急诊介入治疗高龄急性心肌梗死患者的疗效及近期安全性评价

目的：经皮冠状动脉介入治疗术（ percutaneous transluminal coronary intervention, PCI）可有效改善急性心肌梗死（ acute myocardial infarction, AMI）患者的缺血症状和预后,降低近期死亡率,但针对PCI应用于高龄AMI患者的研究较少。文中评价高龄（≥75岁） AMI患者急诊PCI的有效性与近期安全性。方法收集2012年1月至2013年12月连续入住南京军区南京总医院行急诊PCI的AMI患者213例,按年龄分为高龄组（≥75岁,n＝57）与非高龄组（＜75岁,n＝156）。对2组患者的临床资料及冠状动脉介入特点进行回顾性分析。结果与非高龄组比较,高龄组患者以呼吸困难和疲乏等心功能不全为首发症状者多见（21．1％vs 3．2％,P＜0．01）、女性比例高（47．4％vs 16．7％,P＜0．01）,合并高血压、糖尿病者比例高。2组急诊PCI治疗即刻成功率高（均达100％）,高龄组手术相关并发症发生率（3．5％）、主要心脏不良事件发生率（8．8％）及院内死亡率（5．3％）分别与非高龄组的2．6％、6．4％和2．6％比较,差异均无统计学意义（ P＞0．05）。结论高龄AMI患者的不典型临床症状多见,急诊PCI治疗高龄AMI可有效地使梗死相关动脉再通,成功率高,并发症少,近期预后良好。     

80岁以上超高龄冠心病患者临床特点及预后分析

目的：探讨超高龄（≥80岁）冠心病患者病变特点、经皮冠状动脉介入治疗（PCI）的成功率以及并发症的情况.方法：选取2010年4月至2014年4月来我院住院行经皮冠状动脉介入治疗的151例患者资料、冠状动脉造影结果及PCI治疗结果进行回顾性分析,对比3组患者的冠状动脉病变特点以及PCI成功率以及并发症发生情况.结果：（1）≥80岁组患者合并高血压病及心力衰竭、肾功能不全均明显多于60～79岁组及45～59岁组（P＜0.05）;（2）冠脉造影提示在冠脉累及左主干者、多支、钙化闭塞性病变病变方面,≥80岁组患者中均明显多于60～79岁组及45～59岁组（P＜0.05）;（3）≥80岁组行PCI的成功率为94.2％,与60～79岁组（96.0％）及45～59岁组（98.0％）比较无统计学差异（P＞0.05）;（4）≥80岁组患者中并发症发生率11.7％,明显多于60～79岁组（2.0％）及45～59岁组（2.0％）（P＜0.05）.结论：超高龄冠心病患者各种心源性、非心源性合并症均多于低龄患者,且冠状动脉病变复杂、严重,行PCI手术成功率高,并发症发生率更高,但并发症多为可逆性.     

高龄急性ST段抬高型心肌梗死患者延迟急诊冠脉介入对近晚期心功能的影响

目的探讨延迟急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)和药物保守治疗对高龄急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者近晚期心功能的影响。方法回顾分析2014年1月至2014年12月收入天津医科大学宝坻临床学院70岁以上初发AMI未行静脉溶栓治疗或溶栓治疗失败的患者73例的临床资料,根据其是否行冠脉介入治疗分为:采用延迟急诊冠脉介入治疗的治疗组38例和药物保守治疗的对照组35例,记录并比较住院及随访3个月内超声心动图、B-型钠尿肽的情况。结果两组入院后即刻、7 d超声心动图提示左室射血分数、室壁运动异常积分指数比较差异无统计学意义,但随访3个月超声心动图提示延迟急诊PCI手术组左室射血分数(left ventricular ejection fraction,LVEF)、室壁运动异常积分指数优于对照组,差异有统计学意义(P<0.05),治疗组B-型钠尿肽在急性心肌梗死恢复期低于药物保守治疗组,差异有统计学意义(P<0.05)。结论高龄急性ST段抬高型心肌梗死患者延迟急诊PCI对近期心功能改善不明显,但可改善患者远期心功能、降低远期心力衰竭的发生。     

急诊冠状动脉介入治疗急性心肌梗死的临床观察

目的评价过去15个月期间开展急诊经皮冠状动脉介入治疗(PCI)AMI的临床疗效。方法 58例AMI患者在发病的12小时内行急诊PCI,随访60天。结果急性心肌梗死患者58例,男46例,女12例,年龄39～86岁,平均年龄60.96±10.91岁。冠脉造影显示:IRA为前降支20例,回旋支15例,右冠脉23例。56例患者(96.55)介入治疗获得成功,56例置入支架,全部获得TIM 13级血流,术中发生低血压7例,室早6例,加速性室性自主心律2例,显著窦性心动过缓8例,Ⅲ度房室传导阻滞2例,均分别给予利多卡因、多巴胺和阿托品治疗后恢复正常,术后LVEF平均为57.98±6.83。抬高的ST段恢复到基线50例,抬高的ST段下移≥50％ 8例。随访期间无胸痛、无再梗塞及未出现心血管事件。结论急诊PCI治疗AMI可有效地使梗死相关冠状动脉再通并恢复正常血流,成功率高,住院病死率低,近期预后良好。     

