LIFE EVENTS AND MYOCARDIAL INFARCTION

Life events reported to have occurred twelve months before the onset of the illness were compared in 55 in-patients who had a first episode of myocardial infarction and 55 control in-patients matched for age, sex, marital status and social class and afflicted with acute abdomen, trauma and multiple trauma. The Paykel interview for Recent Life Events was used. Myocardial infarction patients reported significantly more previous events than the control group (p<0.001) with more undesirable (p<0.01) and uncontrolled (p<0.01) events. Moreover, myocardial infarction patients had significantly more events (p<0.01) which had an “objective negative impact” (rated as being traumatic). These findings are consistent with the view that certain recent life events have a positive association with the onset of a first episode of myocardial infarction.     

心肌梗死并发脑梗死与颈动脉斑块相关性分析

目的通过对颈动脉内中膜厚度(IMT)的测定,探讨心肌梗死并发脑梗死与颈动脉斑块的相关性。方法采用彩色多普勒测定颈动脉IMT和硬化斑块指数及积分。检测155例患者,其中脑梗死组56例,心肌梗死组43例,心肌梗死并发脑梗死16例,同时检测40例无明显心脑血管疾病患者。结果 颈动脉IMT对照组明显低于其他3个观察组,P<0.01,而观察组的IMT明显高于正常P<0.01,但3个观察组间的IMT相比P>0.05;3个观察组间的颈动脉斑块检出率与对照组相比P<0.01,3个观察组中心肌梗死并发脑梗死组的检出率最高,但3组间比较P>0.05;3个观察组的斑块指数及斑块积分高于对照组P<0.01,心肌梗死并发脑梗死组高于心机梗死和脑梗死组,P<0.01,脑梗死与心肌梗死组相比P>0.05。结论 颈动脉斑块是反映动脉粥样硬化的较好指标,心肌梗死并发脑梗死时与斑块的栓出率、指数和积分成正比。     

实验性家兔心脏和肾脏短暂缺血对急性心肌梗死后QT离散度影响的比较研究

目的分析心脏和肾脏短暂缺血预处理对急性心肌梗死(AMI)后QT间期离散度(QTd)变化的影响.方法观察AMI组(A组)、心脏缺血预处理(MIP)组(B组)和肾脏缺血处理(RIP)组(C组)新西兰兔在AMI前后的QTd,并行心肌电生理诱发室性心动过速(VT),对三组的指标进行比较,同时设假手术组(D组)作对照.结果四组在手术前QTd比较差异无统计学意义(P＜0.05);D组手术前后QTd比较差异无统计学意义(P＞0.05);在AMI后,B、C二组QTd明显小于A组(P＜0.05),而B、C二组QTd比较差异无统计学意义(P＞0.05).结论MIP和RIP均可减少AMI后QTd及室胜心律失常的发生,而且二者的作用无明显差异.     

脑干梗塞的临床与影像学对比研究

为了解脑干梗塞的早期临床特征，对２８例脑干梗塞的影像学改变进行了系统分析。结果表明：延髓和中脑梗塞均具备交叉性麻痹。脑桥梗塞则有不同的临床征象，其中交叉性麻痹８例，四肢瘫３例，纯偏身感觉障碍４例，偏瘫并偏身感觉障碍而无脑神经麻痹３例。脑桥梗塞肢体共济失调可为同侧，亦可表现为对侧。提示ＭＲＩ是诊断脑干梗塞最有意义的检查，阳性率８２．６％，阴性结果与扫描时间过早过晚有关。ＣＴ不能确诊脑干梗塞，但有助于排除脑干出血。     

MONONEURITIS MULTIPLEX AND OCCIPITAL INFARCTION COMPLICATING GIANT CELL ARTERITIS

A 67-year-old lady with giant cell arteritis presented witha normal erythrocyte sedimentation rate (ESR) and developedoccipital infarction and mononeuritis multiplex shortly afterbeing started on high dose steroids. KEY WORDS: Corticosteroids, Erythrocyte sedimentation rate, Neuropathy     

老年和青年急性心肌梗死临床特点和心理分析

目的分析103例青年和老年急性心肌梗死(AMI)患者的临床特点和心理状态.方法将103例AMI患者按年龄分为老年组和青年组,并对二组的临床特点和心理状态进行分析.结果①青年组AMI均为男性,吸烟占95.5%,饮酒占90.9%,均明显高于老年组(P＜0.01).老年组AMI有高血压病占48.1%,高脂血症占60.5%,糖尿病占34.6%,均明显高于青年组(P＜0.05).②青年组AMI患者以焦虑为主,占59.1%,与老年组比较差异有统计学意义,老年组患者以抑郁为主,占45.7%,二组比较差异有统计学意义(P＜0.05).③青年组有典型心绞痛19例,占86.3%,与老年组比较差异有统计学意义.④二组比较,老年组病死率高于青年组(P＜0.05).结论男性、大量吸烟、大量饮酒是青年AMI的主要危险因素;而高血压病、糖尿病等并发症是老年AMI的主要危险因素.青年AMI以焦虑为主,症状典型;而老年AMI以抑郁为主,症状不典型,并发症多,病死率高.     

非Q波与Q波心肌梗死的临床分析

本组急性心肌梗死１１２１例中，非Ｑ波心肌梗死３９２例（３５％），Ｑ波心肌梗死７２９例（６５％）。既往有心绞痛及心肌梗死者，在非Ｑ波心肌梗死组分别有７６．８％及３８．８％，显著地多于Ｑ波心肌梗死组的６１．２％及３０．６％。有高血压、糖尿病史及吸烟者，两组间比较无差别。并发泵衰竭、室性心动过速和（或）心室颤动及Ⅱ～Ⅲ度房室传导阻滞者，在非Ｑ波心肌梗死组分别有１０．２％、１０％及１．５％，显著地少于Ｑ波心肌梗死组的１９．３％、２０．６％及１３．６％。梗死后心绞痛者，在非Ｑ波心肌梗死组有４５．２％，显著地多于Ｑ波心肌梗死组的２８．９％。４周病死率，在非Ｑ波心肌梗死组为２．８％，显著地低于Ｑ波心肌梗死组的８．２％。非Ｑ波与Ｑ波心肌梗死比较，患者在急性期并发症较少，病死率较低；而梗死后早期心绞痛较多。     

超急性及急性脑梗塞的磁共振弥散成像

目的 评价磁共振弥散加权成像在老年人超急性、急性脑梗塞中的应用及与常规磁共振序列、CT之间的比较。方法共收集61例疑似超急性、急性脑梗塞患者（平均年龄70岁）,在发病24h内进行磁共振T1WI、T2WI、水抑制序列、弥散加权扫描以及CT扫描。结果 共有36例患者确诊为超急性或急性脑梗塞,弥散加权序列准确显示了35例,敏感性为97％、特异性为99％;水抑制序列加T2WI为56％、57％,CT为44％、48％。结论 弥散加权对于24h内超急性、急性期脑梗塞的显示明显优于常规磁共振序列及CT,并且可以很好地区分急性与慢性梗塞病灶。     

CARDIAC TAMPONADE FOLLOWING INFARCTION: MANAGEMENT WITH PERICARDIOCENTESIS AND SURGERY

Abstract: Four patients with cardiac tamponade following myocardial infarction are presented. Diagnostic clinical features and the role of echocardiography are discussed. Pericardiocentesis resulted in rapid improvement in clinical state but frequently tamponade recurred. Surgery was undertaken in three patients and two have survived long term.
If promptly recognised, tamponade following myocardial infarction may be treated.