PCI术中联合使用腺苷与盐酸替罗非班对老年急性ST段高型心肌梗死心肌微循环及心功能的影响

目的探讨经皮冠状动脉介入术(PCI)治疗围术期中冠状动脉内联合注射腺苷与盐酸替罗非班对老年急性ST段抬高型心肌梗死(STEMI)心肌微循环及心功能的影响。方法选择2011²013年老年急性前壁STEMI 160例患者行急诊PCI术,随机分为替罗非班组、腺苷组、联合药物组及对照组,每组40例。球囊预扩张梗死相关动脉(IRA)后,通过指引导管冠脉内给予腺苷和替罗非班。分别比较四组患者PCI术后冠脉血流TIMI分级、矫正TIMI计帧(CTFC)、心肌染色分级(MBG)、磷酸肌酸同工酶(CK-MB)及其酶峰曲线下面积,并对随访比较术后半年心脏超声各项指标。结果联合药物组矫正TIMI计帧(CTFC)、心肌微循环灌注MBG分别较腺苷组、替罗非班组、对照组明显改善(P<0.05),联合药物组冠脉血流TIMI分级与腺苷组、替罗非班组相比无明显差异(P>0.05),矫正TIMI计帧(CTFC)、心肌染色分级(MBG)明显改善(P<0.05);联合药物组心肌酶CK-MB酶峰以及CK-MB释放的酶峰下面积较腺苷组、替罗非班组明显降低(P<0.05);术后半年联合药物组较腺苷组、替罗非班组,心脏超声左心室射血分数(LVEF)、心脏指数(CI)、每搏指数(SVI)增加,左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)减少(P<0.05)。结论对于老年STEAMI患者PCI围术期联合使用腺苷和盐酸替罗非班可以发挥药物的协同保护作用,进一步提高心肌微循环灌注水平,减少再灌注损伤,改善心功能。     

替罗非班联合替格瑞洛对STEMI患者行急诊PCI术后TIMI分级、心肌灌注、主要心脏不良事件发生的影响

目的探讨替罗非班联合替格瑞洛对ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入术(PCI)患者术后TIMI分级、心肌灌注、主要心脏不良事件发生的影响。方法选取本院100例行PCI治疗的STEMI患者,随机分为对照组给予替格瑞洛治疗,观察组给予替罗非班联合替格瑞洛治疗,两组各50例。比较两组术后TIMI血流分级、心肌灌注、主要心脏不良事件发生的情况。结果观察组TIMI血流分级3级比例与术后ST段回落高于75%比例均明显高于对照组(均P0.05),且无复流发生率低于对照组(P0.05);观察组术后主要心脏不良事件发生率明显低于对照组(P0.05),且左心室射血分数明显高于对照组(P0.05),左心室舒张末期内径低于对照组(P0.05)。结论替罗非班联合替格瑞洛可有效改善行PCI治疗的STEMI患者心肌灌注,有助于保护患者心脏功能,降低无复流发生率,能够明显减轻主要心脏不良事件的发生率。     

冠脉内注射法舒地尔预防急性心肌梗死原发经皮介入治疗中慢血流及无复流的效果

目的观察冠脉内注射法舒地尔预防急性ST段抬高型心肌梗死(STEMI)患者经皮冠脉内介入治疗(PCI)术中慢血流/无复流的有效性、安全性。方法首发STEMI且具备无复流高危因素患者82例,其中PCI术中予以冠脉内注射法舒地尔联合替罗非班29例(法舒地尔组),单独应用替罗非班27例(替罗非班组),术中不应用上述药物26例(非给药组)。分析各组术后即刻造影TIMI血流、矫正TIMI帧数计数(CTFC)及心肌呈色分级(MBG),测定术后肌酸磷酸激酶同工酶(CKMB)峰值浓度,1 w时检测N端脑钠肽前体(NTpro BNP)并行超声心动图检测室壁运动分数指数(WMSI)。结果法舒地尔组TIMI血流、CTFC及MBG与非给药组比较差异显著,CKMB峰值、NTpro BNP、WMSI与非给药组比较均下降(P0.01);术中收缩压与替罗非班组比较无统计学差异;法舒地尔与替罗非班组比较仅MBG改善有统计学意义;替罗非班组与非给药组上述指标比较差异亦有统计学意义。结论 STEMI术中冠脉内联合给予法舒地尔及替罗非班可有效预防或减少术中慢血流/无复流的发生,无诱发或恶化低血压现象。     

