扑朔迷离的心源性休克

心源性休克指心脏泵血功能衰竭而引起的休克,它是严重的心律失常及任何心脏病的终末期表现,其核心问题是各种原因引起的心脏排血量下降,以及由此产生的一系列病理生理变化[1]。急性心肌梗死是引起心源性休克最常见的病因,约占所有心源性休克的80%,其他原因包括心肌炎、心肌病、严重心律失常、大块肺栓塞等,明确病因是治疗心源性休克的关键,所以临床医生需将寻找病因放在首位[2]。     

急性心肌梗死并心源性休克的诊断与治疗

心源性休克是急性心肌梗死(ＡＭＩ心梗)伴泵衰竭的最严重临床表现,与左心室心肌的广泛损害有关。85%的心源性休克是由于左心功能衰竭(心衰)所引起[1],当40%或以上的左心室心肌受损害时常出现心源性休克,其余病人可能有机械性障碍,如室间隔缺损,乳头肌功能不全等,或有严重的右心室心肌梗塞。ＡＭＩ并心源性休克的发生率在70年代以前为15%,现降至5%～7%。心源性休克的临床特征为左心室充盈压增高,心输出量下降,低血压和重要器官灌注低下。ＡＭＩ并心源性休克多为老年人、女性病人、有心梗史或心衰史、或有前壁心梗的病人,约50%的心源性休克患…     

血清B型利钠肽水平在急性心肌梗死患者心力衰竭诊断中的价值

急性心肌梗死(AMI)是指在冠状动脉粥样硬化的基础上发生的持久而严重的心肌缺血,导致部分心肌急性坏死〔1〕。由于心脏收缩和舒张功能受损,因此AMI后可并发心力衰竭及心源性休克。目前B型利钠肽(BNP)在心血管疾病的诊断、治疗方面及评估患者预后的价值日益得到重视,当患者发生心力衰竭时,由于神经内分泌系统的激活及心室压力负荷的增加,引起血清BNP水平升高。本文旨在探讨BNP水平对AMI心力衰     

急性心肌梗死并发心源性休克

急性心肌梗死(AMI)是最为严重的心血管急症,心源性休克又是AMI最危重的并发症之一,其发生是由于大量坏死心肌收缩力减弱,心排出量显著下降,而导致的休克综合征.     

血糖水平与急性心肌梗死预后的关系

<正>急性心肌梗死(AMI)是由于心肌持久而严重的急性缺血引起的心肌坏死,可发生严重心律失常、心力衰竭、心源性休克和猝死等主要不良心血管事件,是急性冠脉综合征的严重类型〔1〕。研究发现AMI患者空腹血糖(FPG)水平与预后情况存在关联性。FPG水平越高,系统治疗期间和病情控制后出院1年内严重心律失常、心力衰竭、心源性休克和猝死等主要不良心血管事件发生率越大,提示预后越差。ST段抬高AMI(STE-     

急性心肌梗死合并心源性休克诊治进展

心源性休克(CS)是急性心肌梗死(AMI)最严重的并发症之一,也是导致患者死亡最常见的原因。血管活性药物、机械循环支持、早期血运重建等措施广泛应用于AMI合并CS的急诊救治,但AMI合并CS的病死率仍居高不下。本文主要探讨近年来AMI合并CS的临床诊治进展。     

急性心肌梗死伴心源性休克患者PCI治疗中应用主动脉球囊反搏治疗的护理

目的探讨如何提高急性心肌梗死伴心源性休克患者在行冠脉内介入治疗术(PCI)治疗中应用主动脉内球囊反搏治疗的护理配合。方法对5例急性心肌梗死(AMI)伴心源性休克患者在PCI术中应用主动脉内球囊反搏治疗的临床资料进行回顾性分析。结果 5例急性心肌梗死伴心源性休克患者行冠脉内介入治疗术(PCI)治疗中均应用主动脉内球囊反搏治疗,术前熟悉主动脉球囊反搏仪工作原理,主动脉内球囊反搏机(IABP)通过主动脉内球囊与心动周期同步地充放气,舒张期球囊充气,提高平均动脉压,增加冠脉灌注,进而增加氧释放,减轻心肌缺血缺氧;收缩期球囊放气,减少了心脏的后负荷,增加心排血量,降低舒张末期容积及室壁张力,心脏做功减少,从而减少了心肌对氧的需求。故能有效改善心功能,提高心输出量和终末器官灌注。术中密切观察患者生命体征及球囊反搏仪工作状况,加强并发症观察和心理护理,5例患者均顺利结束手术。结论急性心肌梗死伴心源性休克患者PCI治疗中应用主动脉内球囊反搏治疗,由于急性心肌梗死合并心源性休克是危重急症,死亡率极高,在急性心肌梗死合并心源性休克早期应用主动脉内球囊反搏治疗,可改善外周循环和血流动力学,增加心排量,从而防止心源性休克的进一步恶化,如果护理配合工作跟不上,主动脉内球囊反搏治疗不成功,后果很严重,所以,熟练、准确、及时的术中护理配合,对成功救治急性心肌梗死伴心源性休克患者具有重要意义。     

院前急救应用体外膜肺氧合成功抢救心脏性猝死一例

急性心肌梗死(AMI)伴心源性休克(CS)是导致心脏性猝死(SCD)的主要病因之一, 而体外膜肺氧合(ECMO)是治疗AMI导致的CS的有效手段。本文报道一例因AMI伴CS导致SCD于办公室置入ECMO抢救成功的病例, 旨在探讨院前早期置入ECMO对发生SCD患者预后的影响。     

