老年无保护冠状动脉左主干狭窄特点和介入治疗后随访分析

目的:观察老年无保护冠状动脉左主干病变的临床特征,分析老年无保护冠状动脉左主干病变(ULMCA)介入治疗的临床随访结果。方法:回顾性分析276例老年无保护左主干病变介入治疗患者的临床资料及冠状动脉造影结果,并经随访6～24个月,观察心绞痛复发、非致死性心肌梗死、死亡和再次进行冠脉血运重建术等终点事件的发生情况。结果:①老年患者危险因素中高血压、糖尿病比非老年组多见,而非老年组吸烟、肥胖者高于老年组;②临床资料比较:左主干病变老年组中心绞痛发生率88.6%,心肌梗死发生率为65.7%,明显多于非老年组(P<0.05),同时老年组LVEF较非老年组更低(48.3%vs 60.6%)(P<0.05);③老年患者左主干病变合并多支血管病变为主(91.4%),左冠状动脉主干狭窄多位于左主干远端分叉处(55.7%);④老年ULMCA病变PCI术和CABG术,在住院期间的终点事件中,均无死亡及心肌梗死。随访发现,进行PCI或CABG治疗组的死亡率和心肌梗死发生率显著低于药物治疗组(P<0.05)。但PCI组心绞痛复发率、血运重建率高于CABG组(P<0.05)。结论:老年左冠状动脉主干狭窄发生率略高,多伴发糖尿病、高血压,合并有多支血管病变,病情更严重,PCI治疗更复杂。经过选择的老年ULMCA支架置入术是可行和安全的,并可取得较好近、远期疗效。     

介入性完全性血运重建对冠状动脉多支病变患者长期预后的影响

目的 比较单支和多支冠状动脉病变患者经皮冠状动脉介入术(PCI)后的远期预后以及实施完全性或不完全性血运重建对后者长期临床疗效的影响. 资料与方法 959例冠心病患者行选择性冠状动脉内支架置入术,其中单支病变组(single-vessel disease,SVD)362例,多支病变完全性血运重建组(complete revascularization,CR)291 例,多支病变不完全性血运重建组(incomplete revascularization,IR)306例,对比分析3组患者PCI手术后2.5年随访结果. 结果 与CR组比较,IR组患者中冠状动脉病变严重程度、3支病变比例、左主干病变、分叉病变数量均高 (P＜0.05) ,病变数目少而平均置入支架数多(P＜0.05).SVD组冠状动脉病变平均狭窄程度重而植入支架长度和直径均小于另两组(P＜0.05).IR组再发心绞痛(P＜0.05)、再次血运重建比例(P＜0.01)和MACE事件发生率(P＜0.05)均显著高于另两组. 结论 通过行PCI术实现完全性血运重建的多支冠状动脉病变患者长期预后效果与单支病变者类似,优于不完全性血运重建者.     

冠状动脉左主干病变介入治疗研究进展

<正>临床上,冠状动脉左主干病变约占经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的4%~6%。左主干供应大部分左心室心肌,无保护左主干病变PCI的风险高、远期疗效欠佳,因此,冠状动脉搭桥术(coronary artery bypass grafting,CABG)长期以来都作为左主干病变的首选治疗方式~[1-2]。近年来,随着介入器械的改良、治疗技术的优化及术者经验的积累,PCI治疗左主干病变的成功率与临床疗效显著提高,已成为治疗左主干病     

老年无保护左主干病变介入术后长期疗效分析

目的 观察药物洗脱支架(drug-eluting stent,DES)治疗老年无保护左主干(unprotected left main artery,ULM)冠状动脉病变长期临床疗效.资料与方法 分析老年ULM病变冠心病患者的临床特点,并随访置人DES 后远期主要心脏血管事件(major adverse cardiac and cerebral events,MACCE).结果 老年组冠状动脉病变SYNTAX评分更高(P=0.040),慢性闭塞病变(chronic total occlusion,CTO)比例和合并2支病变以上比例明显高于中青年组(P<0.05).老年组发生MACCE共21例,中青年组仅17例,差异有显著统计学意义(Log rank,P=0.034).两组远期死亡、心肌梗死、再次血运重建类似.合并2型糖尿病的老年ULM患者MACCE明显高于单纯老年ULM (Log rank,P=0.037).结论 老年ULM患者冠状动脉病变严重,DES治疗后远期疗效可以接受;2型糖尿病是老年ULM患者MACCE的预测因子.     

经桡动脉途径无保护冠状动脉左主干分叉病变介入治疗

 目的 探讨经桡动脉途径PCI在无保护左主干分叉病变中治疗的可行性和疗效.方法 回顾性分析我院无保护左主干分叉病变择期行PCI的患者22例,21例置入药物洗脱支架,单支架置入7例,双支架置入14例,14例置入双支架的患者均成功进行对吻球囊扩张,1例系支架术后再狭窄,单纯行切割球囊成形术.术后每15 d或1个月门诊复查1次,3～9个月行冠状动脉造影复查.结果 22例PCI均取得成功,术后达TIMI 3级血流,住院期间主要不良心脏事件1例(4.55%),冠状动脉造影复查显示支架内再狭窄2例(10.53%),1例再次行PCI术.术后平均随访(16.86±6.90)个月,随访期内死亡1例.结论 经桡动脉径路无保护左主干分叉病变PCI即刻成功率高,有较好的近、中期疗效.     

