哌拉西林/他唑巴坦治疗急性心肌梗死合并肺部感染疗效观察

目的评价哌拉西林/他唑巴坦治疗急性心肌梗死合并肺部感染的有效性和安全性.方法对86例急性心肌梗死合并肺部感染患者,随机分成两组,治疗组应用哌拉西林/他唑巴坦治疗,对照组应用头孢噻肟治疗,分别观察其临床疗效、细菌清除率和不良反应.结果治疗组有效率为83.3%,细菌清除率为63.9%,优于对照组的47.6%和41.7%;副作用少.结论哌拉西林/他唑巴坦可作为急性心肌梗死合并肺部感染的经验性用药.     

急性心肌梗塞行急诊冠状动脉介入治疗的护理

目的探讨急性心肌梗塞(AMI)行急诊经皮冠状动脉腔内成形术(PTCA)+支架植入术的护理。方法对168例行急诊PTCA的AMI患者术中护理,术后严密观察病情、心电监护、预防并发症等护理。结果急诊PTCA术中出现严重心律失常,术后血管出血等并发症比择期手术高,病人及家属缺乏相关知识,有焦虑、恐惧心理。结论术中密切配合,术后严密观察病情、心电监护、预防出血等并发症、做好心理护理及健康教育,是决定患者早日康复出院的关键。     

2015 - 2016年郑州市居民冠心病监测数据分析

目的 了解郑州市2015 - 2016年户籍居民冠心病发病死亡情况。方法 根据河南省慢性病监测管理系统收集的郑州市户籍居民冠心病发病监测数据,对2年间郑州市居民冠心病发病和死亡情况进行分析。数据库的建立基于Excel2010软件,SPSS19.0统计软件用于描述性分析。结果 郑州市2015 - 2016年报告户籍居民冠心病发病22 259例,死亡13 513例,户籍人口发病率和死亡率为分别为152.75/10（标化率90.21/10万）和92.89/10万（标化率65.16/10万）。相比于2015年（122.91/10万）,2016年全市监测人群冠心病粗发病率上升至182.58/10万,粗死亡率由88.83/10万上升至96.94/10万。女性发病率、死亡率低于男性。60岁以上年龄组发病率和死亡率高于60岁以下年龄组。在冠心病发病病例分型中,急性心肌梗死为主要的病例分型,占比92.08%。1月份发病最多（3 113例,发病率20.63/10万）最多。结论 监测年间郑州市户籍居民冠心病发病和死亡率随年龄增长呈明显上升趋势,男性急性发病率、死亡率高于女性。     

523例急性心肌梗死患者院前急救特点分析

[目的]分析总结523例急性心肌梗死病例特点和急救过程,旨在提高抢救治疗成功率。[方法]回顾性分析某中心2003年1月～2008年12月间出车接诊抢救的306例急性心肌梗死(抢救组)和自行入院的217例急性心肌梗死(对照组)分析比较。[结果]抢救组与对照组得到抢救治疗时间分别为(38.32±12.01)min、(62±13.21)min。并发症分别为27.5%、66.8%,死亡率为15.3%、36.4%。平均住院日分别(18±9)d、(32±16)d,差异有统计学意义(P﹤0.05)。[结论]加强重点人群的健康教育及实行快速有效的院前急救、保证绿色通道完善、院内院外的急救网络对接,是提高AMI患者抢救成功率、降低死亡的关键。     

青年人急性心肌梗死的特点及预防

目的：探讨青年人急性心肌梗死的特点及预防。方法：对28例青年人（≤40岁）心肌梗死的临床资料进行分析。结果：本组男性26例，占92．9％；7-9月份发病16例，占57％；体力劳动者22例，占78．6％；有明显冠心病危险因素者28例，占89．3％；发病前有诱发因素者23例，占82．1％。结论：青年人心肌梗死具有男性多见、夏季多见、体力劳动者多见、危险因素多明显、诱发因素多突出、先兆少、症状多典型等特点。其发生多与不良生活方式有关。加强健康教育，建立良好的生活方式是预防青年人心肌梗死的关键。     

