943例冠心病患者糖代谢情况的调查与分析

目的对冠心病患者的糖代谢情况进行调查并分析。方法对943例冠心病患者进行空腹血糖检测,并对空腹血糖>5.6 mmol/L且既往未确诊糖尿病者进行OGTT检查。结果 943例冠心病患者中,糖代谢异常的共用658例,占69.8%。结论冠心病患者大多存在不同程度的糖代谢异常。管理好冠心病患者的血糖十分重要。     

急性心肌梗死患者糖代谢状况分析

目的探讨急性心肌梗死患者的糖代谢状况。方法连续选择自2010年10月～2011年9月在我院住院的235例急性心肌梗死患者为研究对象,无明确糖尿病史的患者在出院前均常规行口服葡萄糖耐量(OGTT)试验,以明确糖代谢状况。结果急性心肌梗死患者中糖尿病患病率为44.7%,糖调节受损患病率为25.1%,总的糖代谢异常患病率为69.8%。除去既往有糖尿病史的患者,新诊断的糖尿病和糖调节受损患病率分别为24.9%和34.1%。结论急性心肌梗死患者中大多数存在糖代谢异常,行OGTT可及早发现糖代谢异常患者。     

509例住院冠心病患者心理状况调查与分析

目的 探讨住院冠心病患者焦虑和抑郁的症状发生率及严重程度.方法 509 例冠心病患者分为稳定性心绞痛(SA)、不稳定性心绞痛(UA)、非ST段抬高性心肌梗死(NSTEMI)和ST段抬高性心肌梗死(STEMI)4组,选用抑郁自评量表(SDS)和焦虑自评量表(SAS)对患者进行心理调查并分析.结果 总体和各亚组冠心病患者SAS标准分和SDS标准分均显著高于国内标准常模分值(P<0.05);UA组SAS标准分及焦虑发生率显著高于SA和STEMI组(P<0.05);各亚组发生焦虑的严重程度无统计学差异.不同哑组间SDS标准分、抑郁发生率及抑郁严重程度比较均无统计学差异.女性患者SAS和SDS标准分均显著高于男性患者(P<0.01),女性患者抑郁发生率和严重程度显著高于男性患者(P<0.01和P<0.05).结论 住院冠心病患者各有约四分之一的病例并发不同程度的焦虑和(或)抑郁;UA患者更易并发焦虑;女性患者的抑郁发生率高于男性,且抑郁程度相对较重.     

合并糖代谢异常的冠心病患者血Lp-PLA2活性水平研究

目的观察合并糖代谢异常的冠心病患者血浆Lp-PLA2活性水平。方法入选非ST段抬高急性冠脉综合征54例及非冠心病患者24例,所有患者均行冠脉造影检查。如无糖尿病病史的患者,7d后行口服葡萄糖耐量试验明确是否存在糖代谢异常。根据有无糖代谢异常及冠脉造影结果,分为四组:第一组为合并糖代谢异常的NSTEACS组(NSTEACS-AG组)34例,第二组为不合并糖代谢异常的NSTEACS组(NSTEACS组)20例,第三组为单纯糖代谢异常的非冠心病组(AG组)12例,第四组为不合并糖代谢异常的非冠心病组(CONTROL组)12例。观察其血浆Lp-PLA2在四组之间的差别。结果 NSTEACS患者Lp-PLA2活性均较非冠心病患者高(P<0.05);NSTEACS-AG组较NSTEACS组Lp-PLA2活性低;AG组较CONTROL组Lp-PLA2活性也低,但均无统计学意义(P>0.05)。结论 NSTEACS患者Lp-PLA2活性较非冠心病患者升高;糖代谢异常对Lp-PLA2活性无明显影响。     

冠心病患者糖代谢异常的管理

由于冠心病与糖尿病有着共同的危险因素,在住院冠心病患者中其发生率、诊断率也明显增多,高血糖可加速冠状动脉硬化进展,甚至引发急性冠状动脉事件。本文重点阐述对冠心病患者如何进行糖尿病的筛查、诊断,对出现的糖代谢紊乱如何管理。     

冠心病患者血脂结构特点与年龄性别关系分析

冠心病患者血脂结构特点与年龄性别关系分析太原市南城区人民医院（０３０００２）田芳山西医科大学第一医院李茹香临床及流行病学研究结果表明，高脂血症是冠心病（ＣＨＤ）的危险因素之一，降低总胆固醇（ＴＣ）和低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）可减少ＣＨＤ危险〔１...     

