急性心肌梗死再灌注期间的心电变化特征

目的　探讨急性心肌梗死 (AMI)再灌注期间的心电变化特征。方法　 46例经急诊冠状动脉造影明确为成功再灌注的AMI,其中 2 4例接受溶栓治疗和 2 2例接受直接经皮腔内冠状动脉成形 ,于发病的 6小时内以动态心电图技术持续2 4小时监测心电图变化 ,并与 1 5例无灌注者进行对比。结果　①再灌注发生后 ,相应导联ST段迅速下降 ,约 2小时达较低水平 ;同时 ,T波正向振幅进行性降低 ,距再灌注 0～ 2 2 (2 7± 4 5)小时呈现T波倒置并逐渐加深。②再灌注后的 1小时内 ,室性心律失常明显增加 ,6～ 8小时后显著减少。结论　AMI早期再灌注发生后呈现特征性心电变化 ,及时识别这些特征将有助于临床评估再灌注状态和危险度分层     

Psychiatric morbidity among people aged 85+ in 1987. A follow-up study at two and a half years: Associations with changes in psychiatric morbidity

This article reports findings from a longitudinal survey of very elderly people living at home in London. The research aimed to identify social, psychological and physical characteristics associated with positive ageing and successful survival in the community in later life and its converse—negative ageing—as well as the associated policy implications. Associations with psychiatric morbidity, measured using the General Health Questionnaire, among sample members without cognitive impairment between the baseline interviews in 1987 and at follow-up, two and a half years later in 1990, are reported. Twenty-five per cent of survivors scored over the threshold of the GHQ in 1987 and 30% scored over the threshold in 1990. Half of those with a score over the threshold in 1990 also scored over the threshold in 1987. Hierarchical regression (using residualized change analysis) was used to estimate the effects of the independent variables on changes in psychiatric morbidity. The most significant predictor of psychiatric morbidity (GHQ score) in 1990 was baseline GHQ score, followed by health and functional status scores. Health and functional status were also the strongest predictors of baseline (1987) GHQ scores. The uniqueness of the study lies in the collection of follow-up data on a sample of very elderly people, given that most surveys are corss-sectional and contain too few people aged 85+ to merit separate analysis. It contributes to the small body of literature on outcome of depression. The lack of consistent associations with recovery from psychiatric morbidity in the literature enhances the importance of studies aiming to identify factors associated with different outcomes.     

准分子激光冠脉成形术─—附8例报道

本文报道准分子激光冠脉成形术（ＥＬＣＡ）８例，均为男性，年龄平均６１岁。心梗４例（２例有梗塞后心绞痛），４例仅表现为心绞痛。冠脉造影显示ＬＡＤ狭窄６支，ＬＣＸ狭窄４支，ＲＣＡ狭窄４支。按ＡＣＣ／ＡＨＡ分型Ｂ型５例，Ｃ型３例。均用ＥＬＣＡ＋ＰＴＣＡ。根据血管直径选用１．３ｍｍ（能量密度１４．５ｍＪ）和１．６ｍｍ（能量密度２１．０ｍＪ）激光导管，频率２０Ｈｚ。１例导引钢丝未能通过狭窄，ＥＬＣＡ失败，另１例二次心梗，经旁路移植后仍有心绞痛发作，心功能较差，其ＥＬＣＡ虽获成功，但因病情严重死亡。８例中ＥＬＣＡ成功７例，手术成功６例。     

Very old people’s use of the pedestrian environment: functional limitations, frequency of activity and environmental demands

Due to decreased functional capacity as well as high environmental demands there is a risk of diminishing activity outside home in very old age (age 80+). In order to explore differences according to functional limitations (FL) among very old people with respect to frequency of activity, perceived health, overall perception of neighbourhood environment, and perceived problems in the pedestrian environment, data derived from a postal questionnaire survey to very old people living in an urban area in Sweden were used. This explorative study is based on the sub-sample of people aged 80+ who reported outdoor activities (n = 97). Four groups of respondents with different types of FL were identified: with no FL (n = 23), with only movement-related FL (n = 26), with only perception/cognition-related FL (n = 16), and with both movement- and perception/ cognition-related FL (n = 32). The majority of the respondents reported rather high frequency of activity outside home. When examining differences between the four groups, the analysis indicated how the complexity of FL and perceived problems in the pedestrian environment impacted on their activity performance. Persons with both movement- and perception/cognition-related FL were less satisfied with their frequency of activity, experienced their health more negatively and experienced more problems in the pedestrian environment than in the other groups. The findings from this study indicate the importance of considering combinations of FL in creating supportive environments for activity and health.     

Early experience with a novel plaque excision system for the treatment of complex coronary lesions.

The use of directional coronary atherectomy (DCA) in current practice has been limited. The SilverHawk System is a newly developed plaque excision device that aims to overcome the drawbacks of prior DCA platforms. The device was evaluated in a porcine coronary model and in a series of patients. Procedural variables along with outcomes were reviewed. Quantitative angiography (QCA) was performed and excised tissue fragments were weighed and examined histologically. In porcine cases, pretreatment MLD increased from 0.51 +/- 0.26 to 2.36 +/- 0.59 mm postdebulking and 19.9 +/- 7.6 mg of tissue was retrieved. In human cases, pretreatment MLD increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 mm postdebulking and 15.2 +/- 7.8 mg of tissue was retrieved without complications. These data show that the SilverHawk System may offer significant utility in treating a wide variety of complex coronary lesions.     