急性心肌梗死急诊介入术中冠脉内应用替罗非班的近期疗效评价

目的探讨急性ST段抬高心肌梗死（STEMI）患者接受经皮冠状动脉介入术（PCI）治疗中,冠状动脉（冠脉）内应用血小板糖蛋白Ⅱb/IIIa（GPⅡb/Ⅲa）受体阻断药替罗非班对冠脉灌注、心肌灌注及临床预后的影响。方法连续入选87例发生急性STEMI并行急诊PCI的患者,入选患者随机分为冠脉内应用替罗非班组（冠脉组,n=45）与静脉内应用替罗非班组（静脉组,n=42）。冠脉组在支架释放后即刻在冠脉内3min注入替罗非班12μg/kg作为负荷量,随后以0.15μg/（kg·min）静脉维持24～48h;静脉组在支架释放后3min内静脉注入替罗非班12μg/kg作为负荷量,随后以0.15μg/（kg·min）静脉维持24～48h;术后随访3个月。比较两组患者PCI术后即刻梗死相关血管的TIMI血流分级（TFG）、校正的TIMI血流帧数计数（CTFC）、TIMI心肌灌注分级（TMPG）及心肌灌注显影分级（MBG）;并比较两组PCI术后1周心脏超声指标、住院期间以及随访期间主要心脏不良事件发生率。结果 PCI术后即刻两组TFG、CTFC、TMPG、MBG均无显著差异（P均〉0.05）,给予替罗非班冠脉内或静脉内给药后,两组TFG、CTFC、MBG、TMPG指标均较未给药前显著改善,冠脉给药组TFG、CTFC优于静脉给药组,差异有统计学意义（P〈0.05～0.01）。两组PCI术后1周心超结果（LVEF、LVEDD、LVESD）未见显著差异（P〉0.05）;两组院内MACE事件发生率未达到统计学差异（P〉0.05）,1月和3月随访期MACE发生率两组亦未见显著差异（P〉0.05）。结论 STEMI行急诊PCI治疗的患者,冠状动脉内应用替罗非班可显著地改善梗死相关血管的微循环血流,患者耐受性好,安全性高。     

老年急性ST段抬高型心肌梗死急诊PCI术后不同途径应用替罗非班的疗效

目的探讨不同途径应用替罗非班对老年性急性ST段抬高型心肌梗死(STEMI)急诊冠状动脉介入治疗(PCI)术后的近远期疗效。方法采用随机数字表法将该院心内科2012年3月至2013年12月收治的99例老年STEMI患者分为冠脉组(冠脉内应用替罗非班+PCI)(n=50)和静脉组(静脉内应用替罗非班+PCI)(n=49)。两组在急诊确诊后均给予替罗非班静脉应用。行急诊PCI时,治疗组在前向血流恢复后给予冠脉内注射负荷量替罗非班并行PCI术,静脉组直接行PCI术。比较患者手术后梗死相关血管(IRA)的即刻心肌梗死溶栓治疗试验分级(TIMI)、TIMI心肌灌注分级(TMPG)、校正的TIMI计帧数(CTFC)、术后2 h ST段回落百分比、左心射血分数(LVEF)、主要心脏不良事件发生率(MACE)的差异。结果两组PCI术前TIMI血流分级分布情况差异不显著(P>0.05),PCI术后,冠脉组TIMI血流分级3级高于静脉组,TIMI血流分级分布显著优于静脉组(P<0.05)。两组PCI前后的TMPG级分布差异均不显著(P>0.05),冠脉组术后2 h ST段完全回落率(CR)高于静脉组,ST段回落分布显著优于静脉组(P<0.05);PCI术前两组的CTFC值比较差异不显著(P>0.05),PCI术后冠脉组比静脉组下降显著(P<0.05)。PCI术后住院期间,两组患者的不良事件发生率、术后血小板(PLT)减少情况比较差异均不显著(P>0.05),PCI术后冠脉组的LVEF值显著优于静脉组(P<0.05)。结论老年性STEMI患者急诊PCI冠脉应用替罗非班对于改善心肌微循环、心功能有较为显著的作用。     

