米力农治疗慢性心衰急性加重期的疗效观察

目的:分析研讨米力农治疗慢性心衰急性加重期的疗效状况.方法:此研究为前瞻性研究,80例患者入组方式为随机抽签法,抽取范围为我院2015年3月~2016年1月收治的慢性心衰急性加重期患者,按照入院顺序分为对照组(常规性治疗)和研究组(米力农治疗),把两组治疗状况纳入对比讨论.结果:研究组治疗总疗效90%比对照组80%高,组间差异有统计学意义(P<0.05).对比两组治疗前心功能指数,包含血脑尿钠肽含量、左室射血分数、左室舒张末径,组间数据差异无统计学意义(P>0.05);对比两组治疗后心功能指数,血脑尿钠肽含量、左室射血分数,研究组比对照组优,组间差异有统计学意义(P<0.05).对比治疗后左室舒张末径指数,组间差异无统计学意义(P>0.05).结论:临床治疗慢性心衰急性加重期可考虑把米力农药物作为首选方式之一,疗效突出,各指数得到显著改善,应用性较大.     

血清脂蛋白(a)、胆红素水平与冠状动脉病变程度关系研究

目的 检测冠心病(CHD)患者的血清脂蛋白(a)和胆红素水平,并探讨其与CHD的关系.方法 对196例疑诊冠心病而接受冠状动脉造影的患者检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白(a)[Lp(a)]、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL).根据冠状动脉狭窄情况分为非冠心病组(冠状动脉狭窄小于50%,52例)、单支病变组(仅有一支冠状动脉分支狭窄大于或等于50%,53例)和多支病变组(有一支以上冠状动脉分支狭窄大于或等于50%,91例).分析影响冠状动脉病变的相关因素及冠状动脉病变程度与血脂、胆红素的关系.结果 各组间LDL-C、Lp(a)水平依次呈递增趋势,差异有统计学意义(P＜0.05)各组间间接胆红素水平呈依次递减趋势,多支病变组与非冠心病组、单支病变组差异有统计学意义(P＜0.05).单因素logistic回归结果表明血清脂蛋白(a)、间接胆红素均为影响冠状动脉病变的因素(回归系数分别2.125、-1.557,P＜0.01).进一步多因素logistic回归分析表明脂蛋白(a)对冠状动脉病变的影响要弱于低密度脂蛋白胆固醇、甘油三酯(0R值分别为1.238、5.031、3.996,95%CI分别为1.069-6.322、2.457-12.356、2.785-14.764).结论 血清Lp(a)水平升高、IBIL水平降低是CHD发病及病变程度的危险因素. Abstract： Objective To investigate the association of Lipoprotein (a) and bilirubin with coronary heart disease(CHD). Methods One hundred and ninty -six patients undergone coronary angiography and completed clinical examination of TC, TG, HDL - C, LDL - C, Lp ( a), TBIL, DBIL, IBIL were divided into the without coronary diseases group ( coronary artery stenosis ＜50% ,52 cases) ,the single vessel disease group(with only one vessel stenosis ≥50% ,53 cases) and the multi -vessel disease group (with more than one vessel stenosis ≥50% ,91 cases)according to the coronary angiographic results. The correlative factors of coronary lesion and the relationship between Lipid,bilirubin and the severity of coronary lesion were analyzed. Results Higher levels of LDL - C and Lp(a) were found in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group, significant difference was found in the LDL- C and Lp(a) level among the 3 groups(P＜0.05). The levels of IBIL were lower in the single vessel disease group and in the multi -vessel disease group compared with the without coronary disease group,significant difference was found in indirect bilirubin level in the multi -vessel disease group compared with in the without coronary disease group and in the single vessel disease group(P＜0.05). Single factor logistic regression showed that Lp (a) and indirect bilirubin are both correlation factors with coronary lession (r =2. 125 and - 1. 557, P ＜0.01 respectively). Advanced multi - factor logistic regression showed weaker correlation of Lp (a) with coronary lesion compared with LDL - C and TG (OR = 1. 238,5.031 and 3.996,95% CI1.069 - 6.322,2.457 - 12.356,2.785 - 14.764 respectively). Conclusions High level of Lp(a) and Low level of IBIL in human significantly influence the severity of coronary heart disease(CHD).     

心肌梗死介入治疗与保守治疗的长期疗效差异比较

目的 比较心肌梗死介入治疗与保守治疗的长期疗效.方法 方便选取2011年1月—2012年1月间该院收治的心肌梗死患者140例,随机分成两组,各70例.观察组给予介入治疗,对照组给予保守治疗,比较两组长期疗效.结果观察组前壁心肌梗死患者3年后生存率为96.97%,显著优于对照组P<0.05.观察组前壁心肌梗死患者1年和3年的心脏事件和再住院发生率均显著低于对照组(P<0.05).两组下壁心肌梗死患者的长期疗效比较差异无统计学意义P>0.05.观察组患者心功能改善长期疗效显著优于对照组P<0.05.结论 介入治疗对前壁心肌梗死治疗效果和心功能改善方面优于保守治疗,值得推广应用.     