中医药治疗急性心肌梗死的临床研究进展

急性心肌梗死(acute myocardial infarction,AMI)是冠状动脉血供急剧减少或中断,使相应心肌严重、持久地急性缺血而导致的心肌坏死,是冠状动脉粥样硬化性心脏病的严重类型。临床表现为持久的胸骨后剧烈疼痛、血清心肌酶增高和心电图进行性改变,常并发心力衰竭、心律失常及心源性休克。全国各地     

主动脉内球囊反搏术联合连续肾脏替代治疗成功抢救急性心肌梗死合并糖尿病乳酸酸中毒1例

<正>急性心肌梗死(acute myocardial infarction,AMI)合并糖尿病在临床工作中很常见,病情多较严重;如果心肌梗死患者进展至心源性休克,其死亡率极高。而AMI出现心源性休克合并糖尿病急性并发症如乳酸酸中毒、酮症酸中毒时,病情可快速发生进展,导致患者生存率极低。笔者在临床工作中发现了1例AMI出现心源性休克合并糖尿病乳酸酸中毒、酮症酸中毒患者,经主动脉内球囊反搏术(intra-aortic     

Babesiosis diagnosis and treatment

Human babesiosis due to Babesia microti is an emerging malaria-like infection that is endemic in parts of the northeastern and northcentral United States. The clinical manifestations of babesiosis range from subclinical illness to fulminant disease resulting in death. Prompt and accurate diagnosis is difficult because the signs and symptoms are non-specific. A CBC is a useful screening test since anemia and thrombocytopenia are commonly observed and parasites may be visualized on blood smear. Conclusive diagnosis of this disease generally depends upon microscopic examination of thin blood smears. Babesia frequently are overlooked, however, because parasitemia tends to be sparse, often infecting fewer than 1% of erythrocytes early in the course of the illness. Identification of amplifiable babesial DNA by polymerase chain reaction (PCR) has comparable sensitivity and specificity to microscopic analysis of thin blood smear for detection of babesia in blood. Serologic testing provides useful supplementary evidence of infection because a robust antibody response characterizes human babesial infection, even at the time that parasitemia first becomes detectable. The currently recommended therapy for babesiosis is a 7-10-day course of clindamycin (600 mg every 6 h) and quinine (650 mg every 8 h). Recently, azithromycin (500-600 mg on day 1, and 250-600 mg on subsequent days) and atovaquone (750 mg every 12 h) was found to be equally effective in treating adults experiencing babesiosis. This combination also was associated with fewer adverse reactions than clindamycin and quinine. Exchange transfusion is a potentially life-saving therapy for patients suffering from severe disease with high parasitemia (>5%), significant hemolysis, or renal or pulmonary compromise. Babesiosis may be prevented by avoiding areas such as tall grass and brush where ticks, deer, and mice are known to thrive.     

阴蒂肿大的诊断与治疗

阴蒂病变依据其病因可分为激素相关性与激素非相关性,起病可能是先天性,也可能是后天获得性。阴蒂肿大是临床上阴蒂病变最为重要的病变形式。激素相关性阴蒂肿大主要由高雄激素血症引起,激素非相关性阴蒂肿大的最常见病因为神经纤维瘤。涉及阴蒂的疾病复杂多样,临床表现各异,诊断困难,文献可见各种引起阴蒂肿大的散发病例报道,但缺乏对该病变的诊断与治疗的系统阐述。本文通过对这类疾病进行分类与总结,为临床医生对疑似病例的诊治提供帮助,避免误诊与漏诊。     

垂体腺瘤的诊断与治疗

垂体腺瘤是常见的良性肿瘤,人群发生率为1/100 000,约占颅内肿瘤的10%.且近年来随神经影像学和神经内分泌学的发展,发现并确诊为该病逐渐增多,发病率有增多的趋势.临床上已形成了以神经外科为中心的多学科合作治疗模式.随着基础和临床研究的不断深入,现代科学技术的突飞猛进,为垂体腺瘤这个古老的疾病诊治带来了新的"活力",同时对垂体外科治疗也提出了现代要求:力争全切肿瘤,保留残余正常垂体、恢复正常的激素水平和提高患者的生活质量.     

Strongyloidiasis--progress in diagnosis and treatment

Strongyloidiasis is an intestinal parasitic disease caused by Strongyloides stercoralis. Basically, detecting larvae of S. stercoralis in feces makes definitive diagnosis. The ordinary agar plate culture method developed at our department is much simpler to handle and much more sensitive than the conventional filter paper culture method. It is considered to be the most useful method in the diagnosis of strongyloidiasis and in evaluation of the eradicating effect. Among chemotherapeutic agents, thiabendazole representing the benzimidazole compounds is most effective. However, it has a problem in safety, since its adverse effects and liver dysfunction occur with a high incidence, and it can be severe. Regarding the effects of mebendazole, albendazole and ivermectin, a study was conducted which included many patients. A high incidence of liver dysfunction was observed with mebendazole, and eradicating effect was not sufficient with albendazole. Ivermectin is different from benzimidazole compounds in a pharmacokinetic profile. However, ivermectin showed a strong anthelmintic effect with the least toxicity. We therefore consider ivermectin is the most useful drug for the treatment of strongyloidiasis.