急性冠脉综合征患者PCI术后肌钙蛋白I和高敏C-反应蛋白的改变及临床意义

目的探讨血清肌钙蛋白(IcTnI)和高敏C-反应蛋白(hs-CRP)在急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后的变化及临床意义。方法采用双抗夹心ELISA法测定70例行PCI术治疗的高危ACS患者和30例经冠状动脉造影正常者血清cTnI和hs-CRP水平。结果术前ACS组血清cTnⅠ、hs-CRP水平均显著高于对照组,相比较差异有显著性(P<0.05);术后AMI组、UA组血清cTnⅠ、hs-CRP水平显著升高,与术前比较差异有显著性(P<0.05);且AMI组血清cTnⅠ、hs-CRP水平均高于UA组,相比较差异有显著性(P<0.05);血清cTnⅠ和hs-CRP水平呈显著正相关性(r=0.561,P=0.001)。结论 PCI术后血清cTnⅠ和hs-CRP水平升高。cTnⅠ和hs-CR可能会做为PCI术后冠状动脉斑块不稳定性的预测指标。     

急性冠脉综合征合并糖尿病患者血清同型半胱氨酸与高敏C反应蛋白的相关性

目的观察急性冠脉综合征(ACS)及ACS合并有2型糖尿病患者血清中同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)及C-肽、胰岛素敏感指数(ISI)水平,探讨Hcy与hs-CRP及C-肽、ISI的相关性。方法对ACS患者60例,其中合并有2型糖尿病12例,对照组25例,测定血清中hs-CRP、Hcy、血清C肽、胰岛素水平并计算出胰岛素敏感指数。结果(1)ACS组中Hcy及hsCRP与对照组比均有明显差异(P<0.05),而且Hcy与hsCRP两者之间正相关(r=0.427,P<0.01);在ACS合并有2型糖尿病组Hcy与对照组无明显差异。(2)ACS组及合并有2型糖尿病的ACS组中血清C肽、ISI与对照组比较无明显差异(P>0.05);hsCRP在ACS及ACS合并有2型糖尿病组与对照组比较均有明显差异(P<0.01),但在ACS与ACS合并有2型糖尿病组之间无明显差异(P>0.05)。(3)Hcy与C肽、ISI无相关性;ISI与C肽呈负相关,Hcy与hsCRP相关。结论ACS患者血清Hcy与hsCRP呈正相关,与ISI及C肽无相关性。     

血清D-二聚体、肌钙蛋白I、超敏C-反应蛋白水平对心肌梗死患者PCI术后心力衰竭的预测价值

目的探讨D-二聚体(D-D)、肌钙蛋白I(cTnI)、超敏C-反应蛋白(hs-CRP)在预测心肌梗死患者经皮冠状动脉介入(PCI)术后心力衰竭中的应用价值。方法选取2017年1月至2018年1月100例行PCI术的急性心肌梗死(AMI)患者为研究对象,PCI术后随访半年,依据AMI患者术后是否心力衰竭分为疾病组(38例)和正常组(62例)。两组患者均于术前检测血清D-D、cTnI、hs-CRP水平与心功能[血浆B型钠尿肽(BNP)、左室射血分数(LVEF)],采用Pearson相关性分析患者的LVEF与D-D、cTnI、hs-CRP之间的相关性。结果疾病组的血清D-D、cTnI、hs-CRP水平均显著高于正常组(P0.05);疾病组的BNP水平显著高于正常组,LVEF显著低于正常组(P0.05);AMI患者的LVEF与D-D、cTnI、hs-CRP均呈显著负相关(P0.05)。结论术前血清D-D、cTnI、hs-CRP水平检测对于AMI患者PCI术后心力衰竭的发生具有一定临床价值。     

急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗前后血清血管内皮生长因子及高敏C反应蛋白水平变化与术后再狭窄

