老年急性心肌梗死78例临床分析

随着社会人口的老龄化,老年急性心肌梗死(AMI)有逐年增加趋势。现将我院近5年间收治的78例老年AMI患者与同期60岁以下的32例中年患者进行对比分析,以探讨老年AMI的临床特点。 资料和方法 AMI诊断参照世界卫生组织公布的标准.老年组计78例.男56例,女22例,男:女=2.55∶1;年龄60～89岁,平均71.5岁。中年组计32例,男22例,女10例,男∶女=2.2∶1;年龄49～59岁,平均55.5岁。     

溶栓治疗老年急性心肌梗死临床分析

溶栓治疗急性心肌梗死 (AMI)已成为挽救AMI患者生命的重要手段 ,我们观察了国产基因重组链激酶思凯通 (r SK)对老年初发AMI的疗效及安全性。1 对象与方法 :2 0 0 0年 6月～ 2 0 0 3年 3月收住我院冠心病监护病房、发病 6～ 12h的AMI患者 130例 ,其中年龄≥ 6 0岁为老年组 (74例 ,男 5 3例 ,女 2 1例 ) ,<6 0岁的为对照组 (5 6例 ,男 4 0例 ,女 16例 )。平均年龄分别为 (6 8± 8)岁和 (49± 8)岁 ;老年组前壁心肌梗死占 73% ,对照组 6 0 %。诊断均符合WHO的AMI诊断标准。患者均无溶栓禁忌证 ,接受r SK15 0万IU静脉溶栓 ,30～ 6 0mi…     

心肌梗塞前心绞痛与梗塞后并发症关系探讨

心力衰竭、心源性休克、心律失常是急性心肌梗死(AMI)常见严重并发症,我院1988～1998年收住院的AMI患者50例,按AMI前有无心绞痛分成两组,对其并发症进行统计分析,探讨AMI前有无心绞痛与AMI后并发症之间的关系,报道如下。1　对象与方法1.1　对象　AMI50例,具有典型心肌梗塞表现,如心电图及心肌酶改变,无糖尿病史;其中男38例,女12例,年龄48～72岁,平均55岁。1.2　方法　AMI前有心绞痛指AMI发病前24h内有典型心绞痛发作至少1次,否则为AMI前无心绞痛,50例中观察(有心绞痛)组32例,对照(无心绞痛)组18例;观察组中前间壁的AMI18例,广泛…     

有高血压史老年人急性心肌梗死临床特点

老年人高血压 ( HT)收缩压增高较明显 ,呈不对称性收缩期或纯收缩期 HT。老年人收缩压增高是冠心病、心衰等的危险因子 ,脉压大是重要的预测指标 ,随年龄增长 ,急性心肌梗死 ( AMI)的患病率和病死率均明显增高[1] 。为此 ,本文分析了有 HT病史的老年人 AMI临床资料 ,并与同期无高血压( NHT)史的老年人 AMI临床资料对比 ,探讨其临床特点。1　临床资料1 992年至 2 0 0 1年 1 2月收入院 60岁以上的AMI患者 1 76例 ,按是否有 HT史分为 HT组和NHT组。HT组 82例 ,男 49例 ,女 33例 ,年龄 61～86岁 ,平均年龄 ( 65 .6± 1 0 .6)岁 ;NH…     

11例青年心肌梗死患者的临床特点与冠状动脉造影分析

青年心肌梗死是指年龄在 40岁以下的青年 ,不论病因如何而发生的急性梗死 (AMI) [1 ]。我院 1995年 11月～ 1996年10月共收治青年 AMI11例 ,现就其临床特点及冠状动脉造影结果进行分析。1　对象和方法1.1　对象　收集 1995年 11月～ 1996年 10月期间在我院住院 ,做过左心室造影及冠脉造影的年龄≤ 40岁的 AMI患者11例 ,年龄 19～ 40岁 ,平均 35 .1岁 ,均为男性 ,有典型的发病过程 ,心电演变及心肌酶升高 ;其中 3例以 AMI为首发表现 ,4例接受静脉溶栓治疗。1.2　方法　本组患者均于病情稳定后择期行冠脉造影 ,造影时间距 AMI发生时间为…     

