链激酶静脉溶栓治疗急性心肌梗死的效果

1目的　探讨链激酶静脉溶栓治疗急性心肌梗死的效果。2方法　给予 2 3例急性心肌梗死病人 15 0万单位链激酶行静脉溶栓治疗 ,根据临床血管再通指标 ,比较溶栓开始不同时间 (<6 h和 6～ 12 h)和不同的给药速度 (30 m in和 6 0 min滴完 )对疗效的影响。通过择期冠状动脉造影 ,比较临床再通组与未通组冠脉再通率。通过超声心动图及左室造影 ,比较再通组与未通组心功能。3结果　 6 h内溶栓血管再通率 6 8.4% ,6～ 12 h溶栓血管再通率5 0 .0 % ,两者比较差异有显著意义 (χ2 =8.11,P<0 .0 1) ;两种给药速度血管再通率差异无显著意义 (χ2 =0 .0 3,P>0 .0 5 )。左室造影示再通组心功能明显好于未通组 (t=3.2 1,P<0 .0 1)。4结论　链激酶静脉溶栓治疗急性心肌梗死安全有效。     

静脉溶栓治疗急性心肌梗死42例临床分析

目的 通过对急性心肌梗死(AMI)患者早期静脉溶栓治疗进行临床分析,探讨开通急性心肌梗死闭塞冠脉的最佳时间.方法 42例AMI患者2 h之内溶栓9例,2～6 h内溶栓26例,7～12 h之内溶栓7例,观察不同溶栓时间再通率的差别.结果 2 h内和2～6 h组溶栓再通例数比较无统计学差异(P＝0.648),但两组再通例数均分别显著性高于7～12 h溶栓组(P＝0.009,P＝0.005).结论 早期(6 h内)静脉溶栓治疗急性心肌梗死效果好.     

瑞替普酶急诊溶栓治疗急性心肌梗死的临床研究

目的 观察瑞替普酶( r-PA)急诊静脉溶栓治疗急性心肌梗死(AMI)不同时间窗溶栓治疗的血管再通率及安全性.方法 符合入选标准的57例无溶栓禁忌证患者在常规治疗的基础上给予r-PA 18 mg +0.9％氯化钠50 ml快速静脉溶栓治疗,30 min后再给予r-PA18 mg治疗.计算发病0.5～2h、＞2～4h、＞4 ～6 h及＞6～12h内溶栓再通率,并将6h内溶栓病例与将＞6～12 h溶栓病例进行再通率比较.结果 6h内溶栓再通率为86.67％,＞6～12 h溶栓再通率为41.67％,2者比较差异有统计学意义(P＜0.05).结论 临床上应用r-PA急诊溶栓治疗AMI疗效好,再通率高,AMI溶栓时间越早再通率越高,且安全,副作用少.     

直接冠状动脉内支架安置术和r-SK静脉溶栓治疗急性心肌梗死的对比研究

①目的　比较急性心肌梗死 (AMI)病人直接冠状动脉内支架安置和重组链激酶 (r SK)静脉溶栓治疗的临床疗效。②方法　对初次发病 1 2h以内的 1 0 5例AMI病人 ,随机给予直接冠状动脉内支架安置 (支架组 ,6 0例 )和静脉r SK溶栓 (溶栓组 ,5 5例 )治疗。观察两组梗死相关血管再通成功率、心肌梗死溶栓试验 (TIMI)Ⅲ级血流发生率、平均住院天数、住院病死率 ,出院前二维超声心动图测定并推算左心室射血分数 (LVEF)和梗死区室壁运动指数 (RWMI) ,出院后 6个月病死率、LVEF和RWMI。③结果　支架组与溶栓组相比较 ,梗死相关血管再通率显著提高、TIMIⅢ级血流发生率显著增加、平均住院天数显著缩短、住院病死率显著降低 (χ2 =5 .4 2 4～2 8.931 ,t=7.90 1 ,P <0 .0 5、0 .0 1 ) ;出院前LVEF和RWMI ,两组间存在显著差异 (t =3.2 91、2 .1 2 7,P <0 .0 5、0 .0 1 ) ;出院后 6个月病死率、LVEF和RWMI ,两组比较无显著差异。出院后 6个月LVEF、RWMI与出院前比较 ,支架组与溶栓组均有显著改善 (t=2 .1 92～ 4 .6 1 1 ,P <0 .0 5、0 .0 1 )。④结论　与静脉r SK溶栓治疗相比 ,直接冠状动脉内支架安置术治疗AMI,可更有效地再通梗死相关血管、降低住院病死率、更有效地保护病人心脏功能     

