老年男性冠心病患者冠状动脉病变特点

目的探讨老年与中青年男性冠心病患者冠状动脉病变特点的不同。方法对475例经过冠状动脉造影检查诊断为冠心病的男性患者,其中老年组260例;中青年组215例。对比分析两组冠状动脉病变的不同特点。结果在老年组中,不稳定型心绞痛患者平均冠状动脉病变支数（1.9±0.1vs1.6±0.1）与冠状动脉积分（45±6vs27±3）均显著高于中青年组,老年组与中青年组稳定型心绞痛患者冠状动脉病变支数相同（1.9±0.1vs1.9±0.1）,冠状动脉积分（46±5vs44±5）接近。老年男性急性心肌梗死（AMI）患者冠状动脉病变支数（2.4±0.1vs2±0.1）和冠状动脉积分（68±4vs56±4）显著高于中青年AMI患者。两组之间的病变血管的分布无显著性差异。老年组单支病变显著低于中青年组（31.9%vs44.7%）,3支病变（43.8%vs33.0%）和4支病变显著高于中青年组（2.5%vs1.0%）。结论老年患者不稳定型心绞痛和AMI冠状动脉病变程度高于中青年,而稳定型心绞痛和陈旧性心肌梗死两者病变程度相似。     

老年急性心肌梗死并发糖尿病患者急诊介入治疗近期疗效

目的探讨老年急性心肌梗死（AMI）并发糖尿病患者急诊经皮冠状动脉介入治疗（PCI）的安全性。方法将316例老年（≥60岁）AMI患者分为糖尿病组（DM组，76例）和非糖尿病组（ND组，240例），于发病12h内行急诊PCI，比较两组患者临床和冠状动脉造影特征、PCI成功率及术后并发症发生率。结果（1）DM组患者血脂异常、空腹血糖水平、前壁AMI百分比均显著高于ND组[分别为42．1％和24．2％，（10±3）mmol／L和（5±2．1）mmol／L，68．4％和49．6％，P〈0．05]。（2）DM组患者的梗死相关血管为前降支者显著高于ND组（60．5％和42．1％，P〈0．05），DM组三支病变、弥漫病变率显著高于ND组（78．9％和46．3％，67．1％和46．3％，P〈0．01）。（3）PCI即刻成功率、术中无复流发生率、住院期间PCI术后并发症发生率和病死率两组比较差异均无统计学意义。结论急诊PCI治疗老年AMI并发糖尿病患者近期安全有效。     

老年冠心病伴2型糖尿病患者临床相关危险因素及冠状动脉造影特点分析

目的探讨老年冠心病伴2型糖尿病患者临床相关危险因素及冠状动脉造影特点。方法471例经冠状动脉造影确诊的老年冠心病（年龄≥60岁）患者,将其分为冠心病伴2型糖尿病组（179例）,单纯冠心病组（292例）。对比分析两组患者临床相关危险因素及冠状动脉造影资料。结果多因素非条件的logistic回归分析显示,低密度脂蛋白胆固醇（LDL—C）、空腹血糖（FBG）、餐后2h血糖（2hPBG）是2型糖尿病并发冠心病的独立危险因素（P≤0．001）。与单纯冠心病组相比较,冠心病伴2型糖尿病组发生3支病变较多（P〈0．01）、冠状动脉重度狭窄、完全闭塞及弥漫病变比例更高（P〈0．01）,其Gensini积分亦显著高于单纯冠心病组（P=0．009）。结论LDL-C、FBG及2hPBG是老年2型糖尿病并发冠心病的独立危险因素,老年冠心病伴2型糖尿病患者冠状动脉累及范围广且程度重。     

急性心肌梗死并2型糖尿病患者冠状动脉病变特点的分析

目的 探讨急性心肌梗死（AMI）合并2型糖尿病（DM）患者的临床特征和冠状动脉病变特点.方法 226例AMI患者分为AMI并2型糖尿病组（AMI＋DM组）45例和AMI非糖尿病组（AMI组）181例,对比分析两组患者的临床和冠状动脉造影资料.结果 与AMI组比较,AMI＋DM组住院期间主要心血管不良事件增多,左室舒张末期内径增大,左室射血分数降低,血清胆固醇、甘油三酯、载脂蛋白B增高.AMI＋DM组较多发生三支血管病变,冠状动脉病变多严重.结论 冠心病合并2 型糖尿病患者临床表现较严重,常有左心功能异常、代谢异常,冠状动脉病变复杂且严重.     

