急诊PTCA与溶栓治疗急性心肌梗死近期疗效对比研究

目的:对急诊PTCA和溶栓在急性心肌梗死(AMI)治疗中的近期疗效作一对比研究。方法:回顾性分析中山医院自2001年1月至2001年11月收治的行急诊PTCA和溶栓治疗的85例AMI患者的资料.并分析其临床不良事件的发生率、超声心动图检查结果。结果:急诊PTCA患者49名,溶栓患者36名。溶栓组的室性心律失常发生率(25%)、梗死后心绞痛(22.22%)、心源性休克(25%)、左室室壁运动积分指数(1.82±0.32)、行冠状动脉旁路手术(CABG)者(13.89%).死亡率(27.78%).平均住院天数(25.06±16.37)d.分别高于PTCA组的2.04% (P<0.01)、6.12%(P<0.05)、6.12%(P<0.05)、1.47±0.34(P<0.01)、0(P相似文献   

急性心肌梗死存活心肌对左室重构影响的临床研究

目的通过小剂量多巴酚丁胺负荷超声心动图(dobutamine stress echocardiography,DSE)评价急性心肌梗死患者存活心肌,探讨存活心肌对左室重构的影响.方法入选57例首次急性前壁心肌梗死且成功进行急诊冠状动脉介入治疗的患者.心肌梗死后72 h行小剂量[5～10 μg/(kg*min)]DSE评价存活心肌.所有患者在心肌梗死后24 h、72 h、4周及12周定期随访超声心动图.根据DSE检查结果,将患者分为存活心肌组(n=36)和无存活心肌组(n=21).结果存活心肌组患者左室舒张末期容量指数(LVEDVI)无明显变化,左室收缩末期容量指数(LVESVI)明显降低;无存活心肌组患者LVEDVI和LVESVI均逐渐增加.心肌梗死后4周及12周,存活心肌组患者LVEDVI、LVESVI明显低于无存活心肌组患者[LVEDVI梗死后4周为(64.90±13.52)ml/m2 vs (90.75±34.92)ml/m2,P<0.01;梗死后12周为(66.82±9.78)ml/m2 vs (102.71±13.06)ml/m2,P<0.01.LVESVI梗死后4周为(29.63±30.36)ml/m2 vs (54.62±37.90)ml/m2,P<0.05;梗死后12周为(28.45±12.34)ml/m2 vs (51.35±12.51)ml/m2,P<0.05].心肌梗死后4周及12周,存活心肌组患者左室射血分数(LVEF)明显高于无存活心肌组患者(P<0.01).多元回归分析表明存活心肌(r＝-0.615,P<0.01)和术后冠脉血流分级(TIMI)(r＝-0.465,P<0.05)是影响左室重构的重要因素.结论急性心肌梗死患者介入治疗后,尽管梗死相关动脉完全再通,但仍有部分患者出现左室重构.梗死区域内存活心肌影响左室重构的发生、发展,并且改善心功能.     

酷似肺炎的单侧肺水肿1例并文献复习

肺内血管外液体的蓄积即可形成肺水肿,最常见的原因是毛细血管内流体静压增高。单侧肺水肿(unilateral pulmonary edema,UPE)可见于胃酸吸入、气胸后肺组织膨胀、充血性心力衰竭、特定分流的先天性心脏病、胸部创伤等。表现为UPE的急性心衰在临床较为少见,常被误诊为肺炎,继而延误诊断。本文报道1例表现为UPE的急性心衰,治疗后单侧肺水肿消失。病例资料男,32岁。因"咳嗽咳痰伴气促1     

冠状动脉微栓塞后冠脉血流储备及心肌血流量的变化及其机制

目的:经导管建立冠状动脉微栓塞模型,测定微栓塞后冠脉血流储备及心肌血流量的变化情况,并探讨其机制。方法:12只小型猪,通过导管方法建立急性冠脉微栓塞模型,观察急性期（基础、微栓塞后2 h、6 h）及慢性期（基础、微栓塞后1周）冠脉血流储备和心肌血流量的变化情况,并测定血清中内皮素-1（ET-1）浓度变化。结果:急性期冠脉微栓塞后冠脉血流储备在基础、微栓塞后2 h、6 h分别为2.10±0.60、1.40±0.10及1.10±0.10（微栓塞后2 h及6 h与基础相比,均P<0.01）,慢性期实验中,冠脉血流储备在微栓塞前及微栓塞后1周分别为2.03±0.43及1.58±0.22（微栓塞后1周与基础相比,P<0.05）。但前内侧和后内侧心肌血流量以及它们的比值在微栓塞后没有显著变化。测定血清ET-1浓度显示微栓塞后2 h开始升高,但只有微栓塞后6 h较基础有明显增加(P<0.05),微栓塞后6 h及1周心脏标本NBT染色均未见梗死灶。结论:冠脉微栓塞后冠脉血流储备呈现先下降后恢复的趋势,这种变化与内皮功能变化一致,冠脉血流储备和心肌血流量变化不同步。     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