替格瑞洛对行急诊冠脉介入治疗的急性ST段抬高型心肌梗死患者心肌灌注的影响

目的评价替格瑞洛对行经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者术后心肌灌注的影响。方法连续入选2015年12月～2016年12月以STEMI就诊于河北省人民医院并行急诊PCI治疗的患者123例,术前应用随机数字量表分为替格瑞洛组61例和氯吡格雷组62例。明确诊断后即刻口服负荷量抗血小板药物,替格瑞洛组患者口服阿司匹林+替格瑞洛,继以替格瑞洛维持。氯吡格雷组患者术前口服阿司匹林+氯吡格雷,继以氯吡格雷维持。比较术中心肌梗死溶栓试验血流(TIMI)分级,校正TIMI血流帧数计数(CTFC),TIMI心肌灌注分级(TMPG),并观察住院期间患者用药不良反应及安全性。结果两组患者一般基线资料比较均无统计学意义(P0.05);PCI术后替格瑞洛组患者总体CTFC数值、具体血管(LAD、LCX、RCA)比较均小于氯吡格雷组;替格瑞洛组中TIMI3级所占比例、术后心肌灌注TMPG 3级比例高于氯吡格雷组,所有差异均有统计学差异(P0.05)。两组的主要心脏不良事件及出血情况比较,差异无统计学意义(P0.05)。结论对于行急诊PCI术的ST段抬高型心肌梗死患者,替格瑞洛可改善其术后心肌层面的血流灌注,且用药安全。     

冠脉内应用半量替罗非班在老年急性心肌梗死急诊PCI中的疗效及安全性

目的 探讨冠脉内应用半量血小板糖蛋白Ⅱb/ Ⅲa受体拮抗剂盐酸替罗非班在老年急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中的效果及安全性。方法 2012.1—2015.1入院的125例行急诊PCI的老年(>70岁)STEMI患者,随机分为替罗非班组62例和对照组63例,替罗非班组冠脉内注射小剂量盐酸替罗非班(5μg/kg),继而以0.075μg/(kg.min)由微量泵持续静脉泵入24小时,对照组不予应用。对比分析两组PCI术后IRA TIMI血流分级,校正的TIMI计帧数(CTFC)及心肌灌注分级(TMP),PCI术后30d主要不良心脏事件(MACE)及出血并发症。结果 PCI术后IRA TIMI 3级比例替罗非班组高于对照组(91.94% vs 79.37 %, P<0.05),CTFC亦显示替罗非班组低于对照组(22.79±5.75vs 31.36±4.72, P<0.05);心肌灌注分级TMP2级以上的比例替罗非班组高于对照组(74.19% vs 55.56%, P<0.05);出血并发症两组无显著性差异,MACE发生率替罗非班组低于对照组(6.45% vs 19.05%, P<0.05)。结论：老年STEMI患者急诊PCI术前冠脉内应用半量盐酸替罗非班可以迅速抑制血小板聚集,增加IRA TIMI血流分级,改善心肌灌注,减少无复流发生,而且不增加出血并发症,减少了MACE事件发生。     

