氯吡格雷联合曲美他嗪治疗不稳定型心绞痛的疗效观察

目的观察氯吡格雷联合曲美他嗪治疗不稳定型心绞痛的临床疗效。方法采用随机数字表法将95例确诊为不稳定型心绞痛的患者分为两组,对照组给予β-受体阻滞剂、硝酸酯类及降血脂类药物等常规治疗,观察组在常规治疗基础上加用氯吡格雷、曲美他嗪,10d为1个疗程,3个疗程末对比临床疗效。结果治疗后观察组降低心绞痛发作次数和缩短持续时间效果优于对照组,差异有统计学意义(P<0.05);观察组总有效率为93.8%,高于对照组的74.5%,差异有统计学意义(P<0.01)。结论氯吡格雷联合曲美他嗪治疗不稳定型心绞痛疗效确切,能够通过改善心肌缺血、抑制血小板聚集和促进侧支循环等机制改善临床症状与体征,在阻碍心绞痛进行性恶化和提高生存质量方面具有积极的作用。     

阿司匹林联合氯吡格雷治疗老年不稳定型心绞痛的疗效观察

目的探讨阿司匹林联合氯吡格雷治疗老年不稳定型心绞痛(UA)的临床疗效及安全性。方法选择2012年2月—2013年3月我科收治的老年UA患者90例,将其随机分为对照组和治疗组,各45例。两组患者均给予抗心绞痛常规治疗,在此基础上对照组患者给予阿司匹林治疗,治疗组在对照组基础上联合氯吡格雷治疗,两组均以4周为1个疗程。比较两组临床疗效、治疗前后心绞痛发作次数及持续时间,观察治疗期间不良反应情况。结果治疗组总有效率为89%,高于对照组的73%(P0.05)。治疗前两组患者心绞痛发作次数和持续时间比较,差异无统计学意义(P0.05);治疗后治疗组患者心绞痛发作次数少于对照组,持续时间短于对照组(P0.05)。两组患者药物不良反应较轻微,均未发生消化道出血。结论阿司匹林联合氯吡格雷治疗老年UA疗效显著,可明显缓解患者心绞痛发作,且安全性高。     

曲美他嗪应用于不稳定型心绞痛合并糖尿病患者的临床疗效探讨

目的分析曲美他嗪应用于不稳定型心绞痛合并糖尿病患者的临床疗效。方法选择2018年10月—2020年8月来该院开展治疗的不稳定型心绞痛合并糖尿病患者86例,选择奇偶数法进行分组,分为对照组(常规治疗,n=43)与实验组(曲美他嗪+常规治疗,n=43)。对比分析两组的血脂、血糖、心功能、心绞痛发作次数以及发作时间。结果在空腹血糖、餐后2 h血糖、三酰甘油以及总胆固醇水平上,实验组低于对照组,差异有统计学意义(P<0.05)。在左室射血分数与每搏输出量上,实验组高于对照组,差异有统计学意义(P<0.05)。在心绞痛发作次数与心绞痛持续时间上,实验组少于对照组,差异有统计学意义(P<0.05)。结论曲美他嗪用于不稳定型心绞痛并发糖尿病的治疗效果理想,对于血糖与血脂水平的改善具有促进作用,可有效减少心绞痛发作次数,临床可进一步推广运用。     

硫酸氢氯吡格雷治疗不稳定型心绞痛的疗效观察

目的探究硫酸氢氯吡格雷治疗不稳定型心绞痛的疗效。方法选取2014年3月~2016年3月我院收治的不稳定型心绞痛患者72例,随机分为两组,各36例。对照组采取常规治疗措施,观察组在对照组基础上加服硫酸氢氯吡格雷,对比两组症状缓解情况、心绞痛发作频率、心绞痛持续时间。结果两组疗效对比,观察组总有效率91.66%、心绞痛发病频率(1.1±0.6)次/d、心绞痛持续时间(3.2±1.4)min均优于对照组,差异有统计学意义(P0.05)。结论采用硫酸氢氯吡格雷治疗不稳定型心绞痛疗效确切,可有效改善患者心绞痛发作频率、持续时间,提高疗效。     

曲美他嗪在糖尿病合并冠心病治疗中的效果研究

目的探讨曲美他嗪治疗糖尿病合并冠心病的效果。方法选取该院2015年12月—2016年12月收治的糖尿病合并冠心病患者94例,随机分为两组各47例,对照组给予常规治疗,观察组在对照组基础上给予曲美他嗪。结果观察组总有效率为91.49%,明显优于对照组76.59%(P0.05);治疗后两组空腹血糖比较差异无统计学意义(P0.05),观察组心绞痛发作次数(3.1±0.1)次/周,持续时间(3.7±0.5)min均明显优于对照组(P0.05)。结论曲美他嗪治疗糖尿病合并冠心病,可有效缓解患者心绞痛发作次数,缩短发作时间,值得应用。     

曲美他嗪治疗冠心病不稳定型心绞痛126例

目的观察曲美他嗪治疗冠心病不稳定型心绞痛的疗效。方法将冠心病不稳定型心绞痛病人126例随机分为两组,对照组采用常规治疗,治疗组在常规治疗的基础上加用曲美他嗪,服药两周各观察疗效及心绞痛症状、发作次数等。结果治疗组心绞痛症状疗效总有效率为84.4%,心电图疗效为总有效率为84.4%明显优于对照组的61.3%、67.7%(P<0.01);治疗后两组病人每天心绞痛症状及发作次数、硝酸甘油片的消耗量均较治疗前明显下降(P<0.05或P<0.01)。结论曲美他嗪治疗冠心病不稳定型心绞痛疗效肯定。     

