心肌梗死伴胸腔积液16例分析

目的通过分析高龄急性心肌梗死(AMI)病例误诊或延迟诊断的原因,研究防止误诊漏诊的方法。方法分析并发胸腔和/或心包腔积液的AMI患者68例临床资料,选择16例以胸腔积液为首发症状的高龄患者,排除非心源性胸腔积液和/或心包腔积液的患者,分析其在就诊过程中误诊或延迟诊断的相关资料及影响因素。结果16例患者中,仅5例在首次就诊时确诊为AMI,11例患者不同程度地误诊或延迟诊断,其中7例患者以胸腔积液收住呼吸科治疗。该7例患者从发病到确诊时间平均12d。结论高龄AMI患者常同时合并多种疾病,易致误诊或延迟诊断;心电图检查仍是AMI诊断的首选方法。     

急性心肌梗死患者静息心率变化及其临床意义

目的探讨静息心率（RHR）在急性心肌梗死（AMI）中的变化及临床意义。方法对63例AMI患者按照入院时RHR高低分为两组，比较两组患者的梗死部位、梗死面积和预后，探讨RHR与梗死部位以及预后的关系。结果RHR≥85次／min的患者病死率明显高于RHR〈85次／min的患者；广泛前壁梗死和同时两部位梗死患者RHR明显高于单一部位梗死患者；死亡患者平均RHR明显高于存活患者。结论急性心肌梗死患者RHR升高，可能与急性心肌梗死严重程度有关，在基层医院可利用RHR指导临床治疗，预测患者预后。     

急性下壁心肌梗死合并右心室梗死的诊治体会(附24例)

目的 分析急性下壁或正后壁心肌梗死合并右心室梗死时的临床表现。方法 对我院24例急性下壁或正后壁心肌梗死合并右心室梗死患者的临床资料进行回顾性分析。结果 治愈21例,死亡3例,治愈率为87.5％。结论 (1)急性下壁或正后壁心肌梗死患者出现右心衰竭体征而无左心衰竭证据,应考虑右心室梗死;(2)出现低血压不能用泵衰竭或低血容量解释者,应考虑右心室梗死,并加做右胸导联心电图;(3)右心室梗死的低血压可以通过恰当的扩容加以纠正,当右心室梗死合并房室传导阻滞、心动过缓时可静脉应用阿托品或654-2等药物予以改善。右心室梗死并发右心衰竭时慎用或不用利尿剂。     

急性心肌梗死合并糖尿病患者临床特征分析

目的探讨急性心肌梗死合并糖尿病患者的临床特征,并发症发生情况及预后,为临床该病诊治提供借鉴。方法选取2015年8月—2016年5月该院收治的108例急性心肌梗死患者进行研究,将合并有糖尿病的43例心肌梗死患者设置为观察组,无合并糖尿病的65例心肌梗死患者设置为对照组,对两组患者的一般资料、临床特征、并发症发生情况及预后情况进行比较分析。结果观察组多发梗死部位高于对照组,早期压榨样疼痛发生率低于对照组,胃肠道不适反应和呼吸困难等临床症状较对照组严重,且并发症发生率和住院期间病死率均高于对照组,组间比较差异具有统计学意义(P0.05)。结论合并有糖尿病的心肌梗死患者心前区压榨样疼痛等早期典型症状不明显,多以上腹部疼痛或胃肠道不适等临床症状就诊,但其病情发展快,并发症和病死率均高于非合并糖尿病心肌梗死患者,若对临床症状不十分了解,易造成误诊或漏诊。重视合并糖尿病的急性心肌梗死患者临床特征,快速做出准确诊断,在积极控制血糖的同时给予合理治疗,可有效改善患者预后。     

急性下壁合并后壁心肌梗死的心电图表现及其临床特点分析

目的探讨急性下壁合并后壁心肌梗死患者的心电图表现及其临床特点。方法对45例急性下壁合并后壁心肌梗死(A组)及60例单纯急性下壁心肌梗死(B组)患者的心电图进行对比分析。结果A组的平均RV1振幅、V1～V3导联ST段压低值及院内并发症发生率均显著高于乙组,两组比较差异有统计学意义(P<0.01,P<0.05)。结论急性下壁合并后壁心肌梗死患者的梗死面积大,院内并发症发生率高。后壁心梗的正确诊断对整个梗死面积的估计和预后判断有重要意义。     

