曲美他嗪对陈旧性心肌梗死患者心功能影响的临床观察

目的　观察曲美他嗪对陈旧性心肌梗死患者心功能的影响。方法　将 4 0例陈旧性心肌梗死患者在常规疗法基础上随机分为治疗组 (口服曲美他嗪 ,n=2 1 )和对照组 (未口服曲美他嗪 ,n=1 9) ,以单盲法观察曲美他嗪对陈旧性心肌梗死患者心功能的影响 ,并与对照组进行比较。结果　治疗组射血分数 (EF)和左室周径缩短率 (Fs)、每搏量 (SV)、每分钟心排血量 (CO)均显著高于对照组 (P<0 .0 5～ 0 .0 1 )。结论　曲美他嗪能改善陈旧性心肌梗死患者心功能 ,可作为治疗该病的辅助药物     

FDA批准抗血栓药Vorapaxar Sulfate上市

美国FDA于2014年5月8Et批准默沙东（Merck Sharp Dohme）公司的Vorapaxar Sulfate（参考译名：硫酸沃拉帕沙，商品名：Zomivity）片剂上市．用于有心肌梗死或外周动脉疾病史者减少血栓性心血管事件。     

拜阿司匹林联合他汀类药物预防急性心肌梗死再发的临床观察

目的 探讨急性心肌梗死后的二级预防措施.方法 选择急性心肌梗死患者168例,随机分为治疗组86例和对照组82例.2组患者基础治疗相同,治疗组给予拜阿司匹林100～ 200 mg,1次/晚,阿托伐他汀10 - 20 mg,1次/晚,口服;对照组给予拜阿司匹林100～200 mg,1次/晚,口服.所有患者均完成1年随诊.观察2组患者入院时与治疗后1年的血脂水平及再发心肌梗死例数.结果 治疗组1年内再发心梗4例(4.7％),对照组9例(11.0％);2组患者心肌梗死再发率比较,差异有统计学意义(P＜0.01).治疗组治疗后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)与入院时和对照组治疗后比较,差异有统计学意义(P＜0.05);对照组治疗后TC、TG、HDL-C、LDL-C与入院时比较无明显变化(P＞0.05).结论 长期给予拜阿司匹林联合阿托伐他汀预防心肌梗死后再发效果良好.     

2型糖尿病合并急性心肌梗死患者的护理

<正>2型糖尿病患者有较高的心血管并发症,其中以急性心肌梗死最为凶险。2009-01～2011-12笔者所在科共收治糖尿病合并急性心肌梗死患者56例。现将护理措施总结如下。1临床资料本组2型糖尿病合并急性心肌梗死患者56例。男35例,平均年龄(55±10)岁;女21例,平均年龄(60±9)岁。所有患者给予急性心肌梗死常规治疗和胰岛素、口服降糖药物处理,行经皮冠状动脉造影术检查。术前餐后2 h血糖均控制     

阿托伐他汀对急性心肌梗死患者血清成分与水平的影响

目的探讨阿托伐他汀对急性心肌梗死(AMI)患者炎症因子和内皮功能的影响。方法选择我院急性心肌梗死患者120例,随机均分为治疗组与对照组,2组均给予常规溶栓、抗凝、扩冠、β2受体阻滞剂和血管紧张素转换酶抑制剂等药物治疗,治疗组另口服阿托伐他汀。治疗前、后对血清可溶性细胞间黏附分子(sICAM-1)、内皮素(ET)和肿瘤坏死因子-α(TNF-α)水平进行测定,并进行统计学比较。结果治疗前sICAM-1、ET和TNF-α水平2组差异无统计学意义。治疗后2组血清sICAM-1、ET和TNF-α水平均较治疗前有所下降(P<0.05),阿托伐他汀组sICAM-1、ET和TNF-α水平明显低于对照组水平(P<0.05)。结论阿托伐他汀对急性心肌梗死患者炎症因子和内皮功能有一定的影响。     

