Relationship between age and effect of early and long-term captopril treatment in patients with acute myocardial infarction

Objective To analyse the relationship between age and treatment with captopril after acute myocardial infarction (AMI). Methods In a randomized trial, 822 patients with a first AMI received conventional medic al treatment, including intravenous thrombolytic therapy and oral aspirin or metoprolol, and then were randomly allocated to captopril ［dosage fr om the first 6.25 mg to 25 mg/t.i.d, 209 younger patients (≤64 years), 269 elderly patients (65-75 years)］ or conventional treatment only (131 younger p atients, 213 elderly). Survival in the four groups was calculated with the Kapl an-Meier method. Multivariate analysis was performed to understand the degree that multi-variables (including age) affect survival in patients taking captopr il in the hospital or during long term follow-up. Results The survival of patients who took captopril correlated significantly with age ( P<0.001). The survival of the elderly patients on captopril treatment did increase (P<0.0001), but not of the younger ones (P>0.05) during hosp italization. During follow-up, the survival of patients who took captopril cor related insignificantly with age (P>0.05), but both the elderly and the you n ger patients have good survival rates (all P<0.01) and lower cardiac events (all P<0.01) when they took captopril.Conclusions Captopril exerts a weak effect on the younger patients but a beneficial effect o n the elderly patients during hospitalization after AMI. However, there is no d ifference between the younger and the elderly in the prognosis, both having good survival and lower cardiac events when they take captopril long term during fol low-up.     

AMI初期支架植入和rt—PA静脉溶栓加补救支架植入的比较

目的比较急性心肌梗塞(AMI)患者冠状动脉内初期支架植入和静脉rt-PA溶栓加补救支架植入治疗的临床疗效.方法98例首次AMI患者随机给以冠状动脉内初期支架植入(初期支架组48例)和静脉rt-PA溶栓加补救支架植入(溶栓加支架组50例).所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗塞相关冠状动脉(IRA)开通情况;记录住院期心脏事件出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数(LVEF).结果急诊冠状动脉造影显示支架组47例(97.91%),溶栓加支架组50例(100%),IRA血流TIMI2～3级,但前者IRA前向血流TIMI3级者明显增多(分别为93.8%和60.0%,P=0.0001).两组患者住院期死亡率和心脏事件相似,但出院前超声心动图显示支架组LVEF(62.01%±14.03%)高于溶栓加支架组(50.01%±132%,P=0.0001).结论与静脉rt-PA溶栓加补救支架治疗相比,AMI初期支架植入可更好改善急性期心肌再灌注,并减少患者住院期心功能减退.     

PBMV治疗二尖瓣狭窄伴中-重度肺动脉高压

目的评价经皮二尖瓣球囊扩张术（ＰＢＭＶ）治疗二尖瓣狭窄伴中或重度肺动脉高压的疗效。方法用Ｉｎｏｕｅ球囊导管行ＰＢＭＶ治疗二尖瓣狭窄伴肺动脉收缩压≥６０ｍｍＨｇ（８．００ｋＰａ）患者１０１例。用超声心动图和心导管法观察血流动力学效应。结果术后血流动力学明显改善,二尖瓣瓣口面积增加（Ｐ〈０．０１）;肺动脉收缩压及肺循环阻力明显降低（Ｐ〈０．００１）,这些变化在心房颤中层得中尤为明显。结论ＰＢＭＶ治疗严     

心肌梗死恢复期经皮冠状动脉腔内成形术前后心电图及运动耐量的变化

对２３例心肌梗死患者子发病后６±３周行经皮冠状动脉腔内成形术（ＰＴＣＡ），并于ＰＴＣＡ前（平均３±２天）后（平均６±３天）记心电图和做平板运动试验，结果ＰＴＣＡ成功１９例（管腔狭窄由９３．５±６．４％降至１６．３±１１．１％），其运动耐量、时间、最大心率及心率－收缩压乘积均明显增高，而心电图ＱＲＳ积分显著减低。结论，心肌梗死恢复期ＰＴＣＡ对患者有明显的临床效益。     