目的：联合检测急诊经皮冠状动脉介入治疗(PCI)前后血清血管内皮生长因子(VEGF)及高敏 C 反应蛋白(hs-CRP)水平变化,旨在探讨急诊 PCI 术前后血清 VEGF 及 hs-CRP 水平变化与急诊 PCI 术后再狭窄的关系。方法检测100例急诊 PCI 的 ST 段抬高型心肌梗死(STEMI)患者术前、术后3天、术后7天血清中 VEGF、hs-CRP水平,根据6个月随访冠状动脉造影结果分为再狭窄组和无再狭窄组,分析急诊 PCI 术后3天和术后7天血清 VEGF及 hs-CRP 变化水平与术后再狭窄的关系。结果急诊 PCI 术前血清 VEGF 水平高于术后3天和7天水平(P <0.01);急诊 PCI 术前血清 hs-CRP 水平低于术后3天水平,而高于术后7天水平(P <0.01)。再狭窄组急诊 PCI 术前血清 VEGF 水平显著低于无再狭窄组(P <0.05);术后3天血清 VEGF 水平与无再狭窄组无明显差别(P >0.05);术后7天血清 VEGF 水平与无再狭窄组无明显差别(P >0.05);术后3天血清 VEGF 下降幅度明显低于无再狭窄组(P <0.05)。再狭窄组急诊 PCI 术前血清 hs-CPR 水平与无再狭窄组无差别(P >0.05);术后3天血清 hs-CRP 水平与无再狭窄组无明显差别(P >0.05);术后7天血清 hs-CPR 水平与无再狭窄组无明显差别(P >0.05);术后3天血清 hs-CPR 升高幅度明显高于无再狭窄组(P <0.05)。急诊 PCI 术后3天血清 VEGF 下降幅度与急诊 PCI术后支架再狭窄呈负相关(r s =-0.411,P <0.05);术后3天血清 hs-CPR 升高幅度与急诊 PCI 术后支架再狭窄呈正相关(r s =0.414,P <0.05)。结论急诊 PCI 术后3天血清 VEGF 及 hs-CRP 变化水平与急诊 PCI 术后再狭窄高度相关,联合检测急诊 PCI 术后3天血清 VEGF 下降的幅度及术后3天血清 hs-CRP 升高的幅度,或可成为预测急诊PCI 术后再狭窄的生化指标。     

血清可溶性凝集素样氧化低密度脂蛋白受体-1水平对PCI围术期相关性心肌梗死的预测价值

[目的]探讨血清可溶性凝集素样氧化低密度脂蛋白受体-1(sLOX-1) 预测经皮冠状动脉介入术(PCI)围术期相关性心肌梗死的价值.[方法]选择2013年1月至2014年11月本院心脏中心收治的91例冠心病(CHD)患者的临床资料,PCI术前血肌钙蛋白I (cTnI)水平均小于0.01 ng/mL,根据PCI术后血清cTnI水平将患者分为阳性组(血清cTnI水平≥0.05 ng/mL,且经临床诊断为PCI相关性心肌梗死)和阴性组(血清cTnI水平<0.05 ng/mL未发生PCI相关性心肌梗死).观察比较两组患者PCI围术期血清sLOX-1、cTnI水平,分析血清sLOX-1水平与cTnI的相关性.[结果]PCI相关性心肌梗死发生率为12.1%.阳性组PCI术前血清sLOX-1水平明显高于阴性组[(150.1±65.9)ng/L vs (66.1±28.7) ng/L],差异具有统计学意义(P<0.001);阳性组PCI术后血清sLOX-1水平也明显高于阴性组[(154.6±64.3)ng/L vs (67.0±28.8) ng/L],差异具有统计学意义(P<0.001).阳性组PCI术前血清sLOX-1水平与PCI术后cTnI呈显著正相关(r=0.668,P<0.05).[结论]血清sLOX-1水平在一定程度上可预测PCI围术期相关性心肌梗死.     

经桡动脉行PCI术联合术后伊伐布雷定对冠心病患者疗效及对冠脉再狭窄发生率、血清ET水平的影响

目的 探讨经桡动脉行PCI术联合术后伊伐布雷定对冠心病患者疗效及对冠脉再狭窄发生率、血清内皮素(Endothelin, ET)水平的影响。方法 选取2021年1月—2022年8月贵州省纳雍县人民医院经桡动脉行PCI术的120例冠心病患者为研究对象,按照随机数表法分为对照组和观察组,各60例。对照组术后给予常规治疗,观察组在此基础上联合伊伐布雷定治疗。比较两组患者的临床资料、手术指标、疗效(有效率、炎性反应、复发心绞痛率)、冠脉再狭窄发生率及血清ET水平。结果 与对照组(76.67%)相比,观察组的治疗有效率(93.33%)更高,差异有统计学意义(χ²=6.614,P<0.05);观察组的C-反应蛋白、白细胞计数、心绞痛复发率、冠脉再狭窄率、血清ET水平均低于对照组,差异有统计学意义(P均<0.05)。结论 经桡动脉行PCI术联合术后伊伐布雷定能够提高冠心病患者的临床疗效,降低冠脉再狭窄发生率,降低血清ET水平。     

生化参数对老年急性冠脉综合征患者预后的影响

目的:探讨生化参数对经皮冠状动脉腔内血管介入术(PCI)治疗老年急性冠脉综合征(ACS)患者预后的影响.方法:对40例ACS患者在常规治疗的基础上行PCI,分别测定介入前、介入后12 h和介入后2周的生化项目,包括CK-MB、cTnI和hs-CRP,并观察症状体征和心电图的变化.结果:本组患者均CK-MB、cTnI 符合ACS的动态变化,未发现术后再次升高的病例.PCI术后12 h血清hs-CRP水平较术前升高,有统计学意义(P<0.05),但2周后降至正常.结论:介入治疗可加剧冠脉局部炎症反应,使hs-CRP升高,随着血管开通以及他汀类药物的应用,炎症反应逐渐减轻.CK-MB、cTnI的介入前后变化在本组病例中符合ACS的一般规律.制订ACS介入治疗的临床护理指导原则是非常必要的.     

