循环内皮脂酶阳性细胞比例与超敏C-反应蛋白在冠心病患者临床预后中的作用

目的随访检测冠心病患者内皮脂酶阳性的循环内皮细胞比例（EL＋/CECs）和超敏C-反应蛋白（hsCRP）6个月以上,探讨二者在临床预后中的作用。方法107例急性冠脉综合征（ACS）患者和69例稳定型心绞痛（SAP）患者,经冠状动脉（冠脉）造影证实有明显冠脉狭窄;经临床检查和选择性冠脉造影选择82例对照组患者。采集肘静脉血液标本,检测hsCRP,分离循环内皮细胞（CEC）,以免疫组化法检测CEC中EL的表达,并计算EL＋/CECs。所有患者进行6个月以上随访,记录心脏事件（反复心绞痛发作、非致死性心肌梗死、心源性死亡）,分析hsCRP、EL＋/CECs与心脏事件发生的关系。结果3组患者一般情况差异无统计学意义;hsCRP、EL＋/CECs差异有统计学意义（P〈0.05或P〈0.01）,其中以ACS组值最大,对照组值最小。所有研究对象随访结果发现,与低于hsCRP或EL＋/CECs均值（hsCRP为2.64mg/L,EL＋/CECs为25.27）的患者比较,高于均值的患者心脏事件的发生率显著增高（P均〈0.01）。回归分析发现,hsCRP与EL＋/CECs均可作为心脏复合事件的预测因子,二者结合起来,可显著提高预测价值。结论冠心病患者血管内皮细胞表达的EL可能参与了冠心病发病,EL＋/CECs可作为冠心病临床预后的预测因子,联合使用EL＋/CECs与hsCRP可显著提高冠心病患者预后的预测效率。     

TIMI危险积分对冠心病严重程度评估价值的临床研究

目的　探讨 TIMI危险积分对冠心病 (CAD)严重程度的评估和预后预测的价值。方法　对 12 6例 CAD患者分别进行 TIMI危险积分评估和冠状动脉 (冠脉 )造影 ,分析 TIMI危险积分与冠脉狭窄程度、病变范围、病变性质的相关关系 ;比较 4种类型冠心病如稳定型心绞痛 (SA)、不稳定型心绞痛 (U A)、非 ST段抬高性心肌梗死 (NSTEMI)和 ST段抬高型心肌梗死 (STEMI)患者的 TIMI危险积分、冠脉狭窄程度、病变范围及病变性质的差异。结果　 TIMI危险积分与冠脉狭窄程度、病变范围、病变性质积分均有良好的相关性(r值分别为 0 .6 0 7、0 .5 6 9和 0 .36 7) ,TIMI危险积分越高 ,冠脉病变越重。SA与 U A、NSTEMI和 STEMI之间 ,UA与 NSTEMI和 STEMI之间 TIMI危险积分、冠脉狭窄程度积分差异有统计学意义 (P均 <0 .0 5 ) ;SA的 TIMI危险积分和狭窄程度积分明显低于急性冠脉综合征 (ACS) ,UA的 TIMI危险积分和狭窄程度积分明显低于心肌梗死 (MI) ,NSTEMI与 STEMI之间差异无统计学意义 (P>0 .0 5 ) ;4种类型冠心病病变范围相互比较 ,差异均无统计学意义 (P均 >0 .0 5 ) ;SA与 U A、NSTEMI和 STEMI之间病变性质积分比较 ,差异有统计学意义 (P均 <0 .0 5 ) ,SA的病变性质积分低于 ACS,而 U A、NSTEMI和 STEMI3者之间病变性质积分     

调脂和抗血小板治疗对内皮脂肪酶表达的影响

目的 了解调脂治疗和抗血小板治疗对冠心病患者内皮脂肪酶(EL)表达的影响,进一步探讨EL在冠心病中的作用.方法 将157例冠心病患者按临床表现和冠状动脉(冠脉)造影结果分为3组:对照组41例,有1项以上冠心病危险因素,但冠脉狭窄程度＜30%;稳定型心绞痛(SAP)组55例;急性冠状动脉综合征(ACS)组61例.在禁用调脂药和阿司匹林2周后取血查EL阳性细胞率,均给予患者辛伐他汀和(或)拜阿司匹林,如出现并发症或不能依从者停药,6个月后复查EL阳性细胞率.结果 除对照组单用拜阿司匹林外,各组患者不论单用辛伐他汀或拜阿司匹林,还是两药联用,EL阳性细胞率均显著下降[单用辛伐他汀对照组:(3.93±0.87)%比(5.28±1.05)%,SAP组:(8.16±2.11)%比(15.12±2.53)%,ACS组:(13.93±3.22)%比(38.44±4.36)%;单用拜阿司匹林SAP组:(10.57±4.07)%比(14.66±2.29)%,ACS组:(18.28±5.14)%比(40.27±3.96)%;联合用药对照组:(3.13±0.87)%比(5.33±1.25)%,SAP组:(5.68±2.20)%比(14.89±2.15)%,ACS组:(7.81±3.96)%比(39.27±5.17)%,P＜0.05或P＜0.01].结论 调脂治疗和抗血小板治疗能有效抑制内皮细胞表达EL,提示EL参与了冠心病的发病过程.     

