尿激酶静脉溶栓与低分子肝素治疗急性脑梗死

目的 探讨尿激酶静脉溶栓在急性脑梗死治疗中的疗效。方法 选择2002年-2004年住院治疗的急性脑梗死病人60例，随机分为溶栓组与对照组各30例，对照组采用常规治疗，溶栓组采用尿激酶溶栓治疗，两组分别于治疗前及治疗后1h、6h、24h、48h测定血浆D-二聚体含量，且分别于治疗前及治疗后1d、3d、7d、21d对两组病人的神经功能缺损情况进行评分。结果 溶栓后1h血浆中D-二聚体急骤升高至峰值，维持约6h，24h后基本恢复至溶栓前水平，48h后明显下降，基本恢复正常。溶栓组治疗后1d、3d、7d、21d的神经功能缺损评分明显低于对照组（P〈0．05）。结论 应用尿激酶在治疗时间窗内进行静脉溶栓治疗急性脑梗死是一种有效的治疗方法。     

D-二聚体在急性心肌梗死时冠状动脉血栓自溶再通的演变及意义

目的探讨D-二聚体在急性心肌梗死时冠状动脉血栓自溶再通的演变及意义。方法选择4所医院急性心肌梗死(AMI)患者80例,根据治疗方式及冠状动脉造影结果,将患者分为药物溶栓再通组(A组,29例),血栓自溶再通组(B组,30例)及非溶栓组(C组,21例)。各组在治疗前后1、2、4、8、24和48h检测D-二聚体、肌酸激酶同工酶(CK-MB)、肌钙蛋白I、凝血酶原时间等。A组采用重组组织型纤溶酶原激活剂进行静脉溶栓治疗,B组、C组静脉滴注等量生理盐水。结果 3组患者发生AMI后CK-MB和肌钙蛋白I水平均显著增高,与C组比较,A组D-二聚体浓度1、2、4、8h显著升高[(4.31±0.94)mg/L vs(0.89±0.12)mg/L,(5.21±1.06)mg/L vs(1.55±0.43)mg/L,(7.56±1.53)mg/L vs(0.93±0.12)mg/L,(4.33±0.99)mg/L vs(0.61±0.17)mg/L],B组D-二聚体浓度1、2h显著升高[(3.69±0.86)mg/L vs(0.89±0.12)mg/L,(2.39±0.66)mg/L vs(1.55±0.43)mg/L];与B组比较,A组D-二聚体浓度2、4、8、24h显著升高(P<0.05,P<0.01)。C组在相同时间点无显著变化。结论治疗AMI时,D-二聚体浓度变化在药物溶栓再通与血栓自溶再通有显著不同,可作为判断溶栓疗效的指标。     

D-二聚体水平对急性脑梗死患者溶栓疗效的预测意义

目的:探讨D-二聚体水平对急性脑梗死(ACI)患者静脉溶栓疗效的预测作用。方法:选取100例患ACI并接受阿替普酶静脉溶栓治疗的患者,采用Sysmex Cs-5100全自动检测仪分别检测其溶栓前、后24 h内D-二聚体水平,同时记录患者美国国立卫生院卒中量表评分(NIHSS),并进行相关性分析。结果:病情好转患者70例,为好转组,恶化患者30例,为恶化组。2组到达医院至开始静脉溶栓时间(DNT)、性别和入院时NIHSS评分比较,差异有统计学意义(均P 0. 05)。所有患者溶栓前、后24 h凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)和D-二聚体水平比较,差异均有统计学意义(均P 0. 05);且恶化组D-二聚体水平均显著高于好转组(均P 0. 05)。Logistic回归分析示,溶栓后24 h D-二聚体水平显著升高是患者溶栓后病情恶化的危险因素。溶栓后NIHSS评分与溶栓前、后24 h血浆D-二聚体水平分别存在明显正相关性(r分别为0. 316、0. 451,均P 0. 01)。结论:ACI患者溶栓后24 h内D-二聚体水平显著升高预示病情恶化。     