氯吡格雷治疗不稳定型心绞痛的临床观察

目的:探讨氯吡恪雷治疗不稳定型心绞痛(UAP)的临床疗效。方法:84例UAP患者被随机分为两组.治疗组在常规治疗的基础上给予氯吡格雷75 mg,1次/d,对照组除不用氯吡格雷外,其它治疗相同,分别记录入院时及治疗四周后心电图、动态心电图、心绞痛发作持续时间、发作频率等状况。结果:治疗组心绞痛发作持续时间、发作频率、发作时ST↑↓的程度、总缺血时间、缺血总负荷较对照组有显著性改善(P<0.05)。结论:氯吡格雷治疗不稳定型心绞痛疗效显著,而且安全。     

噻氯匹定联合曲美他嗪治疗不稳定型心绞痛的疗效评价

目的评价噻氯匹定联合曲蔓他嗪治疗不稳定型心绞痛的疗效。方法将我院96例符合标准的不稳定型心绞痛患者随机分为对照组（48例）和治疗组（48例）。对照组患者给予基础治疗（硝酸酯类，β-受体阻滞剂，抗凝剂及阿司匹林等），治疗组在此基础上加用噻氯匹定＋曲美他嗪，疗程均为4周，治疗前、后检查心电图。记录心绞痛发作次数厦每次心绞痛发作的平均时间。结果两组患者临床疗效间差异有显著性意义（P〈0．01）。治疗组患者治疗前、后心绞痛发作次数、持续时间及对照组患者治疗前、后心绞痛发作次数间差异均有显著性意义（P〈0．05）。两组患者治疗后心绞痛发作次数、持续时间差异亦均有显著性意义（P〈0．05）。结论噻氯匹定联合曲美他嗪治疗不稳定型心绞痛疗效确切，值得临床推广使用。     

氯吡格雷联合阿司匹林治疗稳定型心绞痛伴糖尿病的疗效及安全性研究

目的研究氯吡格雷联合阿司匹林治疗稳定型心绞痛伴糖尿病的疗效及安全性。方法选取2011年2月~2014年1月我院收治的稳定型心绞痛伴糖尿病患者100例作为研究对象,将其随机分为观察组和对照组,各50例,对照组患者应用阿司匹林治疗,观察组在对照组基础上加用氯吡格雷进行治疗。结果观察组治疗总有效率为94%,对照组治疗总有效率为82.0%,两组比较,差异有统计学意义(P0.05);观察组患者出现心绞痛的次数与对照组患者相比较少,差异有统计学意义(P0.05)。结论氯吡格雷联合阿司匹林治疗稳定型心绞痛伴糖尿病疗效较好,安全性较高,能够有效降低患者心脏不良反应的发生。     

曲美他嗪治疗不稳定型心绞痛合并糖尿病临床研究

将101例不稳定型心绞痛合并糖尿病患者随机分为治疗组和对照组，在常规服用传统药物的基础上，治疗组加服曲美他嗪20mg，3次／d，共8周。治疗后治疗组每周心绞痛发作次数、硝酸甘油消耗量较治疗前明显减少。可见在常规治疗基础上联用曲美他嗪，可以使不稳定型心绞痛合并糖尿病患者的心绞痛症状减轻，运动耐量增加，且安全性好。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

以肥厚性硬脑膜炎为主要表现的肉芽肿性多血管炎临床病例分析

目的探讨肉芽肿性多血管炎(GPA)继发肥厚性硬脑膜炎(HCP)的临床特点。方法回顾性分析北京协和医院2004—2018年收治的GPA继发HCP病例资料的特点。结果①GPA患者315例,19例继发HCP,占6.0%;②男性12例,女性7例;年龄19~64岁,中位年龄57岁。③神经系统表现:19例均有头痛,16例颅神经受累。受累部位:额部8例,颞部8例,颅底8例(鞍旁4例,其中海绵窦3例,眶尖2例),小脑幕6例,大脑镰2例,顶部1例,枕部1例,1例合并硬脊膜炎。④系统表现:发热10例,体质量下降8例,肺部受累4例,肾脏受累3例,16例鼻窦炎,10例中耳炎,16例局限型GPA。⑤15例ANCA抗体阳性,8例蛋白酶3(PR3)-ANCA阳性,6例髓过氧化物酶(MPO)-ANCA阳性。⑥16例行腰椎穿刺检查:脑脊液压力9例升高、5例正常、2例降低;脑脊液蛋白升高10例。⑦15例(78.9%)伯明翰系统性血管炎评分(BVAS)>15分。⑧19例均使用糖皮质激素、免疫抑制剂治疗,其中12例行甲泼尼龙冲击治疗,12例鞘内注射地塞米松(或+甲氨蝶呤),19例病情均缓解。结论HCP是GPA少见且严重的表现,主要表现为颅高压和颅神经受累,多见于局限型GPA患者,常伴有全身疾病的活动,需积极治疗。