注射用丹参多酚酸盐联合替格瑞洛治疗不稳定型心绞痛的效果观察

目的研究注射用丹参多酚酸盐联合替格瑞洛治疗不稳定型心绞痛的效果。 方法选取82例不稳定型心绞痛患者作为研究对象,按照随机抽签法分组,各41例。两组均接受常规治疗,对照组在常规治疗基础上接受替格瑞洛治疗,观察组在对照组基础上接受注射用丹参多酚酸盐治疗。治疗2周后,比较两组治疗效果、心绞痛改善情况、治疗前及治疗2周后血液流变学(红细胞聚集指数、血浆黏度)及血小板聚集率。 结果观察组总有效率92.68%较对照组73.17%高(P<0.05);观察组治疗2周后心绞痛发作频率较对照组低,发作持续时间较对照组短(P<0.05);治疗2周后,观察组红细胞聚集指数、血浆黏度、血小板聚集率较对照组低(P<0.05)。 结论注射用丹参多酚酸盐联合替格瑞洛治疗不稳定型心绞痛效果显著,可明显减轻心绞痛症状,降低血小板聚集率,改善血液流变学。     

美托洛尔联合丹参多酚酸盐对老年冠心病心绞痛病人血脂、超敏C-反应蛋白的影响

目的探讨美托洛尔联合丹参多酚酸盐对老年冠心病心绞痛病人血脂、超敏C-反应蛋白的影响。方法 98例病人根据随机数字表法随机分为观察组和对照组,各49例。两组均给予常规治疗。对照组给予美托洛尔治疗,观察组在对照组基础上结合丹参多酚酸盐治疗。两组疗程均为14d。对比分析两组病人治疗后临床疗效、心绞痛发作时间和持续时间,治疗前后血脂水平和超敏C-反应蛋白(hs-CRP)水平。结果观察组治疗后总有效率(91.84%)显著高于对照组(75.51%),差异有统计学意义(P0.05);治疗后观察组心绞痛发作时间和持续时间显著低于治疗前及同期对照组,且具有统计学意义(P0.05);治疗后观察组TC、TG、LDL-C水平显著低于治疗前及同期对照组,高密度脂蛋白胆固醇(HDL-C)水平显著高于治疗前及同期对照组(P0.05);治疗后观察组hs-CRP水平显著低于治疗前及同期对照组(P0.05);两组病人治疗过程中均未发生明显不良反应。结论美托洛尔联合丹参多酚酸盐对老年冠心病心绞痛病人治疗效果显著,可明显改善病人血脂和超敏C-反应蛋白水平。     

基于“心肝同治法”探讨心痛舒治疗老年冠心病心绞痛的效果

目的基于“心肝同治法”心痛舒治疗老年冠心病心绞痛的效果。方法选取老年冠心病心绞痛患者212例,根据临床治疗策略分为对照组及中药组;对照组给予瑞舒伐他汀钙等常规治疗,中药组在对照组治疗基础上给予心痛舒治疗。对比两组治疗效果及治疗前后临床证候评分、心肌功能、血脂水平、肝功能水平变化。结果治疗后中药组总有效率显著高于对照组(P<0.05);治疗后两组心绞痛发作持续时间及频率均低于治疗前,且中药组下降程度优于对照组,差异有统计学意义(P<0.05);治疗后两组左室射血分数(LVEF)水平显著高于治疗前,左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)水平显著低于治疗前,且中药组LVEF、LVESV、LVEDV改善水平幅度显著优于对照组(P<0.05);治疗后两组ST段下移导联数、T波倒置导联数、T波低平导联数显著低于治疗前,且中药组ST段下移导联数显著低于对照组(P<0.05);治疗后两组高密度脂蛋白胆固醇(HDL-C)水平显著高于治疗前,三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平显著低于治疗前,且中药组TG、TC、LDL-C、HDL-C改善水平幅度显著优于对照组(P<0.05);治疗后中药组谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)水平显著低于治疗前(P<0.05),对照组较治疗前轻微升高,但差异无统计学意义(P>0.05),两组对比差异有统计学意义(P<0.05)。结论心痛舒方剂治疗老年冠心病心绞痛患者效果显著,可有效缓解患者临床症状,改善心功能,调节血脂水平及肝脏功能。     

