. At 2 weeks after AMI, AVs were frequently observed in myocardial cells in the AMI group, the carvedilol group and the sham group, and the number of AVs was significantly increased in the carvedilol group compared with both the AMI group and the sham group (P 〈0.05). The expression of autophagy- and anti-apoptotic-related proteins was significantly increased in the carvedilol group compared with that in the AMI group, and the positive expression located in the infarction region and the region bordering the infarction. Conclusions AMI induces the formation of AV in the myocardium. The expression of anti-apoptosis-related proteins increases in response to upregulation of autophagy. Carvedilol increases the formation of AVs and upregulates autophagy and anti-apoptosis of the cardiac myocytes after AMI.  相似文献   

7.
Objective: To investigate the microR NAs(miR NAs) expression profile of acute myocardial infarction(AMI) rats and the regulating effects of Huoxue Anxin Recipe(活血安心方, HAR) on angiogenesis-related miR NAs and genes. Methods: Forty-five Wistar rats were randomly assigned to 3 groups according to a random number table: sham, AMI, and AMI+HAR groups(15 in each group). AMI rats were established by ligation of the left descending coronary artery. HAR was intragastrically administered to rats of the AMI+HAR group for successive 21 days since modeling, meanwhile the same volume of 0.9% normal saline was administered to rats of the sham and AMI groups. Doppler echocardiography was used for noninvasive cardiac function test. Hematoxylin and eosin staining was used to observe the histopathological change. miR NAs expression profile was detected by quantitative realtime polymerase chain reaction(qR T-PCR). The mR NA and protein expressions of vascular endothelial growth factor(VEGF), and a target gene of miR-210 was further detected by qR T-PCR and Western blot, respectively. The microvessels density of myocardium was evaluated by CD31 immunostaining. Results: Compared with the sham group, ejection fraction(EF) and fractional shortening(FS) values were decreased significantly in the AMI group(P0.01), while the infarction area and the interstitial collagen deposition were increased obviously. As for the AMI+HAR group, EF and FS values were increased significantly(P0.05 vs. AMI group), and the infarction area was reduced and the interstitial collagen deposition were alleviated significantly. Total of 23 miR NAs in the AMI group expressed differently by at least 1.5 folds compared with those in the sham group; 5 miR NAs in the AMI+HAR group expressed differently by at least 1.5 folds compared with those in the AMI group. Among them, miR-210 was low in the AMI group and high in the AMI+HAR group. The relative mR NA and protein expressions of VEGF were decreased significantly in the AMI group(P0.05 vs. sham group), and increased significantly in the AMI+HAR group(P0.01 vs. AMI group). CD31 expression area and optical intensity were decreased significantly in the AMI group(P0.05 vs. sham group), and increased significantly in the AMI+HAR group(P0.01 vs. AMI group). Conclusions: HAR could reduce the infarction area, alleviate the interstitial fibrosis and improve the cardiac function of AMI rats. Those effects could be related to promoting myocardium angiogenesis of HAR by up-regulating miR-210 and VEGF.  相似文献   

8.
In order to investigate the human immunological response to acute myocardial infarction (AMI), lymphocyte cells of peripheral vein blood withdrawn from patients with AMI were continuously and quantitatively assayed by flow cytometry method (FCM). The correlation between the alterations of immunological function and clinical course was analyzed. MATERIAL AND METHODS Thirty-one samples were collected from peripheral vein blood of hospitalized patients with AMI in the author's institution. The patients were aged from 39 to 81 years, ( 26 men and 5 women ). Samples withdrawn from 14 healthy adults served as normal control.  相似文献   

9.
The synthesis of DNA, RNA and protein in L1210 cells was inhibited by HH07A in a dose-dependent and time dependent way. HH07A showed much stronger inhibitory effect on [^3H]-thymidine incorporation than that on [^3H]-uridine or [^3H]-tyrcsine incorporation. The methods of shift of absorption spectrum,shift of fluorescence emission spectrum and excitation spectrum, anal isotope technique were used to investigate the mechanism of action of HH07A on DNA symhesis. The results suggested that the action of HH07A on DNA synthesis was not probably due to direct damage to the DNA template, it might mainly act by interfering with the metabolism of DNA.  相似文献   

