倾斜试验对心神经官能症的诊断价值

目的　探讨倾斜试验在心神经官能症诊断中的应用。方法　对排除器质性心脏病的 6 2例病人进行倾斜试验 ,并与 30例健康自愿者加以对照。结果　观察组 4 6例呈阳性 ,占 71 2 % ,对照组仅 16 7%为阳性。结论　倾斜试验可用于心神经官能症的诊断     

介入联合手术治疗贲门癌疗效评价

目的评价胃左动脉化疗栓塞(碘化油)结合手术切除治疗贲门癌的临床价值。方法选择62例贲门癌患者,随机分介入组(31例),即术前介入法行胃左动脉化疗,已碘油栓塞,30天后左右行手术切除治疗,对照组(31例)直接手术切除23例,占74.2%。结果1、2、3年生存率介入组为90.3%、74.2%、45.2%,对照组为67.7%、35.5%、25.8%。结论术前介入性胃左动脉化疗能提高贲门癌患者的生存率,是治疗贲门癌的理想方法。     

正常儿童心脏轻度杂音与瓣膜返流的临床观察

目的:探讨正常儿童心脏轻度杂音与瓣膜返流的相关性。方法:选取2003年9月~2005年12月该辖区8所小学6~12岁24322例学生进行健康体检跟踪观察。杂音组:67例心脏听诊轻度杂音。对照组:50例心脏听诊无杂音,均行心电图、心脏超声、心肌酶检查。结果:正常儿童心脏轻度杂音发生率0·28%(67/24322)。轻度杂音与三尖瓣轻度返流高度相关。随年龄增加逐步改善。结论:正常儿童心脏轻度杂音与三尖瓣膜返流高度相关,随年龄增加逐步改善。属良性改变。     

cyclinD1和CDK4在低氧心肌中的表达及意义

目的研究低氧心肌细胞周期及缺氧过程中细胞周期蛋白D1(cyclinD1)和细胞周期蛋白依赖激酶4(CDK4)表达的变化,探讨缺氧心肌在凋亡前是否存在增殖能力和自身修复。方法采用SD大鼠乳鼠进行心肌细胞培养,建立心肌缺血模型,实验分正常对照、缺血6 h和缺血12 h三组;以四唑盐比色试验(MTT)检测心肌细胞活力,流式细胞术测定细胞周期,免疫组化检测cyclinD1和CDK4表达。结果与对照组比较,心肌细胞缺氧处理6 h后,细胞周期中S 期比例增高(P<0 01),12 h后,S期比例下降(P<0 05);cyclinD1胞浆表达和CDK4 胞核表达增加。结论在缺氧所致死亡、凋亡过程中心肌细胞经历了一定程度的增殖过程,cyclinD1 和CDK4 表达增加参与了细胞增殖,缺氧损伤可刺激心肌细胞增殖能力。     

Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction

BackgroundIt has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior.MethodsA total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death.ResultsThere was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic.ConclusionDuring the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.     

强化极化液治疗冠心病并心功能不全的疗效观察

目的探索强化极化液治疗冠心病并心功能不全的临床价值。方法观察17例接受强化极化液治疗的冠心病并心功能不全患者的血压、心率、心功能的变化并设对照组。结果治疗组用药前后血压、心率、心功能变化明显(P<0.05或P<0.01)。对照组用药前后血压、心率、心功能变化亦显著(P<0.01或P<0.05)。两组治疗后疗效比较差异显著(P<0.05或P<0.01)。治疗组出现疗效时间为(2.5±0.7)d,对照组(10±2.5)d,治疗组明显短于对照组(P<0.01)。结论强化极化液对冠心病并心功能不全患者有良好的临床治疗效果。     