尿激酶治疗冠心病血浆D-二聚体的变化研究

应用ELISA双抗体夹心法，检测了31例冠心病患者血浆D-二聚体的含量。冠心病中急性心肌梗死（AMI）9例，不稳定型心绞痛（UAP）22例。结果：AMI及UAP患者血浆D-二聚体含量均高于对照组（P＜0．01），且AMI组高于UAP组（P＜0．05）。应用尿激酶治疗后，AMI组中血浆D-二聚体含量又再度升高（P＜0．01），以溶栓后6h升高最为显著。而UAP组1周内均无明显改变（P＞0．05）。提示：①AMI及UAP的交联纤维蛋白D-二聚体增多有血栓的形成和溶解；②AMI患者应用尿激酶溶栓治疗后，血浆D-二聚体再度升高，可为溶栓成功的指标之一，而小剂量尿激酶治疗UAP后，D-二聚体无明显变化。     

急性心肌梗塞溶栓治疗期间血浆D-二聚体的动态变化及其临床意义

目的 :探讨血浆 D-二聚体对评价溶栓治疗急性心肌梗塞 (AMI)的价值及意义。　　方法 :2 9例 AMI患者分为溶栓组 (n=2 1) ,未溶栓组 (n=8) ;溶栓组根据溶栓治疗后冠状动脉 (冠脉 )是否开通又分为溶栓再通组 (n=12 ) ,溶栓未通组 (n=9) ;采用酶联免疫吸附试验 (EL ISA)法检测血浆 D-二聚体的水平 ,并与正常对照组 (n=2 0 )进行比较。　　结果 :AMI未溶栓组血浆 D-二聚体较正常对照组显著升高 (P<0 .0 5 ) ;溶栓组血浆 D-二聚体较未溶栓组显著升高(P<0 .0 5 ) ,溶栓后血浆 D-二聚体较溶栓前显著升高 (P<0 .0 1) ,于溶栓后 6小时达高峰 ;溶栓再通组血浆 D-二聚体较溶栓未通组显著升高 ,溶栓前及溶栓后 6小时两组比较有极显著统计学意义 (P<0 .0 1)。　　结论 :AMI早期已有纤溶系统亢进 ,应用溶栓药后进一步激活纤溶系统而发挥作用 ,且以溶栓再通组更显著。     

急性脑梗死患者血浆D-二聚体水平变化及其与病情和预后的关系研究

目的探讨急性脑梗死患者血浆D-二聚体水平变化及其与病情和预后的关系。方法选取常熟市第二人民医院神经内科2012年收治的259例急性脑梗死患者作为梗死组,选取同期200例体检健康者作为对照组,梗死组患者于入院24 h内、对照组受检者于体检当日清晨空腹采集静脉血检测血浆D-二聚体水平。按入院当天美国国立卫生研究院卒中量表(NIHSS)评分将梗死组患者分为轻型(0~15分)组129例、中型(16~25分)组92例、重型(26~33分)组38例。按预后(即住院4周时NIHSS评分)将梗死组患者分为好转组182例和无好转组77例。比较对照组与梗死组、梗死组各亚组间血浆D-二聚体水平及D-二聚体异常率。结果梗死组血浆D-二聚体水平为(0.46±0.52)mg/L、D-二聚体异常率43.2%,均高于对照组的(0.13±0.29)mg/L、1.0%(P0.05)。轻型组患者血浆D-二聚体水平为(0.27±0.13)mg/L、D-二聚体异常率30.5%,分别低于中型组的(0.42±0.28)mg/L、47.8%,中型组又低于重型组的(0.65±0.32)mg/L、76.3%(P0.05)。好转组患者血浆D-二聚体水平为(0.31±0.26)mg/L、D-二聚体异常率32.9%,低于无好转组的(0.57±0.29)mg/L、67.5%(P0.05)。结论急性脑梗死患者血浆D-二聚体水平明显升高,且血浆D-二聚体水平越高患者病情越严重、预后越差。     

脑梗死患者溶栓前后血浆纤维蛋白原水平与早期再梗死的关系

目的探讨急性缺血性卒中患者在尿激酶溶栓前后，血浆纤维蛋白原（Fg）水平与早期再梗死的关系。方法接受动静脉尿激酶溶栓治疗的脑梗死患者216例，剔除无效和出血病例后共204例。按疗效标准分为溶栓后早期再梗死组（15例）和溶栓成功组（189例），用Clauss法经全自动血凝分析仪对两组患者溶栓前后血浆Fg含量的动态变化进行了监测，并分析其与溶栓后早期再梗死的关系。结果①溶栓前再梗死组低密度脂蛋白、全血低切黏度，均高于成功组，差异有统计学意义（P〈0．05，P〈0．01）。②再梗死组患者溶栓前血浆Fg为（6．1±0．7）g／L，成功组为（4．1±0．3）g／L；溶栓后24h，再梗死组Fg为（5．2±0．4）g／L，成功组为（3．8±0．5）g／L，两组比较差异均有统计学意义（P〈0．05）。③15例再梗死患者中，10例再梗死发生于溶栓后12～24h。④溶栓后，再梗死组的血浆Fg水平下降幅度较小，并于溶栓后12h开始回升，24h达到最高峰，发生再梗死时的平均如水平超过正常值上限（4．0g／L）；成功组血浆Fg水平下降幅度明显，大约12h左右达最低，此后一直保持在正常范围。结论血浆如水平增高是尿激酶溶栓后早期再梗死的危险因素之一。     

