川芎嗪治疗不稳定性心绞痛疗效的系统评价

目的：系统评价川芎嗪治疗不稳定性心绞痛的有效性和安全性，以期为临床实践提供循证医学证据。 方法：计算机检索PubMed、MEDLINE：EMbase（1995—01／2005-06），中国生物医学文献数据库、中国中医药科技文献数据库、中国期刊网全文数据库、中国循证医学中心（2000-01／2005—06），手工检索《中国中西医结合杂志》《中医杂志》《中国中药杂志》（2003—01／2005—06），收集以川芎嗪为干预措施治疗不稳定性心绞痛的随机对照试验，用Cochrane协助网专用软件RevMan4．2．2（Review Manager）进行统计分析。 结果：10篇文献中共1058例不稳定性心绞痛患者符合纳入标准。Meta分析结果显示，与对照组比较，川芎嗪能显著缓解不稳定性心绞痛发作，改善心肌缺血（OR合并=3．20，95％CI=2．27，4．52，P〈0．01）；治疗后心电图较治疗前明显改善（OR合并=2．95，95％CI=2．13，4．08，P〈0．01）；疗效明显优于常规西药和传统中药（OR合并=2．79，95％CI=1．74，4．48，P〈0．01）。 结论：与常规西药和传统中药相比，川芎嗪能有效地提高不稳定性心绞痛症状、心电图和血液流变学指标等方面的治疗效果，但其远期疗效和安全性还有待于设计严格的多中心、大样本随机对照试验来进一步证实。     

不稳定性心绞痛及非ST段抬高急性心肌梗死早期介入及药物治疗的比较

目的：比较不稳定性心绞痛和非ST段抬高心肌梗死患者早期应用经皮冠状动脉介入治疗和药物治疗的疗效。方法：选择我院心内科住院的患者共136例，分为早期药物保守治疗组和介入治疗组。随访患者1～24个月的心绞痛复发率、再次入院率和再次介入治疗率或血管搭桥术，以及心源性死亡和（或）急性心肌梗死发生率。结果：介入治疗组心源性死亡和（或）急性心肌梗死发生率较药物治疗组显著降低，介入治疗组在心绞痛复发率、再住院率方面同药物保守组比较均显著降低（P均〈O．001）。结论：早期经皮冠状动脉介入治疗能显著改善不稳定性心绞痛和非ST段抬高心肌梗死患者的预后。     

曲美他嗪治疗不稳定性心绞痛130例疗效观察

目的：评价曲美他嗪治疗不稳定性心绞痛的疗效及耐受性。方法：130例不稳定性心绞痛患者随机单盲分为常规治疗组（63例）和曲美他嗪组（67例），常规治疗组应用阿司匹林、β-阻滞剂、硝酸酯类和／或钙拮抗剂，曲美他嗪组在常规治疗基础上加用曲美他嗪20mg每日3次，共治疗2周，对常规治疗组和曲美他嗪组心绞痛发作情况进行对比。结果：治疗组、对照组的心绞痛改善总有效率97．01％、71．42％两组比较差异有显著性（p〈0．05）且心率、血压无明显变化（p〉0．05）。结论：①在传统治疗不稳定性心绞痛基础上联用曲美他嗪可使患者心绞痛症状减轻，运动耐量增加。缺血闻改善且耐受良好。②曲美他嗪对血流动力学无影响，其抗缺血机制可能与其直接的细胞保护有关。     

溶栓治疗对不稳定性心绞痛患者心室舒张功能的影响

我们对４２例不稳定性心绞痛患者采用严格随机对照方法，对比尿激酶溶栓与常规治疗对不稳定性心绞痛的疗效，并以多普勒超声心动图检测心室舒张功能，评价溶栓治疗对不稳定性心绞痛患者心室舒张功能的恢复作用，进而评价溶栓治疗的意义。１资料与方法１．１资料本研究所有患者均为１９９７年８月～１９９９年１０月本院心内科住院的不稳定性心绞痛患者，共４２例。（１）人选标准：同时具备以下几条标准的恶化劳力型心绞痛病方可入选：①７２ ｈ内心绞痛突然加重，活动耐量明显下降；②４８ｈ内至少伴有１次以上自发性心绞痛发作；③发作时…     

