冠心病患者心率变异性初步分析

目的 通过观察冠心病患者心率变异性（ＨＲＶ）的改变探讨冠心病对自主神经损害情况。方法 应用２４ｈ动态心电图（Ｈｏｌｔｅｒ）对４８例正常人和５３例冠心病患者检测其心率变异指数（ＨＲＶ１）和ＨＲＶ各项时域指标：包括总体标准差（ＳＤＮＮ０,均值标准差（ＳＤＡＮＮ）,标准差均值（ＳＤＮＮ ＩＤＸ）,差值均方的平方根（ｒＭ ＳＳＤ）和差值〉５０ｍｓ的百分比（ＰＮＮ５０）。结果 冠心病组与对照组比较ＨＲＶＩ和     

粒细胞发光在急性心肌梗死溶栓治疗中的应用

目的：研究急性心肌梗死（ＡＭＩ）患者静脉溶栓前后的中性粒细胞（ＰＭＮ）氧化代谢活性的变化，并探讨其作为冠脉再通指标的可行性。方法：选择发病在６小时以内的ＡＭＩ患者８０例，给予静脉溶栓，按溶栓后冠脉是否现通分为溶栓再通组（Ｉ组）５例及溶栓未通组（Ⅱ组）２６例。     

扩张型心肌心率变异性与预后的关系

目的：探讨扩张型心肌病心率变异怀其预后的关系。方法：应用心率变异性（ＨＲＶ）时域分析法测定１９例扩张型心肌病（ＤＣＭ）经随访１８个月。结果：ＤＣ２４ｈＲＲ间期标准差（ＳＤＮＮ）和相邻正常ＲＲ间差值的均方根（ｒＭＳＳＤ）及心率变异指数（ＨＲＶＩ）均明显低于正常（Ｐ〈０．０５）,心功能Ⅲ－Ⅳ级者明显低于心功能Ⅱ级（Ｐ〈０．０５）,事件组（随访中死亡者）明显低于非事件组（Ｐ〈０．０５）。结论：ＨＲＶ分析可作为判断ＤＣＭ患者心功能及预后的一项指标。     

卡托普利二硝基异山梨醇及其合用治疗无症状性心肌缺血的对比观察

用２４小时动态心电图评价卡托普利（ＣＰＴ）、二硝基异山梨醇（ＩＳＤＮ）及其合用对无症状性心肌缺血（ＳＭＩ）的疗效。２４例有ＳＭＩ发作的冠心病患者随机分为三组。每组８例。ＣＰＴ治疗组、ＩＳＤＮ治疗组、两药合用组（ＣＴ组）。疗程为四周。结果表明，ＣＰＴ组和ＣＩ组ＳＭＩ发作次数显著减少（Ｐ＜０．０５），持续时间缩短（Ｐ＜０．０５），总缺血负荷（ＴＩＢ）减轻（Ｐ＜０．０５），缺血性ＳＴ段压低程度改善（Ｐ＜０．０５）。Ⅰ组疗效不明显。综上所述：①ＣＰＴ和ＣＰＴ与ＩＳＤＮ合用可以显著减少冠心病ＳＭＩ发作和ＴＩＢ，②ＣＰＴｇｎＩＳＤＮ合用治疗ＳＭＩ副作用少。值得临床上进一步探讨。     

国产重组链激酶溶栓对急性心肌梗死病人心功能储备的影响

目的 探讨较重组链激酶（ｒ－ＳＫ）溶栓治疗急性心肌梗化（ＡＭＩ）对于心功能保护及生活质量改善的意义。方法 选择接受ｒ－ＳＫ溶栓治疗及未溶栓的ＡＭＩ患者各３０例,其中溶栓组获得梗死相关血管再通的１９例,示再通的１１例,并于梗死后６个月随访时行Ｍ－型超声左室功能测定（ＬＶＥＦ）及运动心肺功能评定。结果 再通组与未通组、未溶栓组比较,左室射血分数明显增高（Ｐ〈０．０１）、运动时间和最大运动负荷量明显提高     

急性心肌梗塞患者溶栓前后血浆D-二聚体变化

为探讨静脉溶栓治疗急性心肌梗塞的溶栓治疗效果,采用全自动酶联免疫吸附法测定了４２例急性心肌梗塞患者Ｄ－二聚体血浆浓度变化。结果,所有急性心肌梗塞患者于发病后Ｄ－二聚体浓度在（１８７±０３２）～（１９９±０３１）ｍｇ／Ｌ,均高于健康对照组的（０２０±００９）ｍｇ／Ｌ（Ｐ＜００１）。１５例ＡＭＩ溶栓再通的Ｄ－二聚体于溶栓后６小时高达（２２１１±４９６）ｍｇ／Ｌ,２４小时后降至治疗前（２４２±０７８）ｍｇ／Ｌ水平。而溶栓未通组Ｄ－二聚体于溶栓治疗后第５天达高峰,１５天降至治疗前水平。未溶栓组Ｄ－二聚体无明显升高（Ｐ＞００５）。提示检测Ｄ－二聚体对ＡＭＩ溶栓疗效具有一定的判定价值     

