急诊冠状动脉内支架安置术治疗急性心肌梗死的效果

①目的：观察急诊冠状动脉内支架安置术治疗急性心肌梗死(AMI)效果。②方法：用急诊冠状动脉内支架安置术治疗AMI病人80例，观察梗死相关血管开通成功率、心肌梗死溶栓治疗试验(TIMI)Ⅲ级血流及无复流现象的发生率、出院时左心室功能、住院病死率。③结果：梗死相关血管开通成功率为98．7％，达TIMIⅢ级血流73例(92．5％)，无复流者6例(7．5％)，1例术中死亡。出院时左心室排血分数平均57．5％。住院病死率2．5％。④结论：急诊冠状动脉内支架安置术治疗AMI梗死相关血管开通成功率较高，能够降低病死率。     

Original articlesPrimary intracoronary stenting in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary intervention in patients with acute myocardial infarction

目的　比较急性心肌梗死 (AMI)患者冠状动脉内初期支架植入和静脉rt PA溶栓加补救支架植入治疗的临床疗效。方法　 98例首次AMI患者随机给以冠状动脉内初期支架植入 (初期支架组 :4 8例 )和静脉rt PA溶栓加补救支架植入 (溶栓加支架组 :5 0例 )。所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗死相关冠状动脉 (IRA)开通情况。记录住院期心脏事件 ;出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数 (LVEF)。结果　急诊冠状动脉造影显示支架组 4 7例 (97 91%)溶栓加支架组 5 0例 (10 0 %)IRA血流TIMI2 3级 ,但前者IRA前向血流TIMI3级者明显增多 (分别为 93 8%和 6 0 0 %,P =0 0 0 0 1)。两组患者住院期死亡率和心脏事件相似 ,但出院前超声心动图显示支架组LVEF(6 2 0 1%± 14.0 3%)高于溶栓加支架组 (5 0 0 1%± 132 %) ,P =0 0 0 0 1。结论　与静脉rt PA溶栓加补支架治疗相比 ,AMI初期支架植入可更好改善急性期心肌再灌注 ,并减少患者住院期心功能减退。     

AMI病人冠状动脉内支架安置术的无复流现象分析

①目的 了解冠状动脉内支架安置术治疗急性心肌梗死（AMI）的效果并对无复流现象发生机制进行探讨。②方法 采用急诊冠状动脉内支架安置术治疗AMI病人170例，观察梗死相关血管开通成功率、TIMI Ⅲ级血流及无复流现象的发生率、出院时左心室功能、住院病死率。③结果 急诊支架安置术梗死相关血管开通成功率为98.8％，TIMI Ⅲ级血流150例（88.2％），发生无复流现象20例（11.8％）。出院时左心室射血分数（LVEF）平均58％，住院死亡7例，住院病死率4.1％。④结论 冠状动脉内支架安置术治疗AMI，梗死相关血管开通成功率较高，但仍有少数病人会出现无复流现象。     

直接冠状动脉内支架置入术治疗急性心肌梗死30例疗效分析

目的 :观察急性心肌梗死 (AMI)病人 ,在无球囊预扩张情况下 ,直接置入冠状动脉内支架治疗的疗效及其再狭窄的探讨。方法 :对 30例AMI病人在发病 12h内 ,未经球囊预扩张采用直接置入冠状动脉内支架。观察梗死相关血管开通成功率、TIMI血流Ⅲ级发生率、出院时左心室功能、住院死亡率 ,术后 6个月再狭窄率、死亡率、左心室功能情况。结果 :直接置入冠状动脉内支架 30个 ,梗死相关血管开通成功率为 10 0 % ,TIMI血流Ⅲ级 2 9例 (96 .7% ) ,TIMI血流II级者 1例 (3.3% ) ,术后残余狭窄为 4 .5± 3.0 %。出院时左心室射血分数 (LVEF)为 5 6 .5 %± 11.2 % ,住院死亡率 3.3% (1例 )。术后 6个月再狭窄率为 12 .5 % ,无 1例死亡、左心室射血分数 (LVEF)为 5 8.2 %± 9.8%。结论 :急性心肌梗死 (AMI)时 ,在无球囊预扩张情况下 ,直接置入冠状动脉内支架治疗 ,梗死相关血管开通成功率较高 ,TIMI血流Ⅲ级发生率高 ,能降低死亡率及致残率。     