急性心肌梗死患者初期支架植入和rt-PA静脉溶栓加补救支架植入对比研究

目的比较急性心肌梗死(AMI)患者冠状动脉内初期支架植入和静脉rt-PA溶栓加补救支架植入治疗的临床疗效.方法 98例首次AMI患者随机给以冠状动脉内初期支架植入(初期支架组48例)和静脉rt-PA溶栓加补救支架植入(溶栓加支架组50例).所有患者行急诊冠状动脉造影以TIMI血流分级法判断梗死相关冠状动脉(IRA)开通情况.记录住院期心脏事件;出院前用二维超声心动图测定两组患者左心室舒张末期和收缩末期容量并推算左心室射血分数(LVEF).结果急诊冠状动脉造影显示支架组47例(97.91%)溶栓加支架组50例(100%)IRA血流TIMI 2-3级,但前者IRA前向血流TIMI 3级者明显增多(分别为93.8%和60.0%,P=0.0001).两组患者住院期死亡率和心脏事件相似,但出院前超声心动图显示支架组LVEF(62.01%±14.03%)高于溶栓加支架组(50.01%±132%),P=0.0001.结论与静脉rt-PA溶栓加补支架治疗相比,AMI初期支架植入可更好改善急性期心肌再灌注,并减少患者住院期心功能减退.     

老年患者应用抗菌药物治疗的护理体会

通过对老干部病房住院的220例老年患者(年龄65岁以上)使用抗菌药物的护理情况分析,认识到由于老年人患病病种较多,应用药物的品种也较多,因此其副作用发生率大大增加。在临床护理当中应当强调用药前后和治疗当中药物的监控,严格掌握适应症,不乱用和滥用抗生素,应当根据病原学诊断或临床诊断,选用合理有效的抗生素,以免因乱用、滥用抗菌药物而延误诊断或导致药物毒副反应,两重感染,产生耐药菌株和浪费药物。     

自制关节冲洗装置配合注射玻璃酸钠治疗膝关节骨关节炎

膝骨关节炎 (Osteoarthritisofknee ,简称膝OA)是骨科的常见病、多发病。近年来采用补充外源性透明质酸钠 (SH)治疗该病取得较好的结果。但临床发现对重度骨关节炎效果不理想 ,而且发现部分患者有过敏反应出现。我院采用自制关节冲洗装置配合注射玻璃酸钠治疗膝关节炎不仅取得较满意疗效 ,而且无过敏反应发生 ,现将结果报告如下。1　临床资料1 1　一般资料　两组病例均为我院门诊住院诊治病人共 4 2例 ,将病例随机分成两组 ,A组治疗组 ,共2 2例 ,男 14例 ,女 8例 ,其中双膝 2例 ,1例关节内有游离体 ,4例关节积液 ,3例关节变形 ;出现症状…     

血小板受体GPⅢa基因P1A1/P1A2多态性与心肌梗塞关系的研究

冠心病心肌梗塞(MI)与凝血纤溶系统的关系一直广受关注.近来,有报道称美国白种人血小板受体GPⅢa基因的PIA1/PIA2多态性与MI发病相关.本研究运用RFLP和ASO技术对82例MI患者和68例对照进行该多态性的检测,并与50例美国健康白种人作比较.结果显示150例中国人的GPⅢa多态基因型均为P1A1/P1A1,与美国白种人有显著差别.表明中国人群血小板受体GPⅢa基因的PlA1/PlA2多态性与MI发病无相关性.     

冠脉内超声在冠状动脉内支架置入中的意义

目的 对４１例冠心病患者冠状动脉在血管内超声（ＩＶＵＳ）指导下管入支架，评价造影和ＩＶＵＳ及一个月随访结果。方法理想支架置入ＩＶＵＳ标准；支架内截面积≥近端和远端相关血管腔截面积平均值的８０％。