血清hs-CRP与TCH/HDL-C联合检测在冠心病中的应用

目的研究血清高敏C反应蛋白(hsCRP)、总胆固醇与高密度脂蛋白胆固醇之比(TCH/HDLC)与冠心病患者冠状动脉病变狭窄程度的相关性,探讨hsCRP、TCH/HDLC联合检测在冠心病中的应用价值。方法冠状动脉造影确诊的冠心病患者82例,其中稳定型心绞痛(SAP)组25例,不稳定型心绞痛(UAP)组27例,急性心肌梗死(AMI)组30例,对冠脉造影结果采用Gensini积分系统定量评定冠脉血管病变狭窄严重程度,以冠脉造影正常者(52例)为正常对照组,采用颗粒增强免疫透射比浊法测定血清hsCRP,采用酶法测定血清TCH、HDLC,分析血清hsCRP、TCH/HDLC联合检测对冠状动脉病变严重程度的预测价值。结果冠状动脉病变狭窄程度Gensini积分与hsCRP呈正相关(r=0.741,P<0.05),与TCH/HDLC亦呈正相关(r=0.542,P<0.05),而且随着冠状动脉病变程度加重,血清hsCRP、TCH/HDLC有明显升高,与对照组比较,有统计学意义(P<0.05),而SAP组与对照组相比,hsCRP、TCH/HDLC水平差异无统计学意义(P>0.05)。结论hsCRP、TCH/HDLC与冠心病患者冠状动脉病变程度密切相关,其联合检测有助于冠心病患者冠状动脉病变严重程度的临床评估。     

急性冠脉综合征患者血浆脂蛋白(a)测定的临床意义

目的探讨急性冠脉综合征患者血浆脂蛋白(a)测定的临床意义。方法因胸痛或胸部不适行选择性冠状动脉造影的患者494例,结合冠状动脉造影结果及临床诊断分成非冠心病组(NCHD,221例);冠心病稳定型心绞痛组(SAP,58例);冠心病急性冠脉综合征组(ACS,215例),其中不稳定型心绞痛(UAP,114例),ST段抬高型急性心肌梗死(STEMI,66例),非ST段抬高型急性心肌梗死(NSTEMI,35例),测定各组血浆Lp(a)浓度并进行分析比较。结果NCHD组、SAP组和ACS组Lp(a)测定值分别为(166．33±41．92)mg/L、(222．34±44．83)mg/L、(280．32±56．64)mg/L。ACS组Lp(a)测定值明显高于SAP组(F=9．26 P＜0．01)和NCHD组(F=8．13,P＜0．01)。结论急性冠脉综合征血浆Lp(a)浓度较之稳定型心绞痛和非冠心病明显增高,提示血浆Lp(a)增高不仅是冠心病的独立危险因素,也可能是急性冠脉事件的促发因素。     

急性冠脉综合征患者C-反应蛋白与冠状动脉狭窄程度的关系

目的　探讨C -反应蛋白 (CRP)预测急性冠脉综合征 (ACS)的价值以及CRP与ACS患者冠状动脉病变狭窄程度的关系。方法　用免疫速率散射比浊法测定 79例ACS患者血清CRP水平 ,并与 5 0例稳定型心绞痛 (SAP)患者进行对照 ;同时根据ACS患者冠状动脉造影结果 ,对冠状动脉病变的狭窄程度进行评分 ;用统计学方法分析ACS患者血清CRP水平与冠状动脉病变狭窄程度积分间的关系。结果　ACS组的对数转换CRP(logCRP)水平显著高于SAP组 (P <0 0 0 1) ;ACS组患者血清CRP水平与冠状动脉狭窄程度积分之间无相关性 (r =0 0 0 4 5 ,P >0 5 )。结论　CRP可作为预测ACS的指标之一 ;CRP水平不能反映ACS患者冠状动脉病变的严重程度     

冠心病患者红细胞分布宽度与冠状动脉病变程度的相关性分析

目的探讨冠心病患者中红细胞分布宽度(RDW)与冠状动脉病变程度的相关性。方法将102例冠脉造影确诊为冠心病患者,分为稳定性心绞痛组(SAP),不稳定性心绞痛组(UA)和急性心肌梗死组(AMI),据造影结果进行Gensini评分,对不同组别患者RDW水平、血脂水平、高敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、同型半胱氨酸(Hcy)水平进行分析。结果冠心病组患者的血脂水平、Hcy、hs-CRP及WBC的水平均比对照组更高。SAP、UAP、AMI组RDW值均较对照组高(P0.05);AMI组与UAP、SAP组相比RDW值更高,差异显著(P0.01);RDW值随Gensini积分增加依次增大(P0.05),两者呈直线正相关(P0.01);患者中的血脂、hs-CRP、WBC、Hcy水平与RDW均存在正相关。结论红细胞分布宽度水平可作为冠心病患者冠状动脉粥样硬化严重程度的预测指标。     

