微小核糖核酸-590与急性冠状动脉综合征介入术后1年内支架内再狭窄的关系

目的探讨微小核糖核酸-590(miR-590)与急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后1年内支架内再狭窄(ISR)的关系。方法选取2018年2月至2020年1月在重庆市人民医院接受PCI治疗的452例ACS患者作为研究对象。根据术后1年内是否发生ISR,分为ISR组(n=51)和非ISR组(n=401)。实时荧光定量聚合酶链反应(PCR)检测miR-590水平,分析其与ISR的关系。结果 ISR组miR-590相对表达量低于非ISR组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示舒张压(DBP)、空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL-C)和血管病变长度是PCI术后1年内ISR的独立危险因素(P<0.05),miR-590是PCI术后1年内ISR的独立保护因素(P<0.05)。模型Y(由DBP、FBG、LDL-C、血管病变长度和miR-590构成)预测ACS患者PCI术后1年内ISR的ROC曲线下面积高于模型X(由DBP、FBG、LDL-C和血管病变长度构成),差异有统计学意义(P<0.05)。风险...     

中高危血栓风险急性冠状动脉综合征患者经皮冠状动脉介入术1年后应用低剂量替格瑞洛二级预防可行性研究

目的 探讨具有中高危血栓风险同时出血风险较低的中国急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)1年后应用60 mg替格瑞洛二级预防的疗效及安全性.方法 选取自2017年11月至2019年1月于北部战区总医院心血管内科行PCI术的278例ACS患者为研究对象.ACS患者行PCI术后应用替格瑞洛90 mg...     

红细胞分布宽度对行急诊PCI的ACS患者的预后价值

目的 研究红细胞分布宽度(RDW)与行急诊经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者预后的关系.方法 搜集本院2009年1～8月116例因ACS入院并行急诊PCI术的患者资料,根据入院24 h首次RDW中位数(12.8%)检测结果,将患者分为RDW≥12.8%和RDW＜12.8%组,观察其住院期间及出院1年内发生心肌缺血、心力衰竭、心源性死亡等心血管不良事件的差别.结果 共纳入符合条件ACS患者116例,在校正血红蛋白含量(Hb)、平均红细胞体积(MCV)、性别、年龄、高血压、糖尿病等因素影响后,RDW升高仍是行急诊PCI术的ACS患者住院期间及出院1年内发生心血管不良事件的危险因素.结论 RDW值对行急诊PCI术的ACS患者预后有一定价值;RDW较高患者,其住院期间及出院1年内预后较差.     

冠状动脉造影评价鱼油对预防冠状动脉再造再狭窄效果Meta分析

目的 以冠状动脉血管造影直径作为指标,通过Meta分析评估鱼油对预防经皮冠状动脉介入治疗(PCI)术后冠状动脉支架内再狭窄(ISR)的效果。方法 检索中国期刊全文数据库(CNKI)、中国维普全文数据库(VIP)、万方数据库、Pubmed、The Cochrane Library和Embase数据库,检索时间为建库起至2021年12月,查找鱼油对于冠心病(CAD)患者PCI术后冠状动脉影像学指标的随机对照试验(RCT)。观察终点为冠状动脉ISR的影像学评估数据、血清甘油三酯、高密度脂蛋白、血小板计数、总胆固醇,计算合成风险率比(RR)、标准均值差(SMD)及95%可信区间(CI)。结果 纳入7项RCT文献,共1 583例患者,干预组服用鱼油的时间为4～8个月。ISR冠状动脉影像学指标合并结果未发现服用鱼油与CAD患者PCI术后ISR风险降低相关(RR=1.00,95%CI:0.89～1.13,P>0.05)。服用鱼油的干预组患者的血清甘油三酯(SMD=-0.48,95%CI:-0.53～-0.43,P<0.01)和高密度脂蛋白(SMD=0.05,95%CI:0.01～0.09...     

脂蛋白a和同型半胱氨酸对冠状动脉支架内再狭窄影响的临床分析

目的 探讨脂蛋白a[Lp(a)]和同型半胱氨酸（Hcy）对经皮冠状动脉介入治疗（PCI）后支架内再狭窄（ISR）的影响。方法 回顾性分析2016年6月至2021年6月在宁波市医疗中心李惠利医院接受PCI术并随访冠状动脉造影患者临床资料。根据ISR诊断标准随机选取ISR患者102例（ISR组）,未发生ISR患者101例（无ISR组）。采用单因素和多因素logistic回归分析Lp(a)和Hcy是否为PCI术后ISR的危险因素。结果 ISR组、无ISR组术后随访时Lp(a)分别为（0.28±0.23） g/L、（0.15±0.08） g/L,差异有统计学意义（t=5.62,P<0.01）;Hcy分别为（16.35±11.12）μmol/L、（10.37±3.33）μmol/L,差异有统计学意义（t=5.20,P<0.01）,表明Lp(a)和Hcy水平与PCI术后ISR呈正相关。多因素logistic回归分析结果显示,血浆Lp(a)(OR=842.679,95%CI=31.117～22 820.459,P<0.01)和Hcy(OR=1.248,95%CI=1.130～1.3...     

