中国心内科医师高血压患病、知晓、治疗及控制现状

目的 了解中国心血管内科医师高血压患病、知晓、治疗、控制情况.方法 2008年6月1日至8月31日,在中国大陆31个省、自治区、直辖市对386家综合性医院心内科有执业医师资格的4032例心内科医师开展流行病学调查.结果 高血压患病率为12.1%,且在性别间和年龄组间差异均有统计学意义,高血压患者中知晓者占80.0%,治疗者占75.7%,知晓率和治疗率在年龄组间差异有统计学意义,血压得到控制者占42.4%.结论 在被调查的中国心内科医师人群中高血压有较高的患病率,防治工作仍需进一步加强.     

见习医师心电图教学体会

目前在各级医疗机构中,心电图检查已非常普及。心电图是诊断心律失常的金标准,对心律失常的确定性诊断是其他任何检查不能替代的;心电图对心肌梗死的诊断可定性、定位、定期,也有着不可替代的重要作用。因此,心电图诊断不仅心电图专职医师、心血管内科医师需要掌握,而且是每个临床医师都必须掌握的技能。而见习医师是刚进入医疗机构且尚未取得执业医师证(或执业助理医师证)的     

影响结核性多浆膜腔积液疗效的因素

目的探讨入住我院并明确诊断的107例结核性多浆膜腔积液患者的病例分析。方法分析2009~2012年入住我院并明确诊断为结核性多浆膜腔积液的107例患者的病例资料。结果病程1月者57例,46例常规服用强的松,治愈39(68.4%),有效18例(31.6%),无效0例。病程1月者50例,11例服用强的松,治愈13例(26.0%),有效36例(72.0%),无效1例(2.0%)。治愈率统计学比较:χ2=19.19,P0.01,有统计学意义。有效率统计学比较:χ2=17.41,P0.01,有统计学意义。结论正规抗结核治疗基础上,积极穿刺抽液引流和早期常规应用激素治疗,预后良好;就诊时间与浆膜腔肥厚粘连发生有关;诊断困难,导致治疗不及时。     

包头市社区医师高血压病知识技能培训前后对比分析

目的调查并培训包头市社区医师高血压病的诊治能力,探索全科医师的培训模式。方法包头市社区卫生服务中心(站)的医师为研究对象,142人参加"医务人员高血压病防治知识基线调查问卷",122人参加以病例为引导互动式的培训并完成"医务人员高血压病防治知识终末调查问卷"。结果(1)社区医师在高血压病降压治疗策略选择正确率比培训前上升了141.6%,危险分层正确率比培训前上升了186.9%;(2)社区医师对于高血压非药物治疗内容,知道合理膳食、体育锻炼、戒烟、平衡心理,比培训前分别上升了114.2%、21.4%、82.1%和77.3%;(3)社区医师对常用降压药物慎用/禁忌症知识,知道利尿剂、β受体阻滞剂、ACEI、复方制剂的慎用/禁忌症比培训前分别上升了136.6%、108.1%、173.1%和287.9%。结论社区医师对于高血压的诊疗能力一般,经培训后,规范了全科医师高血压病的治疗行为,可以明显提高医师高血压病知识的诊治能力,是可行的并值得进一步推广和探索。     

胃pH联合胆红素监测诊断十二指肠胃反流的应用价值

[目的]探讨胃pH联合胆红素监测诊断十二指肠胃反流(duodenogastric reflux DGR)的应用价值。[方法]对慢性胃炎组90例、对照组20例分别进行胃镜及组织学检查、总胆汁酸测定、核素显像、胃pH联合胆红素监测诊断DGR,并进行对比性分析。[结果]对照组DGR(+)检出情况:胃pH联合胆红素监测检出率0%(0/20),与胃镜及组织学检查30%(6/20)比较,差异有统计学意义(P0.01),与其他检查比较差异无统计学意义(P0.05)。慢性胃炎组DGR(+)检出情况:胃pH联合胆红素监测53.3%(48/90),与胃镜及组织学检查76.7%(69/90)比较,差异有统计学意义(P0.01),与其他检查比较差异无统计学意义(P0.05)。以核素显像检查作为标准,其他3种检查方法对慢性胃炎组检测DGR准确性的比较,胃镜及组织学检查62.2%,差异有统计学意义(P0.01),总胆汁酸测定81.1%,差异有统计学意义(P0.05),胃pH联合胆红素监测90.0%,差异无统计学意义(P0.05)。[结论]胃pH联合胆红素监测是诊断DGR最准确的方法,值得推广应用。     