急性心肌梗死介入治疗前后血清cTnI、BNP、IMA浓度变化的意义

目的:探讨急性心肌梗死(AMI)患者在PCI治疗前后血清肌钙蛋白I(cTnI)、脑钠肽(BNP)、缺血修饰白蛋白(IMA)的浓度变化及意义。方法:选取经PCI治疗的AMI患者35例,治疗前及治疗后6 h检测血清cTnI、BNP、IMA浓度,进行比较、评价。结果:(1)病例组血清cTnI[(50.53±29.95)ng/ml]、BNP[(5.01±1.23)mg/ml]、IMA[(1449.47±213.49)nmol/L]浓度较健康对照组显著升高(t=10.94,P<0.001;t=28.46,P<0.001;t=42.33,P<0.001)。(2)AMI患者经PCI治疗后6 h血清cTnI浓度[(47.02±28.11)ng/ml]与治疗前[(49.59±33.17)ng/ml]差别无统计学意义(t=1.625,P>0.05),但BNP浓度[(6.64±4.37)mg/ml]、IMA浓度[(1908.85±780.30)nmol/L]较治疗前[(5.06±1.16)mg/ml]、IMA[(1463.32±239.13)nmol/L]明显升高(t=-2.387,P<0.05;t=-3.311,P<0.01)。结论:PCI治疗前后血清cTnI浓度无明显变化,而BNP、IMA浓度较治疗前升高,提示PCI对AMI患者造成一过性心肌损伤,这些指标对AMI患者PCI治疗后心肌损伤监测及治疗有重要意义。     

急性心肌梗死合并糖尿病患者生活质量的影响因素分析

目的 探讨急性心肌梗死(AMI)合并糖尿病(DM)患者生活质量的影响因素。方法 2016年8月-2017年3月对唐山市某三甲医院心内科住院的急性心肌梗死合并糖尿病的436名患者,使用统一的一般资料问卷、营养风险筛查量表2002(NRS2002)、心肌梗死多维度量表(MIDAS)进行问卷调查。结果 AMI合并DM患者生活质量总分为(46.43±15.08)分,躯体活动、情绪反应、安全性、依赖性、药物不良反应、担心用药及饮食7个维度得分指标分别为:39.42%、32.00%、33.78%、32.08%、27.63%、13.38%、26.50%;多重回归显示,存在营养风险、年龄大、文化程度低、收入水平低和非经皮冠状动脉介入治疗术的患者生活质量较差。〖HTH〗结论 营养风险、年龄、文化程度、月收入和治疗方式是影响AMI合并DM的患者生活质量的主要因素。     

不同年龄段心肌梗塞危险因素的比较

将２２８例急性心肌梗塞病人分成三个年龄组，以规范的流行病学调查方法对常见危险因素进行了调查和测量。结果显示：６５岁以上老年组高血压、糖尿病、女性、梗塞前心绞痛病史及心电图检出的心肌缺血等暴露率高于其它两组，而吸烟、心脑血管病家族史及心肌梗塞的诱因等暴露率则低于其它两组。脂代谢标志及冠状动脉病变无显著差异。     

Incidence,admission and case-fatality of acute myocardial infarction: weekend versus weekday in a Japanese population: 16-year results from Takashima AMI Registry (1988–2003)

