奥扎格雷钠联合马来酸桂哌齐特治疗难治性不稳定型心绞痛的疗效观察

实验研究显示血小板聚集会释放更多的缩血管物质血栓素A2（TXA2），使冠状动脉内微血栓形成，从而导致管腔阻塞和心肌缺血，引起不稳定型心绞痛（UAP）的发生。因此对一部分不稳定型心绞痛患者采用常规的扩张冠状动脉和降低心肌需氧量的药物并不能减少心绞痛的发作及稳定病情。我们在常规抗心绞痛治疗的基础上，利用新型抗血栓药奥扎格雷钠及改善心肌血液供应和微循环的药物马来酸桂哌齐特联合治疗难治性不稳定型心绞痛取得较好疗效，现报道如下。     

马来酸桂哌齐特致过敏性休克1例

1病例报告患者男,67岁。因头晕、头痛、单侧面部及上肢麻木就诊。诊断为脑供血不足,给予0.9%氯化钠注射液250ml+马来酸桂哌齐特320mg静脉滴注,1次/d。前2天输注过程顺利,无任何不良反应。第3天静脉滴注约100ml时,患者突然出现面色苍白、寒战、呕吐等。立即停止输液,测血压50/30mmHg,脉     

马来酸桂哌齐特治疗急性脑梗死的临床疗效观察

目的观察马来酸桂哌齐特治疗急性脑梗死（ACI）的临床疗效。方法将84例ACI患者随机分为治疗组和对照组各42例,分别给予马来酸桂哌齐特注射液和复方丹参注射液治疗。结果①治疗组的神经功能改善程度明显优于对照组（P〈0.05）;②治疗组生活能力的改善程度也显著优于对照组（P〈0.01）;③治疗组的显效率为54.8%,对照组的显效率为28.6%,两者比较差异有显著性（P〈0.05）;治疗组的总有效率（83.3%）也显著高于对照组（61.9%）,P〈0.05,且未见明显副作用。结论马来酸桂哌齐特能有效改善ACI患者的神经功能和生活能力。     

马来酸桂哌齐特联合藻酸双酯钠治疗耳源性眩晕疗效观察

目的观察马来酸桂哌齐特联合藻酸双酯钠治疗耳源性眩晕的临床疗效。方法选取2013年1月至2014年10月在我科住院的耳源性眩晕患者120例,按简单数字法随机分为治疗组(60例)和对照组(60例)。治疗组患者给予马来酸桂哌齐特注射液联合注射用藻酸双酯钠,1次/d;对照组患者单用马来酸桂哌齐特注射液,1次/d。两组疗程均为7 d,观察两组患者的临床疗效。结果治疗组有效率93.3%,对照组有效率83.3%,治疗组疗效明显优于对照组,两组比较,差异有统计学意义(P<0.01)。治疗7 d后,治疗组眩晕障碍量表评分明显低于对照组,两组比较,差异有统计学意义(P<0.05)。结论马来酸桂哌齐特联合藻酸双酯钠治疗耳源性眩晕效果显著。     

马来酸桂哌齐特注射液治疗脑梗死的临床观察

目的：评价马来酸桂哌齐特注射液对脑梗死的临床疗效。方法脑梗死患者82例随机分为对照组及治疗组,每组均为41例,两组均给予内科常规治疗,对照组加用丹参注射液,治疗组给予马来酸桂哌齐特注射液。结果治疗组神经功能缺损程度评分明显优于对照组（ P＜0．01）,并且无不良反应。结论马来酸桂哌齐特注射液治疗脑梗死疗效更好,能很好地改善神经功能缺损程度。     

马来酸桂哌齐特联合羟苯磺酸钙治疗糖尿病肾病临床观察

目的探讨马来酸桂哌齐特联合羟苯磺酸钙治疗糖尿病肾病的方法和疗效。方法选取2015年5-12月住院的中晚期糖尿病肾病患者30例,根据治疗方法不同分为治疗组(20例)和对照组(10例)。治疗组患者采取马来酸桂哌齐特联合羟苯磺酸钙治疗;对照组患者单用羟苯磺酸钙治疗。治疗2周后,观察两组患者24 h尿蛋白定量、血清尿素氮、肌酐等临床指标变化。结果与本组治疗前比较,治疗组患者治疗2周后的24 h尿蛋白定量、血清尿素氮、肌酐均明显下降(P<0.05);而且,治疗组相关指标改善情况优于对照组(P<0.01)。两组患者均未出现明显药物不良反应。结论马来酸桂哌齐特联合羟苯磺酸钙治疗中晚期糖尿病肾病安全、有效。     

高效液相色谱法测定马来酸桂哌齐特的含量

目的采用高效液相色谱法测定马来酸桂哌齐特的含量。方法选用迪马-C18（250mm×4.60mm,5μm）色谱柱,以乙腈-0.05mol/ml磷酸氢二钠溶液（40：60）为流动相;检测波长为230nm。结果马来酸桂哌齐特在200～700μg/ml（r=0.9998）范围内线性关系良好,平均回收率为101.06%,RSD为0.48%（n=9）。结论本法可用于测定马来酸桂哌齐特的含量。     

