血栓抽吸联合盐酸替罗非班用于心肌梗死急诊介入治疗中的临床效果

目的分析心肌梗死介入治疗中血栓抽吸联合盐酸替罗非班治疗的效果。方法 2013年12月至2015年4月笔者收集急诊经皮冠状动脉介入(PCI)治疗的急性ST段抬高性心肌梗死(STEMI)64例,冠状动脉造影提示高度血栓负荷。根据治疗方法随机分为观察组(血栓抽吸联合盐酸替罗非班)和对照组(仅行PCI术)。结果 PCI术后,观察组MPG 3级以及TIMI血流3级发生率均高于对照组;随访1年,观察组主要心血管不良时间(MACE)、靶血管血运重建(TVR)及靶病变再次血运重建(TLR)发生率均低于对照组(P均0.05)。结论血栓抽吸联合盐酸替罗非班能显著改善高度血栓负荷的急性ST段抬高性心肌梗死患者TMPG分级、TIMI血流,改善患者1年生存质量。     

盐酸替罗非班在急诊冠状动脉介入术中的应用

报告了盐酸替罗非班在84例急性ST段抬高型心肌梗死(ST elevation acute myocardial infarction,STEMI)患者急诊冠状动脉介入术(PCI)中的应用。46例患者术中、术后使用替罗非班,术后24h及30dMACE的发生率明显低于以往只用PCI的患者,并且提高了梗死相关血管(IRA)心肌灌注血流(TIMI),但使用替罗非班组的患者出血事件稍多。总之盐酸替罗非班应用于急诊PCI术治疗急性STEMI患者效果良好,可减少并发症的发生。     

替罗非班联合急诊PCI对急性心肌梗死疗效观察

目的了解急性心肌梗死（AMI）行急诊经皮冠状动脉介入治疗（PCI）时,应用替罗非班改善冠状动脉血流和临床预后的疗效。方法所有确诊ST段抬高性心肌梗死（STEMI）并于发作6h内行急诊PCI手术患者80例,随机分为治疗组（A组）和控制组（B组）各40例,两组均给予急诊PCI术及氯吡格雷、阿司匹林、肝素和低分子肝素、他汀类、β受体阻滞剂等治疗,A组另给予替罗非班静脉内使用,观察两组在病变性质和术后即刻靶血管TIM／血流分级、术后心电图改变（ST段回落幅度）、术后30d内心脏不良事件（MACE）及出血事件发生率,并随访出院后MACE发生情况。结果A组PCI术后即刻靶血管TIMI血流分级明显高于B组,使用替罗非班治疗期间,A、B组出血事件及血小板减少症发生率比较,差异无统计学意义（P〉0．05）,A组术后ST段回落幅度较B组明显、30d内MACE发生率明显低于B组,随访期间心血管不良事件发生率A组明显低于B组。结论在阿司匹林、氯吡格雷抗血小板治疗的基础上,ACS患者急诊PCI术中应用替罗非班比单纯PCI术及常规药物治疗,能进一步改善心肌灌注,从而改善预后。     

比伐卢定和普通肝素在急诊PCI患者中的应用及护理

目的:探讨急性ST段抬高型心肌梗死行急诊PCI患者术中应用比伐卢定和普通肝素的安全性。方法:将75岁以上急性ST段抬高型心肌梗死行急诊PCI患者177例随机分为对照组89例和观察组88例,两组均常规应用急性心肌梗死药物治疗,对照组术中给予普通肝素,观察组术中使用比伐卢定。比较两组术后发生上消化道出血的发生率。结果:观察组上消化道出血发生率与对照组比较差异有统计学意义(χ2=8.234,P=0.03)。结论:75岁以上老年急性PCI患者术中应用比伐卢定的上消化道出血率低于应用普通肝素,安全性更高。     

盐酸替罗非班在急性心肌梗死急诊冠脉介入治疗中的应用

目的：分析Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班对ST段抬高急性心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）中TIMI血流的影响。方法：选择急诊入院STEMI患者96例,分为试验组（盐酸替罗非班＋PCI）54例和对照组（直接PCI）42例,收集所有病例临床和冠状动脉造影资料,观察PCI术前、术后TIMI血流情况。结果：试验组于术前应用盐酸替罗非班使PCI前梗死相关血管TIMI血流分级提高,试验组达1级血流者比例高于对照组（37%比9.5%,P〈0.05）,对照组完全闭塞者比例明显高于试验组（38.1%比7.4%,P〈0.01）。结论：Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班可改善STEMI患者梗死相关血管TIMI血流。     