远程网络心电图在社区医院中的临床应用价值

目的探讨远程网络心电图在社区医院中的临床应用价值。方法选取2016年8月—2017年3月在社区医院就诊的1 500例病人为研究对象,分别对1 500例病人进行常规心电图及远程网络心电图的检查和诊断。1 500例病人先进行常规心电图检查,同时通过社区网络平台进行远程心电图检查,并实时传输到三能甲等医院心电图网络会诊中心,比较常规心电图与远程心电图对心脏异常的检出率。结果远程网络心电图和常规心电图检查相关心电图波形指标,除了心率、Q-T间期两个指标外,其他心电图波形指标差异无统计学意义(P0.05)。远程心电图发现异常心电图763例(50.87%),其中心律失常436例(57.14%),心肌缺血122例(15.99%),心室肥大27例(3.54%),陈旧性心肌梗死15例(1.97%),房室阻滞9例(1.18%)。常规心电图发现异常心电图492例(32.80%),其中心律失常179例(36.38%),心肌缺血31例(6.30%),心室肥大19例(3.86%),陈旧性心肌梗死6例(1.22%),房室阻滞2例(0.41%)。结论远程网络心电图和常规心电图的心电图图形基本一致,且远程网络心电图操作简便,诊断准确率较高,出具报告时间缩短,避免了在社区检查的心电图因社区医生诊断水平有限而造成病情延误的情况。     

动态心电图与常规心电图在临床诊断中的价值以及临床应用

目的分析动态心电图与常规心电图在临床诊断中的价值以及临床应用情况。方法选取2017年2月-2018年11月为研究时间段,以此期间在本院就诊的冠心病心肌缺血患者79例为观察对象,均前后接受动态心电图、常规心电图及冠脉造影,且以冠脉造影为诊断金标准,分析检查结果差异。结果动态心电图检出无症状心肌缺血率64.56%、有症状心肌缺血者35.44%,与常规心电图的45.57%、54.43%比较,差异存在统计学意义(P=0.008);动态心电图检出短阵室上速28例、期前收缩(早搏)30例,持续性心房颤动21例,室内阻滞19例,与常规心电图的12例、10例、20例、17例比较,前二者间存在统计学差异(P<0.05),后二者间无统计学差异(P>0.05)。结论动态心电图、常规心电图在冠心病心肌缺血方面能够发挥良好的诊断及其他的临床价值。     

窄带成像联合放大内镜在食管癌临床诊治中的应用价值探讨

目的探究窄带成像联合放大内镜(NBI-ME)在食管癌临床诊治中的应用价值。方法回顾性分析2014年2月至2019年12月衢州市人民医院162例行内镜黏膜下剥离术(ESD)治疗患者临床资料,其中经NBI-ME引导下ESD治疗84例(观察组),普通白光内镜碘染色引导下ESD治疗78例(对照组)。比较两组术前诊断与术后病理诊断结果差异,并记录两组手术相关指标(手术时间、标记时间、黏膜分离时间、创面处理时间)、临床疗效。结果 NBI-ME术前诊断准确64例(76.19%),普通白光内镜碘染色术前诊断准确46例(58.97%),NBI-ME术前诊断准确率明显高于普通白光内镜碘染色(P0.05)。两组术中标记时间比较,差异无统计学意义(P0.05);观察组手术时间、黏膜分离时间、创面处理时间均低于对照组(P0.05)。两组整块切除率比较,差异无统计学意义(P0.05);两组术前诊断低级别上皮内瘤变者(LGIN)完全切除率比较,差异无统计学意义(P0.05),但观察组术前诊断高级别上皮内瘤变(HGIN)及食管癌者完全切除率均高于对照组(P0.05)。结论 NBI-ME不仅在食管癌术前诊断中应用效果较好,且能引导ESD治疗,提高手术效率及完全切除率,在食管癌诊疗中应用价值较高。     

