尿百草枯与动脉血乳酸浓度对急性百草枯中毒的预后评估

目的：观察急性百草枯中毒（APP）患者入院时尿百草枯（PQ）浓度与动脉血乳酸（Lac）浓度变化,探讨APP 患者预后特异度和敏感度较高的监测指标。方法收集我院急诊内科2012年1月－2015年1月 APP 患者142例的临床资料,根据中毒后30 d 是否死亡分为死亡组与存活组,记录入院时尿 PQ 浓度和血 Lac 浓度,通过 ROC 曲线评估其对 APP 预后的诊断价值。结果死亡组患者入院时尿 PQ 浓度和血 Lac 浓度明显高于存活组（P ＜0．05）;两者对 APP 患者死亡预测的 ROC 曲线下面积（AUC）显示,尿 PQ 浓度的 AUC 为0．843,截断值为50．12 mg／L,敏感度为78．6％,特异度为88．5％,Youden 指数0．671;血 Lac 浓度的 AUC 为0．782,截断值为3．76 mmol／L,敏感度为85．4％,特异度为76．7％,Youden 指数0．621。结论入院时尿 PQ 浓度（≥50．12 mg／L）和（或）血 Lac 浓度（≥3．76 mmol／L）可作为预测 APP 患者预后的参考指标。     

血栓抽吸后冠脉内应用替罗非班对急诊冠脉介入患者血管血流与临床预后的影响

目的：评价急性ST段抬高型心肌梗死（STEMI）患者行急诊PCI术时经血栓抽吸后冠脉应用替罗非班对梗死相关血管血流及临床预后的影响。方法将114例患者随机分为替罗非班组与对照组2组,比较2组TIMI血流、TMPG分级、心功能的改变、出血事件以及住院期间MACE事件率。结果替罗非班组术后TIMI血流及TMPG分级均优于对照组,LVEF明显高于对照组（P＜0．05）,住院期间MACE低于对照组（P＜0．05）,2组出血事件及LVEDD差异无统计学意义（P＞0．05）。结论在血栓抽吸后冠脉内应用替罗非班是处理冠状动脉内血栓安全、有效的方法,可减少慢血流或无血流的发生,改善心肌灌注及近期预后。     

Cardiovascular Complications and Their Association With Mortality in Patients With Thrombotic Thrombocytopenic Purpura

BackgroundDespite widespread availability of plasmapheresis, the mortality in thrombotic thrombocytopenic purpura remains high. Cardiovascular complications have been reported as an important cause of morbidity in these patients. The burden and prognostic implications of these complications have not been well studied. We analyzed the rates of cardiovascular complications in thrombotic thrombocytopenic purpura, temporal trends, and studied its impact on in-hospital mortality.MethodsWe analyzed the National Inpatient Sample (NIS) from January 2005 to September 2015 to identify adult patients with thrombotic thrombocytopenic purpura. This group was further refined by excluding patients who did not receive therapeutic plasmapheresis, and other conditions that can mimic thrombotic thrombocytopenic purpura. We identified the age- and sex-stratified rates of cardiac arrhythmias, cardiac conduction system disorders, heart failure, acute coronary syndrome, myocarditis, pericarditis, takotsubo cardiomyopathy, cardiogenic shock, cardiac arrest, and stroke. We also compared in-hospital mortality with and without cardiovascular complications.ResultsAmong 15,054 thrombotic thrombocytopenic purpura hospitalizations (mean age 46.4 years, 69% in the 18- to 54-age group, 66.2% women, and 42.9% white), a cardiovascular complication was observed in 3802 (25.3%) hospitalizations. The following cardiovascular complications were identified: stroke (10.4%), heart failure (8.3%), acute coronary syndrome (6.4%), atrial tachyarrhythmia (5.9%), ventricular tachyarrhythmia (2.0%), cardiogenic shock (0.5%), takotsubo cardiomyopathy (0.1%), atrioventricular block (0.2%), myocarditis or pericarditis (0.3), and cardiac arrest (1.9%). Rates of several cardiovascular complications were significantly higher in patients 55 years or older compared to a younger age group, whereas males had higher rates of acute coronary syndrome and tachyarrhythmias compared to females. Overall, the cardiovascular complication rate was stable during the study period. The presence of a major cardiovascular complication was associated with a significantly higher in-hospital mortality (19.7%) as compared with no major cardiovascular complication (4.1%) (adjusted odds ratio 2.09, 95% confidence interval 1.41-3.09, P <0.001). Results were generally consistent in age and sex subgroups.ConclusionCardiovascular complications were frequently observed at a rate of 1 in 4 in patients hospitalized for thrombotic thrombocytopenic purpura and were associated with substantially higher in-hospital mortality. These findings underscore the need to promptly identify and treat these complications to improve outcomes.     