10.
Background This study was designed to evaluate the relationship between high-density lipoprotein cholesterol (HDL-C) level and acute myocardial infarction (AMI) and coronary heart disease (CHD) death and to explore the protective effect of HDL against CHD in the elderly Chinese.Methods Started from 1986, 1211 retirees (92% males) were enrolled consecutively and studied prospectively. The average starting age was 70±9 years, and that at the end of the study was 80±9 years. During the follow-up study, all the participants received yearly physical examination and blood chemistry survey from 1986-2000. The average duration of the follow up study was 11.2 years. The end point of this study was either attacks of AMI or death due to CHD and other causes. CHD risk factors were screened by logistic regression analysis. According to their HDL-C levels, cases were divided into low (<1.03 mmol/L), medium (or normal, 1.03-1.56 mmol/L) and high (>1.56 mmol/L) level groups, the differences in incidence of AMI and CHD death in each group were analyzed.Results The cumulative attacks of acute coronary syndrome (mostly AMI) were 214 cases, including 89 cases of coronary death and 308 death caused by other diseases during the follow up study. AMI occurrence and CHD death in normal HDL-C group were lower than those in the low HDL-C group by 40% and 53%; and those in the high HDL-C group were lower than in the normal group by 56% and 50%, respectively. Statistical analysis on normal lipid cases (411 cases, total cholesterol<5.17mmol/L, triglyceride<1.69 mmol/L) revealed that the cases at low HDL-C level had similar rates of AMI events and CHD mortality as those of the entire group (including hyperlipidemia); however, AMI attacks and CHD deaths decreased significantly at the normal and high HDL-C levels. The results demonstrated that the protective effect of HDL against coronary artery disease is more prominent in people with low lipid level.Conclusion Low HDL is an important independent risk factor for AMI attacks and CHD death in the elderly; high HDL has significant protective effect against coronary artery disease.  相似文献   

11.
张凡 《中国医药导刊》2012,14(7):1146+1148
目的:分析STⅢ↑/STⅡ↑≥1及STV3R-V6R↑≥1mm对急性心肌梗死(AMI)的诊断结果.方法:选取2010年1月~2011年6月来我院进行治疗的128例急性心肌梗死患者的冠状动脉造影结果与心电图的变化进行对比分析,以研究心电图对心肌梗死(据患者病情,主要是右室心肌梗死ARVI)的诊断价值体现.结果:对照组76例,其中心电图STV3R-V6R↑≥1mm2例,STⅢ↑/STⅡ↑≥1的4例;ARVI组52例患者,其中心电图STV3R-V6R↑≥1mm50例,STⅢ↑/STⅡ↑≥1的48例.两组患者比较差异有显著性意义,在STⅢ↑/STⅡ↑≥1及STV3R-V6R↑≥1mm指尖差异无显著性意义.结论:诊断右心室心肌梗死的主要依据是STV3R-V6R↑≥1mm,参考依据则可选择STⅢ↑/STⅡ↑≥1.  相似文献   

12.
目的对比分析急性下壁心梗和急性下壁合并右室心梗的临床特征和预后干预的意义。方法单纯急性下壁心梗患者组184例,急性下壁并右室心梗组118例,对两组患者的临床特点及冠脉造影资料进行分析。结果急性下壁合并右室心梗组发生低血压、休克、心律失常、室颤、临时起搏治疗比例较单纯下壁心梗组多(P〈0.05),未行冠脉介入治疗者死亡率增高(P〈0.01)。急性下壁合并右室心梗患者,右冠脉近中段阻塞者占95%。结论急性下壁合并右室心梗患者的血管病变部位多见于优势型右冠脉的近中段;对急性下壁合并右室心梗行早期冠脉介入治疗,可显著降低患者的死亡率。  相似文献   

13.
张成亮 《医学综述》2014,(23):4408-4409
分析比较皮质体感诱发电位与经颅刺激运动诱发电位在评价脊柱手术患者脊髓功能的临床价值。方法选取2009年3月至2013年2月在江苏省沭阳县人民医院进行脊柱手术的患者236例,同时进行皮质体感诱发电位与经颅刺激运动诱发电位,分别对其检测脊髓神经功能损伤的敏感性和特异性进行观察。结果经颅刺激运动诱发电位的灵敏度为86.20%,特异度为97.97%;皮质体感诱发电位的灵敏度为42.00%,特异度为95.48%,经颅刺激运动诱发电位的灵敏度、特异度均高于皮质体感诱发电位。结论经颅电刺激诱发电位较皮质体感诱发电位能够更为理想地监测脊柱手术中患者的脊髓功能。  相似文献   

14.
报告了5例二失瓣再次换瓣的经验和体会。再次二尖瓣换瓣的主要困难有二方面:(1)患者心功能差、病情重、手术风险大。(2)手术粘连重.解剖层次不清,暴露困难,易发生意外损伤。作者介绍了解剖,分离粘连,正确排气,减少气栓等并发症的方法和措施。作者认为:定期随访,早期发现生物瓣毁损,充分的术前准备,精确的手术操作,良好的心肌保护与术后监测是手术成功的关键。  相似文献   