Ⅱ型糖尿病并发冠心病的临床和冠状动脉病变特点分析

目的 :探讨 型糖尿病 （DM）并发冠心病患者临床及冠状动脉病变的特点。方法 :分析经冠状动脉造影诊断的伴有 DM（35 4例 ）和不伴有 DM（12 2 2例 ）的冠心病患者临床表现和造影结果。结果 :与非 DM的冠心病患者相比 ,DM并发冠心病存在有更多的心血管危险因素 :高血压、血清甘油三酯异常、女性吸烟 ,且无症状心肌缺血者比例高。在冠状动脉病变特点方面 ,DM并发冠脉血管三支、C型病变发生率高 （35 .9% vs 2 7.6 % ;6 0 .6 % vs 4 8.7% ,均 P<0 .0 1） ,小血管病变及弥漫性血管病变较多见 （2 6 .3% vs 18.0 % ;32 .0 % vs 2 5 .1% ,均 P<0 .0 1） ,而单支、A型病变少 （34.5 % vs 4 1.8% ;7.3% vs 19.0 % ,均 P<0 .0 1）。结论 :并发 DM与不并发 DM的冠心病患者临床及冠脉病变有显著差异 ,前者多支冠状动脉病变、C型病变发生率高 ,冠脉病变分布于小血管多且病变复杂。     

急性心肌梗死并发2型糖尿病临床及冠脉造影特点分析

目的 分析急性心肌梗死(AMI)并发2型糖尿病患者临床资料和冠状动脉病变特点.方法 对2005年1月-2008年1月中日友好医院285例急性心肌梗死并行冠状动脉造影(CAG)检查的患者进行回顾性研究,分析临床资料、冠状动脉病变的特点.结果 糖屎病患者占38.9%,AMI并发糖尿病组(DM组)患者、高血压、周围动脉硬化症和心肌梗死后行冠脉搭桥术的患者比例均明显高于非糖尿病组(NDM组,P<0.05);DM组三酰甘油(TG)明显高于NDM组,而高密度脂蛋白(HDL)明显低于NDM组(P<0.05).造影结果分析:DM组冠状动脉总病变数、左主干病变、三支病变、C型病变和弥漫性病变均高于NDM组(P<0.05);而单支病变、A和B1型病变低于NDM组(P<0.05).DM组右冠状动脉病变明显高于NDM组,而前降支病变、回旋支病变和心肌梗死部位的比较,两组无统计学意义(P>0.05).结论 急性心肌梗死并发2型糖尿病怠者多并发肥胖、高血压、高脂血症,冠状动脉病变受累范围广,病变严重、弥漫.     

早发和老年急性心肌梗死发病特点的比较

目的:探讨早发急性心肌梗死(AMI)冠状动脉病变特点及其相关危险因素。方法:临床确诊为AMI的患者136例,根据年龄分为早发AMI组(男性<55岁,女性<65岁)55例,老年AMI组(男性≥55岁,女性≥65岁)81例,并进行危险因素、临床、生化及冠状动脉病变特点回顾分析,观察两组是否存在显著差异。结果:与老年AMI组相比,早发AMI组中男性、吸烟、冠心病家族史的比例显著升高(P<0.05或0.01)。临床生化检验显示,与老年AMI组比较,早发AMI组的血清总胆固醇[(4.28±1.03)mmol/L比(4.87±1.41)mmol/L]、甘油三酯[(1.22±0.66)mmol/L比(1.74±1.07)mmol/L]和载脂蛋白B[(0.80±0.18)g/L比(1.04±0.34)g/L]水平显著升高(P<0.05或0.01)。冠脉造影显示早发AMI组单支病变比例(27.3%)显著高于老年AMI组(11.1%)。早发AMI组冠脉病变程度Gensini积分显著低于老年AMI组[(58.70±27.11)分比(75.19±41.37)分,P<0.05]。结论:与老年急性心肌梗死患者比较,早发急性心肌梗死患者最常见的特征是男性,有吸烟、冠心病家族史者更多,血脂水平显著升高;且单支冠脉病变比例较高,冠脉狭窄程度显著较轻。     

