本文基于课题组在沈阳、济南、青岛、上海四个城市的调研数据,以网约车司机群体为例,分析了数字经济下灵活就业者工作满意度情况,运用有序Logistic回归模型探究了其主要影响因素,进一步提出政策建议.研究结果表明,网约车司机整体工作满意度较高,但对劳动关系认定与社会保险缴纳等方面的满意度仍有较大提升空间;收入、奖惩制度、职业发展、心理认知对网约车司机的工作满意度有显著影响.

目的 探讨空腹血糖对老年非糖尿病急性心肌梗死患者预后的影响.方法 入选我院2004年1月至2012年1月接受尿激酶溶栓或经皮冠脉介入治疗并再通非糖尿病急性心肌梗死患者182例,均于入院第二天检测静脉空腹血糖(FPG).按照FPG＜ 5.6 mmol/L(n=72)、5.6 mmol/L≤FPG ＜7.0 mmol/L(n=52)、FPG ≥7.0 mmol/L(n=58)分为三组,多因素分析三组患者住院期间心律失常、左心功能不全发生率的差异.结果 随着FPG水平增高,心律失常、左心功能不全发生率均增加,多因素回归分析表明FPG是心血管事件发生的独立危险因素.结论 FPG增高是非糖尿病老年心肌梗死患者预后的独立危险因素.随着FPG增高,住院患者心血管事件的发生率增高,应将FPG控制在正常范围.

虽然迄今为止冠心病诊断的金标准仍为冠状动脉造影(coronary angiography,CAG),但CAG仅能显示管腔的狭窄程度及范围,而且是有创检查,还可能出现一些严重的并发症.多层螺旋CT冠状动脉成像(multi-slice spiral CT coronary angiography,MSCTCA)不但可以显示血管管腔的改变,亦可同时显示管壁的钙化、斑块的形态、范围、特征及血管与心脏整体间的空间关系[1],且其为无创性检查,费用较低,因此越来越受到关注.本文主要探讨影响MSCTCA图像质量的因素.

目的 观察老年急性冠脉综合征(ACS)患者N-proBNP水平及PCI术对其的影响.方法 入选老年ACS患者134例,按ACS临床谱及是否行PCI治疗分为6组:UA行PCI组;UA非行PCI组;NSTEMI行PCI组;NSTEMI非行PCI组;STEMI行PCI组;STEMI未行PCI组.依次测量入院时、入院后24 h、7 d、30 d的N-proBNP水平,并观察主要不良事件.结果 ACS患者血浆N-proBNP水平均高于对照组(P＜0.01); STEMI组和NSTEMI组血浆N-proBNP水平高于UA组.无论是否行PCI,患者入院时与入院24 h的N-proBNP无显著性差异;7 d时N-proBNP水平较入院时均明显下降.但行PCI者7 d和30 d的N-proBNP水平明显低于同类疾病但未行PCI者(P＜0.05).30 d内发生猝死、有症状心力衰竭、恶性心律失常的患者N-proBNP水平明显高于未发生相应心脏事件的患者(P＜0.05).结论 N-proBNP水平在ACS患者中明显升高,其升高程度与ACS类型相关.PCI介入治疗可以使血浆N-proBNP水平相应下降,N-proBNP可作为判断ACS患者预后的指标,

OBJECTIVE:To compare the efficacy and safety of intravenous levosimendan and dobutamine in patients with decompensated heart failure refractory to conventional medications. METHODS:Patients were recruited into this multicentre, randomised, positive-controlled and parallel-group study to receive either levosimendan or dobutamine therapy. In the levosimendan group, an initial loading dose of levosimendan of 12 microg x kg was infused over 10 min, followed by a continuous infusion of 0.1 microg x kg(-1) x min(-1) for 1 h and then 0.2 microg x kg(-1) x min(-1) for 23 h. In the control group, dobutamine was infused for 1 h at an initial dose of 2 microg x kg(-1) x min(-1) without a loading dose, followed by a continuous infusion of 4 microg x kg(-1) x min(-1) for 23 h. Hemodynamic responses at 24 h were evaluated by echocardiography (in both groups) and Swan-Gans catheter (in the levosimendan group). Clinical assessment was performed to evaluate efficacy and safety of the medications. RESULTS:A total of 225 patients from 12 medical centers were evaluated; 119 assigned to levosimendan and 106 assigned to dobutamine group. The effectiveness rate was 31.9% (38 patients) in the levosimendan group and 17.9% (19 patients) in the dobutamine group (P < 0.01). At 24 h, left ventricular ejection fraction (LVEF) was improved by 6. 4% in the levosimendan group, compared with 4.6% in the dobutamine group (P > 0.05). Stroke volume (SV) was increased by 11.1 ml in the levosimendan group and 2.8 ml in the dobutamine group respectively (P < 0.05). Dyspnea and clinical manifestations improvements were more significant in levosimendan therapy group compared to dobutamine group. There were less adverse effects including hypokalemia, hypotension and ventricular premature beats in the levosimendan group than in the dobutamine group (P < 0.05). CONCLUSION:Levosimendan was well tolerated and superior to dobutamine for patients with decompensated heart failure refractory to conventional medications.

