溶栓与直接PTCA对年轻人急性心肌梗塞患者疗效比较分析

目的：研究以溶栓或直接经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗年轻人急性心肌梗塞（ＡＭＴ）的疗效。方法：４０岁以下ＡＭＴ病人５０例分为溶栓治疗组（３０例）和直接ＰＴＣＡ组（２０例）,比较梗塞相关血管开通率和出院时左心室功能。结果：尿激酶溶栓治疗组血流达ＴＩＭＩ３级４６．２％（１４／３０）,且存在８０～９５％的残余狭窄,出院时左心室射血分数（ＬＶＥＦ）平均４５％;直接ＰＴＣＡＩ且术后血流全部达ＴＩＭ     

老年人急性心肌梗塞静脉溶栓及直接PTCA治疗观察

近年来有关静脉溶栓和不经过溶栓治疗而行直接经皮腔内冠状动脉成形术（ＰＴＣＡ）对恢复梗塞相关血管的血运己有较多研究，两者均是治疗急性心肌梗塞（ＡＭＩ）的有效方法。但在老年ＡＭＩ患者中何种方法得益更大值得进一步探讨。因此，笔者观察对比了直接ＰＴＣＡ及静脉溶栓在ＡＭＩ治疗中的作用，为临床老年人ＡＭＩ治疗决策提供一些参考性资料。１　材料与方法１．１　研究对象　１９９８年２月至１９９９年１月收治老年ＡＭＩ患者４６例。随机分为直接ＰＴＣＡ组及静脉溶栓治疗组。病例入选及冠脉再通标准均以１９９１年中华心血管病杂志编委会推荐的“急性心肌梗塞溶栓治疗方案”为准［１］，但年龄上限除外。１．２　分组及治疗　静脉溶栓组１６例（发病均在１２ｈ以内）。入院后即给予国产尿激酶（广东天普制药公司生产）１５０～３００万ｕ溶于生理盐水１００ｍｌ，３０ｍｉｎ内静脉滴入。均辅以皮下注射低分子肝素和口服阿斯匹林及常规治疗。直接ＰＴＣＡ组３０例。入院后做必要检查即送至导管室，行冠脉造影，在梗塞相关血管行直接ＰＴＣＡ术，必要时植入支架。术后植入支架者口服抵克力得２５０ｍｇ，２次／ｄ，连用１个月，余内科治疗同溶栓组。１．３　观察终点及相应指标　两组均为：①住...     

经皮腔内冠状动脉成形术治疗冠心病临床观察

目的探讨经皮腔内冠状动脉成形术（ＰＴＣＡ）对冠心病的治疗效果。方法对８例冠状动脉造影（ＳＣＡ）后１４处病变的冠心病患者实施了ＰＴＣＡ。结果成功率１００％，病变处血管平均残余狭窄由术前的９２．３％±１１．４％降至６．７％±５．８％。经１～１０个月随访，均无心绞痛发作及心肌梗塞发生。结论ＰＴＣＡ治疗冠心病效果肯定，可明显改善患者的预后     

急性心肌梗死再灌注治疗的临床研究

目的：比较不同再灌注治疗方案治疗急性心肌梗死（ＡＭＩ）的疗效和预后。方法：１１９例采用常规药物治疗,５７例行静脉溶栓、１４例行冠状动态内容栓（ＰＴＣＲ）、１２例行急诊经皮冠状动脉成形术（ＰＴＣＡ）。结果：静脉溶栓治疗冠状动脉再通率为５２．６％,其中,ＡＭＩ发生〈６ｈ者再通率为６７．６％,〉６ｈ者再通率仅为２０％。ＰＴＣＲ再通率为５０％。急诊ＰＴＣＡ手术成功率为９１．７％,２例植入冠状动脉支架成功。     

急诊冠状动脉造影在急性胸痛持续发作中的应用价值

目的：评价急诊冠状动脉造影用于拟诊急性缺血性心脏病胸痛病人的价值。方法：对持续胸痛０．５ ～１２ｈ,心电图拟诊急性缺血性心脏病的病人,急诊行冠状动脉造影术,对确诊为急性心肌梗死而梗死相关动脉ＴＩＭＩ血流≤Ⅱ级者行直接经皮腔内冠状动脉成形术（ｐｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌｃｏｒｏｎａｒｙａｎｇｉｏｐｌａｓｔｙ,ＰＴＣＡ）。结果：５９ 例疑为急性缺血性心脏病发作的病人中,５ 例（５／５９） 被除外冠心病,５４ 例（５４／５９） 确诊为急性心肌梗死,其中单支血管病变２８ 例,双支病变１７ 例,三支病变４ 例,左主干合并三支病变１ 例,冠状动脉造影正常４ 例。梗死血管前降支病变２４ 例,右冠状动脉病变２３ 例,回旋支病变３ 例。对其中４３ 例ＴＩＭＩ≤Ⅱ级心肌梗死病人的梗死相关动脉进行直接ＰＴＣＡ 术,手术成功率１００ ％ ,ＴＩＭＩ血流Ⅲ级４０ 例,Ⅱ级３ 例,３３（３３／４３） 例病人置入冠状动脉内支架。术中无１例出现严重并发症。结论：急诊冠状动脉造影术对急性胸痛持续发作病人是安全和可行的,它可准确判断冠状动脉病变的有无,同时对冠状动脉堵塞引起急性心肌梗死病人可同时进行直接ＰＴＣＡ 术,从而改善预后。     

