老年人急性心肌梗塞12例误诊分析

<正>老年人急性心肌梗塞(以下秒急性心梗)临床常见,病情严重,合并症多,预后差,病死率高,常因临床表现不典型或以其它系统症状表现突出而易治诊。为减少误诊,提高老年人急性心梗的诊治水平,现对我院近四年来12例误诊病例分析报道如下:1对象与方法1.1临床资料:本组12例误诊病例均为住院患者,男8例,女4例,年龄60-81岁,平均72岁。有高血压病史3例,心绞痛史3例,糖尿病史2例,慢性支气管炎史1例,肺气肿1例。1.2梗塞部位及误诊情况:12例中急性前间壁梗塞3例,广泛前壁心梗2例,下壁心梗2便,下壁+石室心梗2例,前侧壁心梗1例,急性非Q波心梗2便。本组患者均属无痛型或疼痛不典型,12例中曾被误诊为支气管哮喘2例,急性胃炎     

不典型急性心肌梗塞的临床观察与护理

典型急性心肌梗塞 (ＡＭＩ)常以胸骨后剧痛为首先症状 ,继而出现典型心肌梗塞的心电图图形和血清心肌酶学的变化 ,诊断即明确。然而不典型急性心肌梗塞的诊断常较困难 ,甚至造成误诊和漏诊。从 1996至2 0 0 0年的 5年中 ,我们碰到不典型ＡＭＩ8例。为提高不典型ＡＭＩ的诊断 ,认识和观察 ,护理 ,减少误诊和漏诊 ,现将对该病的临床观察及护理总结如下 :1　临床资料1.1　一般资料全组 8例均为男性 ,年龄 50～ 82岁。发生广泛前壁心梗 2例 ,下壁心梗 2例 ,前壁心梗 1例 ,前间壁 3例 ,起病时均无明显的胸骨后疼痛 ,既往有高血压史 6例 ,糖尿病史…     

老年急性心肌梗死18例误诊分析

老年急性心肌梗死 (ＡＭＩ)常因症状及心电图不典型或在原有慢性病基础上发生而易误诊。现将入院时误诊的老年性心肌梗死 18例分析报告如下。1　临床资料18例中 ,男 12例 ,女 6例 ,年龄6 0～ 85岁 ,平均 76岁。有冠心病心绞痛 5例 ,高血压 3例 ,糖尿病 3例 ,慢性支气管炎肺心病 2例 ,高脂血症 3例 ,胆石症慢性胆囊炎 2例。其中下壁心梗 3例 ,前间壁心梗 3例 ,正后壁心梗 4例 ,前壁心梗 3例 ,心内膜下心梗5例。误诊时间 2小时～ 2天。误诊为急性心衰 4例 ,冠心病心绞痛 4例 ,慢性胆囊炎胆石症 1例 ,慢性支气管炎肺心病 2例 ,频发性室性早博 2…     

以腹痛为主的下壁心梗5例

急性心肌梗死（AMI）是内科临床工作中的急症,发病率逐年升高,致死率也较高,近年随着治疗水平的提高,使AMI的致死率大大下降,但对于某些部位的心梗,尤其是下壁心梗,因其症状不典型,易被漏诊或误诊,特别是在基层医院。作者自2004年在工作中遇到5例以腹痛为主要症状的急性下壁心梗。均因症状不典型而被基层医院误诊或漏诊。     

老年不典型急性心肌梗死10例误诊分析

目的 探讨老年不典型AMI的临床特点及误诊原因。方法 回顾性分析1997年3月至2003年3月收治的不典型AMI患者的临床资料。结果 10例患者的临床特点为：上腹部疼痛、恶心、呕吐、晕厥、心衰、休克等，梗死部位为前壁2例，前间壁3例，下壁2例，广泛前壁2例，下壁并前壁1例。门诊及住院部分别误诊为急腹症、急性心衰、心绞痛、肺心病、急性胆囊炎胆石症等，误诊时间为8小时至6天。结论 凡遇老年人或既往有心血管病患者，不管有否典型心肌梗死症状，均应常规行心电图及心肌酶检查，以免漏诊误诊。     