急性冠脉综合征患者血清炎性指标及肌钙蛋白I的临床研究

目的 研究急性冠脉综合征患者(ACS)血清炎性指标的水平与肌钙蛋白I的关系及临床意义.方法 测定冠脉造影阳性的ACS患者74例、稳定型心绞痛(SAP)患者58例和造影阴性的冠心病患者46例(对照组)血清超敏C-反应蛋白,(hs-CRP)、白介素-6(IL-6)、可溶性P-选择素(sP-sel)和肌钙蛋白I(cTnI)的水平,并采集相应的各项临床资料.结果 ACS组患者血清各项炎性指标分别为hs-CRP(7.40±2.90)mg/L、IL-6(235.62±87.03)ng/L、sP-sel(87.82±36.02)mg/L、cTnl(4.38±3.85)mg/L,高于SAP组患者和对照组,差异均有统计学意义(t分别=6.52、4.94、2.97、7.23、8.96、5.63、3.32、8.67,P均＜0.05);cTnI增高患者各血清炎性指标分别为hs-CRP(8.74±1.61)mg/L、IL-6(265.33±66.62)ng/L、sP-sel(99.43±25.42)m/L,明显高于cTnI正常者,差异均有统计学意义(f分别:4.59、3.92、3.65,P均＜0.05).结论 血清炎性指标在ACS患者中均表现为增高.cTnI与血清各项炎性指标具有相关性.cTnI及血清各项炎性指标与冠脉内斑块的不稳定状态具有相关性.     

脑梗死患者血清hs-CRP联合cTnI和血脂水平检测及其临床意义

目的探讨脑梗死患者血清超敏C反应蛋白(hs-CRP)、肌钙蛋白I(cTnI)水平及低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、三酰甘油(TG)、总胆固醇(TC)等反映血脂水平指标的变化及临床意义。方法对脑梗死组92例患者(轻型脑梗死组29例、中型脑梗死组36例、重型脑梗死组27例)进行血清hs-CRP、cTnI及LDL-C、HDL-C、TC、TG等血脂指标水平的检测,并与健康对照组的40例健康受试者进行比较分析。结果脑梗死组血清hs-CRP、cTnI及LDL-C、TC、TG等血脂水平高于健康对照组(P<0.05),血清HDL-C水平低于健康对照组(P<0.05);轻、中型脑梗死组血清hs-CRP、cTnI及LDL-C、TC、TG等血脂指标水平均低于重型脑梗死组,HDL-C水平均高于重型脑梗死组,差异均有统计学意义(P<0.05);轻型脑梗死组血清hs-CRP、cTnI水平均低于中型脑梗死组(P<0.05)。血清hs-CRP与LDL-C、TC、TG等血脂指标水平均呈正相关(P<0.05),与血清HDL-C水平呈显著负相关(P<0.05),血清hs-CRP与cTnI水平呈显著正相关(P<0.05)。结论检测脑梗死患者血清hs-CRP、cTnI及LDL-C、HDL-C、TC、TG等血脂指标水平对患者病情评估及治疗均具有重要的临床意义。     

急性冠脉综合征患者血清抵抗素和超敏C反应蛋白水平及临床意义

目的 探讨急性冠脉综合征(ACS)患者血清抵抗素和超敏C反应蛋白(hs-CRP)水平的动态变化及临床意义。方法ACS患者70例根据发病类型细分为不稳定型心绞痛组(UAP组,25例)、急性ST段抬高型心肌梗死组(STEMI组,25例)和急性非ST段抬高型心肌梗死组(NSTEMI组,20例),同时选取35例健康体检人员为对照组。分别检测对照组和ACS组患者胸痛发作后1、3、7、14 d的血清抵抗素和hs-CRP水平。结果 不同时间点下ACS组患者血清抵抗素与hs-CRP水平均显著高于对照组(P<0.05),且血清抵抗素与hs-CRP水平在3 d达到最大值;ACS组患者血清抵抗素水平与hs-CRP水平呈正相关(P<0.01);胸痛发作3 d时,STEMI组、NSTEMI组患者血清抵抗素水平均显著高于UAP组(P<0.05)。结论 血清抵抗素与hs-CRP共同参与了ACS的发生发展,二者水平变化可能与ACS病情严重程度相关。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.