通脉胶囊联合瑞舒伐他汀治疗急性心肌梗死患者疗效观察

目的:探讨通脉胶囊联合瑞舒伐他汀治疗急性心肌梗死患者疗效.方法:90例急性心肌梗死患者随机分为治疗组与对照组,每组45例.两组患者均采取常规抗凝、抗血管痉挛及抗血小板聚集等治疗.对照组口服瑞舒伐他汀,起始给药剂量10 mg/d,最大给药剂量为40 mg/d,连续口服2周;治疗组在口服瑞舒伐他汀基础上服用通脉胶囊,4粒/次,3次/d,连续口服2周.比较两组患者治疗疗效,治疗前后心功能指标及C反应蛋白(CRP)、脑钠肽(BNP)、白细胞计数(WBC)、心肌肌钙蛋白I变化.结果:治疗组总有效率高于对照组,且有显著性意义(P<0.05);两组患者治疗后LVEF和SV较治疗前增加,且均有显著性意义(P<0.05);治疗组患者治疗后LVEF和SV高于对照组,且均有显著性意义(P<0.05);两组治疗后CRP、BNP、WBC和心肌肌钙蛋白I较治疗前降低,且均有显著性意义(P<0.05);治疗组治疗后CRP、BNP、WBC和心肌肌钙蛋白I低于对照组,且均有显著性意义(P<0.05).结论:通脉胶囊联合瑞舒伐他汀治疗急性心肌梗死患者疗效明显,具有重要研究意义.     

银杏叶片联合阿替洛尔治疗急性心肌梗死的临床研究

目的研究银杏叶片联合阿替洛尔片治疗急性心肌梗死的临床疗效。方法选取2018年1月—2019年6月在天津市第三中心医院分院治疗的120例急性心肌梗死患者,将所有患者随机分为对照组和治疗组,每组各60例。对照组口服阿替洛尔片,6.25～12.5 mg/次,2次/d。治疗组在对照组基础上口服银杏叶片,2片/次,3次/d。两组患者持续治疗14 d。观察两组患者临床疗效,对比两组的心功能指标和血清生化指标水平。结果治疗后,对照组和治疗组的总有效率分别为81.67%、95.00%,差异有统计学意义(P0.05)。治疗后,两组患者左心室舒张末期内径(LVEDD)显著降低,左心室射血分数(LVEF)和左心室高峰充盈率(LVPFR)显著升高(P0.05),且治疗组心功能指标改善较明显(P0.05)。治疗后,两组血清白细胞介素-6(IL-6)、N-末端脑钠肽前体(NT-pro BNP)、肌酸激酶(CK)和内皮素-1(ET-1)水平均显著降低(P0.05);并且治疗组血清生化指标水平降低较明显(P0.05)。结论银杏叶片联合阿替洛尔片治疗急性心肌梗死具有较好的治疗效果,能够改善心肌功能,降低血清生化指标水平。     

瑞舒伐他汀片治疗急性心肌梗死的临床研究

目的观察瑞舒伐他汀片治疗急性心肌梗死的临床疗效和安全性。方法将126例急性心肌梗死病患者随机分为对照组63例和试验组63例。对照组予以口服瑞舒伐他汀10 mg,qn;试验组予以口服瑞舒伐他汀20 mg,qn,2组均治疗1个月。比较2组患者的临床疗效、血清心肌肌钙蛋白T(c Tn T)、同型半胱氨酸(Hcy)、胱抑素C(Cys C)、可溶性CD40L(s CD40L)水平,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为95.24%(60例/63例)和84.13%(53例/63例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组的c Tn T分别为(2.14±0.38),(4.83±0.75)μg·L^-1,Hcy分别为(13.21±2.07),(16.32±2.64)μmol·L^-1,Cys-C分别为(0.58±0.08),(1.11±0.17)mg·L^-1,s CD40L分别为(3.06±0.57),(4.26±0.71)μg·L^-1,差异均有统计学意义(均P<0.05)。试验组的药物不良反应为再发心肌梗死,对照组的药物不良反应为再发心肌梗死和再次血运重建,试验组和对照组的总药物不良反应发生率分别为3.17%和6.35%,差异无统计学意义(P>0.05)。结论瑞舒伐他汀片治疗急性心肌梗死可改善患者心功能,同时可降低血清c Tn T、Hcy、Cys-C和s CD40L水平,且高剂量瑞舒伐他汀的临床疗效更好,安全性较高。     