探讨血清视黄醇结合蛋白4与冠心病的相关性

目的 观察冠心病患者血清视黄醇结合蛋白4(RBP4)水平,并探讨RBP4与冠心病的关系.方法 64例冠心病患者分为急性心肌梗死(AMI)组10例,不稳定型心绞痛(UAP)组42例,稳定型心绞痛(SAP)组12例,另选择21例冠状动脉造影结果正常者为对照组.采用酶联免疫吸附法(ELISA)测定血清RBP4水平.结果 血清RBP4在AMI和UAP组中高于SAP组和对照组,差异有统计学意义(P＜0.05),在SAP组与对照组之间差异无统计学意义(P＞0.05);血清RBP4在单支、双支、三支病变组中均高于对照组(P＜0.05),但在单支、双支与三支病变组之间差异均无统计学意义(P＞0.05).结论 RBP4可作为预测斑块稳定性的标志物,为冠心病危险分层及采取积极干预措施提供依据,但不能反映冠状动脉狭窄程度及范围. Abstract： Objective To investigate the serum retinol - binding protein 4 ( RBP 4 ) of coronary heart disease (CHD)patients and evaluate whether plasma macrophage migration inhibitory factor were associated with CHD. Methods Sixty -four patients with CHD were divided into the acute myocardial infarction (AMI) group ( n = 10), the unstable angina pectoris (UAP) group ( n = 42) and the stable angina pectoris(SAP) ( n = 12),21 normal subjests without CHD diagnosed by CAG served as the control group. The serum level of RBP4 measured by enzyme linked immune sorbent assay (ELISA). Results The serum level of RBP4 were higher in AMI and UAP group thai in SAP group and control group ( P ＜ 0. 05 ). The mean level of RBP4 in SAP group was not differently significantly, compared with that in control ( P ＞ 0. 05 ) ;The mean level of in single, double and three vessel lesion group were higher than that in control group (P ＜0. 05 ),but the serum levels of RBP4 among single, double and three were not significant different ( P ＞ 0. 05).Conclusions RBP4 may act as one of vulnerable plaques,we can take active to stabilize vulnerable plaques and decrease the occurrence of cardiac events,but may not reflect the severity of artery stenosis.     

经桡动脉冠心病介入诊疗术的临床应用价值研究

目的：通过观察经桡动脉途径行冠脉造影及冠脉支架置入术的临床应用,总结该方法与传统经股动脉途径介入术相比较的优势与益处。方法：回顾性研究冠心病行桡动脉介入诊疗术患者200例及行股动脉介入术的冠心病患者200例。结果：两组在动脉穿刺成功率、造影成功率方面差异无统计学意义（P〉0.05）,观察组在并发症、住院时间等方面优势明显。结论：经皮桡动脉穿刺行冠脉造影术及介入治疗,成功率高,创伤小,住院费用经济,住院时间短,血管并发症少,安全可行。     

替格瑞洛与氯吡格雷对急性ST段抬高心肌梗死直接经皮冠状动脉介入治疗患者术后慢血流的影响分析

目的:探讨替格瑞洛与氯吡格雷对急性ST段抬高心肌梗死直接经皮冠状动脉介入治疗患者术后慢血流的影响.方法:88例急性ST段抬高心肌梗死患者均为本院于2015年2月~2016年8月收治,所有患者行直接经皮冠状动脉介入治疗.按照双盲法分为两组,对照组治疗前服用氯吡格雷,观察组术前应用替格瑞洛.观察两组术前及术后30d左心功能改善情况,并就两组慢血流发生情况展开分析.结果:两组术后左心功能较术前均有明显改善,但观察组显著优于对照组,差异有统计学意义(P<0.05).术后发现,观察组慢血流发生率显著低于对照组,两组比较差异有统计学意义(P<0.05).结论:针对急性ST段抬高心肌梗死患者经皮冠状动脉介入手术前应用替格瑞洛治疗,可有效降低术后慢血流的发生率,不会对患者心功能造成影响,安全可靠,值得推广.     

早期介入治疗对急性心肌梗死(AMI)合并糖尿病患者心功能及心脏事件的影响

目的 探索及分析对急性心肌梗死(AMI)合并糖尿病患者采用早期介入治疗对其心功能和心脏事件的影响.方法 随机收集该院2012年10月―2014年10月年接诊的AMI合并糖尿病的80例患者进行临床研究,随机分成对照组与研究组,每组40例.研究组于患者发病6 h内施行PCI治疗,对照组患者则于患者发病6~12 h内施行PCI治疗.观察及比较两组患者的心功能变化与心脏事件发生情况.结果 与治疗前相比,两组患者治疗后的IVST、LVEF、LVDD、LVSD等指标均有明显改善,其中又以研究组的改善更为显著(P<0.05).结论 对AMI合并糖尿病患者采用早期PCI治疗能够有效改善患者的心功能,减少患者的心脏事件发生风险.     

原发性高血压患者胰岛素抵抗与血管紧张素Ⅱ的相关性

目的 探讨原发性高血压(EH)患者胰岛素抵抗与血管紧张素Ⅱ(AngⅡ)、左室重构的相关性.方法 收集120例EH患者,根据HOMA-IR公式计算的胰岛素抵抗指数将其分为两组:胰岛素抵抗组(IR)、非胰岛素抵抗组(N-IR),测量并比较两组间电解质、血脂、血肌酐清除率、AngⅡ、左室射血分数、左室质量指数(LVMI)水平.结果 LVMI、AngⅡ水平IR组均明显高于N-IR组(P＜0.05).结论 EH患者胰岛素抵抗与血AngⅡ水平有关,并可能与左室重构有关. Abstract： Objective To investigate the relationship between insulin resistance and angiotensin Ⅱ , the left ventricular remodeling in patients with essential hypertension(EH). Methods According to the insulin resistance index, 120 cases of EH were divided into two groups: insulin resistance group (IR), non- insulin resistant group (N-IR). And the electrolyte, blood lipids, creatinine clearance rate, Ang Ⅱ , left ventricular ejection fraction and left ventricular mass index (LVMI) were measured and the results were compared between the two groups. Results LVMI and Ang Ⅱ levels of IR group were significantly higher than those of N - IR group ( P ＜ 0.05). Conclusions Insulin resistance is related with the levels of Ang Ⅱ , and may be related with left ventricular remodeling.