胸腔积液联合血液浓缩对急性胰腺炎严重度评估的临床价值

目的：探讨胸腔积液、血液浓缩和二者的联合应用对急性胰腺炎疾病严重程度的评估价值，并观察胸腔积液与急性胰腺炎病因，并发症及死亡率的关系。方法：对136例急性胰腺炎住院患者作回顾性分析，急性胰腺腺炎及其严重度评估的标准依据患者的临床表现，实验室检查及增强CT检查。记录患者的胸片和红细胞压积检测结果，并分析胸腔积液与急性胰腺炎患者的病因，并发症及预后的相关性。结果：轻型急性胰腺炎（MAP）96例，重症急性胰腺炎（SAP）40例。SAP患者合并胸腔积液者18例（45％），有血液浓缩现象者6例（15％），胸腔积液和血液浓缩同时存在者5例（12．5％）；MAP患者合并胸腔积液者10例（10．4％），血液浓缩者2例（2．1％），无胸腔积液和血液浓缩同时存在者，两者相比有显著性差异（P＜0．01）；此外，胆源性急性胰腺炎合并胸腔积液者11例（14．4％），酒精性急性胰腺炎合并胸腔积液者5例（48．1％），P＜0．05，结论：胸腔积液，血液浓缩均可作为SAP的独立预测指标，但以胸腔积液联合血液浓缩最为准确。胸腔积液与酒精性急性胰腺炎的病因具有明显的相关性，但未发现胰腺局部并发症如胰腺假性囊肿以及患者死亡率与胸腔积液的关系。     

急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术后发生急性心力衰竭的临床特点

目的分析急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)术后发生急性心力衰竭的临床特点。方法选择STEMI行急诊PCI的患者186例,对其中PCI术后发生急性心力衰竭的患者进行回顾性分析。结果分析显示年龄>55岁合并糖尿病的患者急诊PCI术后更易出现心力衰竭加重,<55岁患者梗死血管更易累及前降支并出现心力衰竭加重;梗死血管闭塞时间、梗死血管重要性、非梗死血管病变程度、侧支循环不良、边支血管闭塞和损伤等均可诱发急性心力衰竭。造影剂、血容量增加、再灌注损伤、缓血流、无再流也是引起急性心力衰竭的重要因素。结论急性心肌梗死(AMI)患者PCI术后发生急性心力衰竭的原因较多,警惕高危因素并给予针对性治疗可提高临床治疗的安全性。     

中性粒细胞与淋巴细胞比值对急性心肌梗死患者梗死面积及预后的影响

目的 探讨中性粒细胞与淋巴细胞比值（NLR）对急性心肌梗死（AMI）患者梗死面积及预后的影响。方法 该研究为前瞻性研究，连续纳入2016年1月1日至2017年12月31日于盛京医院行PCI治疗的急性心肌梗死患者206例，均在术后48至72小时内行心脏核磁共振（CMR）检查，记录心肌梗死面积等数据。基于受试者工作特征曲线（ROC）确定的最佳阈值将患者分为高NLR组（n=78，NLR≥3.91）和低 NLR组（n=128，NLR<3.91）。收集患者临床资料，介入治疗及心脏磁共振检查结果，随访记录终点事件，分析两组患者临床特点及预后差异。结果 高NLR组患者的心肌梗塞面积显著高于低NLR组（23.9±10.8 vs 15.6±8.9，P<0.001），Cox分析显示，NLR大小与全因死亡（HR=1.958，95%CI 1.592~2.317，P=0.003）和心源性死亡（HR=1.621，95%CI 1.174~2.163，P=0.007）事件风险独立相关。 结论 NLR可作为一项简单有效预测急性心肌梗死患者梗死面积及预后的临床指标。     

急性心肌梗死合并糖尿病的临床分析

目的 探讨急性心肌梗死(AMI)合并糖尿病(DM)的临床特点及预后.方法 选取DM合并AMI者43例和非DM合并AMI者60例,对比分析其临床症状、体征、并发症及预后.结果 DM组发生多部位梗死高于非DM组,DM组患者无痛性AMI发生率高,DM组发生AMI时并发症及病死率明显高于非DM组.结论 DM合并AMI患者临床症状不典型,以无痛性多见,易发生严重心律失常、心力衰竭、休克等并发症,病死率高,临床医生应提高警惕,早期发现及时治疗,以改善DM合并AMI患者的预后.     

