老年冠心病患者血清中心肌标志物的检测及应用

目的:探讨心肌标志物C反应蛋白(CRP),肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)的检测对老年人冠心病患者的应用价值。方法:针对急性心肌梗死(AMI)、不稳定型心绞痛(UAP)、稳定型心绞痛(SAP)和健康人群进行cTnI、CRP、CK-MB检测。结果:AMI组、UAP组患者三项指标均显著高于正常对照组(P<0.01);SAP组与正常对照组无明显差异;UAP组、AMI组与SAP组相比差异有显著性(P<0.05)。结论:CRP是一种急性期反应蛋白,灵敏度高,CK-MB灵敏度、特异性均不高,两者可作为初筛指标,cTnI心肌特异性高,可作为确定性指标。     

腺苷在窒息兔心肺复苏中的作用的实验研究

目的观察腺苷在窒息兔心肺复苏中对复苏的影响。方法采用窒息法制作兔窒息模型,将实验动物随机分为对照组(A组)、肾上腺素组(B组)、肾上腺素合并腺苷组(C组)。持续窒息4min后,行胸外心脏按压,呼吸机辅助呼吸,4min后静脉给药。A组(n=6)不用复苏药物;B组(n=12)静脉注射肾上腺素90μg/kg;C组(n=12)静脉注射肾上腺素90μg/kg并持续静滴腺苷150μg·kg-1.min-1至复苏结束。观察窒息至死亡时间、自主循环恢复率、复苏成功率、复苏成功后血浆肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和乳酸浓度。结果自主循环恢复率和复苏成功率C组>B组>A组,但B组和C组间相比差别无统计学意义。复苏成功兔血浆CK、CK-MB和乳酸浓度,C组相似文献   

Reoperation for coronary artery disease in the young: early and mid-term results

Background As the incidence of coronary artery disease (CAD) at young age is high in Asian countries, the number of coronary reoperations in this group of patients is increasing. The aim of this study was to define the incidence, risk factors and to discuss the methods of re-revascularization and early to mid-term outcomes in these patients. Methods This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery (CABG) before the age of 45 years and underwent reoperation for recurrence of angina due to progression of native coronary artery disease and, or, graft occlusion. The data was also analyzed with regards to the risk factors contributing to the recurrence of the disease and the short to mid-term outcomes. During a six year period from January 1998 to October 2004, a total of 68 patients had reoperation for recurrence of angina. The mean interval of presentation following primary CABG was 12.48±3.11 years (ranged from 8 months to 16 years). Reoperation was performed under cardiopulmonary bypass (CPB) in 63 patients and in the remaining five patients on beating heart without using CPB. Results Reoperation accounted for 4.6% of 2478 patients who underwent CABG between January 1998 through October 2004 at our institute. Among these 114 patients, 68 patients underwent primary CABG before the age of 45 years. These 68 patients received a total of 214 grafts (3.14 grafts per patient) of which 169 grafts were re-anastamosed to previously grafted target arteries. Left internal mammary artery was used in 61 patients (89.7%) who required graft to left anterior descending coronary artery at reoperation. The early mortality was 4.4% (3 out of 68). Two patients (2.94%) had perioperative myocardial infarction and two more patients were re-explored for mediastinal bleeding. Freedom from recurrence of symptom of angina at 2 and 4 years was 98.01%, 94.5% respectively. Conclusions Redo CABG is associated with higher morbidity and mortality when compared to first-time CABG. Perioperative myocardial infarction and left ventricular dysfunction contribute significantly to the increased risk of redo CABG.     

