急性冠脉综合征患者发病率季节变异分析

目的：就急性冠脉综合征患者6年发病率的四季构成差异进行了探讨.方法：回顾了成都地区两所医院6年间共1452例急性冠脉综合征患者发病率的四季平均构成比,并进行了汇总分析.结果：急性冠脉综合征患者发病率确实存在季节差异,均表现为冬达峰期夏抵低谷.结论：急性冠脉综合征发病率皆存在冬高夏低的季节变异.     

血清妊娠相关蛋白-A检测在急性冠状动脉综合征诊断中的意义

目的探讨急性冠状动脉综合征(ACS)患者血清妊娠相关蛋白-A(PAPP-A)、髓过氧化物酶(MPO)和C-反应蛋白(CRP)的变化及相互关系。方法以ELISA法检测51例ACS患者、28例稳定型心绞痛(SAP)患者和23例健康人(对照组)血清PAPP-A、MPO和CRP含量。结果ACS患者血清中PAPP-A、MPO和CRP含量均显著高于对照组和SAP组(P<0.01);SAP患者血清PAPP-A、MPO和CRP含量稍高于对照组(P<0.05);急性心肌梗死(AM I)和不稳定型心绞痛(UAP)患者血清PAPP-A、MPO与CRP呈线性相关(PAPP-A与CRP,r=0.71,P<0.01;MPO与CRP,r=0.74,P<0.01)。结论PAPP-A、MPO和CRP在ACS患者血浆中均显著增高,可作为ACS患者的诊断敏感性指标之一,且三者间存在显著相关性。     

急性冠脉综合征与检验医学

冠状动脉心脏病(冠心病)是危及人类生命的常见病。中国近年冠心病发病率明显升高,但病死率却逐步下降,这些可能与检验和治疗技术的发展和进步有关。心肌梗死检验医学的演进20世纪50年代前,临床医师诊断心肌梗死主要是根据临床症状和心电图检查(特别是出现异常Q波)。1954年,Karman等测定血中的门冬氨酸转氨酶(AST),发现心肌梗死时AST有一个迅速上升转而下降恢复正常的过程,才开始根据血中各种酶的检测来辅助临床诊断心肌梗死。主要测定的酶除AST外,还有乳酸脱氢酶(LDH)、α鄄羟丁酸脱氢酶(HBDH)和肌酸激酶(CK),并常常将此4种酶组成一…     

急性冠脉综合征的危险因素

急性冠脉综合征主要是指由于冠状动脉严重粥样硬化导致持续性狭窄或间断性冠脉痉挛引起心肌缺血性损伤，在此病理基础上甚至进一步引起冠脉内血栓形成严重引起急性心肌梗死或心源性猝死所致的临床综合征。包括：（1）不稳定型心绞痛；（2）急性心肌梗死（包括有Q波及无Q波的急性心肌梗死；（3）心源性猝死。近年来急性冠脉综合征越来越引起大家的关注，现对急性冠脉综合征的危险因素予以综述。     

探讨缺血修饰清蛋白在ACS早期的诊断意义

目的 缺血修饰清蛋白(ischemia modified albumin,IMA)与传统心肌标志物在急性冠脉综合症(acute coronary syndrome,ACS)早期诊断中的临床应用价值探讨.方法 选择因急性胸痛就诊的患者47例,于胸痛4,12,24 h连续监测血清IMA,CK-MB,CTnI水平,另选91例健康体检者作正常对照组,通过绘制IMA在该人群中用于诊断ACS的受试者工作特征(ROC)曲线判定最适截断值(cut off值),比较IMA与传统心肌标志物在ACS不同时间的阳性率.结果 ACS组IMA水平(88.3±17.2 U/ml)显著高于健康对照组(61.3±5.4 U/ml),t=2.147,P<0.05;心肌缺血4 h以内IMA阳性率(87.2%)明显高于传统心肌标志物(CTnI:8.5%;CK-MB:44.7%),χ2=63.2,P<0.05.结论 IMA对ACS患者早期心肌缺血的诊断明显优于传统心肌标志物,而在ACS患者中、晚期意义不大.     