硝酸甘油单用与联用治疗不稳定性心绞痛疗效的Meta分析

背景：在治疗不稳定性心绞痛时,联硝酸甘油合用药的疗效是否要优于单用,尚缺乏相关的循证医学证据。目的：评估硝酸甘油单用与联用治疗不稳定性心绞痛的疗效。方法：通过计算机和手工系统检索Cochrane图书馆（2010年第2期）、Medline、Embase、Science Direct、SIGLE、GreyNet、中国生物医学文献数据库（CBMdisc）、中文科技期刊全文数据库（VIP）、中国期刊全文数据库（CNKI）和万方数据库,纳入硝酸甘油单用与联用比较用于治疗不稳定性心绞痛的临床随机对照试验,评价其方法学质量后采用RevMan5.0软件,对其疗效进行Meta分析。结果与结论：纳入8个单中心临床随机对照试验,共715例患者,方法学质量均为B级。Meta分析结果显示：硝酸甘油联用的临床疗效和心电图疗效优于单独应用（RR=0.79,95%CI：1.56～3.08,P〈0.01;RR=0.72,95%CI：0.64～0.81,P〈0.01）。但上述结果可能存在各种偏倚,建议根据临床症状及循证医学证据选用恰当的联用药物而非滥用。     

抗抑郁治疗对142例不稳定心绞痛伴抑郁症患者的临床评价

【目的】观察抗抑郁治疗对142例不稳定性心绞痛伴抑郁症患者的临床疗效、预后等方面的影响。【方法】将不稳定性心绞痛伴抑郁症患者随机分为抗抑郁治疗组（72例）和对照组（70例），治疗组在常规心脏病药物治疗的基础上给予心理治疗及加服抗抑郁药氟西汀20mg／d；对照组给予单纯常规心脏病药物治疗。【结果】治疗组心肌缺血明显改善，心绞痛复发率和严重心脏病事件发生率低，与对照组比较差异有显著性（P〈0．05）。【结论】抗抑郁治疗能明显改善不稳定性心绞痛伴抑郁症患者的临床疗效和预后。     

降纤酶与低分子肝素治疗不稳定性心绞痛疗效观察

目的 观察降纤酶治疗不稳定性心绞痛（UA）的临床疗效和安全性。方法 将57例不稳定性心绞痛患者随机分成两组：A组（对照组，n=27）在常规抗心绞痛及抗血小板活疗基础上加低分子肝素（120mg／kg皮下注射，12h1次，共6d），B组（治疗组，n=30）在同上常规治疗基础上加降纤酶（10单位稀释后静脉滴注，1次／d，共6d）。观察终点为30d非致死性心肌梗死和心性死亡总心脏事件率。结果 A组和B组总心脏事件发生率为11％与10.9％，P〉0.05。出血事件仅A组有3侧轻度皮下出血，B组无出血。结论 降纤酶治疗不稳定性心绞痛临床疗效较好，约与低分子肝素等效，且无任何出血，安全性亦好。     

持续灌流法经皮冠状动脉腔内球囊成形术治疗不稳定性心绞痛

不稳定性心绞痛是介于稳定劳力型心绞痛与心肌梗死之间的一组心肌缺血症候群，如及时处理，可望病情稳定，改善预后，否则易在短期内发生心肌梗死或猝死。如何治疗这些患者，是临床上急需解决的问题之一。本研究的目的在于探讨持续灌流法经皮冠状动脉腔内球囊成形术（CPPTCA）在治疗不稳定性心绞痛中的临床价值。     

刺五加注射液加低分子右旋糖酐治疗不稳定性心绞痛40例临床分析

采用刺五加注射加低分子右旋糖酐治疗不稳定性心绞痛40例，并与单用西药治疗的38例作对照。结果显示：对心绞痛疗效治疗组总有效率为92．7％，对照组总有效率为68．9％，两组比较有显著性差异（P＜0．05）；对心电图疗效，治疗组疗效总有效率为72．5％，对照组总有效率为50％，两组比较有显著性差异（P＜0．01）。该治疗方法未见副作用，是治疗不稳定性心绞痛的有效方法。     

强化抗血小板抗凝血酶治疗后小剂量尿激酶溶栓治疗不稳 …

目的：探讨不稳定性心绞痛患者在抗血小板抗凝血酶强化治疗后应用小剂量尿激酶溶栓治疗的效果,进一步评价溶栓治疗对不稳定性心绞痛的作用。方法：选择心电图明显ＳＴ段动态坟低的不稳定性心绞痛患者７２例,随机分为Ａ、Ｂ两组。Ａ组：小剂量尿激酶组３６例,尿激酶０．５万ｕ／ｋｇ,静脉注射,１次／ｄ,连用３ｄ,首次给药前１ｈ先给低分子肝素（克赛）３０ｍｇ静脉注射和６０ｍｇ皮下注射;Ｂ组：对照组３６例不用尿激酶,以心     