经皮腔内冠状动脉成形术对急性心肌梗死患者左心室功能的影响

目的 :评价延迟的经皮腔内冠状动脉成形术 （PTCA）对急性心肌梗死 （AMI）患者左心室功能恢复的影响。方法 :6 3例初次 Q波型 AMI患者 ,于发病 2～ 3周内分别进行 PTCA治疗。全部病例梗死相关血管均为完全或次全闭塞病变。经过左心室造影计算左室射血分数 （L VEF）。梗死区室壁运动百分率及 Cortina室壁运动不良积分。PT-CA术 6个月后所有患者重复进行左心室造影及重复以上指标的测量。结果 :在 PTCA术 6个月后 ,本组病例表现出左室局部及整体收缩功能明显改善 ,PTCA前后 L VEF（5 8± 11） % vs（5 1± 10 ） % ,P<0 .0 1;梗死区室壁运动百分率 （14± 6 ） % vs（12± 6 ） % ,P<0 .0 5。Cortina室壁运动不良积分下降 （8± 4 ）分 vs（10± 4 ）分 ,P<0 .0 1。结论 :Q波型 AMI患者接受延迟的 PTCA再血管化治疗能改善左心室功能     

分析三支冠状动脉病变患者心电图的特点

目的 :分析三支冠状动脉病变患者的心电图特点。方法 :对经冠状动脉造影证实有三支冠状动脉病变且有典型心绞痛的 10 2例患者 ,根据心电图结果 ST- T段改变将其分为 :ST- T段改变组 ,4 8例 ;无 ST- T改变组 ,5 4例。结果 :110 2例患者中 ,有 4 8例 （4 7% ）患者有不同导联的心电图 ST- T段缺血性改变 ,有 5 4例 （5 3% ）患者的心电图在心绞痛发作时无 ST- T改变。 2 ST- T段改变组中有 3例并发高血压 ,2例并发糖尿病 ;无 ST- T改变组有 9例并发高血压 ,6例并发糖尿病 ,6例同时并发高血压和糖尿病 ,两组间并发相关疾病的情况有显著性差异 （P<0 .0 5 ）。结论 :三支冠状动脉病变患者当心绞痛发作时 ,心电图无明显 ST- T改变者占一半以上 ,且该类患者更可能并发有高血压、糖尿病等疾病。     

冠心病并发Ⅱ型糖尿病患者临床及冠状动脉造影的特点

目的探讨冠心病并发Ⅱ型糖尿病患者临床及冠状动脉造影特点。方法选择经冠状动脉造影确诊为冠心病的患者共150例,分为冠心病并发糖尿病组54例,冠心病非糖尿病组96例。对比分析两组患者的临床和冠状动脉造影资料。结果冠心病并发糖尿病组3支冠状动脉病变的发生率高于非糖尿病组（54% vs 28%,P<0.01）;糖尿病组病变血管比例高于非糖尿病组（59% vs 46%,P<0.01）;糖尿病组弥漫性病变血管的比例高于非糖尿病组（41% vs 15%,P<0.01）。结论冠心病并发Ⅱ型糖尿病患者中并发高血压病和有心血管病家族史的比例高;多支血管病变和弥漫性病变构成比例、冠状动脉狭窄程度高于未并发Ⅱ型糖尿病患者。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

