直接PTCA与静脉溶栓治疗AMI近期疗效观察

目的 :比较直接经皮冠状动脉腔内成形术 (PTCA)与尿激酶静脉溶栓治疗急性心肌梗塞 (AMI)患者住院期间的临床疗效。方法 :随机地将首次AMI患者分为直接PTCA组 (2 6例 )和尿激酶静脉溶栓组 (49例 ) ,观察冠脉再通率、住院病死率和再发心梗率以及出院前左室射血分数 (LVEF)。结果 :溶栓组梗塞相关动脉 (IRA)再通率为 6 9.39% ,直接PTCA组IRA成功再通率为 92 .31% ,差异有显著性 (P <0 .0 5 )。住院期间病死率和再发心梗率溶栓组均有增加的趋势 ,但差异无显著性 (P >0 .0 5 )。出院前左室射血分数溶栓组为 4 5 .91± 9.6 6 ,直接PTCA组为 5 3.4 8± 7.4 7,差异有显著性 (P <0 .0 5 )。溶栓组因再闭塞或缺血发作行择期PTCA的比率明显高于直接PTCA组 (2 0 .4 1%vs 0 % ,p <0 .0 5 )。两组IRA开通组行选择性冠状动脉造影 (CAG)示IRA前向血流达TIMI - 3级 ,溶栓组为 2 5 % ,直接PTCA组为 10 0 % ,两组间有极显著性差异 (P <0 .0 0 5 )。结论 :AMI患者行直接PTCA较溶栓治疗更能充分有效地开通梗塞相关动脉 (IRA) ,更能挽救阻塞血管区域的心肌 ,从而更好地改善患者心功能 ,降低病死率和再发心梗率     

直接经皮冠状动脉腔内成形术与静脉溶栓治疗急性心肌梗塞临床分析

目的 :比较直接经皮冠状动脉腔内成形术 (PTCA)与静脉溶栓治疗急性心肌梗塞 (AMI)的疗效。方法 :96例AMI患者 ,53例接受静脉溶栓治疗 ,43例接受直接PTCA治疗。结果 :溶栓治疗组梗塞相关血管 (IRA)再通率为 64 .1 % ,直接PTCA组的IRA开通率为 93 .0 % ,溶栓组存活患者的LVEF为 (53 .9± 9.4) % ,急诊PTCA组为 (59.4± 1 1 .2 ) % ,两组差异显著 (P <0 .0 5)。两组的病死率分别为 1 5 .1 % (8/ 53)和 7.0 % (3/ 4 3) ,两组差异无显著性 (P >0 .0 5)。溶栓组出血发生率和出血程度较直接PTCA组严重 ,而且心脏破裂的机会增多 ,但无显著差异 (P >0 .0 5)。结论 :直接PTCA治疗AMI可以更加安全、充分有效地开放IRA ,保存心脏功能。     

不同方式再通梗死相关血管对急性心肌梗死面积及近期预后的影响

目的探讨急性心肌梗死(AMI)急诊经皮冠状动脉腔内成形术(PTCA)与静脉溶栓治疗后梗死相关血管(IRA)再通对心肌梗死面积(MIS)及近期预后的影响.方法55例AMI患者中,19例行急诊PTCA 支架植入术,36例静脉溶栓开通IRA,应用ST段运算法和QRS记分法预计IRA再通前及再通2周后MIS,并对其住院期间并发症和死亡率进行分析.结果PCTA组和静脉溶栓组的IRA再通前MIS%分别为(24.13±5.65),(23.80±5.74),两组无明显差别(P＞0.05).IRA再通后,PTCA组实际梗死区心肌存活率可达(32.42±8.59)%,较溶栓组的(20.02±10.12)%要高(P＜0.05).PTCA组和静脉溶栓组的住院期间严重的心功能不全、梗死后心绞痛、出院时IVEF等有显著性差异,而死亡率、恶性心律失常发生率在两组无显著性差异.结论直接PTCA较静脉溶栓治疗再通后可挽救较多处于梗死边缘的心肌;PTCA组近期并发症发生率低于静脉溶栓组.     

直接冠状动脉支架术与rt-PA静脉溶栓治疗急性ST段抬高性心肌梗死的对比研究

目的 比较直接冠状动脉支架术与加速性rt—PA静脉溶栓治疗急性ST段抬高性心肌梗死的近期临床效果。方法 168例STEMI患者中，100例行冠状动脉支架置入术，68例行rt—PA静脉溶栓治疗。观察两组梗死相关动脉(IRA)再通率、30天病死率，靶病变血管重建治疗等指标。结果 ①直接支架组：在99例病人植入135个支架，成功率为99％，93例IRA达TIMI血流3级，7例(7％)IRA达到TIMI血流2级，30天病死率2％；②rt—PA溶栓组：68例IRA再通59例，成功率86．8％，30天病死率5．9％，溶栓后2～4周，52例做冠状动脉造影，均有IRA高度狭窄。结论 与rt—PA溶栓比较，直接冠状动脉支架术扩大了STEMI病人的治疗适应症，能建立可靠的。IRA前向血流，手术并发症和病死率均低。     