4365例多支冠状动脉病变介入治疗近期疗效评价

目的分析经皮冠状动脉介入治疗(PCI)对多支冠状动脉病变患者的近期临床疗效。方法1995～2005年实施PCI的4365例多支冠状动脉病变住院患者,其中急性冠状动脉综合征(ACS)3833例(87.8%),稳定性心绞痛532例(12.2%)。ACS患者中发病30天内急性心肌梗死(AMI)1480例(38.6%)、不稳定心绞痛(UAP)2353例(61.4%)。评价PCI的成功率、合并症及住院期间的临床疗效。结果PCI的病例成功率为96.9%(4230/4365),靶病变成功率为98.8%(11185/11320)。住院期间病死率1.3%(全因死亡56例),术中病死率0.05%(2例),PCI相关并发症发生率7.2%(314/4365)。PCI术后存活出院患者心绞痛症状缓解率为96.2%(4147/4309),住院时间13±9天。结论PCI治疗多支冠状动脉病变成功率高,手术相关并发症和院内死亡率低,近期疗效好。     

双源CT Flash模式冠状动脉成像在经皮冠状动脉介入 治疗术后支架内再狭窄与左心室功能诊断价值

目的探讨双源CT(DSCT)Flash模式冠状动脉成像在经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)及左心室功能评估中的诊断价值。方法选取自2018年8月至2019年3月收治的100例PCI术后患者为研究对象。所有患者均行冠状动脉造影(CAG)检查、DSCT Flash模式检查和超声心动图检查,比较DSCT Flash模式与CAG检查方法评估ISR的特异性、敏感性、准确度、阴性预测值及阳性预测值,比较两种检查方法的辐射剂量、造影剂用量和图像质量的差异,比较DSCT Flash模式与超声心动图检查方法的左心室功能参数并分析相关性。结果以CAG诊断结果为对照,DSCT Flash模式诊断ISR的特异性、敏感性、准确度、阴性预测值及阳性预测值分别为95.5%、84.6%、93.5%、96.4%、81.1%。DSCT Flash模式的辐射剂量和造影剂用量低于CAG检查(P<0.05)。两种检测方式图像质量评分比较,差异无统计学意义(P>0.05)。ISR患者近、远端管腔CT密度差值显著高于支架内通畅患者(P<0.05)。DSCT Flash模式检测的收缩末期容积(ESV)、舒张末期容积(EDV)、每搏输出量(SV)和射血分数(EF)与超声心动图检测结果比较,差异无统计学意义(P>0.05)。相关性分析显示,DSCT Flash模式检测的ESV、EDV、SV和EF与超声心动图检测结果存在显著相关性。结论通过DSCT Flash模式冠状动脉成像在评价PCI术后ISR及左心室功能上均具有很好的临床价值。     

急性冠状动脉综合征患者应用盐酸替罗非班的观察与护理

急性冠状动脉综合征(Acute coronary syndrome,ACS)是由于粥样硬化斑块不稳定、溃破、出血、血栓形成、心肌血氧供应急剧减少而引起的[1].目前,抗凝抗血小板治疗联合经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)已成为ACS最重要的治疗手段.PCI后支架内急性或亚急性血栓形成是PCI严重并发症之一,其病死率可高达20%～25%.为防止此类并发症的发生,在PCI术前、术中和术后都使用足量的抗凝和抗血小板药物.尽管目前已有多种抗凝和抗血小板药物用于临床,急性或亚急性支架内血栓的发生率仍有1%[2].     

血清甘油三酯水平与合并贫血急性冠状动脉综合征患者预后相关性分析

目的 探讨合并贫血的急性冠状动脉综合征(ACS)患者血清甘油三酯(TG)水平与经皮冠状动脉介入治疗(PCI)术后1年出血/缺血事件的相关性。方法 回顾性分析自2016年1月至2019年12月北部战区总医院心血管内科收治的7 456例接受PCI治疗的合并贫血的ACS患者的临床资料。研究的主要结局事件为PCI术后12个月内出血学术研究联合会(BARC)2,3,5型出血事件;次要结局事件为PCI术后12个月内发生的复合缺血性事件(由心原性死亡、心肌梗死及卒中构成),以及全因死亡。按六分位法将TG分类为以下7组：TG≤0.78 mmol/L、0.79～0.97 mmol/L、0.98～1.17 mmol/L、1.18～1.37 mmol/L、1.38～1.67 mmol/L、1.68～2.24 mmol/L及TG>2.25 mmol/L组,使用浮动绝对风险法计算每个类别中终点事件的风险比,并在不同多因素校正的COX回归模型进行验证。结果 在收集的7 456例合并贫血的ACS患者中,血清TG>2.25 mmol/L的患者有1 056例设为TG>2.25 mmol/L组,TG≤2...     

急性冠脉综合征合并糖尿病、高血压患者经皮冠状动脉介入治疗术后收缩压对主要不良心脑血管事件影响

目的探讨急性冠脉综合征(ACS)合并糖尿病、高血压患者经皮冠状动脉介入治疗(PCI)后收缩压水平与主要不良心脑血管事件(MACCE)的关系。方法回顾性分析自2010年1月至2014年12月于北部战区总医院行冠脉造影提示冠状动脉血管病变并行PCI治疗的ACS合并糖尿病、高血压的7 671例患者的临床资料。按降压治疗后收缩压水平将所有患者分为A组(n=938,收缩压<120 mmHg)、B组(n=1 471,收缩压120～130 mmHg)、C组(n=5 262,收缩压>130 mmHg)。比较各组一般资料及临床终点,分析3组不同收缩压水平对MACCE的影响。结果 3组女性、吸烟史、冠心病家族史、不稳定型心绞痛、急性ST段抬高型心肌梗死、肌酐清除率<60 ml/(min·1.73 m~2)的患者比例比较,差异均有统计学意义(P<0.05)。3组患者净临床不良事件(NACE)、MACCE、全因死亡发生率比较,差异均有统计学意义(P<0.05)。结论 ACS合并糖尿病、高血压患者PCI术后收缩压<120 mmHg对心脑血管有不良影响。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。