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中国实用医刊杂志


  • 主管单位:中华人民共和国卫生部
  • 主办单位:中华医学会河南分会
  • 影响因子:0.8
  • 下单时间: 1个月内
  • 国际刊号:1674-4756
  • 国内刊号:11-5689/R
  • 全年订价:¥ 408.00
  • 起订时间:
  • 创刊:1972年
  • 曾用名:中原医刊
  • 周期:半月刊
  • 出版社:中国实用医刊
  • 发行:河南
  • 语言:中文
  • 主编:秦省
  • 邮发:36-23
  • 库存:199
  • 邮编:450003
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中国实用医刊 2010年第04期杂志 文档列表

替罗非班对急性心肌梗死患者高水平血小板聚集率和预后的影响 作者:赵香梅 高传玉 张宾 张优 Xiang-mei Chuan-yu 单位:郑州大学第一附属医院 450052 河南省人民医院
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摘要:目的 观察替罗非班在择期经皮冠状动脉介入治疗(PCI)急性心肌梗死患者应用过程中的高水平血小板聚集率(>40%),及其与临床结果的关系.方法 收集2007年6月至2009年6月在河南省人民医院行择期行经皮冠状动脉介入治疗(PCI)的急性ST段抬高心肌梗死患者资料,满足术后12 h血小板聚集率>40%的共140例,术后应用替罗非班组72例,未应用替罗非班的对照组68例.替罗非班的应用方法为PCI术后即刻静脉注射替罗非班10μg/kg(3 min注完),然后以0.1 μg/(kg·min)静脉滴注维持36 h.所有患者均接受皮下注射低分子肝素及口服二磷酸腺酐(ADP)受体拮抗剂和阿司匹林.观察两组患者7 d、30 d和6个月复合终点事件发生率(死亡、顽固性心肌缺血、再发心肌梗死和靶血管重建术)和出血事件.结果 替罗非班组与对照组7 d、30 d复合终点事件发生率差异无统计学意义(2.7%vs 1.5%,P>0.05;6.9%vs 4.4%,P>0.05);6个月复合终点事件发生率替罗非班组明显高于对照组(19.4%vs7.4%,P<0.05).替罗非班组出血事件有增多趋势(11.1%vs 7.4%,P>0.05),主要是穿刺点出血,两组均无颅内出血等严重出血事件发生.结论 行择期PCI的急性心肌梗死患者,替罗非班应用过程中血小板聚集率处于较高水平(40%以上)者,6个月心血管不良事件发生率增加. Abstract: Objective To observe the relationship between high (above 40% ) platelet aggregation rate(PAR) and clinical outcomes in ST segment elevation myocardial infarction(STEMI) patients undergoing selective percutaneous coronary artery intervention (PCI) after utiliity of tiroban. Methods The clinical materials of 140 STEMI patients with platelet aggregation rate above 40% at 12 hours after selective PCI in the People Hospital of Henan Province from June 2007 to June 2009 were collected, in which 72 patients received tirofiban 10 μg/kg by intravenous injection within 3 minutes immediately after PCI, followed by pump infusion at

高血压及冠心病区域性QT间期差值比较及其临床意义 作者:颜崇平 Chong-ping
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摘要:目的 探讨区域性QT间期差值(QTrd)能否作为鉴别高血压和冠心病两种不同疾病引起的心肌缺血的指标.方法 将80例因体表心电图出现ST段异常改变,经冠状动脉造影确诊为冠心病、高血压病患者分为冠心病组、高血压并冠心病(CH)组及高血压组.把体表十二导联心电图分为Ⅰ、aVL,Ⅱ、Ⅲ、aVF,V2~4,V5~6 4个区域,测量各区域的QTrd并进行分析和比较.结果 在Ⅰ、aVL区域,各组都有部分QTrd≥40 ms;Ⅱ、Ⅲ、aVF,V2~4,V5~63个区域,有1个区域的QTrd≥40 ms的百分比,在高血压组为88%,CH组为60%,冠心病组无一例>40 ms.结论 高血压病时,如心电图出现ST段异常改变,在Ⅱ、Ⅲ、aVF,V2~4,V5~63个区域中,有1个区域的QTrd>40 ms,则心肌肥厚伴缺血的可能性大,如这3个区域中的QTrd都<40 ms,可能为冠状动脉病变引起的心肌缺血的表现. Abstract: Objective To analyze whether regional QTrd could be an index to identify myocardial ischemia caused by hypertension or coronary heart disease(CHD). Methods According to the changes of ST segment in ECG and coronary arteriongraphy,98 caese were divided into three groups :coronary heart disease ( C ) group, hypertension with coronary heart disease ( CH ) group and hypertension ( H )group. QTrd was measured and compared in four regions(lead Ⅰ and aVL,lead Ⅱ , Ⅲ and aVF,lead V2 ~4and lead V5~6)in ECC of each group. Results QTrd>≥40 ms was seen in all three groups in the region of lead I and aVL. The rate of QTrd≥40 ms in one of the other three regions was 88% ,60% and 0 in group H, CH and C respectively. Conclusions In hypertension, myocardial hypertrophy with ischemia is highly possible if there is QTrd≥40 ms in any one of the three regions( Ⅱ, Ⅲ and aVF, V2~4, V5 ~6 );if the QTrd≤40 ms in these all three regions myocardial ischemia may be caused by coronary disease.

探讨血清视黄醇结合蛋白4与冠心病的相关性 作者:王魁风 张金盈 厉菁 张力 王小方 杨培灵 陈坡 董加建 赵江涛 Kui-feng Jin-ying Xiao-fang Pei-ling Jia-jian Jiang-tao
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摘要: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

螺内酯对心肌梗死大鼠血流动力学及血清TGF-β1的影响 作者:陈坡 张金盈 王小芳 赵江涛 董加建 Jin-ying Xiao-fang Jiang-tao Jia-jian
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摘要:目的 研究螺内酯对大鼠心肌梗死后血清转化生长因子-β1(TGF-β1)的影响.方法 结扎SD大鼠冠状动脉前降支,建立心肌梗死模型,将术后存活24 h大鼠随机分为两组:螺内酯(MIS)组给予螺内酯20 mg/(kg·d)溶于2 ml生理盐水灌胃,连续4周;心肌梗死(MI)对照组给予等体积的生理盐水,穿针但不结扎前降支的作为假手术组,给予等体积的生理盐水,4周末行血流动力学测定,同时断尾取血测血清TGF-β1含量.结果 与假手术组相比,4周末AMI组血清TGF-β1含量显著升高(P<0.01),左室舒张末压(LVEDP)显著增加(P<0.01),左室内压最大收缩速率(+dp/dtmax)显著下降(P<0.01).与AMI组相比,4周末螺内酯组血清TGF-β1含量显著下降(P<0.01),LVEDP显著下降(P<0.01),而+dp/dtmax显著增加(P<0.01).结论 螺内酯可能通过抑制TGF-β1产生而改善心功能,抑制心肌纤维化. Abstract: Objective To observe the effects of aldactone on blood serum TGF - β1 in acute myocardial infarction rats. Methods Rats surviving 24 h after AMI induced by left anterior descending branch ligation were randomized to aldactone and control group compared with sham - operated group. The aldactone group was given aldactone 20 mg/( kg · d) , the MI control group and sham -operated group were given an equal volume of saline, continued for 4 weeks. At the end of 4th week,the hemodynamics change was detected, then tails to take blood and measure the serum TGF - β1.Results Compared with the sham - operated rats,the serum TGF - β1 level and the LVEDP of the AMI rats were significantly elevated at the end of the 4th week ( P <0.01 ) , while the + dp/dtmax were significantly reduced ( P <0.01 ) compared with the AMI control group, the serum TGF - β1 level and the LVEDP of the aldactone group rats decrease significantly at the end of the 4th week (P < 0.01 ) ,while the + dp/dtmax were significantly elevated ( P < 0.01 ). The difference had statistical significance. Conclusions Aldactone may im

冠状窦阻塞对心肌细胞的影响 作者:闫世云 杨朝宽 楚英杰 Shi-yun Chao-kuan Ying-jie 单位:郑州大学第一附属医院心内科 450052 河南省人民医院
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摘要:目的 探讨冠状窦阻塞对心肌细胞的影响.方法 健康家犬14只,随机分为实验组7只和对照组7只.开胸,应用无损伤滑线从心外膜在最接近冠状窦口处结扎阻塞冠状窦,阻塞2 h后对心脏标本进行组织学电镜及光镜观察;于阻塞后1 h和2 h时分别取静脉血检测心肌肌钙蛋白I(cTnI)含量.对照组不对冠状窦进行结扎.结果 电镜可见肌原纤维间水肿,部分肌原纤维溶解,肌纤维膜破损,线粒体水肿,核周空泡水肿.组织学光镜可见心肌细胞萎缩,间质血管充血、出血,心肌间质水肿;心肌肌钙蛋白I在实验组和对照组阻塞前和阻塞后1 h、2 h未见明显变化(P均>0.05).结论 冠状窦阻塞损伤心肌细胞,导致心肌细胞萎缩;对心脏结构造成显著影响. Abstract: Objective To investigate the effect of coronary vein sinus occlusion to cardiomyocytes. Methods Fourteen healthy dogs grouped into the experiment and the contrast randomly, each group had 7 dogs. All dogs received chest open operation. Scatheless slide wire was used to ligate coronary vein sinus at where nearest the orifce of coronary vein sinus from epicardium. Cardiac histology was investigated from electron macroscope and optical macroscope at the end of the experiment 2hours after the ligation. To test the vein blood cTnI concentration after 1 hour and 2 hours ligation. In the contrast group, coronary vein sinus was not ligated. Results In the experiment group, myofibril interstitiual edema, part of myofibril dissolved, myolemma of myocardial disrepaired, mitochondre edema and edemaarround nucleolus were observed from electron macroscope. Atrophy of myocardium,hyperemia and hemorrhage in interstistial vascular and myocardial interstitiual edema were observed from optical macroscope;cTnI did not have significent changes between it before ligation and 1 hour after ligation and 2 hours after ligation( all P > 0.05 ) both in the experiment group and in the contrast group. Conclusions Coronary vein sinus occlus

4排螺旋CT对冠状动脉粥样硬化性心脏病的临床价值 作者:郑惠延 马艳丽 Hui-yan Yan-li 单位:郑州大学第二附属医院放射科 450014 河南省医学会
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摘要:目的 探讨4排螺旋CT冠状造影在诊断冠状动脉粥样硬化性心脏病(简称冠心病)中的价值.方法 收集临床上初步拟诊为冠心病的35例患者的93支血管并进行螺旋CT冠状造影和常规冠状动脉造影检查,对比分析螺旋CT冠状造影的准确性.结果 螺旋CT冠状造影发现47支冠状动脉狭窄,常规冠状动脉造影检查发现51支冠状动脉狭窄.螺旋CT冠状造影发现的44支血管狭窄与冠状动脉造影结果一致,敏感性为86.3%,特异性为100%.螺旋CT冠状造影和常规冠状动脉造影检查结果大体一致.结论 4排螺旋CT冠状造影可作为诊断冠心病的一种无创筛选检查方法,提高了冠状动脉造影诊断冠心病的符合率. Abstract: Objective To explore the diagnosticclinical value of 4 -detector row spiral CT with coronary artery disease. Methods Spiral CT coronary angiography (CTCA) and conventionalcoronary angiography(CAG) were used in 93 arteries of 35 coronary artery disease patients. To analysis the precise level of CTCA through contrasting. Results CTCA showed the angiostegnosis with 47coronary arteries,CAG showed theangiostegnosis with 51coronary arteries. The angiostegnosis results of 44 coronary arteries were same with CTCA and CAG. The total sensitivity of CTCA was 86.3% , and specificity was 100%.The results of CTCA and CCA were coincidentalin general. Conclusions 4 - detector row spiral CT can be used as a noninvasive screening method for the patients with suspected coronary artery disease, and the coincidence ratewasincreased ofcoronary angiography with coronary artery disease.

射频消融术对右侧旁道显性预激患者心功能的影响 作者:杨长宝 李莉 邱春光 韩战营 Chang-bao Chun-guang Zhan-ying 单位:郑州大学第一附属医院急诊科 450052 郑州大学第一附属医院心内科 450052
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摘要:目的 观察射频消融术对右侧旁道显性预激患者心功能的影响.方法 选择32例右侧旁道显性预激且反复发作房室折返性心动过速的患者,通过比较射频消融术术前、术后经胸心脏超声及多普勒检查的参数以判定左心功能.结果 射频消融术后左室舒张期A峰较术前显著增高,E/A比值较术前显著降低,而手术前后心率、左室舒张末期容积、左室内径缩短率、左室射血分数、每搏输出量和舒张期E峰差异均无统计学意义.结论 成功的射频消融术可以改善右侧旁道显性预激并室上性心动过速患者左室充盈和舒张功能,但对左室收缩功能未见明显影响. Abstract: Objective To observe the influence of radiofrequency current ablation (RFCA) on left ventricular (LV) systolic and diastolic function in patients with right - lateral Wolff - Parkinson -White syndrome( W- P- W syndrome). Methods The study group consisted of 32 patients with right -side WPW syndrome and recurrent episodes of AVRT without any concomitant diseases. Transthorasic echocardiography (TTE) and doppler were performed before and after RFCA in order to assess LV systolic and diastolic function. Results Doppler analysis revealed an increase in A wave and a decrease in E/A ratio. No significant differences were found in HR, LVEDV, FS, EF, SV and E wave. Conclusions RFCA of accessory pathway in patients with right - lateral WPW syndrome and AVRT are associated with improvement of LV filling and diastolic function. No significant differences in regard to LV systolic function are found post RFCA.

血管回声跟踪技术检测颈动脉弹性变化及主动脉瓣钙化与冠心病的相关性 作者:于瑞娜 秦石成 王学清 何垚 Rui-na Shi-cheng Xue-qing
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摘要:目的 应用血管回声跟踪技术检测颈动脉弹性变化及二维超声观察主动脉瓣钙化,研究二者与冠状动脉粥样硬化关系及预测价值.方法 应用血管回声跟踪技术对196例行冠脉造影(CAG)受检者进行颈总动脉检查,记录血管弹性指标,包括弹性系数(Ep)、僵硬度(β)、顺应性(AC)、脉搏波传导速度(PWVβ).同时二维超声观察主动脉瓣有无钙化,并将上述结果与CAG结果进行t检验.结果 颈动脉弹性减退与冠脉病变的相关性:β、Ep与CHD呈正相关(r=0.281,r=0.253,P<0.01,P<0.05),AVC与CHD呈正相关(r=0.173,P<0.05).结论 颈动脉弹性减退及主动脉瓣钙化是冠心病的高危因素,对冠心病有较大的预测价值. Abstract: Objective To study the relationship and predictive value of variation of carotid artery elasticity detected by echotracking (ET) technique and aortic valve calcification detected by two - dimensional ultrasonography with coronary heart disease (CHD). Methods The carotid artery elasticity of 196 cases who underwent coronary angiography(CAG) for suspected CHD were detected by echotracking (ET) technique and the indicators of artery elasticity were recorded, which includes elasticity modulus ( Ep), stiffness parameter ( β ), arterial compliance ( AC ) and pulse wave velocity ( PWVβ ).And aortic valve calcification was detected by two - dimensional ultrasonography, T test was carried out between the results of ultrasound examination and CAG. Results The indicators β, EP of carotid artery elasticity were positively correlated with the extent of CHD( r =0. 281,0.253; P < 0.01, < 0.05). In the mean time, positive correlation between aortic valve calcification and the extent of CHD was found (r = 0. 173, P < 0.05). Conclusions Carotid artery elasticity reducing and AVC are high risk factors of CHD and have great values in predicting CHD.

曲美他嗪治疗老年顽固性心绞痛临床疗效观察 作者:张卫国 Wei-guo
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摘要:目的 观察在强化治疗基础上加用曲美他嗪治疗老年顽固性心绞痛的疗效.方法 将65例老年顽固性心绞痛患者随机分为强化治疗组和联合治疗组,联合治疗组在强化治疗的基础上加用曲美他嗪20 mg,每日3次,疗程为4周.观察患者心绞痛发作次数、持续时间、心电图ST-T改变和硝酸酯类药物的用量.结果 联合治疗组患者总有效率为88.57%,与强化治疗组相比差异有统计学意义(P<0.05),两组间心绞痛发作次数与持续时间、硝酸酯类药物用量、心电图改善差异均有统计学意义(P<0.05).结论 治疗老年顽固性心绞痛,在强化治疗基础上加用曲美他嗪疗效安全可靠. Abstract: Objective To evaluate the effect of trimetazidine on elderly patients with refractory angina pectoris on the basis of intensive treatment. Methods Sixty - five patients with refractory angina pectoris were randomized into intensive treatment group and TMZ treatment group. In TMZ treatment group,TMZ(20 mg, 3 times per day) were given in addition to intensive treatment. The cycles of treatments in both groups were 4 weeks. The frequency and duration of angina attack, the ST - T segment change of electrocardiogram and the dosage of drugs belonging to ester nifrate were observed in patients with refractory angina pectoris. Results The total effective rate was 88.57% in TMZ group,and there was significant difference between the two groups ( P < 0. 05 ). With regard to the frequency and duration of angina attack,the dosage of drugs belonging to ester nitrate, the maximal ST - T segment depression, there were also significant differences between the two groups ( P <0. 05). Conclusions Combinating therapy of TMZ with intensive drugs have good curative effect for refractory angina pectoris, and is safe and reliable.

血清胆红素和血脂对冠心病发生的作用 作者:李现立 郑晓晖 郝增光 杨睿 葛慧敏 Xian-li Xiao-hui Zeng-guang Hui-min
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摘要:目的 探讨血清胆红素和血脂在冠心病发生中的作用.方法 75例冠心病患者被分为高脂血症组(46例)和非高脂血症组(29例),35例正常健康成人作为对照组,分别测定血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)以及总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)和高密度脂蛋白(HDL)水平等指标作对比分析.结果 高脂血症组TBIL、DBIL、IBIL均低于非高脂血症组和正常对照组,差异有统计学意义(P<0.05);非高脂血症组血清胆红素水平低于正常对照组,差异有统计学意义(P<0.05).高脂血症组同非高脂血症组、正常对照组比较,TC、TG和LDL增高,HDL降低,差异有统计学意义(P<0.05);非高脂血症组同正常对照组比较,TC、TG和LDL增高,HDL降低,但差异无统计学意义(P>0.05).结论 低胆红素水平在高脂血症和非高脂血症的冠心病发生中起着重要的作用,是冠心病的独立危险因素. Abstract: Objective To investigate the effection of serum bilirubin and serum lipid on coronary heart disease (CHD). Methods Seventy -five patients with CHD group were divided into hyperlipidemia group(46 cases) and non- hyperlipidemia group (29 cases),35 healthy controls (healthy control group)were enrolled in the study. Serum total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL)serum triglycride ( TG), total cholestrol ( TC ), low density lipoprotein (LDL), high density lipoprotein (HDLand serum lipid were examined for all subiects,and then the results were compared and analyzed. Results The contents of serum TBIL, direct bilirubin (DBIL), indirect bilirubin (IBIL)were lower in hyperlipidemia group than those of non - hyperlipidemia and healthy control group, the difference was significant (P <0. 05 ). The contents of serum bilirubin were lower in non - hyperlipidemia group than those of healthy control group, the difference was significant( P < 0.05 ). TC,TG and LDL were higher and HDL was lower in hyperlipid

原发性高血压患者胰岛素抵抗与血管紧张素Ⅱ的相关性 作者:董加建 张金盈 李蕾 王魁风 陈坡 杨培灵 Jia-jian Jin-ying Kui-feng Pei-ling
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摘要: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.

冠心病合并2型糖尿病患者冠状动脉造影临床分析 作者:张三强 潘苗 刘建庄 任明芬 San-qiang Jian-zhuang Ming-fen 单位:河南省新乡医学院第二附属医院心内科 453002 河南省新乡医学院第二附属医院老年科 453002
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摘要:目的 探讨冠心病合并2型糖尿病患者冠状动脉造影的特点.方法 选择120例冠心病患者进行冠状动脉造影,其中合并糖尿病60例,无糖尿病60例,根据临床特点及造影结果进行对比.结果 冠心病合并糖尿病患者冠状动脉血管病变明显重于单纯冠心病组.多表现为多支血管病变及弥漫性病变(P<0.05).结论 冠心病合并糖尿病患者冠状动脉造影主要表现为广泛和严重的冠状动脉血管病变. Abstract: Objective To study the coronary artery disease characteristics by coronary angiography in coronary heart diseases patients with type 2 diabetes mellitus. Methods 120 cases of coronary heart disease were treated with coronary angiography, including 60 cases with type 2 diabetes,60 cases of non -diabetic, clinical characteristics and imaging results were compared. Results Coronary artery disease in patients with coronary artery disease with diabetes mellitus was more serious than the other group ( P < 0.05). Conclusions Coronary angiography in patients with coronary heart disease with diabetes mellitus for coronary artery disease mainly manifested more extensive and severe.

血清脂蛋白(a)、胆红素水平与冠状动脉病变程度关系研究 作者:杨培灵 张金盈 赵晓燕 姚海木 陶海龙 张力 王魁风 董加建 陈坡 王小芳 Pei-ling Jin-ying Xiao-yan Hai-mu Hai-long Kui-feng Jia-jian Xiao-fang
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摘要: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

替罗非班治疗不同时间拔除动脉鞘管的急性冠状动脉综合征患者的安全性 作者:荆素敏 陈魁 张艺 何飞 姜正明 张雅娉 李蕾 Su-min Zheng-ming Ya-ping
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摘要:目的 探讨不同时间拔除动脉鞘管对经皮冠状动脉介入治疗(PCI)术后血管并发症的影响,并探讨其与术后替罗非班应用的关系.方法 将150例急性冠状动脉综合征患者随机分为观察组(A组)73例和对照组(B组)77例,A组于PCI术后即刻拔除动脉鞘管,B组于PCI术后留置4 h后拔除动脉鞘.观察两组出血及拔管后压迫止血15 min后出血率.结果 对照组出血率较观察组明显增高,差异有统计学意义(P<0.05).拔管后压迫止血15 min后,对照组出血率较观察组明显增高,差异有统计学意义(P<0.05).结论 PCI术后即刻拔除动脉鞘管可以预防和减少血管并发症的发生,尤其应用替罗非班更适合早期拔管. Abstract: Objective To investigate the effects of removing artery sheath catheter at different time points on blood vessel complications after PCI operation and evaluate whether tirofiban was associated with them. Methods The study was a parallel - group, randomized, controlled clinical trial, 150 patients with ACS who underwent selective PCI were randomly assigned to one of two treatment regimens , tirofiban was predominantly initiated in the catheter laboratory after the patients underwent selective PCI. In observation group of 73 patients, artery sheath catheter was removed immediate after PCI, while in control group of 77 patients, it was removed 4 h after PCI. The incidence of blood vessel complications in two groups were compared. Results There were more bleeding events happened in the control group compared with the observative group, and there was significantly differences between the two groups ( P<0.05 ).Conclusions Immediate removal of the artery sheath catheter after PCI operation could prevent and reduce the occurrence of the blood vessel complications and is more suitable for patients treated with tirofiban.

D-二聚体与纤维蛋白原在冠心病中的临床意义 作者:靳志峰 陈南 殷明君 Zhi-feng Ming-jun 单位:河南省南阳市第一人民医院急诊科 473000 河南省南阳市第一人民医院心内科 473000 苏州大学附属第一医院急诊科
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摘要:目的 研究D-二聚体(D-Dimer,DD)与纤维蛋白原(Fg)的含量在冠心病患者中的差异.方法 将入选的130例经冠状动脉造影(CAG)的患者分为确诊的冠心病组94例与正常对照组36例,其中冠心病组又分为急性心肌梗死(AMI)组25例、不稳定型心绞痛(UAP)组36例和稳定型心绞痛(SAP)组33例;再将冠心病组按CAG结果分为轻度病变组24例、中度病变组27例和重度病变组43例.用免疫透射比浊法分别测定DD、Fg含量进行比较.结果 AMI、UAP两组DD、Fg含量及阳性检出率明显高于SAP和对照组(P<0.05),AMI组的DD、Fg含量明显高于UAP组(P<0.05),重度病变组DD、Fg含量高于轻、中度病变组(P<0.05).结论 联合检测DD与Fg在冠心病的诊断中具有重要的临床意义. Abstract: Objective To examine the diversity of D -dimer(DD) and fibrinogen (Fg)in the patients with coronary heart disease(CHD). Methods The 130 subjects were divided into CHD group(94 cases) which were confirmed by coronary artery angiography(CAG) and control group (36 cases). CHD group was divided into acute myocardial infarction (AMI) group (25 cases), unstable angina pectoris (UAP) group (36 cases) and stable angina pectoris (SAP) group ( 33 cases). In addition, CHD group was divided into slight (24 cases), moderate (27 cases)and severe (43 cases)lesion groups according to the outcome of CAG. The levels of DD and Fg were measured respectively and compared among all groups. Results The levels of DD, Fg in AMI and UAP groups were significantly elevated as compared with that of SAP and control groups ( P<0.05), and DD, Fg in AMI group were higher than that of UAP group. The levels of DD and Fg in severe lesion group were higher than that of moderate and slight groups ( P<0.05 ). Conclusions To measure the levels of DD and Fg simultaneously has important clinical significance in CHD.