目的:探讨多层螺旋CT冠状动脉成像(CTCA)与冠状动脉造影(CAG)的一致性及CT多种重建技术综合评估冠状动脉疾病的临床应用价值.方法:82例临床确诊冠心病及疑似冠心病的患者同时进行多层螺旋CTCA及CAG检查,采用Cardiac IQ软件包进行容积再现技术(VRT)、多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)、仿真内窥镜(CTVE)等多种重建技术的后处理CT所得图像,以CAG为金标准,将二者结果进行对比分析.结果:多层螺旋cTCA与CAG比较结果符合率为97.9%,灵敏度为98.7%,特异度为97.6%.各种重建技术所得结果与CAG对比,82例患者中,73例(89%)VRT可帮助病灶的定位;78例(95.1%)CPR、75例(91.4%)CTVE能更准确判断狭窄程度;82例(100.0%)MIP图像能准确显示血管壁及管腔内的钙化.因此对于不同的病例应选择适合的重建方法进行综合分析.结论:多层螺旋CTCA是一种简便易行、安全可靠的无创性检查方法,与CAG比较具有很高的一致性,可以较准确评估冠脉疾病,可作为冠心病的筛选手段和冠脉狭窄术前评价以及术后复查的首选方法.

目的:探讨在心脏MRI结合药物负荷试验中心肌收缩功能测定及心肌灌注评估心肌缺血程度的临床价值.方法:采用1.5T磁共振扫描仪对76例冠心病患者进行心脏电影MR成像;利用MRI真正快速稳态梯度回波(FIESTA)序列及平面回波成像(EPI)序列,获得左室短轴位MR图像及心肌灌注成像;ATP作为负荷药物,0.15 mg·kg-1·min-1连续经肘静脉注射5 min,采用MASS软件包对左室各节段室壁运动进行半定量靠计分,同时对灌注曲线进行定量分析.结果:静息状态下室壁运动异常(评分为2～4分)心肌节段的SIm、slope值较室壁运动正常组(评分为1分)低,无运动(评分为4分)较中等程度运动减弱(评分为2分)心肌节段的SIm、slope值低(P＜0.05).室壁无运动异常心肌节段较运动严重减弱(评分为3分)心肌节段的slope值显著降低(P＜0.05);其他无运动异常心肌节段与运动异常心肌节段之间的SIm值和slope值比较差异无显著性(P＞0.05).在负荷状态下,室壁运动异常较正常心肌节段的SIm、slope值低(P＜0.05).无运动异常心肌节段较运动异常心肌节段减弱(评分为2～3分)心肌节段的SIm、slope值低(P＜0.05).运动严重减弱较运动中等程度减弱心肌节段的slope值低(P＜0.05).结论:在静息状态和负荷状态下,心肌灌注参数均随着室壁运动评分的增加而降低;心肌灌注和心肌收缩功能具有关联性,可从不同角度反映心肌缺血程度,为诊断冠心病,准确判断心肌缺血程度、范围及冠心病治疗后复查疗效等提供重要的依据.

<正>随着近几年国内PET(正电子发射断层扫描系统)、PET/CT(PET与CT的同机融合)及符合线路的应用越来越多,正电子放射性药物的需求量在逐渐增加。尤其是正电子放射性药物中使用最成熟的18F-FDG,作为目前常规使用的正电子药物,每一个制备该药物的场地,都应保证最好的产率,不仅可以满足临床即时应用的需要,也避免了因同一天重复生产而造成的成本浪费和可能发生的辐射损伤。由于正电子放射性药物的特殊性(高放射性,短半衰期),均采用微量试剂(即参与反应的主要配体试剂为十几毫克至几十毫克之间),全自动化合成。

AIM To explore the relationship between PAPPA and hypertension by measuring the circulating serum PAPPA.METHODS Serum PAPPA,IL-6 and IL-10 were measured in 70 patients with hypertension and 56 controls with enzymatically amplified "two-step" sandwich-type immunoassay,double antibody radio-immunoassay and ABC-HRP.RESULTS ①The serum levels of papp-A,IL-6 and IL-10 were significant higher in patients with hypertension than those of the controls(P<0.05) and elevated with the level of pressure. ②There was a significant association between PAPPA,IL-6 and IL-10.CONCLUSION Inflammatory cytokines(PAPPA,IL-6 and IL-10) in patients with hypertension are higher,indicating that the inflammation is probably involved in the occurrence and development of hypertension.