卒中后抑郁的早期干预与神经功能恢复的临床研究

目的 探讨卒中后抑郁的早期干预对急性脑梗死患者神经功能、生活质量恢复的影响。方法 所选病例随机分为治疗组(舍曲林50 mg 每晚)和对照组(淀粉片1#每晚),两组均联合心理治疗,疗程12周,监测治疗前后血浆皮质醇(COR)水平,依据美国国立卫生研究院卒中量表(NIHSS)、9条目病人健康问卷(PHQ-9)、汉密尔顿抑郁量表(HAMD)、日常生活能力量表(ADL)标准进行评分,评价急性期脑梗死抑郁患者早期干预疗效、神经功能的恢复及生活质量的改善及随访观察卒中后抑郁(PSD)的发生率。结果 两组患者治疗有效率前后对比差异均具有统计学意义 (P<0.05),尤以治疗组明显,治疗后治疗组与对照组对比差异有统计学意义 (P<0.05);治疗后治疗组NIHSS、HAMD评分及COR水平均低于对照组; ADL评分高于对照组,PSD发生率明显低于对照组,差异均具有统计学意义 (P<0.05)。结论 卒中后抑郁的早期干预能促进患者神经功能恢复,提高生活质量,降低COR水平和PSD发生率。应重视卒中后急性期内抑郁的早期筛查。     

Mushroom Consumption and Cardiovascular Health: A Systematic Review

IntroductionEdible mushrooms have a great nutritional value including high protein, essential amino acids, fiber, vitamins (B₁, B₂, B₁₂, C, and D), minerals (calcium [Ca], potassium [K], magnesium [Mg], sodium [Na], phosphorus [P], copper [Cu], iron [Fe], manganese [Mn], and selenium [Se]), low fatty foods, and sodium. The objective of this systematic review was to determine the relationship between edible mushroom consumption and overall cardiovascular risk.MethodsWe systematically searched Ovid MEDLINE, Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through August 2020 for observational studies that reported the association between edible mushroom consumption and cardiovascular risk. Two investigators independently reviewed data. Conflicts were resolved through consensus discussion.ResultsOf 1479 studies, we identified 7 prospective studies. Edible mushroom consumption may have favorable effects on lipid profiles by changing some metabolic markers such as low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, total cholesterol, and triglycerides. Moreover, edible mushroom consumption is probably associated with reduced mean blood pressure. The beneficial overall cardiovascular risk, stroke risk, and coronary artery disease of edible mushroom consumption are not consistent.ConclusionsEdible mushroom consumption has not been shown to conclusively affect cardiovascular risk factors to date. However, potential health benefits may exist, including a favorable alteration of lipid profiles and blood pressure reduction.     

不同巴曲酶治疗时间窗对急性脑梗死患者脑血管储备的影响

目的 探讨不同时间窗使用巴曲酶治疗急性脑梗死患者对脑血管储备(CVR)的影响.方法 根据发病时间以及治疗方法,123例急性脑梗塞患者分为对照A组(29例,发病12 h以内开始常规治疗)、对照组B组(33例,发病12 h以后开始常规治疗)、治疗A组(29例,发病12 h内常规治疗基础上加用巴曲酶)、治疗B组(32例,发病12 h以后常规治疗基础上加用巴曲酶).对比4组患者治疗前后斯堪地那维亚卒中量表(SSS)评分、大脑中动脉平均血流流速增加值(MFV1-MFV0)、CVR、动脉指数(PI)及两治疗组治疗前后各指标的变化量Δ(MFV1-MFV0)、ΔCVR、ΔPI.结果 治疗后4组患者SSS评分、MFV1-MFV0及CVR较治疗前均升高(P<0.05),PI值较治疗前降低(P<0.05);治疗A、B组治疗后上述指标均优于相应对照组(P<0.05);治疗A组Δ(MFV1-MFV0)、ΔCVR、ΔPI高于治疗B组相应指标(P<0.05).结论 巴曲酶对急性脑梗死患者有显著疗效,能改善患者CVR.早期使用巴曲酶对急性脑梗死患者CVR功能改善作用较为显著,随着时间的推移,疗效降低.     

Solitaire AB支架机械取栓联合动脉溶栓治疗急性缺血性脑卒中疗效观察

目的 探讨应用Solitaire AB支架机械取栓联合动脉溶栓治疗急性缺血性脑卒中的安全性及效果。方法 选取2010年1月至2014年10月应用Solitaire AB支架机械取栓联合动脉溶栓治疗的18例急性缺血性脑卒中患者, 评价其疗效和预后。结果 18例患者经支架机械取栓结合动脉溶栓后均成功获得全部或部分再通。术前与术后美国国立卫生研究院卒中量表评分相比, 差异有统计学意义(P<0.05)。3个月后疗效评估, 17例改良Rankin评分(mRS)显示预后良好, 其中0分10例, 1分6例, 2分1例;1例预后不良, mRS 4分。18例患者复查均无血管再闭塞等并发症。结论 应用Solitaire AB支架机械取栓联合动脉溶栓治疗急性缺血性脑卒中是相对安全、有效的, 但应严格把握手术适应证。     