急性心肌梗死43例临床分析

急性心肌梗死 (AMI)属临床急危重症之一 ,来势凶猛 ,表现不一 ,可出现各种危险并发症 ,若不及时诊断和治疗 ,病死率很高。笔者就我院 1 998年1月至 2 0 0 0年 1 0月间 ,共收治 AMI43例 ,现将总结分析如下。1　临床资料1 .1　诊断标准 :AMI的诊断条件为符合下列二项或以上者 :持续而严重的心绞痛发作超过 30分钟 ;系列心电图检查显示有 AMI的典型改变及演变过程 ;血清心肌酶异常升高而无其它原因可解释者。1 .2　一般资料 :男性 40例 ,女性 3例。年龄 2 0～2 9岁 2例 ,30～ 39岁 2例 ,40～ 49岁 7例 ,50～ 59岁 6例 ,60～ 69岁 1 8例 ,7…     

急性心肌梗塞并发急性脑卒中16例分析

急性脑卒中是急性心肌梗塞 (AMI)的严重并发症 ,临床并非少见。国外文献报告其患病率为 1～ 8% [1] ,国内报告较少。现将本院 1990年 1月～ 2 0 0 0年 10月住院的 2 49例并发急性脑卒中 (下称急性心脑卒中 ) 16例报告分析如下。1　临床资料本院AMI诊断均符合 1979年WHO的标准。 16例急性脑卒中主要包括脑栓塞、脑血栓形成及蛛网膜下腔出血 ,其诊断均符合高等医药院校教材《神经病学》第 4版急性脑血管疾病的诊断要求 ,均进行了脑CT检查。本文 2 49例AMI中并发急性脑卒中 16例 (6% ) ,其中男14例 ,女 2例。发病年龄 5 0～ 5 9岁 5例 ,6…     

β受体阻滞剂治疗急性心肌梗死62例临床体会

我院CCU病房自1992年以来,采用β受体阻滞剂(BARA)治疗急性心肌梗死(AMI)62例,效果良好,现予以报道,并浅谈体会。1对象与方法1.1对象治疗组:采用BARA治疗的AMI患者62例,男39例,女23例;年龄36~80岁,平均58.0岁;均为窦性心律,心率(窦率)偏快(>90次/min者),其中8例(下壁AMI)初为缓     

急性心肌梗死患者急诊冠脉介入治疗49例

近年来 ,国外大量研究证实急性心肌梗死 (AMI)急诊经皮冠状动脉介入治疗 (PCI)能更迅速而持久地恢复梗死相关血管 (IRA)的血流 ,挽救濒死心肌 ,降低病死率 ,改善预后[1 ,2 ] 。急诊PCI已成为治疗AMI的最有效办法。本院自2 0 0 0年 5月～ 2 0 0 2年 9月共对 49例AMI患者行急诊PCI治疗 ,现将结果报道如下。1　临床资料1 .1　一般资料　 49例AMI患者均符合 2 0 0 1年美国ACC/AHA有关AMI急诊冠脉介入干预建议[3] 中Ⅰ类适应证。男32例 ,女 1 7例 ,年龄 34～ 81岁 , x±s(59± 1 3)岁。心梗部位 :前壁 2 7例 ,下壁加下后壁 1 5例 ,…     

急性心肌梗死高龄患者的溶栓治疗

随着人类寿命的提高，急性心肌梗死（AMI）高龄患者的发病率逐年增多，本文就高龄AMI患者溶栓治疗和非溶栓治疗的结果进行对比观察，现报道如下. 1对象与方法 1．1研究对象2003年8月～2005年12月，我院住院的高龄AMI患者44例，年龄〉70岁，既往无心梗急性病史。     

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.