NT-proBNP and the diagnosis of heart failure: a pooled analysis of three European epidemiological studies

Many studies have shown that the B-type natriuretic peptides (BNP and NT-proBNP) are proven diagnostic markers for heart failure due to left ventricular systolic dysfunction. The manner in which they are to be used is still being unravelled; most single centre studies have chosen the best concentration of the peptide on ROC analysis as their cut-point resulting in numerous different values for both BNP and NT-proBNP appearing in the literature. We report a different approach of defining an age and sex corrected abnormal concentration for NT-proBNP, derived from normal individuals within a large sample of 3051 subjects pooled from three European epidemiology studies and applying that to the entire population to detect HF and LVD. Three thousand and fifty one subjects were studied. Of these 10% (305) had significant LVD and 3.1% (94) had HF. The median concentrations of NT-proBNP (IQR) in normals, those with LVD and in heart failure subjects were 20 pg/ml (10.30), 117.3 pg/ml (28.145) and 269.6 pg/ml (54.323), P<0.001, respectively. The area under the ROC curve for NT-proBNP for the detection of 'heart failure' was 0.85 and 0.69 for LVD. NT-proBNP was an independent predictor of the presence of HF on multivariate analysis. An abnormal NT-proBNP was defined as being >95th centile for normals, age and sex corrected, and diagnosed HF with a sensitivity of 75% and a negative predictive value of 99%. In an additional analysis in a breathless subgroup of our population, in 30% a raised NT-proBNP concentration could be explained by HF due to LVD, in another 64% the high BNP level was associated with some other structural of functional cardiac abnormality or renal impairment. We were unable to assign a possible cause to the high NT-proBNP values in 5.9% of this breathless subgroup of the population. An abnormal NT-proBNP concentration is an accurate diagnostic test both for the exclusion of HF in the population and in ruling out LVD in breathless subjects. An elevated NT-proBNP merely indicates the presence of 'cardio-renal distress' and should prompt referral for further investigation.     

气候变化对我国部分地区心脑血管疾病死亡率的影响及预防对策

综述了季节变化、气压、气湿、气候变化与空气污染的联合作用对我国心脑血管疾病死亡率的影响,并介绍了国际、国内气候预报模型研究现况,初步提出对策。作者认为探讨血浆氧化型低密度脂蛋白含量与气候变化的关系,具有重要意义。     

Assessment of food environment at work and its association with cardiometabolic health among employed adults in Delhi,India

Background and aimsUnhealthy food environment at work is believed to be playing a role in the burgeoning obesity, cardiometabolic risk, diabetes and cardiovascular diseases in India. Therefore, food environment assessment at work is crucial to understand the effect of food environment and to find its association with cardiometabolic risk among adults in Delhi, India.MethodologyMix-methods study to find association between worksite food environment on the food choices, dietary behavior, and cardio-metabolic health of 455 apparently healthy adults (both males and females) aged 25–55 years was done in urban India.ResultsUnhealthy food environment, poor eating pattern and sedentary lifestyle at work resulted in clustering of CMR factors among the study participants. Work environment assessment revealed that worksites with canteens had higher overall CHEW score for all its domains (Physical, nutritional, and information environment), in comparison to worksites without or no canteens. Four out of ten apparently healthy adults had metabolic syndrome indicating poor cardiometabolic health. The odds of CMR in subjects with access to canteen (unhealthy food) were estimated to be 0.74 (CI: 0.51 to 1.07; p = 0.11) times the odds of CMR in subjects without canteen (limited access to food). Females (β:0.34; 95% CI:0.23, 0.44; p = 0.00) had high CMR factors in comparison to males. Overall cardiometabolic risk factors increased with age (β:0.01; 95% CI:0.01,0.01; p = 0.00).ConclusionFindings of the present study urge the need for dietary and lifestyle intervention along with longitudinal studies to further disentangle the association of the food and work environment on the prevalence of CMR among adults.     

Renal Replacement Therapy in Cardiology Wards: Changing Trends in a Transitional Country