For acute myocardial infarction (AMI), “weekend” has been associated with higher incidence, admission, and fatality. But, very few studies in this regard are available in Japan. Day of the week variation in AMI was examined using an entire community covering 16-year AMI registration data from Japan. Data were obtained from the Takashima AMI Registry, which covers a stable population of approximately 55,000 in central Japan. There were 379 registered first ever AMI cases with 121 fatal events within 28 days of onset during 1988–2003. We divided the days into two groups: ‘Weekend’ (Saturday and Sunday) and ‘Weekdays’ (Monday to Friday). The incidence rate (per 100,000 person-year), admission rate (per 1,000 days) and 28-day case-fatality rates (per 100 events) as well as corresponding rate ratios were calculated with 95% confidence intervals. The distribution of the day of the week for onset, admission and fatality for all subjects was fairly random in our study population; incidence (χ ² test, P = 0.8), admission (χ ² test, P = 0.9) and case-fatality (χ ² test, P = 0.8). The incidence, admission, and case-fatality rates were similar for the 2 day-groups. The incidence rate ratio 1.06 (95% CI: 0.9–1.3), admission ratio 1.03 (95% CI: 0.8–1.3), and case-fatality ratio 1.18 (95% CI: 0.7–1.9) showed no significant risk difference between weekend and weekday. After various adjustments, hazard ratio for weekend AMI in reference to weekday AMI was 1.07 (95% CI: 0.5–2.1). There were no obvious differences in occurrence, hospital admission and acute outcome for AMI patients in the weekday or weekend.     

心肌损伤标志物在诊断急性冠状动脉综合征中的应用

目的：探讨肌红蛋白(Myo)与心肌肌钙蛋白T(cTnT)检测在急性冠状动脉综合征(ACS)中的应用。方法：采用胶体金免疫层析技术，检测病人不同时间采集的血标本，并对Myo与cTnT检测值进行分析。结果：72例不稳定心绞痛(UAP)患者中，Myo增高者占47．2％，cTnT增高者占80．6％；36例急性心肌梗塞(AMI)患者中，Myo增高者占61．1％，cTnT增高者占94．4％。结论：cTnT是诊断急性冠状动脉综合征的高灵敏度、高度特异的生化检测标志物。     

血清H-FABP与hs-CRP联合检测对急性冠状动脉综合征诊断及预后价值研究

目的探讨心脏型脂肪酸结合蛋白（H-FABP）与超敏C-反应蛋白（hs-CRP）联合检测对急性冠状动脉综合征（ACS）诊断及预后的价值。方法采用双向侧流免疫法检测61例急性冠状动脉综合征患者（不稳定型心绞痛（UAP）31例,急性心肌梗死（AMI）30例）及稳定型心绞痛（SAP）患者38例、健康对照组30例血清H-FABP水平,同时测定血清hs-CRP、CK-MB、cTnI水平,并作统计分析。结果 ACS组血清H-FABP、hs-CRP、CK-MB、cTnI水平明显高于SAP组及健康对照组（P〈0.01）;ACS组患者血清H-FABP水平与hs-CRP、CK-MB、cTnI呈正相关（r=0.62、0.58、0.53,P〈0.01）;SAP组、UAP组、AMI组各组间血清H-FABP和hs-CRP水平差异有统计学意义（P〈0.01）。UAP组中H-FABP阳性率明显高于hs-CRP、CK-MB cTnI（P〈0.01）.经治疗病情好转患者血清H-FABP、hs-CRP水平均明显降低（P〈0.01）。结论血清H-FABP、hs-CRP水平变化与冠状动脉病变程度密切相关,联合检测H-FABP、hs-CRP对ACS诊断及预后判断具有重要临床价值。     

三维斑点追踪技术预测急性心肌梗死患者近期急性心衰风险的研究

目的:分析三维斑点追踪技术预测急性心肌梗死(AMI)患者近期发生急性心衰的诊断价值.方法:选取医院诊治的155例AMI患者,均予抗血小板聚集、改善心肌供血等对症治疗,并对患者出院后进行为期3个月的随访,除3例患者失联外,将剩余152例患者纳入随访结果研究.将152例患者中出现急性心力衰竭的43例患者纳入心衰组,未出现心...     

The relationship between coffee consumption and serum cholesterol under consideration of smoking history

A large German population sample of 6820 men and 7258 women was used to investigate the relationship between coffee consumption, total serum cholesterol and HDL cholesterol.Analyses were conducted on men and women separately. Differences in age, body mass index, diastolic blood pressure, smoking habits, alcohol, fish, milk and tea consumption, physical activity and medication use were controlled for in the analyses. Interactions between coffee consumption and smoking habits in their relationship with serum cholesterol were part of the analyses. For men, a positive relationship between coffee consumption and total serum cholesterol was found among smokers and life-long abstainers but not in the group of ex-smokers. In women a relationship between coffee consumption and total serum cholesterol was also present, but very weak (only statistical significant in covariance analyses). Levels of HDL cholesterol did not correlate with coffee consumption in either men and women.Hypotheses concerning the peculiarities of the group of ex-smokers are developed, and supporting empirical evidence is given. It is suggested that the group of ex-smokers should always be analysed separately.     