卡托普利治疗老年急性心肌梗死并心力衰竭28例

目的 探讨卡托普利治疗老年性急性心肌梗死并心力衰竭患者的临床疗效。方法 按照随机双盲对照法,将收治的55例老年急性心肌梗死并心力衰竭患者分观察组(28例)和对照组(27例)。对照组给予针对心肌梗死并心力衰竭的一般药物治疗(脱水利尿、洋地黄、β受体阻滞剂及血管扩张剂),观察组患者在对照组基础上同时给予卡托普利口服,观察两组临床总有效率和心功能好转情况。结果 观察组临床治疗总有效率和对照组患者相比显著占优势,且两组患者的比较差异具有统计学意义(P<0.05);两组患者的心功能较治疗前均有所好转,且观察组好转情况优于对照组(P<0.05)。结论 对于老年急性心肌梗死并心力衰竭患者的治疗,在给予脱水利尿、强心、扩血管等常规药物治疗基础上,加用卡托普利治疗,不仅可增加了患者病情好转率,还能增加患者的心功能,值得临床推广。     

您该选用哪种降糖药

选药原则简而言之有以下几条: 一、按糖尿病类型选药 1型糖尿病患者必须终生使用胰岛素;2型糖尿病患进在饮食、运动及口服抗糖尿病药物效果不好、出现急性合并症(酮症酸中毒等)或严重慢性合并症(视网膜病变、尿毒症等)、严重应激状态(急性心肌梗死等)、大中型手术围手术期及围孕产期也必须使用胰岛素治疗;除上述情况外的2型糖尿病患者才能考虑使用口服抗糖尿病药物.     

Pharmacokinetic drug evaluation of vorapaxar for secondary prevention after acute coronary syndrome

Introduction: Vorapaxar is the first protease-activated receptor-1 inhibitor approved for clinical use. Its main indication is the reduction in thrombotic cardiovascular events in patients with previous myocardial infarction or symptomatic peripheral artery disease.

Areas covered: This article reviews the pharmacokinetics of vorapaxar and its potential use in secondary prevention after an acute coronary syndrome.

Expert opinion: Vorapaxar inhibits platelet aggregation mediated by thrombin. This effect is carried out without affecting to coagulation parameters and bleeding times. This drug has showed a significant reduction of cardiovascular events in patients with chronic atherosclerosis but not during the admission for an acute coronary syndrome. The rate of major bleeding found in patients treated with vorapaxar in randomized trials was consistently higher than placebo in most of the analyzed subgroups. For this reason, cautious evaluation of risk-benefit profiles should be required before prescribing this drug.     

Review of vorapaxar for the prevention of atherothrombotic events

Introduction: Atherosclerosis is frequently caused by clot blockage of the coronary or peripheral arteries, and may lead to myocardial infarction (MI) or peripheral arterial disease (PAD). Despite advancements in management of atherosclerosis, mortality and ischemic rates remain high. Vorapaxar is a protease activated receptor-1 (PAR-1) antagonist, and prevents thrombin activation of PAR-1 receptors on platelets.

Areas covered: Vorapaxar was studied in 2 landmark trials in patients with acute coronary syndrome (ACS) and in those with history of atherosclerosis. For patients with ACS, vorapaxar did not significantly reduce rates of the primary efficacy outcome as compared to placebo. For patients with a history of atherosclerosis, vorapaxar significantly reduced rates of primacy outcome. However, in both landmark trials, vorapaxar significantly increased risks of bleeding, and significantly increases risks of intracranial hemorrhage in patients with a history of stroke. Vorapaxar was approved in 2014 in the US for patients with a history of MI or PAD, and in the European Union for patients with a history of MI.