目的:探讨缺血性心脏病ATP负荷前、后MR心肌灌注成像的影像学特点,分析应用该方法评估心肌血流储备的效果.方法:采用1.5T MR成像设备对20例健康志愿者和30例临床按ISFC/WHO标准确诊为冠心病并经冠脉造影证实有心肌缺血的患者进行ATP负荷MR心肌灌注成像,对心肌灌注储备的相关参数进行定量分析,并与冠状动脉造影(CAG)进行比较.结果:ATP负荷后时间-信号强度曲线的最大上升斜率(slope)明显增加,负荷后与负荷前slope的比值(slope+/-)正常组明显高于病例组(P<0.05);slope+/-的正常参考值范围为2.040±0.395;与CAG的对比分析表明,ATP负荷MR心肌灌注成像诊断心肌缺血的符合率为89%.结论:ATP负荷MR心肌灌注成像能够准确地评估心肌血流储备的异常.

Objective To explore the relationship between pregnancy-associated plasma protein-A(PAPP-A) and occurance,development of cardiovascular diseases,and lipids.Methods 75 patients with coronary disease were divided into acute myocardial infarction(n=32),unstable angina pectoris(n=22) and stable angina pectoris(n=21) groups,and 60 subjects without coronary diseases were used as controls.The serum PAPP-A,IL-6,IL-10,lipids were measured in all patients and controls by different methods of enzymatically amplified two-step sandwithtype immunoassay,double antibody radio-immunoassay,ABC-HRP,auto biochemistic analytist.Results ①The level of PAPP-A in acute coronary syndrome(ACS,including acute myocardial infarction and unstable angina pectoris) patients was significantly higher than that in stable angina pectoris patients and controls(P0.05).(②There) were significantly associations between(PAPP-A) and serum totle cholesterol,ApoA1/ApoB(r=0.348,0.420,P0.05).③The levels of IL-6 and IL-10 in coronary heart disease patients were significantly higher than those in controls(P0.05),and the variations among acute myocardial infarction,unstable angina pectoris,stable angina pectoris patients were significantly(P0.05).There were significantly associations between(PAPP-A),IL-6 and IL-10(Spearman r 0.446,0.523,P0.05).Conclusion PAPP-A is significantly associated with occurance and development of coronary heart disease,probablely as a marker of unstable plaque in coronary heart disease.

目的研究硝酸异山梨酯是否可以不加用液体稀释而通过静脉输液泵经静脉直接泵入。方法采用异舒吉5 mg/h、10 mg/h直接静脉泵入方法分别治疗43例冠心病、8例高血压急症病人。结果异舒吉泵入治疗冠心病组:治疗前后平均每例24 h心绞痛发作频率分别为:2.09±0.23和0.60±0.13(P<0.05);治疗前后缺血ST-T段片段数分别为140和116(P<0.05)。与异舒吉经液体稀释后静脉滴注组比较,抗心肌缺血作用相似(P>0.05),而副反应发生率为11.63%,明显降低(P<0.05);异舒吉泵入治疗高血压急症组,异舒吉泵入后5 m in收缩压下降24.41%,舒张压降低了21.42%%,血压下降迅速(P<0.05),较硝普钠治疗高血压急症组起效快(P<0.05)。结论异舒吉不加液体稀释直接经静脉泵入方法在临床上用于治疗冠心病与高血压急症安全有效。

Objective To investigate the level of C-reactive protein in patients with acute coronary syndrome and the intervention of HMG COM. Method Patients with ACS were randomly assigned into the control group and the simvastatin group. Before and after the treatment the plasma levels of HS-CRP? TC ?HDL-C?LDL-C and TG were detected. Results In the treatment group, the mean levels of HS-CRP were decreased 7.9%(P0.05). The decrease of the levels of HS-CRP in treatment group is not relative to the levels of TC(P0.05),but negatively relative to the levels of HDL-C(P0.01). Conclusion As the marks of inflammation, CRP is better sensitivity and accuratly in predicting the stability of atherosclerosis and it is can also as the invasive index to assessing the instability of atherosclerosis. HMG COM can improve the endothelial function ,stabilize atherosclerosis and play the important role in the occurrence ,development and prognosis of ACS.

