中国经皮冠状动脉介入治疗后康复程序(试用稿)

国内、外研究证明经皮冠状动脉介入治疗(PCI)后的患者是适合心脏康复的对象[1,2];PCI后患者经心脏康复医疗(教育、运动、)较对照组可显著增加运动贮量[3～5,11,12],降低血脂水平[5,11,12],显著改善心功能,减少心肌耗氧量[7,8],显著减少再狭窄[9,11] ,减少并发症[11,12].     

积极推进冠状动脉旁路移植术后心脏康复

近年来,随着社会经济的发展和人民生活的改善,我国心血管疾病患病率及死亡率逐年升高[1]。由于每年冠心病患者人数的不断上升,接受冠状动脉旁路移植术(CABG)的患者人数也在逐年递增。因此,积极实施CABG后心脏康复,实现心血管全生命周期的健康管理,体现以疾病为中心向健康为中心转化,践行“健康中国行动”,既是国家的宏伟目标,也是每个医务工作者责无旁贷的使命。为了进一步规范学科发展的方向,普及全国各级医院对CABG后心脏康复的认识,以及指导我国健康产业的发展,国家心血管病中心、CABG后心脏康复专家共识编写委员会在2016年发布的《中西医结合冠状动脉旁路移植术Ⅰ期心脏康复专家共识》[2]的基础上,结合近年来国内外CABG后心脏康复的重要临床研究结果[3-13],针对CABG后心脏康复的临床实践进行科学论证后达成《冠状动脉旁路移植术后心脏康复专家共识》(以下简称“共识”),以期对我国心脏康复起到积极的指导意义。     

运动疗法对冠心病PTCA术后患者疗效的影响

目的:探讨运动疗法在改善冠心病经皮冠状动脉腔内成形术(PTCA)后患者血脂水平,减少心脏事件发生, 提高患者生活质量中的应用价值。方法:冠心病PTCA术后患者126例随机均分为康复组和对照组,康复组在冠心病药物治疗的基础上,增加运动训练。结果:康复组运动后总胆固醇,高密度脂蛋白-胆固醇水平明显改善,生活质量高于运动前,而心脏事件发生率明显低于对照组(P均<0．05)。结论:运动疗法能明显提高冠心病PTCA患者的运动耐受力,降低其血脂水平,改善其预后。     

早期个体化心脏康复护理对急诊心肌梗死患者疗效的影响研究

目的探讨早期个体化心脏康复护理对急诊经皮冠状动脉介入治疗术后心肌梗死患者疗效的影响。方法纳入我院于2020年1-12月间急诊收治的100例心肌梗死患者作为研究样本,均行经皮冠状动脉介入治疗术,采用随机数字表法分为两组,各50例,观察组给予早期个体化心脏康复护理,对照组给予常规护理,评价两组护理效果。结果在心功能指标与生活活动能力上,两组研究对象在护理前无显著差异（P>0.05）,观察组在护理后的LVEF、6min步行距离以及MBI分别为[（55.37±3.06）%、（35.48±5.36)m、（67.95±10.18）分]均比对照组高[（47.56±3.27）%、（47.65±5.58)m、（56.25±9.84）分],差异有统计学意义（P<0.05）;观察组心血管不良事件发生率（2.00%）低于对照组（10.00%）,差异有统计学意义（P<0.05）。结论早期个体化心脏康复护理应用于急诊经皮冠状动脉介入治疗术后心肌梗死患者中,可改善其心功能,提高生活质量,降低并发症风险,具有良好的临床应用前景。     

心脏Ⅰ期、Ⅱ期运动康复对冠心病PCI术后患者心功能、生活质量及血清和肽素水平的影响

目的:探讨心脏I期、II期运动康复对冠心病(CHD)PCI术后患者心功能、生活质量及血清和肽素水平的影响。方法:在我院行PCI治疗出院的120例CHD患者,被随机均分为常规治疗组(接受常规护理、术后12周的健康宣教以及6个月的常规随访)和运动康复组(在常规治疗组基础上接受6个月的心脏康复I期、II期运动训练)。观察比较两组入院时、术后1个月、6个月的心功能、西雅图心绞痛调查表(SAQ)评分和血清和肽素水平。结果:与常规治疗组比较,运动康复组术后1个月的6min步行距离(6MWD)[(395.32±14.49)m比(418.75±18.14)m]显著升高,P=0.001;术后6个月LVEF [(52.77±6.60)%比(66.42±7.85)%]、6MWD[(416.39±19.85)m比(431.47±23.90)m]显著升高,左室舒张末期内径(LVEDd)[(5.42±0.79)cm比(4.77±0.83)cm]显著降低,P均=0.001。与常规治疗组比较,术后6个月运动康复组SAQ 5个维度得分及总分[(296.46±37.14)分比(378.68±42.66)分]均显著升高,P均=0.001。与常规治疗组比较,运动康复组术后1个月、6个月的血清和肽素水平[1个月:(7.64±1.42)pmol/L比(6.75±1.22)pmol/L,6个月:(5.11±1.18)pmol/L比(3.65±1.05)pmol/L]均显著降低,P均=0.001。结论:对冠心病PCI术后患者实施心脏I期、II期运动康复治疗,可显著提高患者心功能、改善生活质量以及降低血清和肽素水平。     