丹参多酚酸盐对冠心病 PCI 患者术后血液流变学及心功能的影响

目的：观察丹参多酚酸盐对冠心病不稳定型心绞痛PCI患者术后临床症状、血液流变学及心功能的影响。方法随机将136例不稳定型心绞痛PCI术后患者分为两组,丹参多酚酸盐组（70例）与对照组（66例）,对照组采用常规治疗,丹参多酚酸盐组在常规治疗基础上加用丹参多酚酸盐,观察两组治疗前后临床疗效、血液流变学及血hs-CRP、血NT-proBNP水平变化。结果全血高切粘度、低切粘度、血浆粘度、红细胞变形指数、血hs-CRP、血NT-proBNP两组治疗后均明显改善,与治疗前比较差异有统计学意义（ P＜0.05）,且丹参多酚酸盐治疗组的改善更为明显,差异有统计学意义（ P＜0.05）。结论丹参多酚酸盐用于冠心病PCI术后可显著改善血液流变学异常、改善心肌血供和心功能。     

当归补血汤对急性心肌梗死病人心室重塑及心功能的影响

目的观察当归补血汤对急性心肌梗死病人心室重塑及心功能的影响。方法将80例急性心肌梗死病人按随机数字表分为观察组与对照组,各40例。对照组给予急性心肌梗死常规治疗,观察组在对照组基础上联合当归补血汤治疗,两组连续服用4个月。比较两组治疗前后左室后壁厚度(LVPWT)、舒张末期室间隔厚度(IVST)、左室心肌重量指数(LVMI)、左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)及治疗期间心血管不良事件总发生率。结果治疗后,两组LVPWT、IVST均较治疗前下降(P<0.05),LVMI较治疗前升高(P<0.05);且观察组LVPWT、IVST低于对照组(P<0.05),LVMI高于对照组(P<0.05)。治疗后,两组LVESV、LVEDV均较治疗前下降(P<0.05),LVEF较治疗前升高(P<0.05);且观察组LVESV、LVEDV低于对照组(P<0.05),LVEF高于对照组(P<0.05)。观察组心血管不良事件总发生率为5.00%,显著低于对照组的20.0%(P<0.05)。结论当归补血汤可有效干预急性心肌梗死后心室重塑,改善病人心功能,减少心血管不良事件的发生。     

注射用丹参多酚酸盐治疗冠心病心绞痛(心血瘀阻证)的有效性和安全性观察

目的观察分析注射用丹参多酚酸盐治疗冠心病心绞痛(心血瘀阻证)的有效性和安全性。方法选择我院2015年2月~2016年4月收治的冠心病心绞痛患者88例作为研究对象,将其随机分成研究组和对照组,各44例。对照组患者采取常规治疗,研究组患者在对照组的基础上增加注射用丹参多酚酸盐,对两组患者的疗效及不良反应进分析比较。结果经过治疗后,研究组患者总有效率为84.1%,显著高于对照组的65.9%,差异有统计学意义(P0.05);研究组患者不良反应发生率明显低于对照组,差异有统计学意义(P0.05)。结论采取注射用丹参多酚酸盐治疗冠心病心绞痛(心血瘀阻证)疗效显著,不良反应发生率低,安全可靠,值得临床推广应用。     