循证医学与心理治疗

文章对心理治疗中循证医学方法的应用现状进行了综述,提出在心理治疗中应用循证医学中提倡的大规模随机对照试验的方法,积极创造更多的最新证据,特别应注意试验方法的规范;系统综述或荟萃分析也应更加详尽而深入。     

葛根素注射液联合低分子肝素治疗不稳定型心绞痛的Meta分析

目的评价葛根素注射液（PI）联合低分子肝素（LMWH）治疗不稳定型心绞痛（UAP）的疗效和安全性。方法计算机检索中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊全文数据库（VIP-维普）、万方-数字化期刊全文库,纳入在常规治疗上加用PI和LMWH对比单纯常规治疗的随机对照试验（RCT）,对纳入研究进行质量评价和Meta分析。结果共纳入21个RCT,均为C级文献。Meta分析结果显示,在临床症状疗效显效率、心电图疗效显效率和有效率指标方面,两组差异有统计学意义：RR（95%CI）分别为：1.63（1.48,1.79）、1.57（1.34,1.83）及1.28（1.10,1.49）。结论基于上述证据,在常规治疗UAP上加用PI和LMWH疗效优于常规治疗。     

State and territorial boards of nursing approaches to the use of unlicensed assistive personnel

This study examined U.S. state and territorial boards of nursing approaches to the regulation of the use of: unlicensed assistive personnel (UAP) in acute care hospitals; state and jurisdictional authority, oversight and disciplinary action related to registered nurse (RN) delegation, supervision and assignment; educational preparation requirements for UAP; and future projections for their use. A survey was administered to 53 state and territorial boards of nursing officials in 1998. A majority of the states reported that they had regulations/guidelines for RN's who supervised UAP and regulations that protected the use of the RN title. Few states used the American Nurses Association or National Council of State Boards of Nursing definitions for delegation, supervision, or assignment. The majority have formulated their own definitions. The majority of states reported no standardized curriculum in place for UAP employed in acute care hospitals. More than half of the states reported that no plans existed for developing a curriculum.     

急性冠状动脉综合征治疗研究进展

不稳定性心绞痛和非Q波心肌梗死是临床上常见急症 ,称之为急性冠状动脉综合征 ,该综合征具有较高发生率和死亡率 ,早期正确处理非常必要。本文作者复习近年来有关文献 ,就急性冠状动脉综合征治疗研究进展作一介绍。     

阿奇霉素对不稳定型心绞痛干预治疗的临床研究

目的　探讨阿奇霉素对不稳定型心绞痛的影响。方法　应用酶联免疫法检测 10 0例不稳定型心绞痛患者血清肺炎衣原体 (CP)特异性抗体IgG。 76例肺炎衣原体抗体IgG阳性者随机分为治疗组 38例和对照组 38例 ,对照组给予扩张冠脉、抗凝等常规治疗 ,治疗组在常规治疗的基础上应用阿奇霉素。结果　治疗组 12～ 18个月内因不稳定型心绞痛再入院、急性心肌梗死和死亡的发生率均明显低于常规治疗的对照组 ,其中 ,不稳定型心绞痛住院的发生率两组比较有显著差异 (P <0 .0 5 )。结论　阿奇霉素可改善CP感染的不稳定型心绞痛的预后 ,减少心血管恶性事件的发生     

低分子肝素与灯盏细辛注射液联合治疗不稳定型心绞痛疗效观察

目的:观察低分子肝素与灯盏细辛注射液联合治疗不稳定型心绞痛(UAP)的疗效。方法:将96例UAP患者随机分为常规治疗对照组和加用低分子肝素和灯盏细辛注射液治疗组各48例进行疗效观察。结果:10d后总有效率治疗组为91.7%,对照组为68.8%(P <0.01);观察4周总心血管事件发生率治疗组明显低于对照组(P <0.05);治疗组未发现明显不良反应。结论:在常规治疗的基础上加用低分子肝素和灯盏细辛注射液,能更有效地控制心绞痛发作,显著降低近期心血管事件的发生率。     

The challenge of recruiting patients with anterior cruciate ligament injury of the knee into a randomized clinical trial comparing surgical and non-surgical treatment

