目的 评价ST段抬高型心肌梗死(STEMI)合并心源性休克患者体液正平衡与急性肾损伤(AKI)的相关性.方法 回顾性分析192例在安顺市人民医院心内科CICU治疗的STEMI合并心源性休克患者的临床资料.患者均进行体液管理治疗,根据入院后96h是否存在累积液体正平衡,将患者分为两组,即液体正平衡组(n=99)与液体负平衡组(n=93).比较两组患者24、48、72和96 h的液体平衡情况及96 h时累积液体入量和出量,比较两组患者AKI发生率、血肌酐(SCr)变化及AKI恢复患者的比例.采用Pearson检验评价液体平衡量与相关变量间的关系;采用多元Logistic回归模型评价AKI恢复的独立预测因子.结果 在入院24、48、72和96 h,液体正平衡组液体平衡量均明显高于液体负平衡组(均P＜0.001),同时液体正平衡组累计液体输入量明显高于液体负平衡组(t =16.543,P＜0.001),影响液体平衡的主要因素是液体正平衡组患者治疗过程中液体输入较多,而非液体输出较少.与液体负平衡组比较,液体正平衡组患者AKI 2～3期的发生率更高[51.7％(31/60) vs.12.5％ (7/56),x2=20.172,P＜0.001],肾功能恢复比例更低[28.3％ (17/60) vs.75.0％ (42/56),x2=25.240,P＜0.001].液体正平衡患者的液体平衡量与SCr变化值呈正相关(r=0.432,P=0.005),液体正平衡量与患者肾功能恢复可能性降低密切相关.结论 STEMI合并心源性休克的患者液体正平衡与肾功能严重恶化、肾功能恢复可能性降低密切相关.

Objective To evaluate the associativity between renal dysfunction and long-term mortality of cardiovascular disease in patients with acute decompensated heart failure (ADHF) treated by intensive care unit (ICU).Methods A total of 428 patients with ADHF were selected.The patients were divided into worsening renal function group (WRF group, n=168) and no worsening renal function group (non-WRF group, n=260) according to whether WRF occurred during ICU treatment.The demographic data, clinical data and laboratory data and cumulative survival were compared between the two groups.The patients were followed up, and the Cox proportional hazards model was used to assess the relationship between WRF and all-cause mortality or cardiovascular mortality.Results 168 (39.2%) patients of the 428 patients had WRF.The cardiovascular mortality (19.6% vs.8.1%, P<0.001) and all-cause mortality (28.6% vs.15.4%, P<0.001) in the WRF group were significantly higher than those in the non-WRF group.Multivariate Cox proportional hazards model showed that age, serum BNP levels were significantly associated with all-cause death (age: HR=1.125, 95%CI 1.042~1.236, P=0.006;BNP: HR=1.005, 95%CI 1.002~1.011, P=0.026) and cardiovascular death (age: HR=1.132, 95%CI 1.036~1.263, P=0.011;BNP: HR=1.008, 95%CI 1.002~1.035, P=0.030).Conclusion The worsening renal function is associated with cardiovascular death in patients with acute decompensated heart failure.WRF may be one of the criteria for determining follow-up after discharge from patients with acute decompensated heart failure.

目的 探讨氯吡格雷治疗与急性冠状动脉综合征(acute coronary syndrome,ACS)患者主要心血管不良事件增加与早期支架内血栓形成相关性.方法 纳入1286例ACS患者,将患者分为氯吡格雷入院前长期治疗组(氯吡格雷组,n=162)与未接受氯吡格雷治疗组(非氯吡格雷组,n=1124).比较2组患者住院期间及出院后30d主要不良心血管事件发生率,包括死亡、ACS复发、脑卒中发病、支架内血栓形成等.采用Logistic回归分析患者主要心血管不良事件发生的相关因素.结果 氯吡格雷组合并症发生率、心脑血管病史与既往血运重建治疗史患者比例显著高于非氯吡格雷组(均P ＜0.001);氯吡格雷组患者住院期间支架内血栓形成、急性肾衰竭和充血性心力衰竭发病率显著高于非氯吡格雷组(均P＜0.05).出院30d氯吡格雷组患者支架内血栓形成发病率、ACS复发率均显著高于非氯吡格雷组(均P ＜0.05),多元Logistic回归分析表明长期氯吡格雷治疗是患者发生主要不良心血管事件的独立危险因素(OR=1.36,95％ CI:1.03-1.83,P=0.045),也是出院30 d支架内血栓形成的独立危险因素(OR =2.71,95％ CI:1.39-5.76,P =0.02).结论 氯吡格雷治疗是ACS患者主要心血管不良事件,是支架内血栓形成的高危因素.