心血管内科住院患者糖代谢异常的临床观察研究

目的探讨分析心血管内科住院患者糖代谢异常的临床研究。方法随机抽取本院2010年3月至2011年5月心血管内科共收治的202例糖代谢异常患者的临床资料进行分析,其中99例患者为糖尿病患者,剩余103例根据葡萄糖耐量试验进行判断和评价。结果临床所有患者经研究结果显示,在103例非糖尿病患者的临床资料中,患有糖代谢异常者为40例,占到抽样总数的38.8%;在总病例202例患者中,患有糖代谢异常的103例患者,占到抽样总数的51%。结论对于心血管内科的患者,早期的采用葡萄糖耐量试验比空腹血糖的检测准确率要高很多,该类临床检查的使用值得临床推广应用。     

华东医院2002年冠心病住院患者治疗状况回顾性调查

目的 :了解冠心病 (CHD)患者药物治疗状况和医师是否遵循慢性心力衰竭治疗建议。方法 :利用调查表回顾性调查本院 2 0 0 2年度出院CHD患者的一般情况及住院期间的用药情况。结果 :331例CHD患者 (男 198例 ,女 133例 ) ,年龄 (73 0±9 6 )a。使用率较高的药物依次为硝酸酯类、抗血小板聚集药、ACE抑制药和利尿药。 2 38例慢性心力衰竭者 β 受体拮抗药的使用率为 4 0 3%。 2 2 4 %有适应证、无禁忌证但未使用。ACE抑制药的剂量低于建议中的目标剂量。 6 4例心肌梗死后患者抗血小板聚集药、β 受体拮抗药出院带药率为 73 4 %和 34 4 %。 结论 :医师需要提高ACE抑制药的剂量和 β 受体拮抗药的使用率 ,提高抗血小板聚集药、β 受体拮抗药的出院带药率     

住院冠心病患者出院后的心理状况变化

目的 观察住院冠心病患者出院后焦虑和抑郁状况的动态变化.方法 入选2007～2009年住院并经冠状动脉造影(CAG)确诊的冠心病患者1116例,在CAG或支架植入后2 d内选用Zung焦虑自评量表(SAS)和Zung抑郁自评量表(SDS)对入选患者进行心理测评.在患者出院后1年通知其门诊回访,再次进行SAS和SDS量表的测评.结果 共有361例(32.3%)患者接受了门诊随访,收回有效问卷361份.平均随访时期为患者出院后(14.8±4.3)个月.回访时患者SAS、SDS标准分显著低于其住院时的基线值(P<0.01),但仍显著高于国内标准常模分值(P<0.01).焦虑和抑郁的症状患病率显著低于住院时各自的症状患病率(P<0.01),其严重程度也较住院时显著下降.女性患者、心肌梗死患者回访时的焦虑和抑郁症状患病率与住院时无显著差异.基线SD6评分、既往心肌梗死史与门诊随访依从性负相关.结论 国人住院冠心病患者出院后1年焦虑和抑郁状况显著改善,但仍未恢复至正常人群水平;女性患者和心肌梗死患者在出院后1年焦虑和抑郁状况无显著改善.     

Impact of a cardiac risk reduction program in vulnerable patients hospitalized with coronary artery disease

STUDY OBJECTIVE: To increase the use of guideline-based pharmacotherapy in vulnerable patients (ethnic minorities and the poor) with coronary artery disease (CAD) through a nurse-based quality-improvement program. DESIGN: Retrospective program evaluation. SETTING: Inner-city hospital in Denver, Colorado. PATIENTS: One hundred fifty-one consecutive patients hospitalized with a CAD-related diagnosis. INTERVENTION: A nurse-management program was initiated for patients with angiographically documented CAD, and rates of guideline-based care were compared with rates for historic controls. The intervention consisted of two key elements: patient counseling with language-appropriate education materials and direct physician education regarding the importance of cardioprotective drugs. The 151 patients in the intervention group were compared with 125 historic control patients hospitalized before the program was begun. Multivariable logistic regression analysis was used to assess differences in care with regard to ethnicity, education level, and insurance status, and to adjust for different baseline characteristics. MEASUREMENTS AND MAIN RESULTS: At hospital discharge, patients in the intervention group were more likely to receive statins (71% vs 52%, p=0.001) and angiotensin-converting enzyme inhibitors (79% vs 51%, p<0.001) compared with controls. These differences remained after adjusting for ethnicity, education level, insurance status, and baseline clinical characteristics. Also, a trend was noted toward greater use of aspirin (92% vs 86%, p=0.13) and beta-blockers (79% vs 73%, p=0.24) in the intervention group compared with controls. Patients in the intervention group were more likely to receive counseling for smoking cessation. CONCLUSION: An inpatient nurse-management program improved the quality of care for patients with CAD regardless of sociodemographic status. Properly designed disease-management initiatives can be effective for disadvantaged patients, who often obtain health care through emergency and inpatient services.     