AIMS: To determine the number of patients needed to be screened (NNS) and allocated (NNA) in order to include one participant in a randomized clinical trial (RCT), and to compare the characteristics of patients accepting or declining participation in the RCT. METHODS: The recruitment process of an ongoing multicenter RCT, comparing surgical and non-surgical interventions after acute anterior cruciate ligament (ACL) injury of the knee is described. We use the known concept Number Needed to Screen (NNS) and introduce the new concept Number Needed to Allocate (NNA) as variables to support a priori sample size calculations of future investigations. RESULTS: 560 patients were screened to identify 162 patients (29%) eligible for inclusion in the RCT. 41 of those declined participation for various reasons, the most common being unwillingness to undergo surgery (n=23) or unwillingness to risk conservative treatment (n=8). 19 patients were excluded after MRI assessment or arthroscopy. Thus, 102 (18%) patients were allocated to one of the two treatments in the RCT. The NNS was 5.5 individuals with an acute knee injury, and the NNA was 1.6 individuals eligible for inclusion, to include 1 patient in the RCT. Patients declining to participate in the RCT were more frequently self-employed and less frequently injured in sports activities than those accepting RCT participation. CONCLUSIONS: We suggest that the a priori sample size calculation needs to be multiplied by at least 5.5 to provide an estimate of the number needed to screen, or 1.6 to provide an estimate of the number needed to allocate in order to include the desired number of patients in a trial comparing surgical and non-surgical treatment of the ACL injured patient.     

会阴保护的临床证据

会阴保护是产科的一个经典问题，从古至今，人们一直在进行各种尝试和摸索，既总结出一套有效的保护方法又在此方面进行了新的尝试。如何评价这些方法的有效性和可靠性呢？为此笔者检索了Cochrane图书馆（2007年第3期）、MEDLINE（1980．1-2007．5）和中国生物医学文献数据库（1980．1-2007．5），收集关于会阴按摩、会阴切开、分娩镇痛等会阴保护方面的系统评价和随机对照试验，对其进行归纳总结，以求为临床工作实践提供最佳的依据。     

急性冠状动脉综合征患者血清晚期氧化蛋白产物水平的测定意义

目的 探讨血清晚期氧化蛋白产物（AOPP）水平在急性冠状动脉综合征（ACS）中的意义及对预后的影响.方法 选择ACS患者共55例,其中不稳定型心绞痛（UAP）29例,急性心肌梗死（AMI）26例;正常对照组30例;采用分光光度计法检测所有入选者的血清AOPP浓度,并记录4周内所有患者的病情转归情况.结果 2组ACS患者AOPP水平均明显高于正常对照组（均P＜0.01）,AMI组AOPP水平高于UAP组（P＜0.05）;病情转归及预后差者AOPP水平相对高（P＜0.01）.结论 AOPP与ACS的发生有关,并且与病情的严重程度呈正相关,对病情转归有一定预测价值.     

Fluid balance and colloid osmotic pressure in acute respiratory failure: emerging clinical evidence

Available evidence suggests that both hydrostatic and osmotic forces are important in the development of acute respiratory distress syndrome (ARDS) or, more broadly, acute lung injury (ALI). More than 80% of ARDS patients in a large-scale randomized controlled trial (RCT) exhibited, at least intermittently, pulmonary artery wedge pressures (PAWP) above 18 mmHg. Retrospective analyses have shown that PAWP elevation is associated with increased mortality. Reduction in serum total protein (STP) has been shown, in a recent retrospective analysis of data from a sepsis patient population with a high frequency of ARDS, to be highly predictive of positive fluid balance, weight gain, development of ARDS, prolonged mechanical ventilation, and mortality. These findings suggest that therapy with diuretics and colloids might be of benefit in the prevention or treatment of ALI. A prospective RCT was designed and conducted to evaluate combination therapy with furosemide and albumin over a 5-day period in 37 ALI patients. Both mean serum albumin and mean STP increased promptly and substantially in furosemide + albumin recipients. The furosemide + albumin group also achieved a mean weight loss of 10 kg by the end of the treatment phase, and their weight loss exceeded that of placebo patients throughout. Hemodynamics improved in the treatment group during the 5-day protocol. Oxygenation, as assessed by the ratio between the fraction of inspired oxygen and the partial pressure of oxygen in arterial blood (PaO2/FiO2), was significantly higher within 24 h after commencement of treatment in the furosemide + albumin than the placebo group. No clinically important adverse effects of furosemide + albumin therapy were encountered. These results provide evidence that combined therapy with furosemide and albumin is effective in augmenting serum albumin and STP levels, promoting weight loss, and improving oxygenation and longer-term hemodynamic stability. Although mortality did not differ between groups, the RCT showed a trend toward reduced duration of mechanical ventilation and length of stay in the intensive care unit in patients receiving furosemide + albumin. The findings of the RCT further highlight the importance of both hydrostatic and osmotic forces in hypoxemic respiratory failure, a subject that requires further investigation.