急性心肌梗塞致反应性高血糖误诊糖尿病10例分析

<正> 急性心肌梗塞发生后,部分患者血糖可应激性升高,尿糖也可出现阳性,易被误诊为糖尿病。我们1995～1997年度遇到的急性心梗病人伴发血糖升高误诊糖尿病10例,现报道如下,以期引起同道们的重视,避免此类误诊发生。 1 临床资料 1.1 一般资料:10例病人既往均无糖尿病史,男性患者6人,年龄45～67岁,其中急性广泛前壁心梗3例、急性前间壁心梗2例、急性下壁心梗1例;女性患者4人,年龄52～65岁,其中急性广泛前壁心梗3例、急性前间壁心梗1例。     

老年不典型急性心肌梗死10例误诊分析

目的探讨老年不典型AMI的临床特点及误诊原因.方法回顾性分析1997年3月至2003年3月收治的不典型AMI患者的临床资料.结果10例患者的临床特点为上腹部疼痛、恶心、呕吐、晕厥、心衰、休克等,梗死部位为前壁2例,前间壁3例,下壁2例,广泛前壁2例,下壁并前壁1例.门诊及住院部分别误诊为急腹症、急性心衰、心绞痛、肺心病、急性胆囊炎胆石症等,误诊时间为8小时至6天.结论凡遇老年人或既往有心血管病患者,不管有否典型心肌梗死症状,均应常规行心电图及心肌酶检查,以免漏诊误诊.     

心肌梗死患者心电图特征临床分析

目的:探讨心肌梗死病人的心电图表现特征及诊断价值。方法:对60例急性心肌梗死住院病人的心电图资料进行回顾性分析,总结、归纳急性心肌梗死的心电图改变特点及诊断。结果:60例心电图结果显示:下壁、无Q波性心肌梗死位居第一,其次为前壁、前间壁心肌梗死。40例患者心电图表现典型,占66.7%;20例病人心电图表现不典型,占33.3%。20例不典型患者心电图只有ST-T动态改变,其中无Q波心梗为13例,余下7例表现为右心室心肌梗死。60例中同时发生心律失常者37例,占61.7%。结论:加强对老年心梗病人的认知可有效避免心梗患者心电图的漏诊或误诊情况,以便早发现、早诊断、早救治,从而有效提高急性心肌梗死病人的抢救成功率,降低死亡率。     

不典型急性心肌梗塞10例临床分析

急性心肌梗塞是指严重而持久的心肌缺血造成的不可逆心肌坏死 ,是目前临床常见急症之一 ,以持续剧烈的胸骨后压榨样疼痛为主要表现 ,随着年龄增长 ,无典型心绞痛者并不少见 ,现对本院不典型临床表现急性心肌梗塞 10例进行分析 ,以加强对不典型心绞痛心梗的认识 ,减少对本病的误诊和漏诊。1　临床资料1)　一般资料 :年龄 6 0～ 75岁 ,平均年龄 6 7± 4岁 ;男 8例 ,女 2例。下壁心梗 4例 ,前壁心梗 2例。下壁并右室梗塞 1例 ,广泛前壁心梗 3例 ;高血压病史者 8例 ,糖尿病史者5例 ,高血脂病史者 5例 ,8例男性中均有吸烟史。2 )　临床表现 :表现…     

不典型急性心肌梗死临床分析

目的：探讨不典型急性心肌梗死临床特征并进行分析。方法：回顾性分析我院2006年2月～2010年2月收治的不典型急性心肌梗死患者49例。结果：本组49例不典型急性心肌梗死患者入院后经心电图、心肌酶谱连续动态监测明确诊断,明确诊断时间为入院后0.5～20.0 h,平均8.5 h。梗死部位：下壁10例,广泛前壁9例,前间壁4例,下壁16例、正后壁4例,右心室6例。结论：对中老年患者,特别是年龄较大的老年人,突发上述临床症状,应考虑不典型急性心肌梗死存在,行心电图和血清酶学检查,并连续观察,以防漏诊、误诊,导致疾病加剧或影响预后。     

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.