Objectives To evaluate the anti- ischemic effect of ISDN on the patients with coronary heart disease . The change in the size of the defect area as percentage of the entire myocardium as determined by the unfolded surface mapping between the baseline and after ISDN infusion reflects the anti-ischemic effect of ISDN. Methods and Results 99m Tc-MIBI myocardial perfusion SPECT images were acquired, and reconstruction of the bull's eye map and unfolded surface mapping were performed according to the dates of tomography images. In the group (99mTc-MIBI was injected at 30 minutes after the start of ISDN iv drip) : at the 65% threshold value, the percentage of the defect area size in the whole ventricle was 33.01 ± 5.35% at baseline, (28.9 ±5.23)% after ISDN was infused (P < 0.05); at the 55% threshold value, the percentage of the defect area size in the whole ventricle was (22.06±5.58)% at baseline, (19.60±4.07)% after ISDN was infused (P < 0.05); the sum of defect blood ST segments is 60 at baseline, 51 after ISDN was infused. In the group (99mTc-MIBI was injected at 60 minutes after the start of ISDN iv drip): at the 65% threshold value, the percentage of the defect area size in the whole ventricle was (29.20±5.08)% at baseline, (20.81±4.16)% after ISDN was infused (P < 0.001); at the 55% threshold value, the percentage of the defect area size in the whole ventricle was (21.2 ± 5.49)% at baseline, (17.52±5.59)% after ISDN was infused (P < 0.001); the sum of defect blood ST segments is 58 at baseline, 47 after ISDN was infused. In the group (99mTc-MIBI was injected at 150 minutes after the start of ISDN iv drip) : at the 65% threshold value, the percentage of the defect area size in the whole ventricle was (32.87 ±6.46)% at baseline, (20.81±4.16)% after ISDN was infused (P < 0.001); at the 55% threshold value, the percentage of the defect area size in the whole ventricle was (18.42± 5.17)% at baseline, (14.18±3.61)% after ISDN was infused (P< 0.001); the sum of defect blood ST segments was 64 at baseline, 41 after ISDN was infused. Conclusions The unfolded surface mapping of 99mTc- MIBI myocardial perfusion image can be used as a method of quantitatively evaluating the anti-ischemic effect of drugs and ISDN iv drip can improve the blood flow in myocardium (myocardium perfusion).

Objective To evaluate the anti-ischemic effect of isosorbide dinitrate(ISDN) quantitatively.(Methods 36 patients) were divided into three group according to the different time points after the start of ISDN infused intravenously:groupⅠ(30 min),group Ⅱ(60 min),group Ⅲ(150 min).()~(99m)Tc-MIBI myocardial perfusion SPECT images was used to evaluate directly the anti-ischemic effect of ISDN on 36 patients with coronary heart disease.The changes in the percentage of ischemia area in entire left ventricular area and ECG were determined by the unfolded surface mapping before and after ISDN infusion.Results()~(99m)Tc-MIBI myocardial perfusion SPECT images were acquired,and reconstruction of the bull′s eye map and unfolded surface mapping were performed according to the dates of tomography images.In groupⅠ: at the 65% threshold value,(33.01±5.35)% at baseline,(28.9±5.23)% after ISDN was infused(P0.05);at the 55% threshold value,(22.06±5.58)% at baseline,(19.60±4.07)% after ISDN was infused(P0.05);the sum of ischemia ST segments was 60 at baseline,51 after ISDN was infused.In group Ⅱ:at the 65% threshold value,(29.20±5.08)% at baseline,(20.81±4.16)% after ISDN was infused(P0.001);at the 55% threshold value,(21.2±5.49)% at baseline,(17.52±5.59)% after ISDN was infused(P0.001);the sum of ischemia ST segments was 58 at baseline,(47 after) ISDN was infused.In group Ⅲ: at the 65% threshold value,(32.87±6.46)% at baseline,(20.81±4.16)% after ISDN was infused(P0.001);at the 55% threshold value,(18.42±5.17)% at baseline,(14.18±3.61)% after ISDN was infused(P0.001);the sum of ischemia ST segments was 64 at baseline,41 after ISDN was infused.Conclusion The unfolded surface mapping of()~(99m)Tc-MIBI myocardial perfusion image can be used as a method of quantitative evaluation of the anti-ischemic effect of drugs and ISDN iv drip can improve the blood flow in myocardium and myocardial perfusion.