急性冠脉综合征触发的病理生理机制

急性冠脉综合征(ACS)包括不稳定性心绞痛(UA)、急性心肌梗死(AMI)和淬死^[1]。AMI分为Q-波心肌梗死和非公Q-心肌梗死[2]，近来为了治疗方便，又被分为ST段拾高性心肌梗死和非ST段拾高性心肌梗死。诊断仍然靠临床症状、心电图和生化标记物。在近几年，ACS引起人们极大关注，对其机制研究成为热点。多数急性冠脉事件(UA、AMI和碎死)系由冠状动脉狭窄并不十分严重的动脉粥样硬化斑块破裂、继发血栓形成所致，斑块破裂可由血液动力学、生物力学因素(包括血压及脉压、心脏收缩、冠脉血管痉挛、斑块内毛细血管出血、管壁应力)及介入手术机械外力间接或直接引起^[3]。     

急性冠脉综合征的抗血小板治疗

急性冠状动脉综合征(ACS)是严重威胁人类健康的一类急性心血管事件,包括不稳定性心绞痛、非S-T段抬高型和S-T段抬高型心肌梗死,以及以上各病症导致的猝死。血小板的激活在ACS的发生中起着重要作用,抗血小板治疗在ACS防治中的重要地位也越来越受到人们的广泛关注。通过对血小板致病的机制及抗血小板治疗的探讨,进一步明确抗血小板治疗的重要性。     

Acute Coronary Syndrome From Green Snake Envenomation

BackgroundSnake bite is a grossly underreported public health issue in subtropical, tropical suburban, and rural areas of Africa and South Asia. In literature, ophitoxemia (snake bite envenomation) as a cause of acute coronary syndrome (ACS) is limited to very few case reports. Viper envenomation is the most common cause of ACS among snake bites. We report the first case of unstable angina caused by Colubridae snake bite (Ahaetullanasuta, commonly called green snakes) in a young man without comorbidities.Case ReportA young healthy man had a green snake bite that was camouflaged in the green fodder. He was managed elsewhere with anti-snake serum. He developed acute chest pain and breathlessness on day 3 of his treatment. Electrocardiogram (ECG) showed biphasic T wave inversions suggestive of type A Wellens pattern in the anterior chest leads (V1–V4). He was treated for ACS medically outside and was referred to our institute for further management on the following day. ECG and cardiac enzymes were normal. The echocardiogram showed no regional wall motion abnormality. Computed tomography coronary angiography showed normal epicardial coronaries. He was discharged in stable condition and asymptomatic at 2 months follow-up.Why Should an Emergency Physician Be Aware of This?ACS after a snake bite is not limited to venomous snakes. The diagnosis should be considered promptly even with a nonvenomous snake bite, especially in those with typical symptoms and ECG changes. The time interval between snake bite and development of ACS can be long and warrants prolonged medical supervision.     

Patients’ Perspectives With Acute Coronary Syndrome After Percutaneous Coronary Intervention

Patients with acute coronary syndrome after primary percutaneous coronary intervention are still at high cardiovascular risk. This study aimed to investigate patients’ current knowledge, their learning needs, and self-efficacy regarding their heart disease. To achieve this purpose, participants completed questionnaires (the Cardiac Patients Learning Needs Inventory, a questionnaire about disease-specific knowledge of patients with acute coronary syndrome, and the Cardiac Self-Efficacy Scale) before discharge. Risk avoidance of reinfarction and strategies for future emergencies are essential concerns for patients. This study provides a basis for nurse-led education regarding secondary prevention among patients before discharge. Further studies should explore the nurse-led education process.     

急性冠状动脉综合征治疗研究进展

不稳定性心绞痛和非Q波心肌梗死是临床上常见急症 ,称之为急性冠状动脉综合征 ,该综合征具有较高发生率和死亡率 ,早期正确处理非常必要。本文作者复习近年来有关文献 ,就急性冠状动脉综合征治疗研究进展作一介绍。