瑞替普酶溶栓治疗ST段抬高型急性心肌梗死的疗效

目的 评价瑞替普酶(rPA)溶栓治疗ST段抬高型急性心肌梗死(STEMI)的临床疗效及安全性.方法 将81例发病12 h内的STEMI符合溶栓治疗条件的患者分为rPA组41例和尿激酶组40例,分别用rPA和尿激酶进行溶栓,比较两组患者在溶栓治疗后60、120 min的再通率,并发各种出血的发生率,复合终点事件即住院2周内死亡及30 d内心力衰竭、心源性休克和再梗的发生率.结果 溶栓后60、120 min rPA组临床判断再通率均明显高于尿激酶组(P<0.05);住院2周内死亡及30 d内心力衰竭、心源性休克和再梗的发生率rPA组明显低于尿激酶组(P<0.05);并发各种出血的发生率两组差异无统计学意义(P>0.05).结论 rPA溶栓治疗STEMI是较为理想的药物,值得基层医院的临床推广.     

早期静脉溶栓治疗老年急性心肌梗死

目的:观察尿激酶静脉溶栓治疗老年早期急性心肌梗死(AMI)的疗效和安全性。方法:回顾分析17例采用早期尿激酶静脉溶栓治疗与18例采用常规治疗的老年AMI患者的临床资料,观察静脉溶栓治疗及常规治疗患者的冠脉再通情况及两组病人并发症的发生率。结果:尿激酶早期静脉溶栓治疗组冠脉再通率高于常规治疗组(P<0.05);两组病人并发症的发生率差异无显著性(P>0.05)。结论:尿激酶溶栓治疗老年急性心肌梗死,可提高AMI的疗效。     

静脉尿激酶溶栓治疗老年人急性心肌梗死的临床分析

目的:探索静脉尿激酶溶栓对老年人急性心肌梗死(AMI)的治疗价值及最佳溶栓剂量。方法:将98例老年AMI患者分成溶栓组和对照组,溶栓组又分2组,分别使用80万U和150万U的尿激酶进行溶栓治疗,观察他们的冠脉再通率、死亡率及并发症、副作用的发生情况。结果:相同年龄状况下,溶栓组的死亡率及主要并发症的发生率比对照组低(P<0.05)。80万U与150万U两种剂量尿激酶溶栓治疗时,冠脉再通率及死亡率无差异(P>0.05),而大出血、脑出血的发生率,80万U组比150万U组低(P<0.05)。结论:静脉尿激酶溶栓治疗能改善老年AMI的预后,降低死亡率。溶栓药物尿激酶的用量应以小剂量为宜。     

极化液对急性心肌梗死静脉溶栓疗效的影响

目的探讨极化液(葡萄糖-胰岛素-钾-镁注射液)对急性心肌梗死(AMI)静脉溶栓治疗冠脉再通率、再通速率、梗死面积和再灌注心室功能的影响。方法将86例AMI住院患者随机分为极化液组(A组)和对照组(B组)。两组均给予尿激酶150万U(体重>75kg者,按2万U/kg计算)30min内静脉滴入,肝素抗凝,阿司匹林抑制血小板凝集治疗;A组患者在实施溶栓前或溶栓同时应用极化液。在治疗过程中监测心肌酶变化、心电图变化,评估再通指标(再通率和再通速率),计算溶栓前和溶栓后1周时的心肌梗死面积,利用彩超测定左室射血分数(EF)值。结果两组病人血清心肌酶变化对比,CPK、CK-MB的峰值水平A组明显低于B组(P<0.05);溶栓面积组内比较溶栓后比溶栓前明显减小,但A组缩小更明显,组间比较溶栓后面积A组明显小于B组(P<0.05);再通率、再通速率A组均明显大于B组(P<0.05);出院时测得左室射血分数EF值A组显著高于B组(P<0.05);A组发生严重并发症的几率和死亡率都明显低于B组(P<0.05)。结论极化液联合早期溶栓(同时抗凝、抗血小板聚集)是目前药物治疗AMI的理想方案,极化液对AMI静脉溶栓提高冠脉再通率、再通速率、减少梗塞面积、恢复心功能、降低死亡率具有显著的优化疗效作用。极化液可明显提高AMI静脉溶栓的治疗效果。     