138例川崎病临床分析(附65例随访)

临床分析１３８例川崎病，结果：符合其诊断标准中６项主要症状者７１例，５项者５０例，４项件二维伪彩色多普勒超声心动图（２Ｉ）－ＣＦＭ）检查冠状动脉扩张（ＣＡＤ）者１７例１．７５例有心肌炎。２Ｄ－ＣＦＭ检查６３例，有３０例ＣＡＤ，内径＞３ｍｍ，２例４～５ｍｍ。１例左右冠状动脉瘤（ＣＡＡ）［９　１１ｍｍ］，且合并心包积液，二尖瓣主动脉瓣重度返流。随访６５例，急性期２Ｄ－ＣＦＭ异常的２８例，于病程６个月至１年，２６例恢复正常。继续随访３～５年，均正常。有２例（病程３个月），冠状动脉内径仍大于３ｍｍ。治疗中首选阿斯匹林，禁用肾上腺皮质激素。     

急怀心肌梗塞急诊PTCA及支架治疗

评估急性心肌梗塞患者采用急诊ＰＴＣＡ及支架治疗的临床疗效。方法８例急性心肌梗塞患者施行急诊ＰＴＣＡ术，其中４例行冠状动脉内支架植入术。结果所有患者冠脉再通均获成功，ＴＩＭＩ分级均达到Ⅲ级，残余狭窄〈２０％。     

急性心肌梗塞的溶栓治疗和急诊经皮冠状动脉腔内成形术

３４例急性心肌梗塞患者在发病７小时内进行了溶栓治疗，静脉和冠状动脉的溶栓分别是２３例和１１例，８例在溶栓过程中进行了急诊经皮冠状动脉腔内成形术，３例２周至３个月施行了择期ＰＴＣＡ。１１例接受了ＰＴＣＡ治疗的患者有３例安放了血管内支架。     

急性 Ｓ Ｔ段抬高型心肌梗死自溶假象及影响因素分析

目的分析急性 Ｓ Ｔ段抬高型心肌梗死（ Ａ ＭＩ ） 梗死相关血管（ Ｉ Ｒ Ａ ） 自溶（ Ｓ Ｒ ） 的假象， 探讨 Ｓ Ｒ假象 的相关影响因素。方法观察５ ６例考虑梗死相关血管（ Ｉ Ｒ Ａ ） 自溶（ Ｓ Ｒ ） 而未予静脉溶栓治疗， 择期行冠状动脉造 影的 Ａ ＭＩ 病人， 根据冠状动脉造影特点分成自溶组（ Ｔ Ｉ ＭＩ ≥２级） 和非自溶组（ Ｔ Ｉ ＭＩ ０～ １级） ， 比较两组冠心病 的危险因素、 住院期间心脏事件的发生率、 冠脉造影病变特点等资料， 寻求发生 Ｓ Ｒ假象的相关影响因素。结果： 经冠脉造影证实非自溶１ ８例， 占总例数３ ２ ． １ ％， 该类病人存在老年、 糖尿病、 多支病变、 侧支循环等因素， 并发症 多， 预后差。结论对于存在高度可疑自溶假象的Ａ ＭＩ 病人， 积极的静脉溶栓或急诊Ｐ Ｃ Ｉ 开通梗死相关血管仍是 有意义的治疗， 可降低病人病死率、 改善预后。     

经皮穿刺冠状动脉腔内成形术68例分析

我院近年共完成经皮穿刺冠状动脉腔内成形术（ＰＴＣＡ）６８例，其中单支病变３７例（５４．４％）双支病变２２例（３２．４％）三支病变９例（１３．２％），ＰＴＣＡ共扩张７９处病变，Ａ型病变３９处（４９．４％）Ｂ型病变３０处（３７．９％）Ｃ型病变１０处（１２．７％），３例采用双导丝技术；５例采用灌注球囊导管，８例放置冠状动脉内支架，１例进行了冠状动脉内膜斑块定义切除术，ＰＴＣＡ的病例成功率９７．１％，病变     

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.