乌拉地尔对心力衰竭患者血流动力学效应及临床疗效

目的　观察α1受体阻滞剂乌拉地尔对左心瓣膜返流所致的心力衰竭患者的血流动力学效应和临床疗效。方法　 15例二尖瓣和 (或 )主动脉瓣关闭不全患者 ,平均年龄 ( 4 1 0± 16 0 )岁 ,心功能IV级 ,静注乌拉地尔 4～ 10μg/(kg·min) ,2 4h维持 3～ 5d。结果　乌拉地尔可降低总外周阻力、肺血管阻力、肺毛细血管嵌压及肺动脉压 ,增加心输出量及心脏指数。心功能明显改善 13例 ,改善者 2例 ,总有效率 10 0 %。结论　静注乌拉地尔对左心瓣膜返流所致的充血性心力衰竭有良好的血流动力学效应及临床疗效。     

Role of computed tomography in risk assessment for coronary heart disease

Coronary heart disease is the most common cause of death in Western countries, with a rising incidence in developing countries. It is part of the spectrum of cardiovascular diseases that have common end points of myocardial infarction, stroke and death. As these end points often occur suddenly and often in those with no known disease, identification of those people at high risk is important. Besides the known traditional risk factors, direct imaging of the calcified plaque as a marker for atherosclerotic disease has been extensively studied with electron beam computed tomography and now with multislice computed tomography. This review discusses the role of computed tomography in assessment of cardiovascular risk in both people with or without symptoms.     

医疗联合体内冠心病双向转诊实施效果评价

目的：评价上海新华-崇明医疗联合体内冠心病双向转诊实施效果。方法：将转入新华医院设为实验组,未转入新华医院为对照组,通过对照比较分析,从住院天数、治疗费用等方面对转诊效果进行评价。结果：医疗联合体促进了冠心病患者双向转诊的开展,有效降低冠心病患者住院天数与住院费用。结论：建议明确医疗联合体的政策定义、加快建设区域医疗信息网络共享机制及激励约束机制,从而进一步发挥医疗联合体在促进冠心病双向转诊上的作用。     

Microalbuminuria and coronary heart disease in non-diabetics.

Microalbuminuria (or urinary albumin excretion rates (AER) above normal limits) is associated with coronary heart disease (CHD) particularly in diabetics. To determine the sensitivity and specificity of AER for CHD in a non-diabetic population we prospectively studied 115 consecutive patients undergoing coronary angiography and 66 undergoing exercise electrocardiography (ECG). There was no relationship between AER and the severity of CHD determined by angiography (Gensini-scored). While microalbuminuria (AER > 20 micrograms/minute) was 91% specific it had low sensitivity (12%). Microalbuminuria is not a sensitive indicator of CHD in a non-diabetic population.     

冠心病病人球结膜微血栓与病情关系的观察

作者对１８０例冠心病病人球结膜微循环进行了观察，发现有微血栓者占２３．９％。分阶段地将有微血栓、无微血栓的冠心病病人及正常人三者进行对照，并对有微血栓的冠心病病人作了肝素或丹参治疗前后的对比观察。     

地佐辛在老年冠心病患者脊椎术后静脉镇痛中的应用

目的对冠心病患者中施行脊椎手术后比较地佐辛和芬太尼的静脉镇痛效果及对心血管不良事件发生的影响。方法高龄冠心病患者24例,随机分为地佐辛组和芬太尼组,每组12例。均为腰椎后路全椎板减压植骨融合内固定术。地佐辛组给予地佐辛,芬太尼组给予芬太尼,两组均加咪达唑仑,并以0．9％Nacl注射液稀释至100ml静脉镇痛。持续十二导联动态心电图监测,计算出患者24h心肌总缺血频度和缺血时间,以及心率变异性。并测定VAS评分及Ramsay镇静评分。结果两组心率变异性差异无统计学意义,地佐辛组的心肌缺血频度和缺血时间小于芬太尼组（P〈0．05）;2h时芬太尼组VAS评分略低于地佐辛组（P〈0．05）,其余各时点VAS评分差异无统计学意义,各时点镇静评分差异无显著性。结论地佐辛具有良好的镇痛作用,且副作用轻微,是老年冠心病患者脊椎手术后静脉镇痛的一种理想选择。     

军事飞行人员冠心病飞行合格医学鉴定

目的探讨低性能飞机军事飞行人员冠心病放飞的可行性及医学鉴定原则。方法回顾分析经冠状动脉造影诊断为冠心病并成功恢复飞行的6名低性能飞机军事飞行人员病历资料,追踪随访飞行情况,进一步确定有关医学鉴定原则。结果6名飞行人员年龄40—53岁,其中3名冠状动脉主要分支狭窄≤50％,给予药物治疗;1名冠状动脉痉挛导致心肌梗死救治及时,无并发症;另2名冠状动脉左前降支中段狭窄95％,给予冠状动脉支架术及抗血小板药物治疗。所有病例经半年以上地面观察,证明心血管功能正常、病情稳定后予以放飞。随访1-6年,平均每年飞行80—350h,飞行耐力良好。结论运输机、直升机等低性能飞机军事飞行人员冠心病病情较轻或治疗效果好,心血管功能正常,危险因素得到有效控制,可以在医学监督下恢复飞行。