心力衰竭的心脏康复运动

心力衰竭(HF)为临床病理综合征,以往认为应限制HF患者的活动以减少循环负荷,近年来,研究认为HF患者进行适量运动训练有益康复[1]。1心脏康复运动的目的心脏康复运动的目的是提高心脏的功能水平,改变疾病的自然进程,减少心衰发生率和病死率,提高生活质量。研究证实,通过降低危险     

急性心肌梗死患者PCI术后的心脏康复现状及进展

<正>由于人们生活方式的变化和生活水平的提高,人群中当中冠心病、高血压等心血管疾病的发病率也随之增加,其中急性心肌梗死(AMI)明显增加~(〔1〕)。同时随着医疗水平的提高,越来越多的AMI患者得到经皮冠状动脉介入术(PCI)治疗的机会也大大增加,这也使得AMI患者PCI术后相应的心脏康复在冠心病患者心脏康复当中所占得比重也显著增加了。1 AMI患者PCI术后心脏康复的目的与意义     

经皮冠状动脉介入治疗术后康复运动治疗机制的研究进展

近年来我国冠心病的发病率不断上升,经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)已广泛应用于冠状动脉病变的治疗,大大提高了冠心病患者尤其是心绞痛、心肌梗死患者的存活率和生活质量。但PCI术前冠状动脉的狭窄或闭塞病变导致的缺血或坏死心肌严重影响着心功能及PCI术后再狭窄和心肌再缺血的发生,是影响其远期疗效的重要原因,除加强抗栓、调脂等治疗外,有效的康复运动训练可改善缺血心肌的血供和坏死心肌的功能,提高患者的生活质量,减少病死率,延缓或阻止冠状动脉粥样硬化的发生和发展。本文就PCI术后的运动康复治疗的机制做简要综述。     

冠状动脉支架置入术对老年冠心病患者心肌纤维化和左心功能的影响

目的 比较老年冠心病患者行冠状动脉支架置入术前、术后心肌纤维化的程度及左心功能的变化. 方法 经冠状动脉造影证实为单支血管病变的冠心病老年患者121例,在心肌梗死溶栓试验(TIMI)血流分级、症状及心肌流量储备分数(FFR)综合指导下行冠状动脉支架置入术,术后12个月复查冠状动脉造影,采用酶联免疫吸附法(ELISA)测定并比较患者术前、术后3个月、12个月血清Ⅰ型前胶原(PC I)、Ⅲ型前胶原(PCⅢ)、层黏蛋白(LN)、透明质酸(HA)以及醛固酮(ALD)水平的变化;左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、血浆N末端B型脑钠肽前体(NT-proBNP)水平及6 min步行试验(6 MWD)改善情况;并对FFR与PCⅢ、PCⅢ,NT-proBNP、ALD与PC I、PCⅢ、LN、HA进行相关性分析. 结果 患者支架置入术均成功,术后12个月复查冠状动脉造影,6例患者置入支架内或其他大血管存在不同程度狭窄,FFR为0.56～0.82;术后3个月血清PC Ⅰ、PCⅢ、LN、HA、ALD水平和LVEDD及NT-proBNP较术前降低(均P＜0.05),术后12个月更显著(P＜0.01);FFR与PCⅢ呈负相关(r=-0.67,P＜0.01);PCⅢ与NT-proBNP和ALD与PC Ⅰ、PCⅢ、LN、HA均呈正相关(r值分别为0.67、0.52、0.55、0.46、0.51,均P＜0.01).结论 老年冠心病患者在TIMI分级、症状及FFR综合指导下行单支冠状动脉支架置入术,能减轻心肌纤维化,改善心功能,提高生活质量.     

无创检查对冠状动脉旁路移植术疗效的评价

目的 采用组织多普勒超声心动图联合核素心肌断层显像技术评价冠状动脉旁路移植(CABG)术的治疗效果.方法 86例需行CABG手术治疗的冠状动脉粥样硬化性心脏病(冠心病)患者(其中男性62例、女性24例,年龄41～76岁),于术前 1 周、术后 4 周行组织多普勒超声心动图检查和99m锝-甲氧基异丁基异腈心肌断层显像检查.按冠状动脉分布观察心脏节段室壁运动,测量左心室收缩末容积(LVESV)、舒张末容积(LVEDV)、左室射血分数(LVEF)等参数,定量分析心肌灌注缺损部分的范围和程度.结果 CABG术后 4 周超声心动图检查各指标与术前相比,心脏局部室壁运动异常明显改善,LVEsV,LVEDV显著降低,LVEF等显著增加.术后核素心肌断层显像检查发现有 63 例(73%)心肌灌注缺损而积和程度由术前 71.4%减少到54.6%,改善约16.8%(P＜0.01).结论 CABG 术可明显减少心肌灌注缺损而积,有效提高心脏功能.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.