河南省启动消除疟疾行动计划后医疗机构在输入性疟疾防控中的作用

目的回顾分析2010-2014年河南省报告的疟疾病例诊断和救治情况,了解医疗机构在输入性疟疾防控中的作用。方法通过传染病信息报告管理系统和寄生虫病防治信息管理系统收集2010-2014年河南省疟疾疫情数据和病例诊治信息,用描述性流行病学方法分析医疗机构在疟疾病例的报告、确诊和治疗中的作用。结果 2010-2014年河南省共报告输入性疟疾病例821例,其中死亡12例,均为恶性疟,输入来源地为非洲,病死率为1.7%。医疗机构和疾控机构分别报告病例432例(占52.6%)和389例(占47.4%)。在569例有诊断记录的输入性疟疾病例中,380例首诊为疟疾,诊断正确率为66.8%(380/569)。医疗机构的首诊正确率(49.2%,178/362)明显低于疾控机构(97.6%,202/207)(χ~2=139.147,P0.01)。乡镇级及以下、县级、地市级和省级医疗机构的首诊正确率分别为14.2%(18/127)、43.4%(23/53)、73.6%(67/97)和76.9%(70/91),各级医疗机构间的差异有统计学意义(χ~2=112.764,P0.01),而各级疾控机构间的差异无统计学意义(χ~2=0.380,P0.05)。医疗机构和疾控机构确诊的病例比例分别为48.9%(278/569)和51.1%(291/569),两者间差异无统计学意义(χ~2=0.594,P0.05)。乡镇级及以下、县级、地市级和省级医疗机构的确诊比例分别为1.2%(7/569)、3.7%(21/569)、12.5%(71/569)和31.5%(179/569),各级医疗机构间的差异有统计学意义(χ~2=299.143,P0.01),各级疾控机构间的差异亦具有统计学意义(χ~2=91.569,P0.01)。结论各级医疗机构间的首诊准确率和确诊率差异较明显,基层医疗单位主要根据镜检疟原虫来确诊疟疾病例,其诊断准确率明显低于同级疾控机构。     

心电图aVL导联对阵发性室上性心动过速折返途径的鉴别作用

目的:研究体表心电图aVL导联对阵发性室上性心动过速的鉴别诊断作用。方法:选取2009-01至2009-11因症状性阵发性室上性心动过速在我院行心脏射频消融术(RFCA)治疗的连续病例112例,按心动过速类型分为房室结折返性心动过速(AVNRT,n=60)和房室折返性心动过速(AVRT,n=52),比较两者心电图特点。结果:AVNRT与AVRT患者在年龄上差异没有统计学意义(P0.05),但是AVNRT中女性患者的比例多于AVRT(55.6%和33.3%,P=0.04)。aVL切迹与V1导联伪R波及下壁导联伪S波(标准心电图算法)发生在AVNRT的比例均大于AVRT(P均0.001)。aVR导联ST段抬高发生在AVNRT的比例小于AVRT(P=0.0001),并且在AVRT患者中71.4%为左侧旁道。QRS电交替在AVRT和AVNRT间差异没有统计学意义(P0.05)。aVL切迹和V1导联伪R波及下壁导联伪S波诊断AVNRT的敏感性分别为53.3%、46.7%,42.2%,特异性分别是82.1%、84.6%、94.9%。aVL切迹诊断AVNRT的敏感性高于V1导联伪R波及下壁导联伪S波(标准心电图算法),但是三者之间差异没有统计学意义(P0.05)。结论:aVL切迹多发生于AVNRT并有助于AVNRT和AVRT的鉴别诊断。     