急性右心室心肌梗死的临床特点及预后分析

目的 对急性下壁心肌梗死住院患者的临床资料进行分析,观察合并右心室梗死对病情和转归的影响,并探讨早期再灌注治疗对预后的作用.方法 急性下壁心肌梗死患者304例,其中单纯下壁心肌梗死232例,合并右心室梗死72例,记录一般资料、并发症、实验室检查和治疗情况.结果 右心室梗死组心源性休克、机械并发症、完全性房室传导阻滞、心室颤动、持续性室速和再梗死均明显增高.单纯下壁心肌梗死组病死率为8.6%,右心室梗死组病死率为34.7%.右心室梗死组进行再灌注治疗者病死率为27.8%,保守治疗者病死率为55.6%.结论 右心室梗死作为急性心肌梗死的高危亚组,其严重并发症和病死率显著增加.通过早期再灌注治疗能显著降低右心室梗死的住院期病死率,改善预后.     

以胸腔积液为首发症状的甲亢性心脏病7例

目的探讨甲状腺功能亢进性心脏病合并胸腔积液的特点和误诊原因。方法分析7例甲状腺功能亢进性心脏病合并胸腔积液误诊的临床资料。结果入院前误诊为癌性胸腔积液2例,结核性胸腔积液3例,肺炎旁胸腔积液2例。确诊后给予抗甲亢、利尿等治疗,效果明显。结论对胸腔积液的患者应详细询问病史,认真查体,积极完善相关检查,当胸腔积液原因不确定,经验治疗效果差时,应想到是否存在甲状腺功能亢进性心脏病可能。     

超声引导下改良胸膜活检术对诊断原因不明胸腔积液的临床观察(附49例临床分析)

目的 观察超声引导下改良胸膜活检术对原因不明胸腔积液诊断中的价值.方法 使用改良胸膜活检术对49例不明原因胸腔积液患者进行胸膜活检术.结果 所有患者胸膜活检均成功,其中间皮瘤3例,低分化癌6例,腺癌7例,未分型4例,结核18例,慢性炎症11例(经治疗最终证实为结核),病理确诊率77.6％,仅2例出现胸膜反应,未出现局部出血及气胸.结论 超声引导下改良胸膜活检术安全、方便,对胸腔积液确诊率高、并发症少.     

胸膜淀粉样变

目的探讨胸膜淀粉样变在胸腔积液鉴别诊断中的意义。方法回顾性分析系统性淀粉样变病例中胸腔积液的发生率及其临床特点。结果１５例系统性淀粉样变中，７例（４７％）合并胸腔积液，其中４例由经皮针胸膜活检刚果红染色阳性而确诊为胸膜淀粉样变。结论系统性淀粉样变合并胸腔积液并非罕见。多器官损害合并胸腔积液时应疑及该病。经皮针胸膜活检具确诊价值。     

Myocardial infarction and late pericarditis]

The post-infarction syndrome was observed in 8 out of 138 consecutive patients with acute myocardial infarction; 24 other cases of the post-infarction syndrome diagnosed over the preceeding 3 years were also reviewed. In order to determine the clinical significance and the prognosis, this group of 32 was compared to another of 105 patients with myocardial infarction without pericarditis, with respect to age, sex, medical history and characteristics of the underlying necrosis (location and size). Several clinical signs are discussed. This study showed the post-infarction syndrome was associated with large infarcts, the course of which was marked by arrhythmias, conduction defects and haemodynamic problems. A considerable inflammatory syndrome was often observed. The relation between the post-infarction syndrome and early pericarditis is not proved; on the other hand, a close correlation between late pericarditis, atrial fibrillation and left pleural effusion was demonstrated. The long term prognosis of infarcts complicated by the post-infarction syndrome is without doubt determined by the size of the necrosis and by the presence of ventricular aneurysms which are frequently associated.     