高敏肌钙蛋白T检测在心肌梗死中应用价值的研究

目的:观察高敏肌钙蛋白T(hs-cTnT)、肌酸激酶同工酶质量(CK-MBmass)、肌红蛋白(Myo)和肌钙蛋白T(cTnT)在疾病发生及发展过程中的变化特征,研究高敏肌钙蛋白T检测在诊断急性心肌梗死方面的应用价值。方法:选取100例急性心肌梗死患者,分别在0 h、4 h、12 h抽取静脉血,正常对照组为68例空腹抽取静脉血,分别测定4项指标的含量,比较它们在不同时间内对AMI的诊断特性。结果:AMI患者发病入院后,hs-TnT的敏感性为91%,特异性为83%,阳性预测值为89%,阴性预测值为86%。结论:高敏心肌肌钙蛋白具有最好的灵敏度和较好的组织特异性,适合作为AMI早期检测指标。     

急性心肌梗死患者早期心律震荡与梗死面积及预后的关系研究

[目的]探讨急性心肌梗死(AMI)患者早期心律震荡(HRT)与梗死面积及预后的关系。[方法]选择165例早期AMI患者进行24h动态心电图(Holter)检查,计算HRT的两个参数:震荡初始(TO)和震荡斜率(TS),并对TO、TS进行分析。所有患者根据是否发生心源性死亡分为死亡组和生存组。规定12导心电图中病理性Q波导联数≥4者为大面积梗死,≤3者为小面积梗死。组间比较采用χ2检验。[结果]死亡组TO≥0且TS≤2.5ms/RR间期的阳性率显著高于生存组(P﹤0.01)。大面积AMI组TO≥0且TS≤2.5ms/RR间期的阳性率显著高于小面积AMI组(P﹤0.01)。[结论]TO,TS值的变化与AMI患者早期的心源性死亡及梗死面积密切相关。HRT的减弱或消失可作为预测AMI患者早期发生恶性心脏事件的敏感指标之一。     

急性心肌梗死类型及PCI治疗前后BNP水平的分析

目的探讨不同类型急性心肌梗死B型尿钠肽(BNP)水平及经皮冠状动脉介入(PCI)治疗前后BNP的变化。方法选取2010年7月—2011年7年于邢台市第三医院心内科住院并诊断为急性心肌梗死且行PCI治疗患者100例,分为急性ST段抬高心肌梗死组(A组)55例与急性非ST段抬高心肌梗死组(B组)45例。记录每位患者入院时及PCI术后48 hBNP水平,分析急性心肌梗死类型与BNP的关系、BNP与冠脉病变程度相关性以及BNP水平与急性心肌梗死患者6个月内发生心血管事件的关系。结果 A组BNP水平高于B组(108.8±44.3 vs 83.1±28.9 pg/ml,P<0.01)。A、B 2组术后BNP水平明显低于术前BNP,差异有统计学意义(108.8±44.3 vs 78.7±27.7,P=0.000;83.1±28.9 vs 65.1±20.9,P<0.01)。Gensini积分与术前BNP水平正相关(r=0.484,P<0.05)。术后随着BNP水平增高,心血管事件发生率有增高趋势,BNP>85.1 pg/ml组心血管事件发生率显著高于其他组并与BNP≤55.0 pg/ml组比较,差异有统计学意义(χ2=6.04,P<0.05)。结论在排除心衰因素后,冠状动脉病变程度与BNP水平呈正相关,急性心肌梗死缺血改善后BNP水平明显降低。术后BNP水平越高,6个月内心血管事件发生率越高。测定外周血BNP水平对评价冠状脉动脉病变程度及判断预后有重要参考价值。     