急性心肌梗死急诊冠状动脉介入后应用丹参多酚酸盐联合生脉注射液治疗的临床疗效观察

目的探讨丹参多酚酸盐联合生脉注射液应用于急性心肌梗死(AMI)急诊冠状动脉介入术(PCI)后应用的临床疗效。方法选择2016年1月—2017年9月我院收治的行急诊冠状动脉介入术治疗的80例急性心肌梗死病人,分为研究组和对照组各40例。两组病人于PCI术前均口服氯吡格雷和阿司匹林。对照组在PCI术后给予常规西药治疗;研究组在对照组基础上联合丹参多酚酸盐(150mg,每日1次)和生脉注射液(50mL,每日1次)。观察治疗前、治疗24h、治疗48h、治疗72h和治疗7d时两组血清N末端脑利钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、高敏C反应蛋白(hs-CRP)血清学指标以及左室射血分数(LVEF)、左心室舒张末期内径(LVED)、左心室舒张末期容量(LVEDV),并统计不良反应发生率及并发症情况。结果经过治疗后两组血清NT-proBNP、cTnI、hs-CRP、LVED和LVEDV水平均呈下降趋势,LVEF呈上升趋势;研究组自治疗24h起血清NT-proBNP水平较对照组明显下降,且随治疗时间呈正相关性(P<0.05);研究组血清hs-CRP水平在治疗48h后与对照组比较开始呈显著下降(P<0.05),研究组治疗72h时血清cTnI水平显著低于对照组(P<0.05),但治疗7d时两组间比较差异无统计学意义;治疗后研究组LVEF显著高于对照组(P<0.05);研究组自治疗24h起LVEDV显著低于对照组,而治疗72h和治疗7d时LVED显著低于对照组(P<0.05)。经过治疗后,研究组和对照组QRS积分和梗死面积均显著减小,研究组并发症总发生率显著低于对照组(12.50%与35.00%,P<0.05)。对照组和研究组发生慢血流现象及不良反应发生率对比差异无统计学意义(P>0.05)。结论急性心肌梗死急诊PCI术后联合使用丹参多酚酸盐与生脉注射液能够有效减弱病人心肌损伤程度,从而改善心功能。     

丹参多酚酸盐对不稳定性心绞痛患者的纤溶活性的影响

目的观察丹参多酚酸盐对不稳定性心绞痛患者的血浆纤溶活性的影响。方法选取2014年1月~2015年3月在我院心内科住院的不稳定性心绞痛患者60例,随机分为常规治疗组30例与丹参多酚酸盐治疗组30例,另设正常对照组20例;治疗前检测各组纤溶酶原激活剂抑制剂(PAI-1)、纤溶酶原激活剂(t PA),治疗2周后复查上述检查项目,观察其变化及疗效。结果丹参多酚酸盐治疗组临床有效率为90%,常规治疗组为60%,丹参多酚酸盐治疗组疗效优于常规治疗组(P0.05);丹参多酚酸盐治疗组心电图改善率为90%,常规治疗组为66.6%,丹参多酚酸盐治疗组心电图改善率优于常规治疗组(P0.05)。不稳定性心绞痛患者PAI-1水平高于正常组,而tPA水平低于正常组;丹参多酚酸盐治疗组较常规治疗组PAI-1水平下降较为明显,tPA水平升高较为明显。结论丹参多酚酸盐能改善不稳定性心绞痛患者纤溶活性,稳定冠脉斑块,缓解症状,有效治疗不稳定性心绞痛。     

注射用丹参多酚酸盐治疗冠心病心绞痛合并2型糖尿病疗效观察

目的研究观察注射用丹参多酚酸盐治疗冠心病心绞痛合并2型糖尿病的疗效。方法将该医院于2016年9月—2018年2月期间接诊的72例冠心病心绞痛合并2型糖尿病患者作为研究对象,按照信封法随机分为对照组和观察组,每组36例患者。对照组采取常规冠心病、2型糖尿病药物进行西医治疗,观察组在对照组常规冠心病、2型糖尿病西医治疗的基础上联合注射用丹参多酚酸盐进行治疗。观察指标为两组患者的心绞痛治疗效果、心电图缺血改善情况、血糖水平以及硝酸甘油停减情况。结果在进行治疗后,观察组患者在心绞痛治疗效果、心电图缺血改善情况、血糖水平以及硝酸甘油停减情况的比较上明显优于对照组(P0.05)。结论常规方法治疗冠心病心绞痛合并2型糖尿病的治疗效果提升空间较大,在此基础上联合注射用丹参多酚酸盐进行治疗具有显著的治疗效果,能够明显改善患者缺血情况和血糖水平,且显著减少硝酸甘油的用药量,值得推广研究。     