早期应用替罗非班对急诊ST段抬高型心肌梗死患者经皮冠状动脉介入术后机体状况的影响

目的探讨早期应用替罗非班对急诊ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后炎症反应、血管造影和临床结果的影响。方法将123例STEMI行PCI患者分为观察组(n=65)和对照组(n=58)。观察组应用替罗非班,对照组未应用替罗非班。比较2组患者入院时和治疗3 d后血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和降钙素原(PCT)水平;比较2组患者术后TIMI 3级血流恢复率、校正TIMI帧数及术后90 min的ST段回落高于75%、30 d主要不良心脏事件(MACE)和住院期间出血事件的发生率;对MACE的影响因素进行单因素和多因素分析。结果治疗3 d后,观察组hs-CRP、IL-6、PCT低于对照组,差异均有统计学意义(P<0.05)。与对照组相比,观察组术后梗死相关血管的TIMI 3级血流恢复率较高,校正TIMI帧数较低,术后90 min ST段回落高于75%的发生率较高,30 d的MACE发生率较低,差异均有统计学意义(P<0.05)。单因素分析显示,MACE组患者糖尿病患病率、Killip心功能分级和血肌酐高于非MACE组,收缩压低于非MACE组,差异有统计学意义(P<0.05)。多因素分析显示,入院时心功能分级、收缩压和早期应用替罗非班是MACE的独立影响因素(P<0.05)。结论早期应用替罗非班可减轻急诊STEMI行PCI患者术后炎症反应,改善血管造影和临床结果,且是MACE的独立影响因素。     

替罗非班在急性心肌梗死患者急诊介入治疗术中的疗效和安全性评价

目的观察盐酸替罗非班在急性ST段抬高型心肌梗死患者急诊介入治疗术中的疗效和安全性。方法58例急性ST段抬高型心肌梗死患者随机分为2组，其中盐酸替罗非班（欣维宁）组30例，对照组28例，均于发病12h内行急诊经皮冠状动脉介入治疗术（PCI）。盐酸替罗非班（欣维宁）组PCI术中即刻静脉予负荷量0．4ug/kg·min^-1×30min，维持量0．15ug／kg·min^-1×36h。两组患者PCI术中均给予肝素8000～10000U。PCI术前服用氯吡格雷300mg，阿司匹林300mg，术后各75mg／d，观察PCI术前、术后梗死相关血管TIMI血流情况、术后4周内并发症及主要不良心脏事件的发生情况。结果盐酸替罗非班组PCI术后慢复流发生率及主要不良心脏事件的发生率均低于对照组，差异有统计学意义。出血并发症的发生率高于对照组，差异无统计学意义。结论盐酸替罗非班能改善急性心肌梗死患者PCI术后梗死相关血管的TIMI血流，减少PCI术后主要不良心脏事件的发生率，临床应用安全有效。     

替罗非班在急诊经皮冠状动脉介入治疗急性

目的 探讨替罗非班在急诊经皮冠状动脉介入治疗(PCI)急性ST段抬高型心肌梗死(STEMI)中的应用价值.方法 选择急性STEMI患者90例,随机分为观察组与对照组各45例,对照组给予常规PCI术治疗,观察组给予PCI术联合替罗非班治疗,观察两组疗效与出血事件等.结果 治疗后,两组患者均获得良好的血流灌注,且观察组显著优于对照组(P＜0.05);观察组ST段回落幅度显著优于对照组(P＜0.01);右室射血分数(LVEF)均显著优于治疗前(P＜0.05),且治疗后观察组显著优于对照组(P＜0.01);观察组血清肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTNT)及血小板聚集率均显著低于对照组(P＜0.01),且不良心血管事件(MACE)发生率显著低于对照组(P＜0.05);观察组术后出血并发症发生率略高于对照组,但无统计学差异(P＞0.05).结论 替罗非班在急诊PCI治疗急性STEMI中具有肯定的疗效,但可能增加出血风险,临床应用中应注意监测.     

盐酸替罗非班用于行PCI的ST段抬高型急性心肌梗死患者的临床护理研究

目的:探讨对ST段抬高急性心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)术中、术后应用盐酸替罗非班的效果、安全性及相关护理问题.方法:选择50例行急诊PCI的STEMI患者应用盐酸替罗非班(除有禁忌证),为盐酸替罗非班组.对照组为50例行急诊PCI的STEMI患者,未应用盐酸替罗非班,两组进行对照研究.观察两组患者心电图ST段下降幅度及出血情况,观察患者住院期间及出院后主要心脏不良事件(MACE,包括死亡、非致命性再梗死、靶血管再血管化治疗)的发生.结果:STEMI患者行PCI术应用盐酸替罗非班安全有效,能够较早改善STEMI患者直接PCI术后冠脉微循环灌注状态,但增加出血倾向,未增加大出血发生率,临床工作中应严密观察用药后穿刺部位和全身出血情况,采取有效的护理措施.结论:对STEMI行直接PCI治疗护理者,除充分给予阿司匹林、氯吡格雷和肝素外,还应联合应用盐酸替罗非班,采取有效的护理措施,有助于减少急诊PCI的STEMI患者血栓栓塞和无复流、慢复流现象发生,降低术后不良心脏事件的发生,改善患者症状和预后,使早期行介入治疗的ACS患者明显受益.     