急性脑梗死患者血浆抗凝血酶和血管性血友病因子及D-二聚体水平变化及其临床意义

目的观察急性脑梗死患者血浆抗凝血酶(AT)、血管性血友病因子(vWF)、D-二聚体水平变化,并探讨其临床意义。方法选取我院2012年8月—2014年1月收治的经CT检查确诊的急性脑梗死患者70例为观察组,同期在我院体检健康者70例为对照组,检测其血浆AT、vWF、D-二聚体水平。结果对照组受检者血浆AT、vWF、D-二聚体水平分别为(102.03±9.74)%、(115.39±9.26)%、(0.29±0.07)mg/L,观察组患者分别为(79.53±10.35)%、(169.88±19.01)%、(1.20±0.98)mg/L,观察组患者血浆AT水平低于对照组,血浆vWF、D-二聚体水平高于对照组(P0.05)。结论急性脑梗死患者血浆AT水平降低,血浆vWF、D-二聚体水平升高,与患者凝血功能改变密切相关,检测其血浆水平有助于指导治疗和判断预后。     

血浆D-二聚体水平与急性脑梗死患者的预后相关性分析

目的分析血浆D-二聚体水平与急性脑梗死患者的预后之间的相关性。方法将我院收治的41例急性脑梗死患者纳入本次研究,于发病后1d测量41例患者的脑梗死面积,根据患者脑组织梗死面积将患者分为大面积梗死组和非大面积梗死组,对比两组患者血浆D-二聚体水平。于41例患者发病后1d、1周、2周进行血浆D-二聚体检测,根据发病后2周的检测结果将41例患者分为高水平组(血浆D-二聚体水平明显升高)和对照组(血浆D-二聚体水平正常或轻微升高),应用改良Rankin量表(mRS)评价两组患者的预后。结果大面积梗死组的血浆D-二聚体水平高于非大面积梗死组(P0.05)。41例患者发病后1周的血浆D-二聚体水平高于发病后1d和发病后2周(P0.05)。高水平组患者的m RS评分高于对照组(P0.05)。结论急性脑梗死患者发病后血浆D-二聚体水平明显升高,可作为评估患者预后的辅助指标。     

血浆D-二聚体在心源性脑梗死患者中的表达

目的分析心源性脑梗死患者血浆D-二聚体水平的表达情况。方法回顾性连续纳入2013年1月至2016年7月马鞍山中心医院收治的心房颤动致脑梗死患者136例,均在入院次日清晨检测静脉血浆D-二聚体水平。依据出院时情况,分为死亡组(21例)和生存组(115例)。记录两组患者性别、年龄、合并疾病、美国国立卫生研究院卒中量表(NIHSS)评分、抗凝治疗情况、脑梗死体积、并发症、血脂、同型半胱氨酸、血浆D-二聚体水平并进行比较。采用受试者工作特征(ROC)曲线判断住院死亡患者的血浆D-二聚体的临床截点。结果死亡组与生存组比较,中枢性高热[28.6%(6例)比8.7%(10例)]、NIHSS评分[(19±3)比(12±3)]、入院昏迷[66.7%(14例)比15.7%(18例)]、C反应蛋白[13.5(9.1,50.6)比2.3(0.0,15.1)mg/L],差异均有统计学意义(均P0.05)。死亡组的血浆D-二聚体水平显著高于生存组[2.9(0.9,4.0)比0.6(0.4,0.9)mg/L,P0.01],血浆D-二聚体判断住院死亡的ROC曲线下面积为0.816(95%CI:0.686~0.946,P0.01)。结论急性心房颤动致脑梗死死亡患者入院时血浆D-二聚体水平显著高于生存者。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.