注射用丹参多酚酸盐治疗冠心病心绞痛合并2型糖尿病患者临床疗效观察

目的探讨注射用丹参多酚酸盐治疗冠心病心绞痛合并2型糖尿病患者的临床疗效。方法选取我院收治的冠心病心绞痛合并2型糖尿病患者86例为研究对象,随机分为观察组与对照组,每组43例。对照组患者采用常规的降糖药物及抗血小板药物治疗,观察组在此基础上给予丹参多酚酸盐治疗,疗程2周。观察比较两组患者治疗前后的血糖水平及硝酸甘油使用量变化情况;检查比较两组患者治疗前后的心电图变化情况与心绞痛治疗效果。结果观察组患者的心绞痛疗效优于对照组,观察组患者心绞痛的治疗总有效率为97.67%,对照组为86.05%,两组比较差异有统计学意义(P0.05)。观察组患者治疗后心电图恢复的情况优于对照组,观察组患者缺血表现改善率(69.77%)显著高于对照组(48.84%),差异有统计学意义(P0.05)。观察组患者的硝酸甘油停减率为76.74%,对照组为46.51%,两组比较差异有统计学意义(P0.01)。治疗后,两组患者的空腹血糖(FPG)与餐后血糖(PPG)均显著降低,观察组患者FPG与PPG水平显著低于对照组(P0.05)。治疗过程中两组患者均未发生明显的不良反应。结论在常规降血糖与抗血小板治疗的基础上给予丹参多酚酸盐治疗冠心病心绞痛合并2型糖尿病患者,临床效果显著,可有效缓解患者的临床症状,减少硝酸甘油的用量,治疗安全性高,值得推广应用。     

Antihypertensive therapy with diltiazem and comparison with hydrochlorothiazide

Fourteen hypertensive patients with a mean sitting systolic and diastolic blood pressure (BP) of 153 +/- 16/100 +/- 4 mm Hg were treated successively with hydrochlorothiazide and diltiazem for 8 weeks each. The BP response and changes in heart rate, left ventricular size and function, and plasma catecholamine concentrations and renin activity were monitored. The 2 drugs had comparable antihypertensive effects, with mean decreases of 14, 9 and 11 mm Hg for the sitting, standing and supine diastolic BP, respectively, during hydrochlorothiazide treatment and mean decreases of 16, 18 and 12 mm Hg during diltiazem treatment. Heart rate was unchanged, although plasma norepinephrine concentrations increased significantly during diltiazem treatment. Plasma renin activity increased slightly, from 0.6 to 0.9 ng/ml/hour during diltiazem treatment, but the change was not significant (p less than 0.10). Left ventricular ejection fraction and end-diastolic volume were not affected by either agent. In conclusion, diltiazem is an effective antihypertensive agent, which because of its benign side effect profile, may be useful as a step 1 agent.     

Beta blocker overdose with propranolol and with atenolol

During a one-month period, two cases of beta-adrenergic blocker overdose were treated by the emergency staff at our hospital. One case of propranolol intoxication demonstrated profound cardiovascular collapse and generalized tonic-clonic seizures. The condition failed to respond to high-dose intravenous pressor agents, but did improve significantly with IV glucagon infusion. The second overdose involved atenolol. Although the blood levels reported were very high, the patient showed no cardiovascular compromise and required only inhaled bronchodilators for an exacerbation of her asthma.     

Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil.

BACKGROUND: The aim of this study was to assess the efficacy of patient-controlled analgesia and sedation with propofol/alfentanil for colonoscopy compared with continuous drug infusion and conventional nurse-administered medication. METHODS: One hundred fifty patients undergoing colonoscopy on an outpatient basis were randomly assigned to 1 of 3 medication regimens. To maintain blinding, all patients were connected to an infusion pump. Group I patients could self-administer boluses of 4.8 mg propofol and 125 microg alfentanil without restriction. Group II patients received a continuous infusion with 0.048 mg/kg propofol and 0.12 microg/kg alfentanil per minute. Group III patients received intravenous premedication with 0.035 mg/kg midazolam and 0.35 mg/kg meperidine. RESULTS: There were no differences between the groups with respect to pain (visual analogue scale) and procedure time. Patient-controlled analgesia and sedation with propofol/alfentanil (group I) resulted in less of an increase in the transcutaneous partial pressure of carbon dioxide (p = 0.0004) during colonoscopy and less of a decrease in mean arterial blood pressure (p = 0.0021) during recovery, as well as more complete recovery (p = 0.0019) after 45 minutes compared with conventional administration of midazolam/meperidine. Furthermore, patient-controlled analgesia and sedation yielded a higher degree of patient satisfaction than continuous infusion of propofol/alfentanil (p = 0.0033) or nurse-administered midazolam/meperidine (p = 0.0094). CONCLUSIONS: Patient-controlled administration of propofol and alfentanil for colonoscopy may provide a better margin of safety than conventional administration of midazolam and meperidine and results in a higher level of patient satisfaction and shorter recovery.     

Refractory anemia with ring sideroblasts and RARS with thrombocytosis

Disease Overview : Ring sideroblasts (RS) are erythroid precursors with abnormal perinuclear mitochondrial iron accumulation. Two myeloid neoplasms defined by the presence of RS, include refractory anemia with ring sideroblasts (RARS) and RARS with thrombocytosis (RARS‐T). Diagnosis : RARS is a lower risk myelodysplastic syndrome (MDS) with dysplasia limited to the erythroid lineage, <5% bone marrow (BM) blasts and ≥15% BM RS. RARS‐T is a provisional entity in the MDS/MPN (myeloproliferative neoplasm) overlap syndromes, with diagnostic features of RARS, along with a platelet count ≥450 × 10(9)/L and large atypical megakaryocytes similar to those observed in BCR‐ABL1 negative MPN. Mutations and Karyotype : Mutations in the SF3B1 gene are seen in ≥80% of patients with RARS and RARS‐T, and strongly correlate with the presence of BM RS; RARS‐T patients have additional mutations such as, JAK2V617F (～60%), MPL (<5%), and CALR (<5%). Cytogenetic abnormalities are uncommon in both RARS and RARS‐T. Risk stratification : Most patients with RARS are stratified into lower risk groups by the International Prognostic Scoring System (IPSS) for MDS and the revised IPSS. Disease outcome in RARS‐T is better than that of RARS, but worse than that of essential thrombocytosis. Both RARS and RARS‐T have a low risk of leukemic transformation. Treatment : Anemia and iron overload are complications in both diseases and are managed similar to lower risk MDS. Aspirin therapy is reasonable in RARS‐T, especially in the presence of JAK2V617F, but the value of platelet‐lowering drugs is uncertain. Case reports of RARS‐T therapy with lenalidomide warrant additional studies. Am. J. Hematol. 90:550–559, 2015. © 2015 Wiley Periodicals, Inc.     

Mapping quantitative traits with random and with ascertained sibships

Use of a robust score statistic based on a variance components model to map quantitative trait loci in randomly sampled pedigrees is reviewed. Sibships ascertained through a single proband are discussed. Under a standard assumption of multivariate normality, two suggested methods of ascertainment correction are shown to be asymptotically equivalent when the number of sibships is large.