哌克昔林注射液治疗不稳定型心绞痛36例

哌克昔林注射液具有显著扩张血管、降低血黏度、改善血液流变学和改善微循环的功能,在缺血性循环障碍疾病的治疗中具有独特作用。2004年以来,我们应用哌克昔林治疗不稳定型心绞痛36例,疗效满意。     

血府逐瘀汤加减治疗稳定型心绞痛40例疗效体会

冠心病心绞痛是冠状动脉供血不足,心肌急剧的、暂时的缺血与缺氧所引起的临床综合征。冠心病心绞痛属祖国医学胸痹心痛范畴,笔者采用血府逐瘀汤加减治疗稳定型心绞痛40例收到很好疗效,现报告如下。     

经皮冠状动脉血运重建术对稳定性心绞痛患者血浆可溶性P选择素的影响

经皮冠状动脉血运重建术（percutaneous coronary intervention,PCI）会损伤冠状动脉内皮,从而有可能激活内皮细胞和血小板,导致一系列炎症反应和急性或亚急性血栓形成。可溶性P选择素存在于血小板α颗粒和内皮细胞Weibel-Palade体中,可能在启动炎症反应,介导白细胞在内皮上黏附和聚集中发挥重要作用。研究表明可溶性P选择素水平在急性冠状动脉综合征患者明显升高,在稳定性心绞痛患者中较低,但仍比冠状动脉造影正常者高。本研究旨在通过P选择素水平观察PCI对冠状动脉内皮的损伤程度以及常规抗血小板治疗对血小板活化的抑制作用。     

芪参益气滴丸治疗冠心病心绞痛临床观察

目的观察芪参益气滴丸治疗冠心病心绞痛的临床疗效。方法选择冠心病心绞痛患者80例．随机分成治疗组和对照组各40例。芪参益气滴丸治疗组40例，西药对照组40例。治疗4周为1疗程。观察心绞痛症状及心电图ST段的变化。结果治疗组患者的心绞痛缓解总有效率及减少心绞痛发作频率、缩短发作持续时间方面，均优于对照组（P〈0．05）；心电图改善，治疗组亦显著优于对照组（P〈0．01）。结论芪参益气滴丸治疗冠心病心绞痛疗效确切。     

拜新同联合血府逐瘀汤对稳定性心绞痛的疗效观察

目的观察拜新同联合血府逐瘀汤对稳定型心绞痛的临床疗效。方法将我院135例于2008年3月～2009年5月收治的稳定性心绞痛患者随机分为两组,拜新同联合血府逐瘀汤组（治疗组,n=68）和单纯拜新同组（对照组,n=67）,治疗期28天,观察两组疗效。结果治疗组的总有效率为94.1%,对照组的总有效率为74.6%,治疗组显著优于对照组（P〈0.05）。心电图总有效率分别为64.7%和53.7%,差异有显著性。结论拜新同联合血府逐瘀汤可显著提高稳定性心绞痛的临床疗效。     

血清同型半胱氨酸在不稳定型心绞痛危险度分层中的作用

 目的观察血清同型半胱氨酸(Hcy)在不稳定型心绞痛(UAP)危险度分层中的作用.方法对UAP患者168例,稳定型心绞痛(SAP)患者98例和正常对照组54例,分别测定空腹静脉血清Hcy浓度,按照文献[1]的分层,将UAP分为低、中、高危险组,比较各组间的差异.结果UAP组Hcy水平高于对照组和SAP组(P＜0.05),低、中、高危险组的Hcy水平逐步升高(P＜0.05).结论血清Hcy水平是UAP患者危险度分层的重要指标.     

Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as ≥ 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures.     

氯吡格雷联合阿司匹林对老年稳定型心绞痛的疗效及其预后影响

 目的 分析氯吡格雷联合阿司匹林对老年稳定型心绞痛的疗效及远期预后的影响。方法 选取2013-09至2016-09西部战区总医院180例老年稳定型心绞痛患者作为研究对象,根据入院顺序将患者分为研究组和对照组,每组90例。对照组在常规治疗基础上给予口服阿司匹林肠溶片(100 mg/d)进行治疗,研究组在对照组疗法基础上口服硫酸氢氯吡格雷片(75 mg/d)进行治疗。两组均连续给予抗血小板治疗3个月。检测并比较两组治疗前、后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板凝集率(PAR)、左心室射血分数(LVEF)、每搏输出量(SV)及血浆D二聚体(D-D)、纤维蛋白原(FIB);进行2年的随访,对两组治疗期间不良反应发生率、不稳定型心绞痛、心肌梗死、心源性猝死等心血管事件发生率、无心血管事件生存期进行对比分析。结果 治疗后,两组的PT、APTT、LVEF、SV水平均较治疗前升高,FAR、D-D、FIB水平均较治疗前降低,差异有统计学意义(P<0.05),研究组PT、APTT、LVEF、SV水平均高于对照组,FAR、D-D、FIB水平均低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率的差异无统计学意义。在随访发现,两组的心血管事件发生率、平均无心血管事件生存期的差异无统计学意义。结论 老年稳定型心绞痛治疗中应用氯吡格雷联合阿司匹林,能够提高抗血小板治疗效果,降低凝血系统活性,具有较高的安全性。对于患者远期预后的改善作用还需要进一步研究。     