目的：评价应用替罗非班经皮冠状动脉介入治疗（ percutaneous coronary intervention ，PCI）中无复流及慢血流的临床疗效。方法选取2012年7月至2013年6月接受PCI治疗的急性冠状动脉综合征（ acute coronary syndrome ，ACS）患者69例，通过简单随机法分为对照组28例（未接受替罗非班治疗）、治疗1组25例（静脉内推注替罗非班）和治疗2组16例（静脉内和冠状动脉内均推注替罗非班）。比较三组TIMI血流、校正的TIMI帧数（ corrected TIMI frame count ，CTFC）、住院期间不良心血管事件（ major adverse cardiovascular events ，MACE）及出血事件发生率。结果治疗1组和治疗2组的TIMI血流3级获得率高于对照组，CTFC帧数及MACE发生率均低于对照组，差异有统计学意义（ P ＜0．05），治疗2组PCI后末次CTFC帧数低于对照组及治疗1组，差异有统计学意义（ P＜0．05）。三组术后出血事件发生率比较，差异无统计学意义（ P ＞0．05）。结论应用替罗非班对PCI中无复流及慢血流具有良好的临床疗效及安全性，值得临床推广。

Objective To evaluate the clinical efficacy of meglumine cyclic adenylate in treatment of patients with chronic congestive heart failure.Methods Forty patients with congestive heart failure admitted in this hospital during August 2008 to February 2009 were randomly allocated into two groups,each with 20 cases.Patients in control group were treated with digitalis,diuretics,ACEI agents etc.On this basis,patients in treatment group were additionally added with meglumine cyclic adenylate.Observations on improvement of clinical symptoms,cardiac function etc were carried out at two weeks after treatment as indicators for determining the efficacy of treatment in patients of these two groups.Results Five of 20 patients with markedly effective,14 cases with effective and failure in 1 case were seen in treatment group after treatment with a total effective rate of 95.0%.Two patients with markedly effective,13 with effective and 5 with failure were seen in 20 patients of control group,with a total effective rate of 75.0%.The difference among patients of these two groups was statistically significant(P0.05).Left ventricular ejection fraction of patients in these two groups was improved after treatment,the difference was significant(P0.05),and the improvement in patients of treatment group was much marked in comparison with that of patients in control group after treatment and their difference was statistically significant(P0.05).Conclusion Meglumine cyclic adenylate has good clinical efficacy in treatment of patients with chronic congestive heart failure,and it is worthy to be recommended.

目的评价尿常规用于初步筛查糖尿病患者的临床意义。方法门诊患者中随机抽取600例无糖尿病史及糖尿病症状的患者行尿常规检测,对于尿糖阳性者进一步做空腹血糖、餐后2h血糖及糖化血红蛋白等检查,以确诊或排除糖尿病。结果600例无糖尿病史及糖尿病症状患者中共检出尿糖阳性者26例,占4.33%,经进一步做空腹血糖、餐后2h血糖及糖化血红蛋白等检查确诊糖尿病患者23例,占3.83%,糖耐量异常者2例,占0.33%,肾糖阈降低1例,占0.17%。结论尿常规用于筛查糖尿病患者具有良好的临床意义,方法简便易行,值得临床推广。

目的探讨经右锁骨下静脉远端入路安置永久性心脏起搏器的临床意义。方法患者取仰卧位,去枕,穿刺右锁骨下静脉远端成功后置入导引钢丝,沿钢丝置入血管鞘,沿鞘管置入起搏电极至心房及(或)心室,调整电极位置测试电极达标,制作囊袋,埋藏起搏器。结果13例患者安置心脏起搏器后临床症状均明显改善,随访6~42个月无电极脱位、头昏、晕厥及阿斯综合征发作等。结论右锁骨下静脉远端穿刺入路安置心脏起搏器具有重要的临床应用价值。

目的评价动态心电图(Holter)在心律失常引起的心源性晕厥的临床诊断中的应用价值。方法对21例不明原因黑朦、晕厥的患者,行24h或更长时间的动态心电图(Holter)检查,捕捉患者黑朦晕厥等症状发作时心电图变化情况。结果21例患者行Holter检查期间有6例出现黑朦、晕厥发作,其中5例患者症状发作时Holter记录发现3.0s以上窦性停搏,1例患者出现短阵性室性心动过速,均确定为心律失常引起的心源性晕厥。结论Holter检查对于心律失常引起的心源性晕厥患者的临床诊断有着很高的应用价值。

目的探讨银杏达莫注射液在无再灌注治疗的急性心肌梗死(AMI)中的疗效。方法26例无再灌注治疗的急性心肌梗死患者随机分为治疗组13例及对照组13例。治疗组在对照组的治疗基础上予以银杏达莫注射液20～30ml加液静脉滴注,1次/d,连用14d。结果治疗组:再梗死0例,死亡2例,总有效率84.62%;对照组:再梗死1例,死亡5例,总有效率53.85%,两组间比较有统计学意义(P<0.05)。结论银杏达莫用于无再灌注治疗的急性心肌梗死有明显的疗效。