急诊PCI对AMI患者血浆P-选择素和hs-CRP水平的影响

目的 探讨AMI患者急诊冠脉介入治疗(PCI)前后血浆P-选择素和高敏C反应蛋白(hs-CRP)水平变化的意义及与冠脉病变程度的相关性.方法 110例AMI患者分为急诊PCI治疗组58例和非急诊PCI治疗组52例,分别于入院即刻、入院24 h和4周进行血浆P-选择素和hs-CRP水平检测,急诊PCI组于PCI术中行冠脉造影确定冠状动脉病变数目;分析两组在入院不同时间血浆P-选择素和hs-CRP水平变化的差异及急诊PCI组血浆P-选择素和hs-CRP水平与冠脉病变程度的相关性.结果 两组患者血浆P-选择素和hs-CRP水平在入院即刻无显著性差异(P＞0.05),而在入院24 h和4周有显著性差异(P＜0.05);急诊PCI组中单支病变患者P-选择素和hs-CRP水平明显低于双支和三支病变患者(P＜0.05).结论 PCI可导致体内P-选择素和hs-CRP表达增加,而且P-选择素和hs-CRP水平与冠脉病变程度存在明显的相关性;PCI术前检测血浆P-选择素和hs-CRP水平对于AMI患者冠状动脉病变程度的预先判断具有一定的指导意义.     

急性心肌梗死患者急诊冠脉介入治疗前后BNP的变化

目的探讨急性心肌梗死（AMI）患者急诊冠脉介入术前后B型尿钠肽（BNP）水平的变化及其临床意义。方法选取98例行急诊冠脉介入治疗的AMI患者,检测介入治疗前后BNP水平的变化,并与同期非急诊冠脉介入术的89例AMI患者治疗前后的BNP水平进行比较。结果两组患者治疗前后BNP水平均降低（P〈0.05）;组间比较显示：行PCI组较非PCI组BNP水平降低更加显著（P〈0.01）,死亡率也显著降低（P〈0.01）。结论 AMI患者治疗前后BNP水平的变化体现心功能恢复的差异,表明急诊冠脉介入术在治疗AMI及改善心功能方面有重要的临床价值。     

负荷量替格瑞洛在急性心肌梗死急诊经冠状动脉介入术的有效性和安全性研究

目的探讨负荷量替格瑞洛在急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)中应用的有效性和安全性。方法将该院2018年1月‐6月收治的80例行急诊PCI治疗的AMI患者随机分为观察组和对照组各40例。对照组急诊PCI术前即刻嚼服阿司匹林+氯吡格雷。观察组急诊PCI术前即刻嚼服阿司匹林+替格瑞洛。术后对照组给予氯吡格雷,观察组给予替格瑞洛。比较两组的血小板聚集率、心肌灌注水平、左室EF值、心血管不良事件(MACE)等。结果观察组心肌灌注分组级(TMPG)3级的例数多于对照组,ST段完全回落率高于对照组,比较差异有统计学意义(P 0.05)。观察组术后2 h、24 h的血小板聚集率低于对照组,比较差异有统计学意义(P 0.05)。观察组术后1周的左室射血分数(LVEF)高于对照组。观察组随访期间的MACE、不良反应少于对照组,差异有统计学意义(P 0.05)。结论负荷量替格瑞洛能够抑制血小板聚集,改善心肌灌注,减少MACE的发生。     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年(≥80岁)急性心肌梗死(AMI)患者行急诊与择期经皮冠状动脉介入治疗术(PCI)的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组(AMI组)和非心肌梗死组(对照组),其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者(AMI择期组)和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率(72.2%)低于非急诊组(92.2%),差异有统计学意义(P=0.036)。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义(P<0.001,P=0.039),AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高(P<0.05)。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

老年人急性心肌梗死的经皮冠状动脉介入治疗

近年来,随着社会人口的老龄化,老年急性心肌梗死(AMI)患者逐年增多,尤其是冠状动脉(冠脉)介入治疗日益引起关注,本文回总结68例≥70岁AMI患者的经皮冠脉介入治疗(PCI)的情况评价其疗效及安全性。1资料与方法入选病例为2007年1月～2009年12月在我院心内科就诊并接受PCI的≥70岁的AMI患者共68,男52,女16,年龄70～84(72.4±5.3)岁。     

急诊护理团队综合干预对急性心肌梗死患者直接冠状动脉介入治疗效果的影响

目的探究急诊护理团队综合干预对急性心肌梗死患者直接冠状动脉介入治疗(PCI)效果的影响。方法回顾性分析2013年1月-2014年12月在我院接受急诊直接冠状动脉介入治疗(PCI)的90例急性心肌梗死患者的临床资料。将接受急诊直接冠状动脉介入治疗(PCI)的90例急性心肌梗死患者分为两组,其中2013年1-12月给予常规护理干预的患者为对照组,2014年1-12月给予护理团队综合干预的患者为观察组。对比两组患者急诊科停留时间、患者满意率、院内AMI复发率、院内再行PCI率、住院时间。结果治疗护理后,观察组急诊科停留时间(18.26±5.78)min,住院时间为(10.35±4.34)d,显著短于对照组;患者满意率96.68%,显著高于对照组;院内AMI复发率5.65%,院内再行PCI率7.43%,均显著低于对照组,差异有统计学意义(P0.05)。结论急性心肌梗死患者于急诊直接冠状动脉介入治疗(PCI)前给予护理团队综合干预,可缩短急诊科停留时间及住院时间、提高抢救成功率和患者满意度。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.