急性心肌梗塞直接冠状动脉介入治疗的临床疗效观察

目的 :比较直接冠状动脉介入治疗 (PCI)与静脉溶栓治疗对急性心肌梗塞 (AMI)患者住院期间的临床效果。方法 :在 166例AMI患者中 ,86例患者直接PCI ,80例患者接受尿激酶溶栓治疗。结果 :溶栓梗塞组相关血管 (IRA)再通率 5 2例 ,再通率 62 % ;直接PCI组IRA成功开通 80例 ,成功率 10 0 % ,住院期间左室射血分数 (LVEF)溶栓组为 5 2 8± 10 1% ,直接PCI为 63 8± 9 6%差异有显著性 (P <0 .0 5 )。结论 :直接PCI与溶栓治疗AMI患者比较 ,前者能使IRA充分有效开通 ,可更好地改善患者的左心室功能。     

重组组织型纤溶酶原激活剂治疗急性心肌梗塞89例

目的 :观察重组组织型纤溶酶原激活剂 ( rt- PA)对急性心肌梗塞的治疗效果。方法 :对 89例急性心梗患者口服肠溶阿司匹林 30 0 mg或巴米尔 0 .3g泡水饮 ,然后给 rt-PA1 0 mg,2 min内静脉推注完毕 ,之后给 rt- PA90 mg在 1 2 0 min内静脉滴注随即给低分子肝素 5 0 0 0 IU皮下注射 ,每 1 2 h1次 ,连用 7d。结果 :<6h入院者 37例 ,再通 30例 ,再通率为83% ,6～ 1 2 h入院者 48例 ,再通 2 9例 ,再通率 62 % ,>1 2 h入院者 4例 ,再通 1例 ,再通率2 5 % ,总再通率为 67%。结论 :rt- PA治疗急性心肌梗塞再通率明显高于 UK,是目前比较理想溶栓用药     

合并2型糖尿病对急性心肌梗死静脉溶栓疗效的影响

目的　探讨合并 2型糖尿病对急性心肌梗死患者静脉溶栓效果的影响。　方法　 2 5例合并 2型糖尿病和 4 0例无糖尿病的急性心肌梗死患者 ,行尿激酶静脉溶栓治疗 ,观察两组患者的冠状动脉再通率和病死率。　结果　糖尿病组溶栓后冠状动脉再通率明显低于非糖尿病组 (P <0 .0 5 ) ;病死率糖尿病组高于非糖尿病组 (P <0 .0 5 )。　结论　合并 2型糖尿病急性心肌梗死患者静脉溶栓的疗效不如非糖尿病急性心肌梗死患者。     

静脉溶栓及直接经皮冠脉腔内成形术对急性心肌梗死预后的影响

目的　对比直接冠状动脉内介入治疗 (PCI)及静脉尿激酶 (UK)溶栓治疗对急性心肌梗死 (AMI)的临床疗效。方法　 2 5 4例AMI患者 ,180例接受静脉溶栓治疗 ,74例接受PCI治疗。比较两组住院期间临床结果及超声心动图 (UCG)结果。结果　直接PCI组 :IRA开通率 (95 .9% )高于UK组 (6 1.2 % ) ,P <0 .0 5 ;心衰发生率12 .1% ,严重心律失常发生率 8.1% ,心源性休克发生率 2 .7% ,病死率 2 .7% ,均低于PCI组 (分别为 2 5 .0 % ,2 0 .0 % ,10 .0 % ,11.1% ,两组比较有显著差异P <0 .0 5 )。UCG检查 :室壁矛盾运动发生率直接PCI组为 2 .7% ,低于UK(12 .7% ) ,P <0 .0 5 ;而左室射血分数 (LVEF) (% )直接PCI组为 5 6 .8± 8.3,高于UK组 5 1.2± 10 .4 ,两组比较P<0 .0 5。而两组中出血率、再发心绞痛率和再闭塞率无明显差别 (P >0 .0 5 )。结论　直接PCI治疗AMI与UK治疗相比能更有效开放IRA ,保护心功能 ,减少心衰及心脏恶性事件发生率和病死率 ,改善心肌梗死患者预后。     

小剂量重组组织型纤溶酶原激活剂治疗急性心肌梗死的临床观察

目的 :探讨小剂量 ( 50mg)重组组织型纤溶酶原激活剂 (rt PA)静脉溶栓治疗急性心肌梗死(AMI)的疗效及安全性。方法 :90min内静脉注射rt PA50mg治疗AMI 116例 ,依据临床指标判断再通。应用超声心动图比较再通组与未通组的心功能。结果 :冠脉再通率、出血发生率及住院期间再梗死率分别为78 4 % ( 91/116)、14 7% ( 17/116)和 5 2 % ( 6/116) ,再通组心功能明显好于未通组 (P <0 0 1) ,5w病死率再通组 1 1%显著低于未通组 8 0 % (P <0 .0 0 1)。结论 :小剂量rt PA静脉溶栓可获较高冠脉再通率 ,明显改善心功能 ,降低病死率、出血并发症及医疗费用。     

63例急性心肌梗死溶栓治疗的临床分析

目的　分析急性心肌梗死 (AMI)溶栓治疗效果。方法　比较急性心肌梗死患者治疗后冠脉再通、胸痛、严重并发症、出血副反应、住院病死率情况。结果　冠脉再通率静脉溶栓治疗组为 60 .7% ,非溶栓治疗组为 8.6% ,两组比较有显著性差异 (P <0 .0 1) ;溶栓组心衰发生率 17.9% ,非溶栓组 40 .0 % ,两组比较亦有明显差异 (P <0 .0 5 ) ,而其他严重并发症、住院病死率、出血副反应两组比较均无明显差异 (P均 >0 .0 5 )。结论　急性心肌梗死的静脉溶栓具有显著的治疗效果。     

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.