15.
132例急性心肌梗塞患者入院及出院时体表心电图Q-Tc间期的变化,与冠心病组、心律失常组及正常对照组比较,结果发现急性心肌梗塞患者入院时Q-Tc间期较出院时明显延长(P<0.01);较冠心病组、心律失常组及正常对照组亦显著延长(P<0.01)。Q-Tc间期≥440ms的急性心肌梗塞患者病死率为20.41%,较Q-Tc间期<440ms的急性心肌梗塞患者病死率(8.23%)明显增高(P<0.05)。提示Q-Tc间期可做为观察急性心肌梗塞患者病情及其恢复情况的参考指标,对评价急性心肌梗塞患者的预后。  相似文献   

16.
冠状动脉旁路移植术围术期的处理   总被引:4,自引:0,他引:4  
目的 总结冠状动脉搭桥手术围术期的处理经验。方法 采用连续心排血量仪,心电图和血压监测等手段及早发现低心排血量,使用各种血管活性药物及主动脉内球囊反搏治疗低心排。结果 在34例冠状动脉搭桥手术中,出现3例低心排,2例抢救成功,1例死亡,病死率为2.9%。  相似文献   

17.
艾辉  徐小平  李卓成 《实用医技杂志》2006,13(15):2631-2632
目的:了解我院念珠菌感染和耐药情况。方法:对临床标本分离的念珠菌用VITEK32鉴定仪鉴定,对分离株进行抗生素体外敏感性检测。结果:435株念珠菌以白色念珠菌检出率居首位。435株念珠菌对4种抗真菌药物出现不同程度的耐药。结论:广谱抗生素、免疫抑制剂和抗肿瘤药物的广泛应用,增加了真菌的感染机会,应加强真菌的耐药性监测,以指导临床合理使用抗生素。  相似文献   

18.
目的 比较研究心肌肌钙蛋白I和T对急性心肌梗塞(AMI)的临床诊断应用价值。方法 采用前瞻性双盲随机及平行对照试验方法,将研究对象分为AMI组和非AMI组。AMI组共有按WHO标准诊断的AMI病人121例,随机分二组分别作肌钙蛋白I(cTnI)和肌钙蛋白T(cTnT)检查。作cTnI的共62例,作cTnT的59例。非AMI组包括健康人80例及陈旧心肌梗死、心绞痛、肾衰等患者。本法采用单克隆抗体酶联免疫法检测。cTnI和cTnT的正常值均为0.2mg/L。CK-MB正常为25U/L。结果 在AMI早期cTnI诊断敏感性较cTnT为高,胸痛2h阳性率分别为41.7%和0.0%(P<0.01)。在AMI中晚期则cTnI较cTnT为低,AMI第10d阳性率分别为38.7%和62.7%(P<0.05)。连续检测两者敏感性均可达100%(AMI8~12h)。各期敏感性均优于CK-MB。在非AMI组cTnT可出现在肾衰病人。cTnI、cTnT和CK-MB诊断AMI特异性无明显差异(P>0.05)。cTnI和cTnT有较高的阴性预测值,它们均可达100%。血管再通和梗塞部位及有无Q波影响它们在AMI早期的敏感性。结论 cTnI和cTnT是诊断AMI的敏感指标。在AMI早期检测cTnI而中晚期检测cTnT可提高AMI的诊断阳性率。  相似文献   

19.
目的探讨血清基质金属蛋白酶-9(MMP-9)水平与急性心肌梗死(AMI)患者冠状动脉疾病严重性及预后的关系。方法选取AMI患者87例,在急诊经皮穿刺冠脉内介入术(PCI)后根据冠脉造影结果分为1支、2支和3支病变组,正常对照组30例。对照组于清晨空腹,AMI患者于PCI术前采血,采用ELISA法测定MMP-9,随访其心血管事件半年。结果 AMI患者PCI术前血清MMP-9水平在3支病变组均显著高于2支、1支病变组、对照组;在2支、1支病变组显著高于对照组;经随访,25例发生心血管事件,3支病变组心血管事件发生率显著高于2支、1支病变组;以血清MMP-9水平846μg/L为界分为A组和B组,A组心血管事件发生率显著高于B组。结论 AMI患者血清MMP-9可能用于评价冠状动脉疾病严重性,并对冠脉支架置入术后的心血管事件的发生有预测价值。  相似文献   

20.
急性心肌梗死患者血浆TAT变化的价值   总被引:2,自引:2,他引:2  
目的观察急性心肌梗死(AMI)患者溶栓治疗前后血浆凝血酶-抗凝血酶复合物(TAT)的变化。方法AMI患者34例,对照33例,采用双抗体夹心法检测血浆TAT;对其中6例患者溶栓前、溶栓后6 h及对12 h的血浆TAT进行动态观察,与对照组进行比较。结果AMI组TAT[(13.10±6.70)μg/l]较对照组[(6.96±3.60)μg/l]显著升高(P<0.01);6例溶栓治疗的患者;溶栓6 h后,TAT[(15.10±7.60)μg/l]较治疗前显著升高(P<0.05)。结论TAT是AMI早期诊断、治疗及预后判断的良好指标之一。  相似文献   

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