小剂量β—受体阻滞剂对急性心肌梗死患者心率变异的影响

目的 研究小剂量β－受体阻滞剂对急性心肌梗患者心率变异的影响。方法 ４４例急性心肌梗死患者入院后随机分为β－ 体阻滞剂治疗组（１８例）和对照组（２６例）。治疗组于即刻给予氨酰心安（１２．５～２５ｍｇ／ｄ）或美多心安（２５～５０ｍｇ／ｄ），余治疗相同。１０～１４ｄ后行２４ｈ动态心电图检查，分析心率变异的时域指标ＳＤＮＮ ＳＤＡＮＮ ｒＭＳＳＤ ＰＮＮ５０、散点图指标ＶＬＩ ＶＡＩ的变化。用配对ｔ检验     

重组链激酶对急性心肌梗死溶栓治疗临床观察

目的：观察溶栓新药重组链激酶（ｒ－ＳＫ）在急性心肌梗死（ＡＭＩ）静脉溶栓治疗中的临床疗效和不良反应。方法：采用平行随机单盲对照的研究方法,以尿激酶（ＵＫ）为对照比较ｒ－ＳＫ对ＡＭＩ的溶栓治疗效果和不良反应。结果：ｒ－ＳＫ１５０万Ｕ对ＡＭＩ的溶栓再通率为８４．４％,而ＵＫ１５０万Ｕ仅为５６．７％（Ｐ＜０．０５）。不良反应除发冷外其他方面两组无差异。结论：国产ｒ－ＳＫ是一个血管再通率高,不良反应及出血并发症低,安全有效的溶栓药物。     

急性心肌梗塞后QT离散度改变及临床意义

分析了６６例急性心肌梗塞（ＡＭＩ）病人的ＱＴ间期，ＱＴｃ离散度（ＱＴｃｄ），ＪＴｃ离散度（ＪＴｃｄ）ＱＲＳ离散度（ＱＲＳｄ）的变化。结果显示除ＱＴｃｍｉｎ，ＱＲＳｄ外ＱＴｃｍａｘ，ＱＴｃｄ，ＪＴｏｄ在ＡＭＩ后４８小时内均显著增加；第２周显著降低（Ｐ〈０．０１），其中溶栓治疗再灌注组国无灌注和非溶有下降更为显著（Ｐ〈０．０１）；第３～４周再灌注组明显回升（Ｐ〈０．０１），无再灌注和非溶栓组则无变化，     

无症状心肌缺血的动态心电图观察

无症状心肌缺血的动态心电图观察济南军区总医院（山东省济南市２５００３１）曲莉霞，许琳，卫亚，尤乃祯无症状心肌缺血（ＳＭＩ）是冠心病（ＣＡＤ）研究的一个新的领域。本文通过分析１００例ＣＡＤ息者２４小时动态心电图检测结果，探讨其对ＣＡＤ患者ＳＭＩ检出率，...     

Intravenous streptokinase. A reappraisal of its therapeutic use in acute myocardial infarction

Streptokinase, the first of the thrombolytic agents to be used in acute myocardial infarction, has now been administered to many thousands of patients with this condition. Since early intervention and accessibility of care is paramount in these patients, intravenous infusion of streptokinase has largely replaced intracoronary use. Results of major trials (GISSI, ISIS-2 and ISAM) comparing streptokinase with standard treatment in more than 30,000 patients prove convincingly that intravenous streptokinase increases patient survival after myocardial infarction. The largest trial, ISIS-2, demonstrated a 23% reduction in 5-week vascular mortality after streptokinase use. The greatest benefits occur where streptokinase infusion is initiated early after symptom onset, although late benefit has been observed in patients treated up to 24 hours after pain onset. Importantly, mortality is further decreased by combining streptokinase with aspirin, as shown by a 53% reduction in mortality using the combination in the ISIS-2 trial. Mortality has also been reduced in trials investigating the use of the thrombolytic agents rt-PA and anistreplase. Streptokinase and rt-PA produced similar reductions in mortality in the recent GISSI-2 and International t-PA/Streptokinase Mortality trials, findings which may be further clarified by ongoing comparative trials such as ISIS-3. Reperfusion of about 50 to 60% of occluded coronary arteries occurs with intravenous streptokinase, and left ventricular function is improved. Direct comparisons with rt-PA show a superior effect for the newer agent on early reperfusion, but a similar ability to salvage myocardial function. The complexities of the relationship between reperfusion, left ventricular function and mortality constitute an area of considerable clinical interest requiring further study to clearly differentiate between the drugs available to the physician. The most common adverse events observed during intravenous streptokinase infusion are bleeding complications. An incidence of 3.6% for minor bleeding and 0.4% for major haemorrhage (requiring transfusion) is derived from the combined results of the GISSI and ISIS-2 studies. Bleeding does not appear to be more frequent or severe with intravenous streptokinase than with the more fibrin-selective agent, rt-PA. While the risk to benefit ratio of sequential heparin following streptokinase therapy remains equivocal, the adjuvant use of aspirin confers a clinical advantage over streptokinase alone. In conclusion, streptokinase has now been proven to reduce mortality in patients with acute myocardial infarction, with an acceptable risk of bleeding complications. Given the substantial data that have now accumulated with extensive clinical experience, intravenous streptokinase should be considered a first-line agent in suitable patients.     