急性心肌梗死患者血小板相关参数与血清同型半胱氨酸测定的临床意义

目的:观察急性心肌梗死(AMI)患者的血小板相关参数、血清同型半胱氨酸的变化,探讨其检测在急性心肌梗死中的意义。方法:测定对照组与急性心肌梗死组治疗前后的血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)及血清同型半胱氨酸(Hcy)并对检验结果进行分析。结果:与对照组相比,AMI组治疗前MPV与PDW水平明显升高(P<0.01),Hcy水平升高(P<0.05),PLT水平明显降低(P<0.01),两组差别具有统计学意义,AMI组治疗后PLT水平上升,MPV、PDW、Hcy水平下降,与对照组相比差别无统计学意义。结论:监测血小板参数和Hcy的变化,有助于对急性心肌梗死的治疗和预后。     

Effects of dietary vitamin E and high supplementation of vitamin C on plasma glucose and cholesterol levels

Weanling male Sprague Dawley rats were fed ad libitum a purified basal diet free of vitamins E and C. In Experiment I (4 weeks), 24 rats were divided into four groups with 2×2 factorial design. They were supplemented with 0 or 45 IU/kg diet of vitamin E, and O or 2.0 g/kg diet of vitamin C. In Experiment II (16 weeks), 36 rats were divided into six groups with 2×3 factorial design. Vitamin E was supplemented at the level of O or 45 IU/kg diet, and vitamin C was supplemented at the level of O, 1.5, or 3.0 g/kg diet, respectively. Plasma glucose level and cholesterol level were determined in both experiments. The plasma levels of glucose and cholesterol were significantly and negatively correlated. Plasma glucose level was significantly increased and plasma cholesterol level significantly decreased by the high supplementation of vitamin C with or without vitamin E in the diet. Vitamin E deficiency decreased plasma glucose level and increased plasma cholesterol level significantly with or without vitamin C supplementation. The groups with adequate level of vitamin E (45 IU/kg diet) and no vitamin C showed moderate plasma glucose and cholesterol levels.     

Regional variations in medical expenditure and hospitalization days for heart attack patients in Japan: evidence from the Tokai Acute Myocardial Study (TAMIS)

In Japan, the use of percutaneous transluminal coronary angioplasty (PTCA) for the treatment of acute myocardial infarction (AMI) is extraordinarily frequent, resulting in large medical expenditure. Using chart-based data and exploiting regional variations, we explore what factors explain the frequent use of PTCA, employing propensity score matching to estimate the average treatment effects on hospital expenditure and hospital days. We find that the probability of receiving PTCA is affected by the density of medical resources in a region. Moreover, expenditure is higher for treated patients while there are no significant differences in hospitalization days, implying that the frequent use of PTCA is economically motivated.      

急性心肌梗死患者个性特征、负性情绪和生活方式对照研究

目的探讨急性心肌梗死患者个性特征、负性情绪和生活方式的临床特征,为临床干预提供依据。方法将60例急性心肌梗死患者设为研究组,60例正常健康者设为对照组。采用艾森克个性问卷、生活方式调查表、汉密顿抑郁量表、汉密顿焦虑量表对2组进行评定分析。结果研究组中有81.67%的患者急性心肌梗死发作前有明显心理刺激因素;艾森克个性问卷的外倾性、神经质维度分均显著高于对照组（P〈0.01）,不良生活方式占有率均显著高于对照组（P〈0.01）;汉密顿抑郁量表总分,焦虑/躯体化、认知障碍,阻滞、睡眠障碍,绝望因子分和汉密顿焦虑量表总分、躯体性焦虑、精神性焦虑因子分均显著高于对照组（P〈0.01）,不同程度抑郁及焦虑发生率均显著高于对照组（P〈0.05）。结论不良个性倾向、负性情绪和不良生活方式可能是急性心肌梗死的发病危险因素,在控制生物病因的同时,应改善不良生活方式,调整情绪,加强心理治疗,改变不良认知模式和应激情绪反应方式,有助于预防疾病的发生与康复。