小剂量尿激酶静脉溶栓治疗高龄急性心肌梗死临床观察

目的:探讨高龄(≥75岁)急性心肌梗死(AMI)患者小剂量尿激酶静脉溶栓的临床疗效。方法:将81例高龄AMI住院患者随机分为溶栓治疗组38例和常规治疗组43例,常规组给予吸氧、镇痛、镇静、抗凝等常规治疗;溶栓组在常规治疗组基础上,静脉给予小剂量尿激酶100万U,于30 min内滴入,并观察临床疗效。结果:溶栓组再通率60.52%(23/38),严重并发症发生率13.16%(5/38),病死率10.53%(4/38);常规组再通率11.62%(5/43),严重并发症发生率39.54%(17/43),病死率30.23%(13/43),两组比较差异有统计学意义(P<0.05)。溶栓组脑出血率2.63%(1/38)。结论:高龄AMI患者进行小剂量尿激酶静脉溶栓治疗切实有效且安全性高。     

急性心肌梗死患者尿激酶溶栓治疗后低分子肝素的应用

目的探讨急性心肌梗死(AMI)患者尿激酶溶栓治疗后应用低分子肝素抗凝治疗的效果和安全性。方法63例AMI患者作常规尿激酶溶栓治疗后,分为普通肝素(UHF)抗凝组(32例)和低分子肝素(LMWH)抗凝组(31例),比较两组病例冠脉血管再通率和1周内并发症的发生率。结果两组病例冠脉血管再通率相仿,UHF组为56.3%,LMWH组为61.3%(P>0.05);UHF组重度出血率(12.5%)和再梗死的发生率(18.8%)高于LMWH组(分别为0和3.2%,P<0.05)。结论AMI患者尿激酶溶栓后应用低分子肝素抗凝效果肯定,安全性优于普通肝素。     

国产重组链激酶溶栓治疗急性心肌梗塞的临床观察

目的:观察国产重组链激酶(rSK)在急性心肌梗塞(AMI)静脉溶栓治疗的临床疗效和不良反应。方法:79例符合溶栓治疗的AMI患者,按用药情况分为rSK组30例和尿激酶(UK)组49例,观察冠状动脉再通率,出血并发症以及rSK的不良反应。结果:rSK组的临床血管再通率76.67%,显著高于UK组的55.10%(P<0.05)。两组出血并发症无显著性差异(P>0.05)。rSK组发生轻微过敏反应6.7%,低血压10.0%,对症治疗后迅速好转。结论:国产rSK溶栓治疗AMI,血管再通率高,不良反应发生率低,程度轻,为一安全有效的溶栓药物。     

应用尿激酶溶栓急诊治疗急性心肌梗死患者64例临床疗效观察

目的:探讨尿激酶溶栓急诊治疗急性心肌梗死(AMI)患者的临床疗效。方法:选取接受治疗的128例AMI患者,随机分为溶栓组和对照组,对照组给予常规治疗,溶栓组在常规治疗基础上加用尿激酶溶栓治疗,并比较两组疗效。结果:溶栓组治疗90 min、120 min后的冠脉再通率分别为53.1%、71.9%,均明显大于对照组,差异有统计学意义(P<0.05),治疗4周后的并发症发生率和死亡率分别为3.1%、0,均明显小于对照组,差异有统计学意义(P<0.05)。结论:尿激酶溶栓治疗在急性心肌梗死治疗中可明显提高患者血管再通率,减少并发症发生,降低死亡率。     

再次溶栓治疗急性心肌梗死41例疗效分析

目的:研究急性ST段抬高心肌梗死(AMI)发病后,二次尿激酶溶栓治疗对血管再通的影响。方法:将符合溶栓条件的41例AMI患者按溶栓次数分为A组(再次溶栓治疗组)22例和B组(常规溶栓治疗组)19例,比较两组患者血管再通率、再通组与未再通组的死亡率及并发症。结果:A组血管再通率72.73%,B组42.11%,A组再通率高于B组(P<0.05)。再通组死亡率低于未再通组(P<0.05)。结论:首次溶栓治疗没有再通或下降的ST段再次抬高可考虑行再次溶栓治疗,能获得更好的临床疗效。     

心理干预对急性心肌梗死患者溶栓治疗效果的影响

目的:探讨心理干预对急性心肌梗死(AMI)患者溶栓治疗效果的影响。方法:急诊监护室收治的38例AMI患者在溶栓治疗过程中给予常规治疗护理外还予以切实有效的心理干预措施(观察组),回顾对比2006年1月~2008年5月收治的38例AMI患者在溶栓治疗过程中只给予常规治疗护理(对照组)。分析两组溶栓治疗再通率及并发症发生率。结果:观察组溶栓治疗再通率明显高于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。结论:心理干预能提高溶栓治疗效果,减少并发症的发生。     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.