Expert opinion: Use of vorapaxar may be limited due to its high potential for causing bleeding. Efficacy of vorapaxar in addition to aspirin and prasugrel or ticagrelor for the management of ACS should be studied in the future.     

Emerging antithrombotic drugs for acute coronary syndrome

Introduction: Acute coronary syndrome (ACS) encompasses acute myocardial infarction (MI) and unstable angina. Activation of platelets and coagulation cascade plays a central role in the development of ACS. Over the past decade, there have been substantial improvements in the strategies for secondary prevention of ACS, including the development of more potent oral antiplatelet agents such as prasugrel and ticagrelor. However, therapies with even better efficacy and safety profiles and more rapid onset and offset of action would be desirable.

Areas covered: This review discusses the advantages and disadvantages of the currently available antithrombotic agents and describes the findings from recent clinical trials of three novel agents; cangrelor (an intravenous P2Y12 receptor antagonist), vorapaxar (protease-activated receptor-1 inhibitor) and rivaroxaban (an oral factor Xa inhibitor).

Expert opinion: Cangrelor appears more promising than clopidogrel when a very rapid onset and reversal of antiplatelet effect is needed. Vorapaxar in addition to standard oral antiplatelet therapy was effective in patients with prior MI, but was not safe in patients with a prior stroke. Low dose rivaroxaban decreased cardiovascular events and mortality in patients post-ACS compared to placebo, although bleeding was increased.     

Statins: new data in secondary prevention and diabetes. Pravastatin and simvastatin are the best-assessed statins

The efficacy of pravastatin and simvastatin was first shown several years ago in patients with coronary heart disease. Other trials have since been published. In the HPS trial, which studied patients with coronary heart disease, other cardiovascular conditions, or diabetes, simvastatin significantly reduced the risk of death, coronary events and stroke when compared with placebo. In the ALLHAT-LLT trial, in patients with treated hypertension, pravastatin did not reduce overall mortality. In the PROSPER trial, in patients aged over 70 with cardiovascular disease or cardiovascular risk factors, pravastatin reduced the incidence of coronary events relative to placebo, but did not reduce overall mortality. Pharmacovigilance studies suggest there is no difference between these four statins in terms of their potential to cause rhabdomyolysis. Taken together, these trials show that statin use can be extended to patients with levels of LDL-cholesterol over 2.4 mmol/l (0.9 g/l) if they have coronary heart disease (and no hypercholesterolaemia), a history of ischaemic stroke, or lower-limb arterial disease. Statins can also be prescribed for diabetic patients with no signs of cardiovascular disease but whose LDL-cholesterol exceeds 3.4 mmol/l (1.3 g/l). Clinical trial data support the use of pravastatin or simvastatin in these situations, at a dose of 20 or 40 mg daily. Plasma creatine phosphokinase assay should be done if muscle symptoms occur or if the patient has a particular risk of rhabdomyolysis.     

Periodontitis and cardiovascular diseases

Periodontitis is characterized by gingival inflammation and periodontopathic bacteria generate immunological inflammatory responses. Recent epidemiological reports suggest that periodontitis is one of the key risk factors for the onset of cardiovascular diseases. Several studies reported that periodontal bacteria in cardiovascular specimens were frequently detected. We revealed that patients with acute coronary syndrome showed significantly higher serum IgG titers to a strain of periodontopathic bacteria compared with patients with chronic coronary disease. Periodontopathic bacteria were also present in a high percentage of specimens of diseased arteries from patients with Buerger disease or abdominal aortic aneurysm. Although periodontopathic bacteria may play a role in the development of cardiovascular diseases, the influence of these bacteria on the disease has not yet been proven. In this article, we review the relationship between periodontopathic pathogens and cardiovascular diseases to conduct further clinical and experimental investigations in near future.     