IABP辅助PCI治疗高危急性冠脉综合征的效果评估

目的 评价主动脉内球囊反搏术(IABP)辅助经皮冠状动脉介入(PCI)治疗高危急性冠脉综合征(ACS)患者的效果。方法 选取95例ACS合并血流动力学不稳定或心源性休克的高危患者并分为两组, 50例患者PCI前24 h内进行IABP治疗(IABP+PCI组), 45例直接PCI(PCI组)。在入院及PCI术后第5天分别检测N末端B型利钠肽原(NT-proBNP)和超敏C反应蛋白(hs-CRP)水平;入院时及出院后4周心脏彩超测定左心室射血分数(LVEF)。结果 治疗前两组收缩压均偏低, 两组差异无统计学意义(P>0.05)。治疗后, IABP+PCI组血压较PCI组血压明显升高(P<0.05);同时IABP+PCI组病死率有所下降(P<0.05), 住院天数减少 (P<0.05)。两组治疗前的血浆NT-proBNP 和 hs-CRP差异无统计学意义 (P>0.05), 治疗后IABP+PCI组血浆NT-proBNP 和 hs-CRP水平较PCI组明显下降(P<0.05), LVEF明显提高(P<0.05)。结论 IABP辅助PCI治疗高危ACS患者, 在一定程度上改善了血流动力学, 并使住院天数和短期病死率有所下降, 同时降低了血浆NT-proBNP 和 hs-CRP水平, 提高了LVEF。     

Secondary Causes of Hypertriglyceridemia are Prevalent Among Patients Presenting With Hypertriglyceridemia Induced Acute Pancreatitis

BackgroundHypertriglyceridemia induced acute pancreatitis (HIAP) is the third common cause of acute pancreatitis. HIAP can result in recurrent attacks of severe AP with significant morbidity and mortality. Hypertriglyceridemia (HTG) could be primary or secondary. Although genetic causes of HTG are well studied, the prevalence of secondary causes of HTG in patients presenting with HIAP is not well characterized. This study aimed to identify the prevalence of risk factors for secondary hypertriglyceridemia among patients presenting with HIAP in a tertiary referral center in a large metropolitan area.MethodsThis is a retrospective analysis of all patients admitted with AP from August 2012–2017. A subgroup of patients with triglycerides >880 mg/dl were included for analysis. Secondary causes of HTG were identified. Secondary analysis evaluating the severity of pancreatitis was performed.ResultsThere were 3,746 patients admitted for AP of which 57 patients had AP and HTG. Of these 57 patients, 70.2% had history of diabetes mellitus, 26.3% had history of heavy alcohol use, 22.8% had chronic kidney disease, 47.3% with obesity, and 21.1% with metabolic syndrome. Two patients were classified as unexplained HTG. Secondary analysis showed a total of 45.6% of patients requiring ICU admission. 26.3% of patients with severe inflammatory pancreatitis and 17.5% of patients with severe necrotizing pancreatitis.ConclusionsIn our cohort of HIAP, 55 out of 57 patients had secondary causes for HTG. Identifying secondary causes of HTG during acute hospitalization is important to tailor outpatient treatment in order to prevent future admissions with HIAP.     

Efficacy of Acetazolamide for the Prophylaxis of Acute Mountain Sickness: A Systematic Review,Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials

BackgroundAcute mountain sickness (AMS) is a benign and self-limiting syndrome but can progress to life-threatening conditions if leave untreated. This study aimed to assess the efficacy of acetazolamide for the prophylaxis of AMS and disclose potential factors that affect the treatment effect of acetazolamide.Materials and MethodsRandomized controlled trials comparing the use of acetazolamide versus placebo for the prevention of AMS were included. The incidence of AMS was the primary endpoint. Meta-regression analysis was conducted to explore potential factors associated with acetazolamide efficacy. Trial sequential analysis (TSA) was conducted to estimate the statistical power of the available data.ResultsA total of 22 trials were included. Acetazolamide at 125, 250, and 375 mg/ twice daily (bid) significantly reduced incidence of AMS compared to placebo. TAS indicated that the current evidence was adequate confirming the efficacy of acetazolamide at 125, 250, and 375 mg/bid in lowering incidence of AMS. There was no evidence of an association between efficacy and dose of acetazolamide, timing at start of acetazolamide treatment, mode of ascent, AMS assessment score, timing of AMS assessment, baseline altitude, and endpoint altitude.ConclusionAcetazolamide is effective prophylaxis for the prevention of AMS in doses of 125, 250, and 375 mg/bid. Future investigations should focus on personal characteristics, disclosing the correlation between acetazolamide efficacy and body mass, height, degree of prior acclimatization, individual inborn susceptibility, and history of AMS.