重组组织型纤溶酶原激活剂治疗急性心肌梗死的疗效分析

目的　评价重组组织型纤溶酶原激活剂 (rt -PA)静脉溶栓治疗急性心肌梗死 (AMI)的疗效及安全性。方法　 39例AMI患者接受rt -PA静脉溶栓治疗 ,观察临床症状、心电图、心肌酶谱的变化 ,判断冠状动脉的再通率。结果　 39例中冠状动脉再通 2 9例 ( 74 .3% ) ,其中发病 6小时以内的溶栓再通率为 85.7% ( 12 14 ) ,发病 6～ 12小时的溶栓再通率 6 8% ( 17 2 5) ,两者相比差异显著性 (P <0 .0 5)。≤ 6 5岁患者的血管再通率与不良反应发生率与 >6 5岁的相比差异无显著性 (P >0 .0 5)。结论　rt-PA静脉溶栓治疗AMI是一种安全、有效的方法 ,应提倡急诊室溶栓 ;>6 5岁的患者静脉溶栓同样是安全可行的     

尿激酶静脉溶栓治疗急性心肌梗死84例临床观察

目的 观察尿激酶静脉溶栓治疗84例急性心肌梗死（AMI）的疗效。方法 应用国产尿激酶150万U加生理盐水100ml，30min内静脉滴入。结果 84例AMI总再通率为78.57%，其中发病1～6h、6～12h、〉12～24h溶栓再通率分别为88.33%、57.14%、20%，各时段之间差异均有显著性（P〈0.05）。结论 尿激酶静脉溶栓时间越早，冠状动脉再通率越高，可显著降低AMI住院患者的死亡率，是治疗AMI安全、有效，积极的抢救措施。     

急性心肌梗死尿激酶溶栓时机分析

目的 观察ST段抬高的急性心肌梗死(AMI)溶栓时间与溶栓成功的关系.方法 溶栓适应证的ST段抬高的AMI病例68例,给予国产尿激酶100～150万U溶栓,肠溶阿司匹林0.3 g口服;尿激酶溶栓6 h后,给予肝素5000 U肌注,2次/d.结果 静脉溶栓治疗2 h以内再通13例(再通率72.2%);3～6 h以内再通21例(再通率91.3%);7～12 h以内再通7例(再通率38.9%);13～24 h再通0例(再通率0%).结论 急性心肌梗死(AMI)尿激酶溶栓治疗,越早越好.     

老年急性心肌梗死静脉溶栓治疗的临床研究

目的　探讨老年急性心肌梗死 (AMI)患者静脉溶栓的近期疗效与半年病死率。方法　选择符合静脉溶栓治疗适应症 ,且无禁忌症的 5 6例AMI患者 ,分为老年组 31例 ,年龄 6 0～ 6 9岁 ,高龄组 2 5例 ,年龄≥ 70岁 ,同时给予国产尿激酶静脉溶栓治疗。结果　梗死相关血管再通率在 6 0 %以上 ,随年龄增加虽有所下降 ,但两组间比较差异无显著性意义 (P >0 .0 5 )。两组 30d病死率和老年组 180d病死率较低 ,高龄组 180d病死率为 2 4%。两组间比较差异无显著性意义 (P >0 .0 5 )。半年总病死率为 14.2 9%。高龄组泵衰、恶性心律失常、感染等合并症高于老年组 ,但无统计意义 (P >0 .0 5 ) ,两组均未发生严重出血。结论　老年AMI患者静脉溶栓治疗有效 ,可减少病死率 ,但高龄患者合并症相对较多。     

尿激酶超早期静脉溶栓治疗高龄急性心肌梗死临床观察

目的 :观察尿激酶超早期静脉溶栓治疗高龄急性心肌梗死的临床效价及安全性。方法 :2 6例高龄急性心肌梗死患者按发病情况及开始溶栓时间分为两个时间区段 :即 2 h～ 6 h内为 A组 ;7h～ 12 h内为 B组。两组患者年龄均在 70岁以上 ,均采用常规抢救措施加用尿激酶静脉溶栓。结果 :A、B两组再通成功率达 6 1.5 3% ,无明显副作用。且溶栓时间愈早 ,再通率愈高。结论 :尿激酶超早期静脉溶栓治疗高龄急性心肌梗死安全有效     

急性心肌梗死通过绿色通道静脉溶栓100例临床观察

目的观察急性心肌梗死通过绿色通道静脉溶栓的效果。方法对2000年1月～2008年12月我科应用急诊绿色通道早期静脉溶栓治疗AMI100例的临床资料进行回顾性分析。结果100例AMI患者静脉溶栓再通率75％，其中发病〈3h再通率83．3％（40／48），〈6h75％（33／44），6—12h33．3％（2／6），〉12h0％（0／2）。5周病死率11％，再通组20％（4／75），未通组28％（7／25）。结论急诊绿色通道在完善急救的情况下可使AMI患者尽早静脉溶栓，明显降低AMI患者的死亡率。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.