老年急性心肌梗死146例临床特点与近期预后分析

目的:分析老年急性心肌梗死（AMI）患者临床特点与近期预后。方法: 对2005年1月~2010年5月在我院住院治疗老年（年龄≥65岁）AMI患者电子病例数据146例进行回顾性分析。包括年龄、性别、梗死部位、发病时间、发病月份、就诊时间、临床症状和30 d心血管事件等进行分析。结果: 共计146例患者入选。其中男性57例（39.0%）、年龄（72±6）岁;女性89例（61.0%）、年龄（77±9）岁（均P<0.05）。男性以前壁心肌梗死较多（40例,27.4%）（P<0.05）。女性以下壁、右室壁、侧壁较多（65例,44.5%）（P<0.01）。老年AMI患者在早上05:00～08:59时段发病人数最多53例（36.3%）、17:00～20:59时段最少为9例（6.2%）（P<0.01）。发病月份以10月（23例,15.8%）、1月（21例,14.4%）及3月（23例,15.8%）较多,5月份最低（3例,2.0%）（P<0.01）。发病12 h内就诊人数为44例（30.1%）、12～48 h时段最多为88例（60.3%）（P<0.01）。就诊时间延迟。 首发胸痛、胸闷典型症状29例（19.9%）、其他不典型症状117例（80.1%）（P<0.01）。30 d心血管终点事件:老年AMI患者严重缓慢心律失常和联合终点事件病死率、心力衰竭、Ⅲ度AVB和心室停搏致死性心律失常发生率,女性组高于男性组（均P<0.05）。心室颤动病死率、心室颤动和持续性室速致死性心律失常发生率,男性组高于女性组（均P<0.05）。结论: 老年AMI患者在构成比、年龄、梗死部位、心力衰竭、致死性心律失常和病死率类型存在性别差异。在早上05:00～08:59时段发病人数最多。发病月份以10月、1月、3月较多。发病在12～48 h时段就诊人数最多。发病后不典型临床症状人数较多。     

Smoking cessation practices of Dutch general practitioners, cardiologists, and lung physicians

STUDY OBJECTIVES: To assess and compare the smoking cessation practices and smoking behavior of Dutch general practitioners (GPs), cardiologists, and lung physicians. METHODS: We conducted questionnaire surveys among a random sample of 2000 Dutch GPs, all Dutch cardiologists (N=594), and all Dutch lung physicians (N=375). RESULTS: In total, 834 GPs (41.7%), 300 cardiologists (50.5%), and 258 lung physicians (68.8%) filled out and returned the questionnaire. The prevalence of current smokers was 8.2% among GPs, 4.3% among cardiologists, and 3.5% among lung physicians. Of the pharmacological aids for smoking cessation, physicians recommended bupropion most frequently, followed by nicotine patches and nicotine gum. More lung physicians recommended the use of these three aids (67.0%, 36.3% and 18.2%, respectively) than GPs (65.7%, 18.7% and 9.8%, respectively), and than cardiologists (31.6%, 19.7% and 13.2%, respectively). A higher proportion of lung physicians (69.3%) had referred at least one smoker to a nurse for smoking cessation treatment than cardiologists (25%), and than GPs (11.3%). CONCLUSIONS: Based on this national survey, one may conclude that the prevalence of current smoking among Dutch physicians is relatively low and has further decreased since 1988. Dutch GPs, cardiologists, and lung physicians mainly use interventions for smoking cessation that are easy to administer and are not very time consuming. Furthermore, more lung physicians than GPs and cardiologists recommend the use of bupropion, nicotine patch, and nicotine gum. When designing interventions for smoking cessation, one should take into account that physicians are often reluctant to provide interventions which demand much time. Therefore, intensive counseling of smokers who want to quit smoking may be more feasible for trained non-physicians, such as nurses.     

