C‐C Chemokine Receptor 2 Expression by Circulating Monocytes Influences Atherosclerosis in Patients on Chronic Hemodialysis

Mortality from cardiovascular or cerebrovascular disease due to atherosclerosis is increased in patients on chronic hemodialysis. Monocyte chemoattractant protein‐1 and its receptor, C‐C chemokine receptor 2, play an important role in recruiting monocytes to atherosclerotic lesions. The relationship between atherosclerosis in hemodialysis patients and C‐C chemokine receptor 2 expression is unknown. Fifty‐six patients on chronic hemodialysis and 27 age‐ and sex‐matched controls were enrolled. Serum levels of monocyte chemoattractant protein‐1 and expression of C‐C chemokine receptor 2 by circulating monocytes were determined. Atherosclerosis was evaluated from the carotid intima‐media thickness and cardio‐ankle vascular index. Serum levels of monocyte chemoattractant protein‐1 and expression of C‐C chemokine receptor 2 by monocytes were significantly higher in the hemodialysis patients than the controls. Multiple regression analysis showed a positive correlation between receptor expression and both indexes of atherosclerosis. C‐C chemokine receptor 2 expression by circulating monocytes influences atherosclerosis in patients on chronic hemodialysis.     

有机磷杀虫药中毒程度与心肌损伤关系的探讨

目的 探讨有机杀虫药中毒程度与心肌损伤的关系。方法 对247例不同程度中毒患者血清心肌肌钙蛋白Ⅰ（CTn—Ⅰ）和肌酸激酶（CK—MB）同步检测，同时设立40例健康献血员作为对照组，并将实验资料进行统计学分析。结果重度中毒、中度中毒、轻度中毒和对照组CTn—Ⅰ阳性率分别为100．00％（126／126）、65．79％（50／76）、17．78％（8／45）、0．00％（0／40），CK—MB活性升高率分别为100．00％（126／126）50％（38／76）、8．89％（8／45）、0．00％（0／40o组间比较除轻度中毒组CK—MB活性升高率与对照组比较差异无显著统计学意义（P〉0．05），其余各组间差异均有显著统计学意义（P〈0．01）。结论 有机杀虫药中毒程度与心肌损伤有正相关关系。     

腺苷对复苏兔心肌及脑组织超微结构的影响

目的 观察腺苷对复苏兔心肌及脑组织超微结构的影响。方法 采用窒息法制作兔复苏模型，随机分为对照组（A组）、肾上腺素组（B组）和肾上腺素合并腺苷组（C组）。持续窒息4min后，行心肺复苏，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0、09mg／kg；C组（n=12）静脉注射肾上腺素0．09m/kg并持续静脉滴注腺苷150μg·kg^-1·min。至复苏结束。取左心室心肌和脑海马组织，电镜下观察超微结构改变。结果 B组兔心肌细胞和脑海马神经元超微结构有明显损害，C组损害较轻，两组均明显好于A组。结论 复苏时合并应用腺苷可以保护心肌细胞和脑海马神经元超微结构，可能会改善复苏成功后心脑功能。     

杭州市区2001年居民心脑血管病对寿命的影响

目的 探索心脑血管疾病对寿命的影响，为心脑血管疾病的防治措施提供依据。方法 通过增寿年数、增寿率及潜在寿命损失率揭示各种心脑血管病对寿命的影响程度。结果 心脑血管病在死因谱中居首位。去除心脑血管病后，人群期望寿命可增加4．8岁，增寿5．78％；其中去除脑血管病和心血管病后人群平均期望寿命分别增加2．54岁和1．52岁，增寿率分别为3．06％和1．83％。心脑血管病的潜在寿命损失率为5．4l‰；其中脑血管病为1．92‰。心血管病为1．74‰；潜在寿命损失最大的为40-60岁的人群。结论 心脑血管病是严重影响人群寿命的疾病，积极进行预防对延长人群的寿命具右有重要的意义。     

慢性心力衰竭患者心肌肌钙蛋白Ⅰ水平与心功能的关系

目的研究慢性心力衰竭患者心肌肌钙蛋白I(cTnI)水平与心功能分级、左室功能的关系。方法采用ELISA法测定96例慢性心力衰竭患者cTnI水平,以心脏彩色多普勒超声诊断仪测定其左心室功能。结果cTnI水平随着心力衰竭程度的加重而显著增加,并与左室射血分数(LVEF)呈负相关(r=-0.38,P<0.01)。结论cTnI水平随着心力衰竭的严重程度的增加而升高,并能反映左室功能状态。     