Incidence and significance of pericardial effusion in acute myocardial infarction as determined by two-dimensional echocardiography

To determine the incidence and clinical significance of pericardial effusion after acute myocardial infarction, two-dimensional echocardiography was serially performed in 66 consecutive patients. Pericardial effusion was observed in 17 (26%); the effusion was small in 13 patients, moderate in 3 and large with signs of cardiac tamponade in 1. In this patient, two-dimensional echocardiography strongly suggested myocardial rupture. The observation of pericardial effusion was not associated with age, sex, previous myocardial infarction, atrial fibrillation or treatment with heparin. It was more often a complication of anterior than of inferior acute infarction. Patients with pericardial effusion had higher peak levels of creatine kinase and lactic dehydrogenase and a higher wall motion score index. More patients with pericardial effusion had congestive heart failure or ventricular arrhythmias, developed a ventricular aneurysm or died within 1 year after their infarction. In conclusion, pericardial effusion is frequently visualized by two-dimensional echocardiography after acute myocardial infarction and its presence is associated with an increased occurrence of complications and cardiac death.     

二氧化碳冷冻法在结核性胸膜炎中的临床运用

目的观察经支气管镜代替胸腔镜二氧化碳冻切法在结核性胸膜炎中的运用价值.方法将98例结核性胸膜炎导致胸腔包裹性积液患者随机分为对照组和观察组,每组49例,对照组采用放置中心静脉导管引流充分后于胸腔内注入尿激酶10万U,隔天注射1次,观察组采用支气管镜代替胸腔镜二氧化碳冻切治疗.比较2组胸腔积液吸收情况、胸膜厚度、临床症状、肺功能等变化.结果对照组显效16例(32.6%),有效25例(51.0%),无效8例(16.4%),总有效率83.6%.观察组经治疗后患者胸腔积液吸收较快、症状明显改善,胸膜无明显增厚,肺功能改善明显,显效25例(51.0%),有效24例(49.0%),总有效率100.0%.结论经支气管镜代替胸腔镜能在直视下发现胸膜腔内纤维粘连包裹,二氧化碳冻切法可以对病变进行清除,有效减少胸膜肥厚粘连的发生.     

Pericardial effusion in acute myocardial infarction: clinical feature and significance]

To determine the incidence and clinical significance of pericardial effusion after acute myocardial infarction, two-dimensional echocardiography was serially performed in 137 consecutive patients. Pericardial effusion was observed in 45 patients (33%), of whom 22 were followed until they recovered and were discharged. Pericardial effusion was more frequent in patients with anterior acute infarction than those with inferior acute infarction, and so it was in non-recanalized patients than in recanalized ones. Patients with pericardial effusion had higher peak levels of creatine kinase, higher wall motion score indices, and higher defect scores of thallium imagings. The improvement of regional wall motion at an infarct zone in patients with pericardial effusion was less regardless of the successful early recanalization. These results show that pericardial effusion is a common event in patients with acute myocardial infarction and observation of transition of pericardial effusion is important for predicting prognosis.     

Tuberculous pleural effusion. Twenty-year experience

We reviewed the records of 1,738 cases of tuberculosis seen during the period from 1968 to 1988 in Mobile, Alabama. Seventy cases of tuberculous pleural effusion were identified and constituted 4.9 percent of all disease due to Mycobacterium tuberculosis during this period. Tuberculous pleural effusion was diagnosed if the patient had M tuberculosis cultured from sputum, pleura, or pleural fluid and had a roentgenographic pleural effusion without an alternative explanation for the presence of the effusion. The diagnosis of tuberculous pleural effusion was made in the absence of a positive culture if the patient had an undiagnosed lymphocytic exudative pleural effusion and all clinical and roentgenographic abnormalities resolved on antimycobacterial chemotherapy. The mean age of all patients was 47 +/- 18.4 years. The 70 cases were evenly divided between 35 that were accompanied by roentgenographic pulmonary parenchymal infiltrates and 35 that occurred in the absence of parenchymal infiltrates. We conclude that cultures of all potentially diagnostic specimens (sputum, pleural fluid, and pleura) and an intermediate-strength skin test, are sensitive tests for the diagnosis of tuberculous pleural effusion. In addition, the age of patients with tuberculous pleural effusion appears to be increasing.     

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P>0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P<0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart