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急性心肌梗塞早期静脉溶栓治疗后,一些溶栓再通患者中,可见早期降低的ST段再度出现抬高现象。本文回顾溶栓成功者81例,其中早期出现ST段再度抬高者21例(占35%),与ST段非再度抬高者相比,CPK、CPK-MB峰值,心功能及院内死亡率等无显著差异。笔者认为,此现象也为再通的标志之一。因此,急性心肌梗塞溶栓治疗的早期连续监测心电图对确认再通与否非常重要 相似文献
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Jager F Taddei A Moody GB Emdin M Antolic G Dorn R Smrdel A Marchesi C Mark RG 《Medical & biological engineering & computing》2003,41(2):172-182
The long-term ST database is the result of a multinational research effort. The goal was to develop a challenging and realistic
research resource for development and evaluation of automated systems to detect transient ST segment changes in electrocardiograms
and for supporting basic research into the mechanisms and dynamics of transient myocardial ischaemia. Twenty-four hour ambulatory
ECG records were selected from routine clinical practice settings in the USA and Europe, between 1994 and 2000, on the basic
of occurrence of ischaemic and non-ischaemic ST segment changes. Human expert annotators used newly developed annotation protocols
and a specially developed interactive graphic editor tool (Semia) that supported paperless editing of annotations and facilitated international co-operation via the Internet. The database
contains 86 two- and three-channel 24h annotated ambulatory records from 80 patients and is stored on DVD-ROMs. The database
annotation files contain ST segment annotations of transient ischaemic (1155) and heart-rate related ST episodes and annotations
of non-ischaemic ST segment events related to postural changes and conduction abnormalities. The database is intended to complement
the European Society of Cardiology ST-T database and the MIT-BIH and AHA arrhythmia databases. It provides a comprehensive
representation of ‘real-world’ data, with numerous examples of transient ischaemic and non-ischaemic ST segment changes, arrhythmias,
conduction abnormalities, axis shifts, noise and artifacts. 相似文献
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目的探讨急性ST段抬高型心肌梗死(STEMI)患者提前肝素化的疗效及风险。方法选取2019年5月至2020年5月我院收治的160例STEMI患者作为研究对象,随机分为两组各80例。治疗组给予提前肝素化PCI术治疗,对照组给予常规肝素化PCI术治疗。比较两组的TIMI血流分级、不良事件发生率以及治疗前后的症状评分、 LVEF。结果术后,治疗组的TIMI血流0~1级率低于对照组,3级率高于对照组(P <0.05)。治疗后,两组的症状评分均低于治疗前,LVEF水平均高于治疗前(P<0.05);治疗组的症状评分低于对照组,LVEF水平高于对照组(P <0.05)。治疗组的不良事件发生率低于对照组(P <0.05)。结论 PCI术提前肝素化可以提高灌注效果,有效缓解STEMI患者的病情,改善患者心功能,改善预后,且具有较高的安全性。 相似文献
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Mostafa M. Baraka Hany M. Hefny Mahmoud A. Mahran Tamer A. Fayyad Haytham Abdelazim Amr Nabil 《Journal of children's orthopaedics》2021,15(1):12
PurposeSurgical treatment in advanced-stage infantile Blount’s disease with medial plateau (MP) depression is challenging. Several osteotomies and fixation methods have been described with no established benchmark. We conducted this study to evaluate the efficacy and safety of a new single-stage technique for acute medial condyle elevation and metaphyseal osteotomies with internal fixation.MethodsA prospective case series of 19 consecutive patients (21 knees) with severe infantile Blount’s disease underwent a single-stage MP elevation and metaphyseal osteotomies, with internal fixation. The mean age was 10.3 years (8.2 to 13.6) and the mean follow-up was 5.1 years (3.2 to 8.3). The outcome measures included clinical and radiological parameters and patient-reported pediatric outcomes data collection instrument (PODCI) score.ResultsThe mean PODCI score improved significantly from 50% to 88%. The mean internal tibial torsion improved from -27° to 11°. All cases maintained full knee extension, no limitation in flexion range of movement and no signs of instability or lateral thrust gait. All the radiographic parameters improved significantly; the mean tibiofemoral angle improved from -29° to 7°, the metaphyseal-diaphyseal angle improved from 33.4° to 4.7° and the angle of depressed MP improved from 38.3° to 2.4° (p < 0.001). At the latest follow-up, no cases of deformity recurrence were identified, the final limb-length discrepancy was < 1 cm in all patients.ConclusionSingle-stage MP elevation and metaphyseal osteotomies with internal fixation significantly improved the clinical and radiographic parameters and PODCI score in advanced infantile Blount’s disease and precluded the use of external immobilization, with no evidence of deformity recurrence.Level of evidenceIV 相似文献
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Seventy-eight consecutive survivors of a first acute anteriorQ wave myocardial infarction (AMI) underwent two-dimensionalechocardiography (2D echo), colour Doppler echo and radionuclideangiography (RNA) for the diagnosis of left ventricular (LV)anteroapical aneurysm, in order to study the relationship ofthis complication to precordial ST segment elevation in thesepatients. The ST elevation (mm) in lead V2, the maximum ST elevationin V1-V6 and the sum of ST elevation in V1 to V6 were calculated.LV aneurysm was present in 19 patients by 2D echo, of whom 12had a paradoxical systolic flow pattern (red and outward towardsthe transducer) at the apex. There was no difference between the mean ST elevation in V2or the maximum ST elevation in V1-V6 in patients with and withoutan aneurysm, although the sum of ST elevations in V1 to V6 washigher in the former group (P<0.01). ST elevation of patientswith and without paradoxical systolic flow also did not differsignificantly. Wall motion abnormality (akinesis and dyskinesis)by 2D echo in the anterior wall was seen in 74% of patientswith and 36% of patients without an aneurysm (P<0.005), andin the septal region in 63% and 47% of respective patients (P-NS).There was no difference between the magnitude of ST elevationin subgroups of patients with ejection fraction (EF) 30% to40%, but the mean EF of patients with (23 ± 2.1%) andwithout a LV aneurysm (34 ± 1.3%) differed (P<0.001). It is concluded that precordial ST segment elevation does notclearly and in the diagnosis of an anteroapical LV aneurysm.It is related to akinesis and dyskinesis in anterior and septalregions inherent in patients with AMI and does not indicateimpaired LV function. 相似文献
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OBJECTIVES: To evaluate the clinical implications of early electrocardiographicchanges during thrombolysis in a randomized study in patientswith an acute myocardial infarction. BACKGROUND: Re-elevation of a rapidly resolving ST segment during thrombolysisis currently interpreted as a sign of re-occlusion, but a furtherelevation at very early stages of lytic therapy may not necessarilyhave the same implications. METHODS: In 214 patients with a first transmural acute myocardial infarctionof 4 h randomized to fibrinolytic (streptokinase group, n: 110)vs non fibrinolytic medical therapy (control group, n: 104),a standard 12 lead ECG was continuously recorded during thefirst 60 min and at 2, 4, 10, 16 and 24 h. Serial enzymes weremeasured during 72 h, and in 156 patients (73%) a coronary angiogramwas performed at 1015 days. RESULTS: Within the first 2040 min there was an additional STsegment elevation in 50 patients (45%) from the streptokinasegroup and in 19 from control group (18%) (P<0·0001)but the increment was greater in the streptokinase group (1·2± 1·4 vs 0·3 ± 1·4 mm, P<0·0001).In the streptokinase group, the interval from onset of painto peak creatine kinase MB was shorter in patients with additionalST segment elevation than in those without it (699 ±193 vs 856 ± 299 min, P<0·01). Moreover, in-hospitalmortality tended to be lower in patients whose ST segment waselevated than in those without such elevation (2150, 4%, vs6160, 10%). Incidence of recanalization was high but comparablein these two subsets. In recanalized patients, with or withoutadditional ST segment elevation, the ST segment declined significantlyat 1 h ( 1·0 ± 1·7, P<0·001,vs 0·1 ± 1·5 mm, ns). CONCLUSIONS: Additional ST segment elevation is frequently observed duringthe first hour of intravenous thrombolysis with streptokinase.Its association with a subsequent early decline of ST elevation,reduced mortality, a shorter time interval to peak creatinekinase, and a high rate of late recanalization, suggest thatin some patients it is one of the earliest markers of reperfusion. 相似文献
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B. G. Woodcock P. A. Thürmann S. Pfleiderer N. Reifart 《European journal of clinical pharmacology》1992,43(6):587-590
Summary The ability of a fatty-alcohol matrix, slow-release tablet of nifedipine 60 mg to maintain a 24-hour antiischaemic action in the fixed dose of 60 mg once daily has been investigated in a randomised, placebo-controlled, double-blind trial.12 normotensive patients with angiographically proven coronary artery disease (stenosis of at least one major vessel 70%) were studied. The anti-ischaemic response was assessed over a period of 4 days as changes in the exercise-induced ST-segment depression 6 h and 24 h postdose, and ST segment changes in 24-h ambulatory ECGs.A measurable anti-ischaemic response was observed in 8 of the 12 patients. Exercise-induced ST-segment depression 6 h after the administration of nifedipine was reduced by 30% compared to placebo, and there was still a measurable anti-ischaemic response 24-h post-dosing. Both responses were independent of changes in exercise blood pressure. In 7 patients with ischaemic episodes in the 24-h ECGs, nifedipine treatment had only a minor effect on the intensity and duration of ischaemia.It is concluded that a significant anti-ischaemic effect lasting 24 h could be demonstrated using effort-induced ST-segment changes in patients with angiographically proven coronary heart disease, who were treated once daily with nifedipine 60 mg as a fatty-alcohol slow release tablet. 相似文献
10.
胸骨上举术的固定方式与结果 总被引:10,自引:0,他引:10
目的:分析胸骨上举术的不同固定方式与手术效果的关系。方法:148例经胸骨上举术治疗的漏斗胸患儿,术中分别用自制金属支杠、三点式悬吊和塑料及金属制成的支架背心悬吊固定胸骨。结果:其中84例患儿获术后6个月至6年(平均2年)随访观察,绝大部分效果满意,仅2例复发。27例保留金属支杠于术后10~12个月拔除者,无复发,外观更满意。结论:胸骨上举术治疗漏斗胸的效果肯定,手术安全。用自制金属支杠固定上举的胸骨操作简便,术后护理方便。保持金属支杠于手术后10~12个月才拔除,有利于防止复发,胸廓外形更满意。三点式悬吊固定对较小的轻度患儿适用。支架背心悬吊固定法术后护理不便,影响患儿日常生活,使用受限 相似文献