猝死27例抢救临床分析

目的探讨猝死患者心肺复苏的方法及药物。方法对我科2年来抢救的27例猝死患者,按原国际上通用的A(airway)、B(breathing)、C(circulation)、D(defibrillationdiagnosis)法和实施的DCB法进行复苏并行回顾性分析。结果按ABCD法抢救12例猝死病人,其中成功1例(占8.33%),按DCB法抢救15例猝死病人,其中成功5例(占33.33%),两者比较差异具有显著性意义(P<0.05)。结论按DCB法抢救猝死病人成功率高于按ABCD法,应在临床推广。     

院外猝死心肺脑复苏失败主要原因探讨

目的：讨论院外猝死心肺脑复苏(CPCR)失败主要原因。方法：对108例院外猝死患实行常规心肺脑复苏。结果：只有2例呼吸循环恢复。但呈植物状态。结论：超出心肺脑复苏安全时限，氧供与氧耗的严重失调，是院外猝死患心肺脑复苏失败的重要原因。     

影响心肺复苏成功因素的临床分析

目的 :研究影响心搏骤停患者复苏成功的因素。方法 :就本院急诊中心收治的 14 8例非创伤性心搏呼吸骤停患者进行回顾性分析。结果 :14 8例中 ,院内心搏骤停患者 5例 ,经复苏存活 2例 ;14 3例院外心搏骤停患者经送来医院 ,复苏存活仅 2例 ( 1 4% )。结论 :应尽早除颤 ,积极治疗原发病 ,在救治过程中时间乃是制约成败的关键因素 ,故应大力加强心肺复苏的普及     

猝死抢救182例临床分析

目的比较应用《2005年美国心脏学会心肺复苏和心血管急救指南》和《2000年美国心脏学会心肺复苏与心血管急救指南》救治猝死患者的临床效果。方法2000年3月-2005年6月急诊科抢救的112例猝死患者（A组）按《2000年美围心脏学会心肺复苏与心血管急救指南》抢救。2005年6月～2007年4月的70例猝死患者按照《2005年美围心脏学会心肺复苏和心血管急救指南》进行抢救：心脏按压与吹气的比例调整为30：2;人工吹气时间要维持2s;按压频率达100次／min．并不间断进行;施行CPR2min即检查一次脉搏;将胺碘酮作为复苏的首选抗心率失常药物：比较两组的自主循环恢复率、存活率、出院率及5min内复苏成功率。结果B组的自主循环恢复率为343％（24／70）,显著高于A组[11．6％（13／112）,P〈0．05]。B组的存活率为15．7l％（11／70）,出院率为14．29％（10／70）,均显著高于A组[7．14％（8／112）和6．25％（7／112）,均P〈0．05];B组5min内复苏成功率为27．1％（19／70）,显著高于A组[9．8％（11／112）,P〈0．05]。结论按照《2005年美国心脏学会心肺复苏和心血管急救指南》救治猝死患者,效果优于按《2000年美国心脏学会心肺复苏与心血管急救指南》抢救。     

Limb performance and patient satisfaction after radial artery harvesting: endoscopic versus open techniques

Background  The differences in hand functionality after harvesting the radial artery for coronary artery bypass grafting (CABG) in an endoscopic technique relative to open technique are unclear. Methods  One hundred and sixty-four patients who had CABG and their non dominant hand radial artery was harvested either in an open technique (n = 92) or in an endoscopic technique (n = 72) in a period of 9.8 ± 3.5 months after the operation were studied. Surgical technique was surgeon specific. Patients were asked either five questions (endoscopic group), or six questions (open group), to assess how radial artery harvesting affected them. Results  Significantly more patients in the open group experienced significant limitations in their work and regular daily activities (12% versus 0%, p = 0.02), social activities (13% versus 0%, p = 0.005), and experienced significant pain (8% versus 0%, p = 0.04) compared with the endoscopic group. More patients in the open group complained that their arm incision disturb them (24% versus 10%, p = 0.01). Forty-two patients (46%) in the open group would prefer smaller incision. A “limitation score” variable was created from the first four questions to reflect overall functionality. Severe limitation was present in 3% of the open group versus 0% in the endoscopic group (p = 0.04). Female sex and open harvesting technique were found to be independently associated with higher limitation score. Conclusions  After a mean of 9.8 months after surgery, patients reports good overall upper-limb function. However, more patients in the open technique had significant disabilities and dissatisfaction.