卒中单元联合重组组织型纤溶酶原激活剂静脉溶栓治疗脑梗死效果观察

目的探讨卒中单元联合重组组织型纤溶酶原激活剂（rt—PA）静脉溶栓治疗急性脑梗死的效果。方法2012年1—10月采用卒中单元联合rt—PA静脉溶栓治疗发病4．5h内急性脑梗死15例,观察治疗后神经功能缺损量表（NIHSS）评分改善情况、临床疗效和不良反应发生情况。结果治疗后各时点NIHSS评分较治疗前均降低,差异有统计学意义（P〈0．05）;治疗21d总有效率为86．67％,治疗期间未见明显不良反应。结论急性脑梗死发病4．5h内给予卒中单元联合rt—PA静脉溶栓治疗疗效显著,且安全可行。     

早期尿激酶静脉溶栓治疗急性心肌梗死的循证护理

目的探讨循证护理在急性心肌梗死（AMI）早期尿激酶溶栓治疗中的应用效果。方法选择29例AMI患者,均为采用尿激酶溶栓治疗,并采用循证护理方法进行护理。结果29例患者均好转出院,其中21例溶栓成功,再通率达72．41％,24例患者的胸痛迅速消失或缓解;发生再灌注心律失常26例,2例患者皮肤出现静脉穿刺部位瘀斑,未见牙龈出血、消化道出血及出血性脑卒中等并发症。结论在AMI溶栓治疗中应用循证护理方法,可有效地提高AMI患者的治愈率,降低并发症的发生率,提高患者的生活质量。     

30例急性心肌梗死溶栓治疗临床分析

目的探讨尿激酶静脉溶栓治疗急性心肌梗死的临床效果及安全性,并总结治疗经验。方法回顾性分析笔者所在医院2011年1～12月采用尿激酶溶栓治疗的30例急性心肌梗死患者资料,观察再通情况、并发症发生及患者预后情况。结果 30例急性心肌梗死患者经尿激酶溶栓治疗后再通率为93.3%,其中,发病<6h内溶栓的再通率为100.0%;6～12h再通率为88.9%,>12～24h再通率为33.3%。治疗过程中出现并发症4例,并发症发生率为13.3%,死亡2例,死亡率为6.7%,其中1例死于心力衰竭,1例为并发室颤最终抢救无效死亡。结论尿激酶静脉溶栓治疗急性心肌梗死再通率高,并发症发生率低,有效降低病死率;且溶栓距发病时间越短,冠状动脉的再通率则越高,疗效越好。     

急性心肌梗塞早期静脉溶栓对QT间期离散度及JT间期离散度的影响

目的 :观察QT间期离散度 (QTd)及JT间期离散度 (JTd)在急性心肌梗塞溶栓治疗前后的变化。方法 :我们将64例施溶栓治疗的急性心肌梗塞 (AMI)病人分为2组 :再通组42例 ,未通组22例。测定和计算溶栓前及溶栓后2、8、24、48小时和1周的同步12导联心电图QTd及JTd并比较它们的变化。结果 :溶栓前再通组与未通组QTd、JTd相比无显著差异 (P>0 05)。溶栓后 ,再通组与未通组各对应时间相比 ,有显著差异 (P<0 01)。结论 :成功的溶栓治疗可使QTd、JTd明显缩短 ,QTd、JTd的变化可作为判断溶栓成功的无创性指标     