直接冠状动脉内支架置入术与静脉溶栓治疗急性心肌梗死的近期疗效对比研究(摘要)

目的 :比较直接冠脉内支架置入术与静脉溶栓治疗AMI的临床疗效和安全性 ,为进一步提高AMI的治疗水平提供科学依据。方法 :1999年 10月至 2 0 0 2年 9月收治AMI的患者 2 2 5例 ,其中直接支架置入 118例 ,梗死后6～ 12小时内常规急诊冠脉造影术 ,只对梗死相关血管行支架治疗 ;溶栓组 10 7例 ,小剂量t-PA(5 0mg) 90分钟方案治疗 95例 ,国产尿激酶 15 0万单位 3 0分钟。辅助用药支架组 :阿司匹林 15 0mg d ,一月后可小剂量长期口服 ,抵克力得 2 5 0mg ,每日两次或氯吡格雷首剂 3 0 0mg ,以后每日 75mg ,共 3 0天 ,肝素抗凝一周 ;溶栓组 :阿司匹林和肝素同支架组。疗效判断 :支架组按照心肌梗死溶栓治疗TIMI血流分级 ;溶栓组血管再通依据临床标准间接判断。出院前应用二维超声心动图简化的Simperson法计算左室射血分数 (LVEF)。结果 :支架组与溶栓组两组患者的临床基本特征相同 ,无统计学差异 (p >0 .0 5 )。LVEF :直接支架组显著高于溶栓组 (63 .2± 12 .3 %比 5 1.4± 3 .4% ,p <0 .0 1) ;住院期间的病死率 :直接支架组低于溶栓组 (3 ..4%比 6.7% ,p <0 .0 5 )。另外 ,溶栓治疗组有 17例 (15 .9% )因溶栓失败而行补救性支架置入术。并发症比较 ,脑出血溶栓治疗组 1.8% ,支架组 0 % ,有非常显著性差异 (P <0     

AMI初期支架植入和rt-PA静脉溶栓加补救支架植入的比较

目的比较急性心肌梗塞(AMI)患者冠状动脉内初期支架植入和静脉rt-PA溶栓加补救支架植入治疗的临床疗效.方法 98例首次AMI患者随机给以冠状动脉内初期支架植入(初期支架组:48例)和静脉rt-PA溶栓加补救支架植入(溶栓加支架组:50例).所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗塞相关冠状动脉(IRA)开通情况;记录住院期心脏事件:出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数(LVEF).结果急诊冠状动脉造影显示支架组47例(97.91%),溶栓加支架组50例(100%),IRA血流TIMI 2～3级,但前者IRA前向血流TIMI 3级者明显增多(分别为93.8%和60.0%,P=0.0001).两组患者住院期死亡率和心脏事件相似,但出院前超声心动图显示支架组LVEF(62.01%±14.03%)高于溶栓加支架组(50.01%±132%,P=0.0001).结论与静脉rt-PA溶栓加补救支架治疗相比,AMI初期支架植入可更好改善急性期心肌再灌注,并减少患者住院期心功能减退.     

AMI初期支架植入和rt—PA静脉溶栓加补救支架植入的比较

目的比较急性心肌梗塞(AMI)患者冠状动脉内初期支架植入和静脉rt-PA溶栓加补救支架植入治疗的临床疗效.方法98例首次AMI患者随机给以冠状动脉内初期支架植入(初期支架组48例)和静脉rt-PA溶栓加补救支架植入(溶栓加支架组50例).所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗塞相关冠状动脉(IRA)开通情况;记录住院期心脏事件出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数(LVEF).结果急诊冠状动脉造影显示支架组47例(97.91%),溶栓加支架组50例(100%),IRA血流TIMI2～3级,但前者IRA前向血流TIMI3级者明显增多(分别为93.8%和60.0%,P=0.0001).两组患者住院期死亡率和心脏事件相似,但出院前超声心动图显示支架组LVEF(62.01%±14.03%)高于溶栓加支架组(50.01%±132%,P=0.0001).结论与静脉rt-PA溶栓加补救支架治疗相比,AMI初期支架植入可更好改善急性期心肌再灌注,并减少患者住院期心功能减退.     