醒脑开窍针法对脑外伤患者认知功能和日常生活能力的影响

目的：观察醒脑开窍针法对脑外伤（TB）I患者认知功能和日常生活能力影响。方法：将60例TBI认知功能障碍患者随机分为观察组（规范化醒脑开窍针法）、对照组（非规范化的醒脑开窍针法）。治疗前后分别采用神经行为认知状态检查表（NCSE）和改良的Barthel指数评定法（MB）I来评定2组患者的认知功能和日常生活能力。结果：观察组治疗前后比较,在定向能力、专注能力、复述能力、记忆能力、命名能力、计算能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）;对照组治疗前后比较,在定向能力、复述能力方面上,差异均有显著性意义（P〈0.05）;治疗后2组间比较,在专注能力、定向能力、复述能力、记忆能力方面上,差异有非常显著性或显著性意义（P〈0.01,P〈0.05）。2组MBI治疗前后比较,差异均有非常显著性意义（P〈0.01）;治疗后2组间MBI比较,差异有显著性意义（P〈0.05）。结论：规范化的醒脑开窍针法能更有效地改善脑外伤后认知功能和日常生活能力。     

心肌肌钙蛋白T在川崎氏病早期的诊断意义

目的　探索心肌肌钙蛋白T(cTnT)在川崎氏病早期的意义。方法　应用ELISA方法对25例川崎氏病早期的病人血清中cTnT、CPK、CKMB进行监测,观察其对心肌缺氧的敏感性,并选择cTnT与心脏扇扫提示的冠状动脉改变情况进行对比。结果　25例中14例cTnT,1例CPK,1例CKMB升高,21例冠状动脉有改变,冠状动脉无改变4例中2例cTnT升高且同时伴有心电图改变。结论　①在川崎氏病早期cTnT的敏感性高于CPK和CKMB;②CTnT可以提示一些扇扫中无法发现的冠状动脉异常所致的心肌缺血     

G蛋白抑制肽GCIP-27对小鼠心肌肥大的影响

目的:探讨G蛋白抑制肽GCIP-27对去甲肾上腺素诱导的小鼠心肌肥大的作用。方法:50只小鼠随机分为对照组、模型组和GCIP-27组,分别给予生理盐水、去甲肾上腺素和GCIP-27低、中、高剂量(10、30、100μg·kg-1)连续15d。之后称量小鼠体质量、心脏重、左心室重,计算心脏指数和左心室指数。采用免疫组化法测定心肌组织的原癌基因c-Fos和细胞外信号调节激酶p-ERK1/2表达。结果:与对照组比较,模型组可明显诱导小鼠产生心肌肥大。与模型组比较,GCIP-27各剂量组能明显降低心脏指数和左心室指数,减少心肌组织中c-Fos和p-ERK1/2的表达量(P<0.05或P<0.01)。结论:GCIP-27可抑制小鼠发生心肌肥大,其机制可能与抑制c-Fos和p-ERK1/2表达有关。     

双极射频消融治疗心房纤颤的临床研究

目的对心内直视下双极射频消融治疗心房纤颤(Atrial fibrillation,AF)的临床疗效进行总结及分析。方法回顾性分析在心内直视下瓣膜置换同期行双极AF射频消融术病例219例,术前行心电图及超声心动图了解心律及心功能指标。术中射频消融路线相同,术后定期复查心电图并口服胺碘酮半年,随访半年以上,行心电图出现窦性P波则表明转律成功。结果围手术期死亡5.48%(12/219),出院时窦性心律(Sinus rhythm,SR)79.00%(173/219),非SR 15.53%(34/219)。出院后随访6~58个月,平均(27.96±15.57)个月,随访率83.57%(173/207),失访率16.43%(34/207),随访期间死亡1.73%(3/173),维持SR 89.02%(154/173),非SR 10.98%(19/173)。单因素分析示左房内径(Left atrial diameter,LAD)、年龄及高血压病是影响术后转复的危险因素(P<0.05)。结论心内直视下瓣膜置换同期射频消融治疗AF安全、有效,LAD大、年龄大及高血压病可降低术后转复率。