门冬氨酸钾镁在高龄未行溶栓治疗急性心肌梗死病人中的应用

目的 :评价急性心肌梗死高龄老人未行溶栓治疗早期应用门冬氨酸钾镁的临床疗效。方法 :6 7例年龄 >75岁未行溶栓治疗急性心肌梗死病人随机分为两组 ,均给予常规治疗 ,治疗组加用门冬氨酸钾镁治疗 ,对照组加用安慰剂 ,观察两组的死亡率和再灌注心律失常及左室射血分数的影响。结果 :治疗组总死亡率低于对照组 (9%vs.2 4 % ,P<0 .0 1) ;治疗组再灌注心律失常发生率低于对照组 ,但无统计学意义 (39%vs.4 8% ,P >0 .0 5 )。结论 :对于未行溶栓治疗高龄急性心肌梗死病人早期应用门冬氨酸钾镁治疗可能改善预后。     

急性心肌梗死重组组织型纤溶酶原激活剂溶栓治疗的观察及护理

目的探讨重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗急性心肌梗死的疗效及静脉溶栓的护理要点。方法入选54例急性心肌梗死患者,常规应用阿司匹林和肝素等药物,静脉注射重组组织型纤溶酶原激活剂（rt-PA）100mg,同时予积极护理干预。观察患者溶栓后的冠状动脉开通率（根据临床判定）,出血等并发症和发病30d左室射血分数。结果冠状动脉开通率为81．5％（44例）;30d左室射血分数为（51．6±7．8）％;54例患者中20例出现穿刺处皮下淤血,2例肉眼血尿,29例心律失常,9例低血压。结论重组组织型纤溶酶原激活剂（rt—PA）溶栓治疗急性心肌梗死具有较好疗效,同时结合有效的心理护理,溶栓前、中、后的观察及护理和正确合理的生活护理可防止患者溶栓后出血,心肌再灌注性心律失常等并发症。     

急性心梗溶栓后再灌注性心律失常的临床研究

目的：主要对急性ST段抬高性心肌梗死（AMI）溶栓中再灌注心律失常的发病机制进行探讨,以找到更有效的防治方案。方法：对2009年1月～2010年3月入本院治疗的55例急性心肌梗死患者行rt-PA静脉溶栓治疗,然后观察患者心肌酶谱、心电图变化情况以及再灌注心律失常出现的时间、类型及症状。结果：溶栓后冠脉再通的患者有47例,再通率为85.45%,再通时间为（53.0±17.1）min,其中40例患者出现再灌注性心律失常,大多数患者心律失常的类型属于单纯室早,少数为房室传导阻滞、室颤和短阵室速。结论：患者在实现冠脉再通以后,胸痛症状明显缓解,但是,由于急性心肌梗死患者溶栓成功后大多会发生心律失常,所以应该保持对患者持续的血压和心电图监测。     

Anisoylated plasminogen streptokinase activator complex (APSAC). A review of its mechanism of action, clinical pharmacology and therapeutic use in acute myocardial infarction

APSAC is a new thrombolytic agent with advantages over conventional therapy such as streptokinase. In particular, it is suitable for intravenous administration over 4 to 5 minutes, in contrast with the prolonged infusion required with intravenous streptokinase, thus facilitating treatment of acute myocardial infarction outside a coronary care unit. Additionally, its fibrinolytic action is theoretically selective for fibrin associated with thrombi, which should minimise systemic fibrinolysis. However, in practice, systemic fibrinolysis does occur to some extent in most patients, but clinically significant haemorrhagic complications are rare. At the recommended dose of 30U injected intravenously over a period of 4 to 5 minutes in patients with acute myocardial infarction of less than 6 hours' duration, reperfusion of occluded coronary arteries occurs in about 72% of patients (range 53 to 91% in individual studies). Subsequent reocclusion has been reported in 0 to 20% of patients in most studies, with an average reocclusion rate of around 10%. The reperfusion rate compares favourably with that reported for intracoronary streptokinase and has tended to be superior to that with intravenous streptokinase. Thus, APSAC is an important advance in thrombolytic therapy for patients with acute myocardial infarction. Of particular importance is its relative ease of administration, reducing the dependence on coronary care units with catheterisation facilities, and the associated costs and delays in implementing treatment. APSAC should result in effective thrombolytic therapy being rapidly introduced after acute myocardial infarction in a wider proportion of patients than was previously feasible.     

rt-PA静脉溶栓治疗超早期脑梗死的临床护理

目的 探讨超早期脑梗死患者使用重组组织型纤溶酶原激活剂(recombinant tissue-type plasminogen activator,rt-PA)静脉溶栓治疗的疗效及护理.方法 对32例有不同程度肢体瘫痪或言语障碍的脑梗死患者进行rt-PA超早期静脉溶栓及实施系统化护理.结果 静脉溶栓后,患者肌力有明显提高,言语障碍在溶栓后也明显改善.其中基本治愈10例,显效17例,好转4例,无效1例.有2例出现出血性并发症,皮下淤斑1例,1例于溶栓后6h出现少量继发性颅内出血.结论 超早期脑梗死患者治疗过程中密切观察病情变化,及时预防并发症的发生,是提高疗效的重要环节.