The leading causes of death in patients with chronic kidney disease (CKD) are cardiovascular diseases, regardless of the stage of disease or method of renal replacement therapy. On the other hand, CKD is a major risk factor for cardiovascular complications after acute myocardial infarction, as well as for adverse outcome in patients with chronic heart failure. In the present study we prospectively followed‐up nephrological interventions in cardiology wards in order to determine changes in indications, treatment possibilities and outcome of patients. All patients treated at cardiology ward of the Clinical Hospital Centre Zagreb and requiring renal replacement therapy from January 2003 to December 2009 were included in the investigation. Cardiology hospital unit (intensive care or regular hospital cardiology ward), age, gender, Sepsis‐related Organ Failure Assessment (SOFA) score, indication for dialysis, primary diagnosis, vascular access, methods of treatment, number of treatments, prescribed and delivered dose of dialysis and outcome were recorded. Patients were followed up until death during hospitalization or discharge from the hospital. From January 2003 to December 2009, 251 patients had been hospitalized at different cardiology wards and required renal replacement therapy. Mean age was 64.95 years (range 22 to 97 years), and there were 27.8% female patients. 52.9% of patients were hospitalized in the coronary intensive care unit. SOFA score had increased during the observed period from average 6.5 in 2003 to 13.45 in 2009. Specific knowledge with close collaboration between nephrologists and cardiologists is needed to achieve optimal outcome in this complex condition.     

有氧运动对稳定期慢性阻塞性肺疾病患者血清炎性因子及心肺运动功能的影响

背景　慢性阻塞性肺疾病（COPD）是常见的慢性气道疾病,此病常年反复发作,严重危害患者的生活质量和健康。研究有氧运动对患者心肺功能储备和生活质量的影响具有重要意义。目的　观察稳定期COPD患者有氧运动前后血清白介素10（IL-10）、白介素17（IL-17）、基质金属蛋白酶9（MMP-9）及心肺运动功能情况,探讨有氧运动改善身体功能、促进康复的作用机制。方法　选择2019年1月至2020年7月解放军杭州疗养院收治的稳定期COPD患者60例为研究对象,根据随机数字表法将其分为对照组和试验组,各30例。对照组给予氧疗、舒张支气管等常规治疗12周,试验组（其中1名受试者因急性发作症状退出试验）在常规治疗的同时,脚踩功率自行车在无氧阈水平强度下规律进行有氧运动12周。比较治疗前后患者外周血清中IL-10、IL-17、MMP-9表达情况及心肺运动功能变化情况。结果　有氧运动12周后,试验组IL-17、MMP-9水平较治疗前及对照组下降,而IL-10水平高于治疗前及对照组,差异有统计学意义（P<0.05）;6 min步行距离（6MWD）、圣乔治呼吸问卷（SGRQ）得分、峰值摄氧量（Peak VO2）、最大分钟通气量（VEmax）较治疗前及对照组升高,而无氧阈时二氧化碳通气当量（VE/VCO2 at AT）低于治疗前及对照组,差异有统计学意义（P<0.05）。结论　早期启动、长期坚持有氧运动能够明显改善稳定期COPD患者健康状态,减轻炎性反应,增强心肺功能储备,提高生活质量,改善预后。     

PBL教学法结合ECS在社区居民2010版心肺复苏指南培训的效果评价

目的 评价以问题为基础的教学法（problem based learning,PBL）结合高级综合模拟人（emergency care simulator,ECS）在社区居民推广2010版心肺复苏指南的应用效果及价值.方法 将586名社区居民随机分为研究组和对照组各293名,研究组采用ECS结合PBL教学法进行CPR培训,对照组采用常规方法培训,比较两组教学效果.结果 研究组心肺复苏理论考核及格267人（91.13％）,对照组及格250人（85.32％）,差异有统计学意义（x2=4.7474,P=0.0293）.研究组心肺复苏技能考核及格271人（92.49％）,对照组及格245人（83.62％）,差异有统计学意义（x2=10.9672,P=0.0009）.结论 ECS结合PBL教学法有助于社区居民掌握心肺复苏的基本理论和CPR的操作技能,值得推广和应用.     

多媒体综合教学在乡村医生心肺复苏培训中的作用

目的：研究多媒体综合教学在乡村医生心肺复苏（CPR）培训中的作用,探讨提高乡村医生CPR培训的方法。方法：采用分组研究的方法,按随机分组原则设试验组和对照组,对62名乡村医生分别采用多媒体综合CPR电脑教学模拟人教学法与传统版书教学法情况进行跟踪调查研究。结果：试验组与对照组在理论知识考试和操作考核中成绩显著,差异有统计学意义（X^2=7．4,P〈0．01）。结论：多媒体综合CPR电脑教学模拟人教学在乡村医生CPR培训考核中具有显著效果,应予以推广。