替格瑞洛联合替罗非班对PCI术后STEMI患者临床疗效及短期预后的影响

目的:观察替格瑞洛联合替罗非班对经皮冠脉介入治疗(PCI)后ST段抬高型心肌梗死(STEMI)患者的临床疗效及短期预后的影响。方法:选择急诊行PCI的STEMI患者280例为研究对象。根据随机数字表法,患者被随机均分为氯吡格雷组(接受氯吡格雷+替罗非班治疗)和替格瑞洛组(接受替格瑞洛+替罗非班治疗)。测量比较两组PCI术前后梗死相关动脉TIMI血流分级情况、血小板聚集率、P2Y12反应单位,以及随访30d后主要不良心血管事件(MACE)、出血事件和心功能情况。结果:与氯吡格雷组比较,替格瑞洛组PCI术后TIMI血流3级比例(81.4%比91.4%)显著升高,血小板聚集率[(55.2±4.1)%比(50.8±4.4)%]和P2Y12反应单位[(196.2±15.1)U比(180.8±12.0)U]均显著降低,P均0.05。随访30d后,与氯吡格雷组比较,替格瑞洛组再次心肌梗死(5.0%比2.9%)、心源性死亡发生率(2.9%比0.7%)、左室舒张末期内径[(53.1±2.8)mm比(49.0±2.0)mm]和左室收缩末期内径[(40.2±2.1)mm比(37.4±1.8)mm]均显著降低,左室射血分数[(51.8±2.7)%比(55.4±2.5)%]显著升高(P均0.05)。两组均无严重出血事件发生,且氯吡格雷组和替格瑞洛组的轻微出血发生率(5.0%比6.4%)无显著差异,P=0.591。结论:对于急诊行PCI治疗的STEMI患者,替格瑞洛联合替洛非班能有效降低血小板聚集率,改善梗死相关动脉TIMI血流,提高临床疗效,改善其短期预后,而不增加出血风险,值得临床运用推广。     

美托洛尔缓释片联合替罗非班对老年急性心肌梗死患者PCI术后冠脉血流恢复和心功能的影响

目的 探讨琥珀酸美托洛尔缓释片联合替罗非班对老年急性心肌梗死患者经皮冠状动脉介入(PCI)术后血流恢复及并发症的影响。方法 选取行PCI的急性心肌梗死患者80例，随机数字表法分为两组各40例。常规组在PCI术后服用常规治疗药物治疗(阿司匹林+替格瑞洛+阿托伐他汀/瑞舒伐他汀),联合组加用琥珀酸美托洛尔缓释片联合替罗非班治疗。比较两组TIMI血流分级、血流计帧数(CTFC)、90 min内ST段回落百分率、左室短轴缩短率(FS)、左室射血分数(LVEF)及术后并发症。结果 治疗后，联合组术后TIMI血流分级显著优于常规组(P<0.05);联合组术后90 min内ST段回落率明显高于常规组(P<0.05);联合组CTFC明显低于常规组(P<0.05);治疗后，常规组FS水平显著低于联合组，联合组LVEF显著高于常规组(均P<0.05);两组并发症发生率无显著差异(P>0.05)。结论 替罗非班联合美托洛尔缓释片可有效改善PCI术后冠状动脉血流灌注状况和心功能，同时减少心血管不良事件和并发症的发生，安全性高。     

替格瑞洛联合替罗非班治疗急性ST段抬高型心肌梗死有效性及安全性观察

观察替格瑞洛联合替罗非班对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)的有效性及安全性。方法选择诊断为STEMI、接受直接PCI治疗患者81例,随机分为替格瑞洛联合血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)受体拮抗剂替罗非班组(治疗组,41例)和氯吡格雷联合替罗非班组(对照组,40例)。评估两组PCI前后梗死相关血管TIMI血流分级、术后90天主要心血管事件(MACE)及术后出血等情况。结果两组血管开通率均为100%,与对照组比较,治疗组无复流减少(7.3%vs 20%,P0.05),90 d MACE有下降趋势但无统计学差异(7.3%vs 12.5%,P0.05)。而围术期出血发生率无明显差异。结论替格瑞洛联合替罗非班可有效改善STEMI患者梗死相关血管的血流,同时安全性良好。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

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.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.