嗜铬细胞瘤分泌高浓度儿茶酚胺可引起持续性和阵发性高血压,以及头痛、焦虑、颤动、脑血管意外、高糖血症和心脏损害等.本文报道了5例嗜铬细胞瘤患者,其心脏损害表现为左心功能不全.其中2例病人死亡,另外3例病人,手术切除肿瘤后,心衰症状改善.本文5例病人均是1980年以来于我院经手术及术后病理明确诊断为嗜铬细胞瘤患者.

Objective To study the consistency of the results between of MR myocardial perfusion imaging and DSA coronary arteriography. Methods MR myocardial perfusion imaging and DSA cornary artery imaging were perfromed to 51 patients with coronary heart disease with typical clinical symptoms and typical cardiogram. Dynamic contrast enhanced myocardial imaging (DCEMI) myocardial perfusion imaging analysis software for GE AW4.0 working station was employed to analyze the first pass phase images of the myocardial perfusion of the left ventricle short axle. A curve of the time-intensity of the cardiac muscle perfusion was obtained and the rising slope and the peak value of signal intensity were observed. According to the description of the relation between the position of the short axle of left ventricle and the distribution of the coronary artery blood vessels, the existence of narrowed coronary artery was determined. DSA machine of DAR 1 200 double C arm was employed in the coronary artery imaging. Judkin method employing Seldinger′s method of femoral centesis was carried out and the value ≤50% of the diameter of the coronary artery was determined as the diagnostic standard of narrowness of clinical significance. Results The results of the two methods in 43 cases were consistent and 8 not, the rate of consistency was 84.3%. Conclusion High consistency of the results was found between MR myocardial perfusion imaging and DSA coronary arteriography. MR myocardial perfusion imaging is a non-traumatic method to determine the blood flow of myocardium and it can supply valuable information and guidance for the diagnosis and treatment for the patients.

目的探讨磁共振心肌灌注成像对老年冠心病的诊断价值.方法对临床确诊的35例冠心病患者,利用磁共振心肌灌注成像方法得到心肌灌注时间-信号强度曲线,观察曲线的上升斜率和信号强度的峰值.并同期作了冠脉造影,确定心肌异常改变与冠脉病变血管分布相对应关系.结果 33例经心肌灌注成像有41个病灶呈低灌注区为心肌缺血,其中5例出现延迟强化为心肌梗死,经冠脉造影证实35例均有不同程度的冠脉狭窄.结论磁共振心肌灌注成像与冠脉造影检查结果无明显差异,具有高度的一致性.而磁共振心肌灌注成像是一种无创性测定心肌血流的检查方法,为及时诊断及恰当治疗冠心病提供可靠的依据.

目的:观察两种心脏疾病双腔生理性起搏不同房室间期(AV interval)程控对血流动力学、心功能的影响.方法:选择缓慢心律失常患者15例,肥厚梗阻型心肌病患者(HOCM)6例,术后分别程控二种心脏疾病起搏器的AV间期,并测定左室射血分数(LVEF)、每搏量(SV)和(或)左室流出道(LVOT)压力阶差,评价最佳AV间期时心功能变化.结果:病窦综合征患者AV间期长于自身PR间期、房室传导阻滞患者AV间期为0.16～0.18 s,HOCM患者AV间期为0.10～0.12 s及CHF患者AV间期短于自身PR间期时LVEF和SV最佳(P＜0.05或0.01),HOCM患者LVOT压力阶差下降最显著(P＜0.001),心功能(NYHA分级)平均提高1～2级以上,运动耐量亦有一定提高.结论:不同心脏疾病双腔生理性起搏适宜的AV间期程控可以获得最佳的血流动力学指标及临床预后.

目的分析双腔生理性心脏起搏治疗老年人缓慢心律失常,改善心功能及生活质量的临床效果.方法 1998～2001年为老年人植入双腔生理性心脏起搏器39例,起搏器DDD型26例,DDDR型13例.术后平均随访0.5～3年,随访内容为起搏阈值等参数,左室射血分数(LVEF),心功能(NYHA分级法)及常见并发症(如充血性心衰、房颤及栓塞等).结果同期老年人双腔生理性起搏器植入率达27.5%～49.5%,术后LVEF由(40.2±16.8)%增至(48.1±17.2)%(P＜0.001),心功能平均提高(1.2±0.3)级以上(P＜0.05),运动耐量增加,未见常见并发症发生,与同期老年人非生理性心室起搏比较LVEF提高18.2%(P＜0.01).结论双腔生理性心脏起搏能改善缓慢心律失常老年人心功能,提高生活质量.