替罗非班联合不同时间介入治疗对急性ST段抬高型心肌梗死的影响

目的 探讨替罗非班联合不同时间经皮冠状动脉介入治疗(PCI)对急性ST段抬高型心肌梗死(STEMI)冠脉血流的影响.方法 连续入选符合入选条件的412例STEMI患者,根据是否应用替罗非班分为替罗非班组(n＝195)和常规组(n＝217),两组患者均根据指南和实际情况进行急诊PCI、补救PCI、易化PCI、溶栓后PCI和单纯PCI.所有患者均进行PCI术前、术后TIMI血流和校正的TIMI帧数(cTFC)计算及比较.结果 虽然术前两组患者各种指标比较差异无统计学意义(P>0.05),但替罗非班组cTFC术后即刻明显小于常规组(P<0.05),尤其是在急诊PCI时,替罗非班组cTFC与常规组比较差异有统计学意义(P<0.01).结论 替罗非班联合介入治疗STEMI可以有效改善梗死心肌区微循环,提示替罗非班治疗STEMI安全、有效,尤其是对急诊PCI获益更大,值得临床进一步深入研究.     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Erythropoietin and uremic platelet aggregation in vivo and in vitro

Erythropoietin treatment is known to correct anemia and to improve hemostasis. Since platelets may contribute to thromboembolic complications, we assessed platelet aggregation in whole blood and platelet-rich plasma from chronically hemodialyzed patients treated with erythropoietin and evaluated in vitro effects of this drug on aggregatory responses of uremic and normal platelets. Recombinant human erythropoietin was given to uremic patients at a dose of 2.000 IU subcutaneously three times a week. Platelet aggregation in whole blood and platelet-rich plasma was induced by collagen, ADP, arachidonic acid, and ristocetin. In uremic patients, erythropoietin therapy resulted in an enhancement of platelet sensitivity to various agonists, particularly in platelet-rich plasma, reaching values comparable to those of healthy volunteers. In vitro studies we were unable to show any direct effect of erythropoietin, used at concentrations that occurred post intravenous administration, on platelet aggregation both in whole blood and in platelet-rich plasma.     

Responses in extracellular and intracellular calcium and magnesium in aldosteronism

We hypothesized the hypercalciuria and hypermagnesuria that accompany aldosteronism could be pharmacologically attenuated to prevent shifts in extracellular and intracellular levels of these divalent cations and the adverse outcomes associated with them. Accordingly, rats administered aldosterone/salt treatment (ALDOST) were cotreated with either hydrochlorothiazide (Hctz), to selectively reabsorb urinary Ca2+, or with Hctz plus spironolactone (Hctz+Spi), where Spi retards the excretion of these cations in both urine and feces. We monitored urinary excretion and responses in extracellular and intracellular Ca2+ and Mg2+, together with indices of oxi/nitrosative stress in plasma and ventricular tissue. At 4 weeks ALDOST we found the following: (1) hypercalciuria was reduced by Hctz and normalized by Hctz+Spi, and this combination, unlike Hctz alone, also rescued hypermagnesuria; (2) the decrease in plasma-ionized [Ca2+]o was not seen with Hctz or Hctz+Spi, whereas Spi cotreatment protected against a decline in [Mg2+]o; (3) the Ca2+ loading of peripheral blood mononuclear cells and cardiac tissue was not seen with Hctz+Spi; and (4) the induction of oxi/nitrosative stress, expressed as reduced plasma alpha1-antiproteinase activity and activation of gp91(phox) subunit of NADPH oxidase in inflammatory cells invading intramural coronary arteries of the right and left ventricles, together with vascular fibrosis, was completely prevented by Spi cotreatment. In rats with aldosteronism, cotreatment with Hctz+Spi more effectively (vis-à-vis Hctz alone) protects against adverse iterations in extracellular and intracellular concentrations of Ca2+ and Mg2+, as well as the appearance of oxi/nitrosative stress to prevent the proinflammatory vascular phenotype.     

Rosamicin in Urethral and Vaginal Secretions and Tissues in Dogs and Rats

In animal studies we investigated the distribution of rosamicin in plasma and urethral and vaginal tissues in rats as well as in urethral and vaginal secretions in dogs. We found concentration ratios between urethral secretion and plasma of 1.9 and between vaginal secretion and plasma of 2.4. The rosamicin concentrations in urethral and vaginal tissue significantly exceeded the levels of all other tissues investigated. Because rosamicin could be valuable for the treatment of bacterial urethritis and the colonization of the vaginal introitus with fecal bacteria in women, it should be investigated clinically in this respect.     

Similarities and differences in clients treated and in medications prescribed by APRNs and psychiatrists in a CMHC

This study is part of a larger study comparing prescribing practices of psychiatrists and advanced practice psychiatric nurses (APRNs) using the following three groups of patients: patients treated by psychiatrists, those treated by APRNs, and those treated by both APRNs and psychiatrists at different times in 1 year. Demographics for 5507 patients were examined. A subsample of APRNs and psychiatrists prescribed similar total numbers of medications. Psychiatrists prescribed more types of antidepressant medications other than the SSRI antidepressants, and they prescribed more than twice the number of benzodiazepines. APRNs prescribed more SSRIs and spent more time with clients during medication visits.     

Postural strategies and falls in elderly and in parkinsonism]

OBJECTIVE: To use a posture analysis to show the evolution of postural pattern connected with falls.MATERIAL AND METHOD: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year. RESULTS: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters. DISCUSSION: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies. CONCLUSION: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.