原发性高血压患者脉压指数联合血尿酸检测对冠心病严重程度的预测价值

目的 探讨原发性高血压(EH)患者脉压指数(PPI)、血清尿酸(UA)水平与其冠心病(CHD)严重程度的关系.方法 收集2011年4月至2012年4月心内科422例诊断为EH且行冠状动脉(冠脉)造影的患者.根据冠脉造影结果分成正常组、单支病变组、两支病变组及三支病变组,根据PPI分为PPI ＜0.4、0.4≤PPI ＜0.5及PPI≥0.5组,根据UA水平分为UA＜ 420 μmol/L和UA ≥420μmol/L组.根据冠脉狭窄程度计算冠脉积分(Gensini积分).结果 以单因素分析筛选出P＜0.05的变量为自变量,分别以平方根转化后的Gensini积分为因变量,进行多因素直线逐步回归分析,结果显示在排除多种因素的交互影响后,血清UA、PP、PPI、吸烟史、糖尿病史、TG、CHOL对冠脉病变的严重程度有独立的预测价值(P＜0.05或P＜0.01).各组Gensini积分的组间比较显示,随着PPI和UA的升高,Gensini积分增高,即冠脉狭窄程度逐渐加重(P＜0.05或P＜0.01).结论 PPI联合UA检测对于EH患者CHD严重程度具有良好的预测价值.     

冠状动脉造影病变特征与急性冠脉综合征猝死的相关性分析

目的 分析急性冠脉综合征(acute coronary syndrome,ACS)猝死(sudden cardiac death,SCD)患者冠状动脉造影基本影像学特征,探讨其作为ACS猝死危险评估的价值.方法 收集2000-01～2010-12在广西医科大学第一附属医院心研所收治的ACS发生猝死患者共52例,于猝死发作前后1个月内曾行选择性冠状动脉造影.分析冠脉造影病变的特征(病变支数、分布部位、IRA形态改变等因素)与ACS猝死的相关性.结果.冠脉造影,单支、双支和多支病变者分别为15、14和23例,合并左主干病变者7例;IRA狭窄程度为完全闭塞、次全闭塞、严重狭窄、临界狭窄者分别为29、14、6和3例;IRA的冠脉病变呈弥漫性、管状和局限性分别为29、13和10例;IRA分布部位,LAD、RCA、LCX分别为16、30和6例,合并左主干病变者7例,IRA发现血栓14例.冠脉病变支数、IRA长度、合并左主干病变、IRA狭窄程度及IRA分布差异有统计学意义(P值均<0.05);冠脉病变支数、IRA狭窄程度、IRA分布对冠心病猝死发生影响具有统计学意义(P<0.05).结论.ACS患者猝死多存在多支和严重的冠脉病变基础,IRA病变狭窄程度较重,需要紧急血运重建.     

胱抑素C与髓过氧化物酶在冠心病严重程度评估中的应用

目的研究分析冠心病病变程度与白细胞计数、超敏C反应蛋白(CRP)、纤维蛋白原(FG)、髓过氧化物酶、胱抑素C、肌酐(Scr)、肾小球滤过率(eGFR)之间的关系。方法收集121例冠脉造影后有冠状动脉狭窄患者(男86例,女35例)的临床资料及静脉血,根据临床诊断结果分为急性冠脉综合症组(ACS)和稳定性心绞痛组(SAP),以同期50例体检者作为健康对照组,检测患者组及健康组白细胞计数、超敏CRP、FG、髓过氧化物酶、胱抑素C、Scr、eGFR,统计分析各组间的关系。结果(1)SAP组白细胞计数、超敏CRP、FG、髓过氧化物酶、胱抑素C、eGFR水平较健康组有增高,差异有统计学意义(P0.05);(2)ACS组FG、中性粒细胞、单核细胞、超敏CRP、髓过氧化物酶、胱抑素C、eGFR水平明显高于SAP组,差异有统计学意义(P0.05),而白细胞计数、Scr水平差异均无统计学意义(P0.05);(3)ACS组(1.42±0.46)mg/L、SAP组(0.93±0.29)mg/L,与健康对照组之间胱抑素C(0.78±0.37)mg/L,比较差异有统计学意义(P0.05)。结论白细胞计数、超敏CRP、FG、髓过氧化物酶、胱抑素C、eGFR与冠心病病变程度密切相关,尤其是超敏CRP、胱抑素C。对于早期发现冠心病,监视冠心病病程,对急性冠脉综合征与稳定性心绞痛区分有意义。     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.