直接PTCA与静脉溶栓治疗AMI近期疗效观察

目的 :比较直接经皮冠状动脉腔内成形术 (PTCA)与尿激酶静脉溶栓治疗急性心肌梗塞 (AMI)患者住院期间的临床疗效。方法 :随机地将首次AMI患者分为直接PTCA组 (2 6例 )和尿激酶静脉溶栓组 (49例 ) ,观察冠脉再通率、住院病死率和再发心梗率以及出院前左室射血分数 (LVEF)。结果 :溶栓组梗塞相关动脉 (IRA)再通率为 6 9.39% ,直接PTCA组IRA成功再通率为 92 .31% ,差异有显著性 (P <0 .0 5 )。住院期间病死率和再发心梗率溶栓组均有增加的趋势 ,但差异无显著性 (P >0 .0 5 )。出院前左室射血分数溶栓组为 4 5 .91± 9.6 6 ,直接PTCA组为 5 3.4 8± 7.4 7,差异有显著性 (P <0 .0 5 )。溶栓组因再闭塞或缺血发作行择期PTCA的比率明显高于直接PTCA组 (2 0 .4 1%vs 0 % ,p <0 .0 5 )。两组IRA开通组行选择性冠状动脉造影 (CAG)示IRA前向血流达TIMI - 3级 ,溶栓组为 2 5 % ,直接PTCA组为 10 0 % ,两组间有极显著性差异 (P <0 .0 0 5 )。结论 :AMI患者行直接PTCA较溶栓治疗更能充分有效地开通梗塞相关动脉 (IRA) ,更能挽救阻塞血管区域的心肌 ,从而更好地改善患者心功能 ,降低病死率和再发心梗率     

急性心肌梗死序贯性再灌注研究

目的:探讨经尿激酶静脉溶栓加即刻准备的支架植入治疗急性心肌梗死(AMI)的临床疗效。方法:80例AMI患者中,直接冠脉支架植入20例(直接支架组),尿激酶静脉溶栓加即刻准备的支架植入30例(溶栓支架组),尿激酶静脉溶栓30例(溶栓组)。均行急诊冠状动脉造影,以Timi血流分级判断梗死相关冠状动脉(IRA)开通、血栓、慢复流情况;记录住院期间心脏事件;出院前用二维超声心动图测定左心室射血分数(LVEF)。结果:直接支架组IRA开通率为100％,溶栓支架组开通率为96.7％,溶栓开通率为46.7％(P<0.01);直接支架组与溶栓支架组术中冠脉内血栓发生率分别为25.0％,20.0％,P>0.05;慢复流发生率分别25.0％,30.0％,P>0.05;临床事件:出血、心力衰竭、心绞痛、再梗死,脑梗死,支架纽较溶栓组发病率低,但3组间统计学上无差异(P>0.05),住院天数明显短缩(P<0.01);3组病死率分别为0％,3.3％,6.7％(P<0.05);3组LVEF分别为(65.5±11.5)、(64.0±14.5)、(54.5±13.0)(P<0.05)。结论:直接支架植入或尿激酶静脉溶栓加即刘准备的支架植入较单纯尿激酶溶栓治疗惠性心肌梗死更能充分开通IRA,改善心功能,降低病死率。     

急诊冠状动脉腔内支架植入术治疗急性心肌梗死的临床疗效

目的　探讨急诊冠状动脉支架植入术 (PCI) 对急性心肌梗死 (AMI) 患者的临床疗效。方法　将发病12h以内或 12~24h仍有心肌缺血且无溶栓禁忌证的患者分为PCI组和溶栓组, 分别给予直接急诊PCI和尿激酶 (150万U) 静脉溶栓治疗, 比较两组患者的临床疗效和发病 2周时超声心动图结果。结果　溶栓组患者血管再通率为62 5%, PCI组再通率为 93 3%; PCI组患者梗死相关血管 (IRA) 均达到TIMIⅢ级血流; 溶栓组患者住院时间长于PCI组 (P<0 .001)。溶栓组患者心绞痛复发率大于PCI组患者 (P<0 .01)。溶栓组患者AMI发作 2周后左室射血分数 (LVEF) 低于PCI组 (P<0 .05)。结论　急性心肌梗死患者急诊PCI可及时开通梗死相关血管, 缩短住院时间,有效保护心功能。     

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.