冠心病合并慢性肾功能不全患者的临床特征和PCI远期预后分析

目的 测定冠心病合并慢性肾功能不全(CRI)患者的临床特征,并探讨药物洗脱支架对这些患者冠状动脉介入治疗(PCI)的主要不良事件发生率和临床远期预后的作用.方法 973例经冠状动脉造影确诊冠状动脉明显狭窄(管腔内径减少＞50%)中,516例合并肾功能不全(CRI组),457例肾功能正常(对照组).记录两组基础临床和造影情况,每例均接受PCI治疗和术后临床随访.结果 CRI组高龄、高血压及糖尿病患者明显多于对照组,但左室射血分数显著低于对照组.CRI组冠状动脉复杂病变(C型)明显多于对照组.平均17个月随访结果显示,CRI组总病死率高于对照组(6.2%和3.3%,P＜0.05).亚组分析显示,CRI患者药物洗脱支架治疗后病死率低于普通支架(4.1%和8.5%,P＜0.05).结论 CRI患者通常冠状动脉病变严重,PCI后病死率明显增加,但药物洗脱支架较普通支架显著改善远期预后.     

43例无保护左冠状动脉主干病变支架治疗

目的 评价无保护左冠状动脉主干(LMCA)支架治疗的安全性和有效性.方法 2001年12月～2006年4月,43例无保护LMCA病变患者接受介入治疗,年龄62.8±11.3岁(45～86岁).既往有心肌梗死史4例(9.3%),合并高血压30例(69.8%),糖尿病5例(11.6%).结果 43例患者共植入56枚支架.孤立性LMCA病变4例(9.3%);LMCA合并其他血管病变39例(90.7%):其中LMCA开口病变11例(25.6%),体部病变6例(13.9%),分叉病变26例(60.5%).43例LMCA支架植入均获成功,术中无主要并发症.住院期间主要不良心脏事件(MACE)2例(4.7%),其中TLR 1例(2.3%),死亡1例(2.3%).随访2～53个月,总MACE 4例(9.5%),其中靶段血管再建术(TLR)4例(9.5%).不同病变部位(开口、体部、分叉)住院期间MACE、随访期间MACE、症状复发差异均无统计学意义.经皮冠脉介入治疗(PCI)术后6个月、9个月、12个月无心脏事件生存率分别为93.3%、89.4%、84.5%.结论 随着PCI策略及介入设备的不断改进,在有经验的介入中心,LMCA病变介入治疗技术成功率高,可取得较好的近远期结果.     

冠状动脉左主干急性闭塞介入治疗新术式临床应用

目的 探讨冠状动脉左主干急性闭塞病变介入治疗新术式临床应用的效果.方法 收集2003年5月至2016年10月收治的左主干急性闭塞患者58例临床资料.其中14例接受传统经皮冠状动脉介入治疗(PCI),44例先接受小球囊扩张,血流恢复TIMI分级3级后等待30～40 min再植入支架.结果 接受传统PCI治疗患者中8例死亡,死亡率为57.1％(8/14);接受先行小球囊扩张再行支架植入术患者中仅3例死亡,死亡率为6.8％(3/44).结论 小球囊扩张后延时支架植入术治疗急性左主干闭塞患者死亡率更低,是一种安全有效的术式.     

药物洗脱支架联合药物涂层球囊在冠状动脉左主干分叉病变中的应用

目的评价药物洗脱支架(DES)联合药物涂层球囊(DCB)治疗冠状动脉左主干(LM)分叉病变的临床效果。方法回顾性分析2016年7月至2017年7月采用DES联合DCB治疗的8例LM分叉病变患者临床资料。8例患者均接受LM和左前降支病变处DES治疗,左回旋支开口处DCB治疗,其中6例手术在血管内超声导引下进行。术后即刻造影评价病变血管通畅情况,术后6个月随访再狭窄率及6个月内严重临床事件发生率。结果 DES联合DCB治疗LM分叉病变再狭窄率低[LM(8.4±5.3)%,左前降支(18.2±5.0)%,左回旋支(30.5±16.5)%]。术后所有患者未发生严重临床事件。结论 DES联合DCB介入治疗LM分叉病变安全有效。     

药物涂层支架与冠脉搭桥术治疗冠状动脉多支病变疗效对比与评估

目的:评价与比较多支冠脉病变行冠状动脉旁路移植术(CABG)与药物洗脱支架(SES)植入的近期与中期治疗效果。方法:入选2007年7月至2010年6月在我院行血管重建术的407例冠心病多支冠脉病变患者,其中251例行DES置入术(DES组),156例行冠脉旁路移植术(CABG组)。比较两组住院期和随访期不良心血管事件(死亡、非致死性心肌梗死、再次血管重建术和脑血管意外)的发生情况。结果:两组的临床和冠脉病变特征相似,CABG组三支病变、前降支近段病变、左主干病变和慢性完全闭塞病变,及陈旧性心梗(OMI)患者数与SES组差异有统计学意义(p﹤0.05)。住院期两组总体不良心血管事件发生率无明显差异,随访367例患者(92.1%),平均临床随访12～36(17±9)个月,2组总体不良心血管事件发生率仍无明显差异(9.2%∶11.4%,P0.05),但DES组再次血管重建的发生率较CABG组有增高趋势(8.9%∶2.6%,P0.05)。结论对于多支冠状动脉病变患者,DES置入术安全可行,总体不良心血管事件发生率与CABG无明显差异。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.