Plasma protein binding of furosemide in the elderly

Summary The protein binding of furosemide was investigated in plasma from 22 old and 11 young subjects by equilibrium dialysis. The unbound fraction of furosemide was 3.16% in plasma from the elderly and 1.71% in plasma from the young. A significant correlation was found between the unbound fraction of furosemide and the plasma concentration of albumin. The average number of binding sites was 3.8 (elderly) and 2.7 (young) 10^–6 mol/g albumin. The average association constant (K) was 4.3 (elderly) and 4.2 (young) 10⁵ M^–1. By increasing the concentration of furosemide up to 200 µg/ml buffer the unbound fraction of the drug rose to 5.2% (elderly) and 3.5% (young).     

溶栓及经皮冠脉腔内成形术治疗急性心肌梗死的疗效分析

目的　对比直接冠状动脉腔内成形术 (PTCA)及静脉尿激酶 (UK)溶栓对急性心肌梗死 (AMI)治疗的临床疗效。方法　采用观察性队列研究的方法 ,对 97例AMI患者采用UK溶栓 ,60例AMI患者采用直接PTCA治疗 ,比较两组住院期及随访期的超声心动图 (UCG)和临床结果。结果　住院期间UCG检查室壁运动正常者在PTCA组为 (4 6.0 0 % ) ,高于UK组 (2 4.73 % ) (p =0 .0 2 1) ,矛盾运动发生率PTCA组为 0 ,而UK组为 11.83 %。LVEF在PTCA组为 5 6.88± 10 .47,高于UK组 (5 1.5 8± 10 .97) (p =0 .0 41)。住院期心衰发生率UK组为 3 2 .5 9% ,高于PTCA组 (18.3 3 % ) (p =0 .0 2 9)。随访 13 .3 2± 6.86个月累计心衰发生率UK组为 16.2 8% ,也高于PTCA组 (5 .19% ) (p =0 .0 0 1)。住院期间的病死率UK组为 10 .3 1% ,PTCA组为 5 .0 0 % (p =0 .10 0 )。累计病死率UK组为 15 .5 6% ,明显高于PTCA组 (5 .0 0 % ) (p =0 .0 2 1)。 60岁以上年龄组累计的病死率仍然是UK组 (2 8.99% )高于PTCA组 (10 .3 4% ) (p =0 .0 49)。在随访 3、6、12及 2 4个月时PTCA组的生活质量计分各自为 :5 9.90± 14 .67、74.40± 12 .86、73 .86± 9.70、82 .47± 10 .47均高于同时期UK组的计分 (分别是 5 2 .0 8± 14 .49、65 .0 0± 14 .72、67.0 2     

罗格列酮对2型糖尿病患者冠脉支架内再狭窄的预防作用

目的 探讨罗格列酮对2型糖尿病患者行冠脉成形及支架植入术后支架内再狭窄的预防作用。方法 选择行冠脉成形及支架植入术的2型糖尿病患者60例。在原有降糖药物治疗的基础上，研究组(n=31)加服罗格列酮；对照组(n=29)用药方案不变。术后随访6mo，观察患者死亡、急性心肌梗死及再次血管重建术等心血管事件的发生情况，在随访结束时行活动平板检查，结果 阳性的再次行选择性冠脉造影术。结果2组患者随访期间均无死亡、急性心肌梗死等心血管事件发生。6mo内研究组9例再次心绞痛发作，5例活动平板试验阳性，其中5例(16．1％)冠脉支架内再狭窄；而对照组18例再次心绞痛发作，其中15例活动平板阳性，15例(48．4％)冠脉造影术证实支架内再狭窄，2组再狭窄对比有显著差异(P=0．013)。结论 对于2型糖尿病合并冠心病行冠脉成形及支架植入术患者，罗格列酮能有效降低支架内再狭窄。     

Pleural effusion following coronary perforation during balloon angioplasty: an unusual presentation of the postpericardiotomy syndrome.

We report on the development of features of the postpericardiotomy syndrome following coronary perforation during balloon angioplasty, in a patient that was managed conservatively. The case illustrates that while cardiac tamponade does not invariably follow coronary perforation, late consequences derived from this complication may occur. It also widens the spectrum of conditions where the postpericardiotomy syndrome has been observed.     

Fluorescence behaviour of human arterial tissue

Total fluorescence from arterial tissue is influenced by three factors: the absorption coefficient of tissue at a specific excitation wavelength, the laser excitation power and the fluorescence coefficient which is related to chemical species in tissue. These various influences were demonstrated by the following experimental results in vitro: (1) the effect of increasing power on fluorescence intensity, (2) the total fluorescence intensity in normal aorta and plaque and (3) the effect of a chromophore such as β-carotene on total fluorescence intensity. The fluorescence intensity of normal artery is an incremental function of laser excitation power, and the fluorescence emission from normal artery compared to fluorescence emission from plaque is significantly different at the same excitation power. The total fluorescence of normal artery was measured to be twice as great as that of atheromatous plaque (relative mean ratio of 2.58±0.46 compared to unity,p<0.0002 at 488 nm; relative mean ratio of 2.57±0.51 compared to unity,p<0.0009 at 514 nm). The total fluorescence emission decreases with the increase of β-carotene content in arterial tissue (R=0.97). These emission differences, when intensified by an exogenous chromophore of β-carotene, may provide an improved guidance signal for diagnosis of plaque from normal artery during laser angioplasty procedures.