Doctors' perceptions of the prognostic benefit of statins in patients who have had myocardial infarction

Background: We wished to assess how General Practitioners (GPs) and cardiologists perceive and communicate the benefits of therapy with statins (hydroxymethylglutaryl-coenzyme A reductase inhibitors) in a patient following myocardial infarction.
Methods: We interviewed 20 GPs and 22 cardiologists to determine treatment policy and ways of expressing its benefits to a patient after myocardial infarction with moderate dyslipidaemia. We asked what drug and dosage they would recommend and how they would express potential benefits of therapy, given a range of options including reduced relative and absolute risk of events.
Results: Most GPs would start a low dose (10–20 mg/day) of simvastatin (the only freely prescribable funded statin in New Zealand) whereas cardiologists would commence 40 mg/day immediately ( P  = 0.001). All but one cardiologist would justify therapy to the patient by citing a reduced chance of a major adverse cardiovascular event. Nine GPs and one cardiologist estimated a gain of more than 5 years of life from statin therapy. Cardiologists were more optimistic than GPs about relative risk reduction ( P  = 0.04). Only 50% of GPs and 68% of cardiologists were able to estimate an absolute risk reduction over 5 years, such estimates varying widely with no significant difference in responses between the groups ( P  = 0.2). No doctors felt comfortable using number needed to treat or odds ratio.
Conclusion: There were substantial differences between the two groups of clinicians in perception and policy of statin therapy, frequent overestimation of treatment benefits and a reluctance to impart numerical estimates of benefit to patients.     

环磷酸腺苷葡甲胺治疗病态窦房结综合征疗效研究

目的评价环磷酸腺苷葡甲胺（即心先安）对病态窦房结综合征（病窦）的疗效及治疗价值。方法采用随机单盲对照法,对152例病窦分为治疗组和对照组,两组分别静脉点滴心先安和黄芪注射液,15d后比较两者临床、心电图和食管电生理的变化。结果（1）临床疗效治疗组和对照组总有效率分别是86.7%和49.2%,两组差异有显著性（P<0.01）;（2）体表心电图和24h动态心电图治疗组和对照组总有效率分别是84.3%和40.5%,其24h心率总数分别是(89360±5987)次/min和(64321±4170)次/min,统计学比较有明显差异（P<0.01）;（3）食管电生理检查窦房结功能窦房结恢复时间、校正后窦房结恢复时间和窦房结传导时间,在治疗组的治疗后与治疗前相比较以及与对照组的治疗前后相比较,治疗组中治疗后有明显提高心率的作用（P<0.01）。结论心先安治疗病窦有明显疗效,近期疗效好,副作用少,其远期疗效有待观察。     

85例儿童癫痫患者心电图分析

目的：探讨儿童癫痫患者的心电图特点。方法：回顾性分析2005年1月至2010年6月在我院就诊的85例癫痫患儿（癫痫组）及同期84例正常儿童（正常对照组）的心电图资料,并进行比较。结果：异常心电图：癫痫组检出30例（35.29%）,正常组检出5例（5.95%）,二者差异有显著性（P〈0.05）。癫痫患儿心电图改变以房性早搏（9.4%）、ST-T改变（5.9%）、传导阻滞（5.9%）、室性早搏（4.7%）为主。结论：癫痫患儿心电图异常发生率较高。     

医学高知识社区高血压患者血压控制达标状况及影响因素分析

目的:了解医学高知识社区高血压患者目前血压的控制达标状况,分析其影响因素. 方法:对2005-08至2008-08间在北京大学医学部医院就诊的481例高血压患者进行问卷调查.高血压诊断标准按2005年<中国高血压防治指南>:收缩压≥140 mmHg(1 mmHg:0.133 kPa)和(或)舒张压≥90 mmHg. 结果:在资料完整的458例患者中,血压控制达标者202例,控制率44.1%.其中,60岁以上、不吸烟、高学历者以及大学教师、干部、职员和医护技师的血压控制率均较高(P<0.05～0.01);合并症(包括糖尿病和肥胖)患者血压控制率较低(P<0.01).多因素分析结果表明:年龄、吸烟、是否患糖尿病及治疗前血压水平对血压控制影响显著(P<0.05). 结论:尽管医学高知识社区高血压控制率高于一般社区,但仍远不理想.社区高血压防治除增加医学知识的宣传和普及之外尚需其他创新手段.     