Prognostic value of myocardial perfusion scintigraphy in type 2 diabetic patients with mild, stable angina pectoris

Aim  To determine the prognostic value of reversible myocardial perfusion defects on myocardial perfusion scintigraphy (MPS) in patients with type 2 diabetes mellitus and mild anginal complaints. Methods and results  In the MERIDIAN trial, patients with diabetes mellitus type 2, stable, mild anginal symptoms (Canadian Cardiovascular Society classification (CCS) I-II/IV) and reversible perfusion defects were randomized to either continued pharmacological treatment or early invasive treatment. In this sub analysis, the severity of the myocardial perfusion defect was related to the occurrence of cardiac death and non-fatal myocardial infarction, in 319 patients (63% male, 65 ± 9 years). During follow-up (2.2 ± 0.6 years), 14 patients had a cardiac event: 3 in 171 patients without myocardial ischemia and 11 in 148 patients with myocardial ischemia. Annual event rates rose from 0.8% to 5.8% with increasing severity of myocardial ischemia. Multivariable analysis identified the presence of severe myocardial ischemia (hazard ratio (HR) 5.45, 95%CI 1.89-15.71) and insulin use (HR 4.00, 95%CI 1.25-12.75) as independent predictors of cardiac events. Conclusions  Type 2 diabetics with mild anginal symptoms with no or moderate myocardial ischemia have a low annual cardiac event rate. In patients with severe myocardial ischemia event rate increased 3-6 fold. See related editorial, doi:.     

大株红景天治疗高龄老年人不稳定型心绞痛临床分析

目的探讨大株红景天治疗高龄老年人不稳定型心绞痛的临床疗效。方法将64例患者随机分为对照组30例和治疗组34例,对照组釆用常规治疗;治疗组在常规治疗的基础上,加用大株红景天注射液10 ml＋5%葡萄糖液或生理盐水250 ml,静脉滴注,1次/d,10 d为1疗程。结果治疗组心绞痛、心功能及心电图明显改善,两组比较有统计学差异（P〈0.05）。结论大株红景天注射液辅助治疗老年人不稳定型心绞痛疗效显著,安全性高。     

Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina

Purpose The aim of this study was to evaluate spiral multidetector computed tomography (MDCT) angiography using 64-slice technique in the detection of functionally relevant coronary artery stenoses (CAS). Methods Thirty-eight patients (62±11 years, 28 men) with stable angina (26 with suspected and 12 with known coronary artery disease) were investigated using 64-slice MDCT angiography and gated myocardial perfusion SPECT (gated SPECT); a subgroup of 30 patients had additional invasive coronary angiography (ICA). Stenoses with luminal narrowing of ≥50% were defined as “significant” in MDCT angiography and ICA. MDCT angiography was compared with gated SPECT and the combination of gated SPECT plus ICA with respect to the detection of functionally relevant CAS. Results The sensitivity, specificity and negative and positive predictive values of MDCT angiography in detecting reversible perfusion defects on gated SPECT were 63%, 80%, 94% and 32%, respectively, in vessel-based analysis and 71%, 62%, 72% and 60%, respectively, in patient-based analysis. If only reversible perfusion defects on gated SPECT with CAS ≥50% on ICA were considered, the sensitivity, specificity and negative and positive predictive values were, respectively, 85%, 79%, 98% and 33% for vessel-based analysis and 85%, 59%, 83% and 61% for patient-based analysis. Conclusion Sixty-four slice MDCT angiography failed to predict the functional relevance of CAS, but had a high negative predictive value in the exclusion of functionally relevant CAS in symptomatic patients. An editorial commentary on this paper is available at .     

不稳定型心绞痛调脂治疗对血浆C反应蛋白及纤维蛋白原水平的影响

 目的 观察不稳定型心绞痛(UAP)患者调脂治疗前后,血浆C反应蛋白(CRP)及纤维蛋白原(FIB)的水平变化。方法 选择UAP患者67例,随机分为两组,治疗组(n=35)给予辛伐他汀和常规治疗,对照组(n=32)仅给予常规治疗,分别测定两组患者治疗前后的血浆CRP水平、FIB水平。结果 (1)治疗6周后,治疗组血浆CRP水平、FIB水平均明显低于对照组,分别为(6.81±3.97)mg／L对(9.73±4.86)mg／L,P＜0.01和(2.86±0.98)mg／L对(4.15±1.03)mg／L,P＜0.01;(2)治疗组血浆CRP水平、FIB水平的降低与胆固醇(TC)水平的降低不相关。结论 UAP调脂治疗具有抗血管内皮炎症反应的作用,并独立于降脂之外。