气囊漂浮导管在重度冠心病冠脉搭桥术后的应用

目的探讨气囊漂浮导管对重度冠心病冠脉搭桥术后心血管功能监测的方法和结果。方法观察22例重度冠心病冠脉搭桥术后的患者,插入气囊漂浮导管同时进行血液动力学监测。对病情判断及治疗进行整体效果的评估,同时选用重度冠心病18人进行全身麻醉体外循环下搭桥并进行监测。结果该组22例患者病情好转出院,术后心指数基本正常,肾功能衰竭、高血压、围手术期心肌梗死、脑血管意外、二次开胸止血等严重并发症没有发生。两组相比,观察组总有效率高于对照组,差异有统计学意义(P<0.05)。结论气囊漂浮导管在重度冠心病冠脉搭桥术后的心血管功能监测上具有良好的效果,临床上应该推广应用。     

Arterial stiffness and cardiovascular outcome

1. Studies have reported an association between arterial function indices and cardiovascular risk factors, as well as the risk of incident cardiovascular events, including coronary heart disease and stroke. 2. The data are overwhelmingly in favour of an independent role for aortic pulse wave velocity in predicting fatal and non-fatal cardiovascular events in healthy and diseased populations and in the evaluation of cardiovascular risk. 3. Augmentation index may independently predict all-cause mortality and cardiovascular events in coronary and end-stage renal disease patients, but some outcome studies have questioned its usefulness in hypertensive subjects and dialysis patients. 4. Systemic arterial compliance, to this time, has not been shown to independently predict cardiovascular outcome. 5. Future cardiovascular risk is greatly modified by prior disease and risk factors; the greatest additional value in measuring arterial stiffness and compliance may be in those with little or no end-organ disease.     

P2Y12 receptor antagonists in acute coronary syndrome: clinical implications of pharmacologic and pharmacogenetic differences

Platelet activation and aggregation are key events in the pathophysiological process of thrombosis, and vascular occlusions. Antiplatelet therapy has proven to be crucial for managing patients with acute coronary syndromes, coronary artery disease and in patients undergoing percutaneous coronary interventions. However, residual platelet reactivity on antiplatelet treatment confers a five-fold increased risk of major adverse cardiovascular events which indicates a need for more effective antiplatelet medications to address the substantial burden of cardiovascular disease. This article reviews the P2Y(12) receptor antagonists with regards to pharmacologic and pharmacogenetic differences and their clinical implications along with the discussion of recent patents.     

Treating depression in coronary artery disease and chronic heart failure: what's new in using selective serotonin re-uptake inhibitors?

Depression is a common co-morbidity in patients with cardiovascular diseases such as chronic coronary artery disease, acute coronary syndromes, post by-pass surgery and chronic heart failure. The presence of depression is independently associated with a decline in health status and an increase in the risk of hospitalization and death for patients with coronary artery disease or congestive heart failure. Novel treatment modalities such as selective serotonin re-uptake inhibitors (SSRIs) may improve depressive symptoms and prognosis of post-myocardial infarction and heart failure patients interacting with the common pathophysiological mechanisms of depression and cardiovascular disease. This review summarizes current experimental and clinical evidence regarding the effects of SSRIs on platelet functions, immune and neurohormonal activation, and cardiac rhythm disturbances in patients with cardiovascular disease.     

Vitamins for the Management of Cardiovascular Disease: A Simple Solution to a Complex Problem?

Attention is focusing on the relationship between homocysteine and cardiovascular disease and the role of vitamins in the management of this prevalent ailment. Epidemiologic studies have shown that a relationship between elevated homocysteine concentrations and cardiovascular disease may exist; however, a cause-and-effect relationship has not been proven. The B vitamins are key components of homocysteine metabolism, and the trend is toward their being increasingly prescribed for cardiovascular disease. Prescribing of antioxidant vitamins, vitamin E in particular, has increased as well. Vitamin E may decrease the risk of nonfatal myocardial infarction in patients with coronary artery disease, but its benefit in preventing fatal myocardial infarction has not been shown. Vitamin supplements are not warranted in all patients with cardiovascular disease but may have a place in therapy for selected patients.