自拟复方蜂房乙肝液治疗乙肝病毒感染和慢性HBsAg携带者336例临床观察

病毒型乙肝炎 (以下简称乙肝 )是一种严重危害人类健康而难以治愈的疾病。要解决这一难题 ,首先应明确乙肝及慢性无症状携带者 (ＡＳＣ)的体质辨证问题、病变脏腑定位问题、治疗周期问题以及在治疗中针对乙肝多样性、复杂性问题而独特用药问题 ,方能取得治疗上的创新与突破。1　关于体质辨证乙肝病毒感染及慢性无症状携带者(ＡＳＣ)的无临床症状特点 ,往往使医生无从下手 ,体质的差异无疑成为了关注焦点。近二十年的经验发现 ,机体的免疫应答能力与调节功能受遗传因素的控制。而人类体质的类型毫无疑问是在遗传基础上形成的 ,分清乙肝病毒感…     

杂交策略治疗冠状动脉慢性完全闭塞病变的有效性和安全性

目的 探讨药物洗脱支架（drug-eluting stent, DES）联用药物涂层球囊（drug-coated balloon, DCB）的杂交策略治疗冠状动脉慢性完全闭塞（chronic total occlusion, CTO）病变的有效性和安全性。方法 连续纳入2021年9月至2022年9月在复旦大学附属中山医院确诊为CTO并采用单纯DES植入或杂交策略治疗的369例患者，分为DES组（n=220）和杂交策略组（n=149）。比较两组患者的临床基线信息、介入手术特征、术后定量冠状动脉造影（quantitative coronary angiography, QCA）参数和定量血流分数（quantitative flow ratio, QFR）。随访术后1个月内主要不良心血管事件（major adverse cardiovascular events, MACE）发生率。结果 369例患者的369个病变以前降支病变（44.7%）和右冠状动脉病变（43.1%）为主。与DES组相比，杂交策略组植入支架数[1.67±0.66 vs 2.00±0.81, P<0.001]和植入支架...     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

磁共振延迟成像时间对急性心肌梗死测定的影响

目的 本研究探讨不同磁共振延迟成像(comrast-enhanced magnetic resonance imaging,CeM-砌)时间是否影响急性心肌梗死(acute myocardial infarctin,AMI)后梗死面积的测定.并探讨磁共振测定的射血分数与左窒造影测定的射血分数的相关性.方法 选择在2005年6月至2006年4月在复旦大学附属中山医院住院治疗的患者,27例首次确诊为急性心肌梗死的患者进行前瞻性研究,年龄(54.3±10.5)岁.所有患者均动态观察心肌酶谱的变化,并经冠脉造影明确,冠脉造影同时测定左室造影射血分数,磁共振(SIMENS 1.5T)检查时间为心肌梗死后(13.2±5.2)d,磁共振检查方法 是首先进行电影扫描,测定射血分数,然后经静脉以5 mL/秒注入0.05 mmol/kgGd-DTPA行首过成像,最后经高压注射器静脉以2 mL/s注入0.15 mmol/kg Gd-ffFPA行延迟成像,测定心肌梗死面积,在延迟注药后5 min开始延迟期采集.选择存在延迟增强高信号区的同一短轴层面,每间隔5 min成像一次测定梗夕匕面积,直至20 min.采用配对t检验进行统计,并进行相关分析.结果 27例患者在延迟CeMRI上均存在延迟增强区,27例患者测定的梗死面积为(17.9±9.8)%,测定CK峰值为(2003.5±1496.8)U/L,肌钙蛋白T峰值为(4.6±3.3)ng/mL.梗死面积与CK峰值的相关系数为r=0.819(P<0.01),梗夕匕面积与肌钙蛋白T相关系数为r=0.517(P<0.05).存在梗死心肌的同一层面测定的梗死而积百分比在5 min,10 min,15 min及20 min时分别为(7.2±6.2)%,(8.5±7.4)%,(7.3±6.3)%及(6.9±6.4)%(10 min与20 min相比,P<0.05).MR测定的左室射血分数与造影测定的射血分数相关系数为r=0.867(P<0.01).结论 CeMRI可以诊断心肌梗死和定量测定梗死范围.磁共振测定与左室造影测定的射血分数密切相关.测定梗死范围时,不同延迟成像的时间影响梗死范围的测定.