冠心病并发焦虑症的临床治疗分析

目的: 研究冠心病并发焦虑症患者同时接受小剂量抗焦虑药物治疗对冠心病治疗的影响。方法: 40例冠心病并发焦虑症患者随机分成试药组和常规组,试药组在常规组基础上加用小剂量抗焦虑药物治疗,用药4周后分别比较临床心绞痛发作次数,心电图改善程度,以及焦虑症状评定。结果: 两组患者同等劳动程度心绞痛发作次数均明显减少,试药组总有效率为96%,常规组总有效率为79%,差异有显著性（P<0.05）。两组心电图总有效率（试药组84%,常规组85%）比较差异无统计学意义,两组治疗后SAS分数均有下降,但常规组差异无统计学意义,试药组SAS分数显著下降（P<0.05）,差异有统计学意义,评分亦明显低于常规组(P<0.05),提示试药组的焦虑症状较常规组明显改善。结论: 加用小剂量抗焦虑药物,在同等劳动程度下心绞痛发作次数明显减少,患者的焦虑症状也得到有效改善。     

On attitudes about colorectal cancer screening among gastrointestinal specialists and general practitioners in the Netherlands

AIM: To find out whether there are differences in attitudes about colorectal cancer (CRC) screening among gastrointestinal (GI) specialists and general practitioners (GPs) and which method is preferred in a national screening program METHODS: Four hundred and twenty Dutch GI specialists in the Netherlands and 400 GPs in Amsterdam were questioned in 2004. Questions included demographics, affiliation, attitude towards screening both for the general population and themselves, methods of screening, family history and individual risk. RESULTS: Eighty-four percent of the GI specialists returned the questionnaire in comparison to 32% of the GPs (P<0.001). Among the GI specialists, 92% favoured population screening whereas 51% of GPs supported population screening (P<0.001). Of the GI specialists 95% planned to be screened themselves, while 30% of GPs intended to do so (P<0.001). Regarding the general population, 72% of the GI specialists preferred colonoscopy as the screening method compared to 27% of the GPs (P<0.001). The method preferred for personal screening was colonoscopy in 97% of the GI specialists, while 29% of the GPs favoured colonoscopy (P<0.001). CONCLUSION: Screening for CRC is strongly supported by Dutch GI specialists and less by GPs. The major health issue is possibly misjudged by GPs. Since GPs play a crucial role in a successful national screening program, CRC awareness should be realized by increasing knowledge about the incidence and mortality, thus increasing awareness of the need for screening among GPs.     

Are physicians aware of the side effects of angiotensin-converting enzyme inhibitors?: a questionnaire survey in different medical categories

STUDY OBJECTIVE: Angiotensin-converting enzyme inhibitors (ACE-I) are considered safe, but they are associated with characteristic side effects, namely cough and angioedema, usually requiring discontinuation. We perceived that referrals for these side effects have become more and more frequent; therefore, we evaluated the degree of knowledge on the safety of ACE-I in different medical categories. DESIGN: A questionnaire (13 questions) on side effects of ACE-I was posted to physicians. SETTING: Everyday clinical practice. PARTICIPANTS: Cardiologists, allergists, and general practitioners (GPs) from the National Healthcare System. MEASUREMENT AND RESULTS: Three hundred twelve physicians were contacted, and 154 returned questionnaires that could be analyzed. Of the 154 physicians (mean age, 45 years) 48 were cardiologists, 52 were GPs, and 54 were allergists. The percentage of correct answers was low: 31.9% for cardiologists, 40% for GPs, and 33% for allergists. Thus, GPs provided a significantly higher percentage of correct answers with respect to the remaining categories (p = 0.05). The lower rate of correct answers (0 to 15.9%) concerned the time of onset of cough and the action to take. Cardiologists seemed to be less aware of the fact that angiotensin receptor blockers (sartans) can cross-react with ACE-I. CONCLUSION: Overall, there was a poor knowledge of the side effects of ACE-I. This may account for the increased referrals for chronic cough and angioedema.