Weighing the QT Intervals with the Slope or the Amplitude of the T Wave

Objective: The reproducibility of QT interval measurements is low, even for the mean QT interval based on the standard ECG. In this study we analyzed whether the reproducibility of the mean weighed QT interval was better than the simple mean QT interval. The weighing was based on the amplitude of the T wave or the slope of the steepest tangent on the terminal part of the T wave. Material and methods: 12‐lead ECGs of 130 postmyocardial infarction patients were obtained. The QT intervals were measured by the tangent‐method on two occasions by the same observer Mismatch QT intervals were defined as QT intervals that were measured at only one occasion. Sixteen ECGs were rejected. The data were split into 34 and 80 ECGs for optimization and validation of the weighing, respectively. The weighed QT dispersion was calculated as the weighed mean of the three longest minus the weighed mean of the three shortest QT intervals. Results: Weighing with the slope increased the reproducibility by 41% (P = 3 10^‐6), but weighing with the amplitude reduced it by 20% (P = 0.02). However, if measurements with errors above 75 ms were rejected, weighing with the slope or the amplitude increased the reproducibility with 26% and 20% (P = 0.02), respectively. Weighing did not change the reproducibility of the weighed QT dispersion. Conclusion: Weighing with the slope improved the reproducibility of the mean weighed QT interval. However, if measurements with errors above 75 ms were rejected, weighing with the amplitude also increased the reproducibility. Weighing did not change the reproducibility of the weighed QT dispersion. Weighing is particularly efficient at reducing the negative impact of mismatch QT intervals on the reproducibility. A.N.E. 2002;7(1):4–9     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

大骨节病病区水,粮实验对动物的骨和软骨中化学元素组成的影响

用质子激发 X 线荧光分析方法(PIXE)测定了大骨节病病区和非病区的水、粮以及用该水粮喂养的大白鼠的肋软骨和硬骨中22种化学元素的含量。结果发现水粮中存在差异的元素反应在用该水粮喂养的大白鼠的骨、软骨中也存在差异,含量都低的元素有 P、Mn、Cu、As、Zn。都高的有铅。其中锌低在水、粮、硬骨和软骨中都完全一致呈非常显著性差异(p<0.01)。提示病区水、粮中化学元素对骨质的影响不是单一元素缺乏或过多所致,而是多种元素的复合因素。     

Assessment of the Soft-Tissue Seal at the Interface between the Base of the Fixed Denture Pontic and the Oral Mucosa

Fixed dentures (bridges) are often selected as a treatment option for a defective prosthesis. In this study, we assess the contact condition between the base of the pontic and oral mucosa, and examine the effect of prosthetic preparation and material biocompatibility. The molars were removed and replaced with experimental implants with a free-end type bridge superstructure after one week. In Experiment 1, we assessed different types of prosthetic pre-treatment: (1) the untreated control group (Con: mucosa recovering from the tooth extraction); (2) the laser irradiation group (Las: mucosa recovering after the damage caused by a CO₂ laser); and (3) the tooth extraction group (Ext: mucosa recovering immediately after the teeth extraction). In Experiment 2, five materials (titanium, zirconia, porcelain, gold-platinum alloy, and self-curing resin) were placed at the base of the bridge pontic. Four weeks after the placement of the bridge, the mucosa adjacent to the pontic base was histologically analyzed. In Experiment 1, the Con and Las groups exhibited no formation of an epithelial sealing structure on the pontic base. In the Ext group, adherent epithelium was observed. In Experiment 2, the sealing properties at the pontic interface were superior for titanium and the zirconia compared with those made of porcelain or gold-platinum alloy. In the resin group, a clear delay in epithelial healing was observed.     

高胆红素血症对肿瘤标志物测定的影响探讨

目的探讨高胆红素血症对Ca19-9、Ca24-2和CEA检测的影响.方法对320例胆管、胆囊良恶性疾病病人,15例胆囊炎病人的胆汁和血清以及10例肝硬化、10例黄疸肝炎病人进行Ca19-9、Ca24-2和CEA检测.结果在良性胆管、胆囊疾病中,Ca19-9的假阳性最高;在胆红素增高的良性疾病中,Ca19-9假阳性率达46.7%;15例胆汁和血清以及10例肝硬化和10例黄疸肝炎病人中,Ca19-9的假阳性率分别为93%、20%、80%和80%.结论高胆红素血症对Ca19-9检测影响最明显,胆囊、胆管良恶性疾病鉴别时,以Ca24-2和CEA检测为佳.     

Echocardiography in the Emergency Department: From the Perspective of the Emergency Physician and the Cardiologist

Echocardiography performed in the emergency department must adapt to this new setting for noninvasive diagnostic testing. Emergency physicians require echocardiography to provide rapid diagnosis in life-threatening emergencies. New initiatives are being proposed by emergency physicians in the delivery of this test. Cardiologists now use echocardiography in the emergency-department to make the diagnosis of heart disease earlier and with greater accuracy.