Ranolazine in patients with coronary artery disease

Traditional anti-anginal agents such as beta-blockers and nitrates improve symptoms of cardiac ischemia by affecting either blood pressure or heart rates. Despite aggressive therapy, many patients suffer persistent angina, and optimal therapy is limited by intolerance to traditional agents. Ranolazine, a novel anti-anginal agent that is approved for use in the US, is felt to improve ischemic symptoms by reducing myocardial cellular sodium and calcium overload via inhibition of the late sodium current (I(Na)) of the cardiac action potential. Several Phase-III trials in patients with chronic angina have demonstrated that ranolazine improves exercise tolerance and reduces ischemic symptoms as compared with placebo. In the largest evaluation of ranolazine, the MERLIN-TIMI 36 trial (Metabolic Efficiency with Ranolazine for Less Ischemia in non ST elevation acute coronary syndrome), ranolazine did not reduce the risk of death or recurrent myocardial infarction in patients with non-ST-elevation acute coronary syndromes, but it did improve ischemic symptoms over the subsequent year of therapy. Thus, ranolazine offers clinicians a new therapy in the long-term treatment of patients with chronic angina.     

Ranolazine in patients with coronary artery disease

Traditional anti-anginal agents such as β-blockers and nitrates improve symptoms of cardiac ischemia by affecting either blood pressure or heart rates. Despite aggressive therapy, many patients suffer persistent angina, and optimal therapy is limited by intolerance to traditional agents. Ranolazine, a novel anti-anginal agent that is approved for use in the US, is felt to improve ischemic symptoms by reducing myocardial cellular sodium and calcium overload via inhibition of the late sodium current (I_Na) of the cardiac action potential. Several Phase-III trials in patients with chronic angina have demonstrated that ranolazine improves exercise tolerance and reduces ischemic symptoms as compared with placebo. In the largest evaluation of ranolazine, the MERLIN-TIMI 36 trial (Metabolic Efficiency with Ranolazine for Less Ischemia in non ST elevation acute coronary syndrome), ranolazine did not reduce the risk of death or recurrent myocardial infarction in patients with non-ST-elevation acute coronary syndromes, but it did improve ischemic symptoms over the subsequent year of therapy. Thus, ranolazine offers clinicians a new therapy in the long-term treatment of patients with chronic angina.     

冠心病合并糖尿病者冠脉造影结果分析

目的 通过冠脉造影探讨冠心病合并糖尿病者冠脉病变特点。方法 回顾我院2000—2006年1068例冠心病患者造影检查阳性者对380例糖尿病合并冠心病者行冠脉造影，并与688例非糖尿病的冠心病患者相比较。结果 糖尿病并冠心病者三支病变和弥漫性病变者分别为56．8％和58％，明显高于非糖尿病者（21.5％和16％）。结论 冠心病并糖尿病者冠脉造影主要表现为多支病变及复杂病变，而非糖尿病者多为单支或双支病变，糖尿病组冠脉狭窄程度明显高于非糖尿病组，显示糖尿病对冠脉病变影响大，糖尿病为冠心病的独立危险因素。     

依诺沙星片对老年患者血糖代谢的影响

目的研究依诺沙星片治疗感染性疾病对老年患者血糖代谢的影响。方法选择7d内未接受过其他氟喹诺酮类药物治疗,肝、肾功能正常的在院老年患者(≥60岁),随机分为治疗组和对照组各25例,测量其治疗前后空腹血糖(FPG)、空腹胰岛素(Fins)并进行统计分析。结果治疗组和对照组在治疗前后空腹血糖(FPG)、空腹胰岛素(Fins)、胰岛素敏感指数(IAI)水平间差异无统计学意义(P>0.05)。结论依诺沙星片治疗感染性疾病对老年患者血糖代谢没有发现临床意义上的影响。     

心房颤动合并冠心病患者抗栓治疗分析

目的 观察心房颤动合并冠心病患者抗栓治疗方法.方法 选择我院收治的心房颤动合并冠心病患者61例,随机分为两组A组阿司匹林联合氯吡格雷(31例);B组阿司匹林联合氯吡格雷联合华法林(30例),各组患者治疗观察12个月,分别随访分析患者出血事件和出血状况.结果 A治疗组5例(16.1%)发生脑栓塞,与B治疗组1例(3.3%)比较发生率差异具无统计学意义(P>0.05).严重出血发生率A治疗组4例(12.9%)与B治疗3例(10.0%)组比较差异无统计学意义(P>0.05).结论 阿司匹林联合氯吡格雷与阿司匹林联合氯吡格雷联合华法林三重治疗心房颤动合并冠心病患者抗栓疗效及安全性相似.