患者 ,男 ,48岁 ,因"反复胸痛20 d ,加重3 d"于2018 年3 月12日入院.患者20 d前无明显诱因出现胸前区紧缩样痛 ,伴背部痛、头痛、心悸 ,有轻微恶心感 ,2～3 min可自行缓解 ,未予重视.3 d前患者再次出现胸前区疼痛 ,性质同前 ,发作次数较前增多3～5次 ,持续约5 min ,未予处理.1 d前患者就诊于我院急诊科 ,患者血压为305.4/127.9 kPa ,心率为126次/min ;心电图检查示 :窦性心律 ,Ⅱ 、Ⅲ 、aVF、V3R～ V5R及 V1～ V5导联ST 段弓背向上抬高.高敏肌钙蛋白 T 03.17 μg/L ,N 末端B型尿钠肽前体 21040.0 ng/L.心脏超声示 :左心室射血分数40％ ,左心室侧壁及后壁中间段、心尖段运动减弱 ;前间隔及左心室前壁中间段、心尖段运动减弱 ;左心室心尖部圆隆 ,运动消失 ;室间隔基底段代偿性增厚(1 .3 cm );二尖瓣反流(轻度),三尖瓣反流(轻度).初步诊断为 :急性心肌梗死.即刻给予患者阿司匹林+ 替格瑞洛抗血小板治疗 ,阿托伐他汀调节血脂治疗 ,依诺肝素钠抗凝治疗 ,硝酸异山梨酯注射液扩张冠状动脉治疗 ,托拉塞米利尿治疗 ,泮托拉唑护胃治疗后转入病房.

目的:探究β受体阻滞剂的应用在 STEMI患者 PCI术后冠脉再灌注中的相关性研究,观察β受体阻滞剂的应用对冠脉无复流的影响.方法:选取 2016 年 2月至 2017 年 6 月青岛大学附属医院急诊科收治的急性心肌梗死患者行 PCI治疗后冠脉再灌注患者 116 例为研究对象,分为服用长效β受体阻滞剂的 A组(23 例),服用短效β受体阻滞剂的 B组(33 例)与未服用β受体阻滞剂的C组(60 例),比较组间患者复流率和3 月、6 月及 12 月后的终点事件发生率.结果:A、B、C组患者未复流率为26.09％、33.33％、38.33％,组间比较差异显著(P<0.05),A、B、C组终点事件发生率为 4.35％、9.09％、13.33％,组间比较,A组、B组较 C 组终点事件发生率略低(P<0.05),A组与B组终点事件发生率(P>0.05)无统计学意义.结论:分析STEMI患者行PCI术后冠脉再灌注与β受体阻滞剂的应用存在密切联系,且在急性心肌梗死发病前长期应用β受体阻滞剂可降低 PCI术后再灌注后的未复流风险,同时患者术后终点事件发生率均有所降低.

Intra-aortic balloon pump counterpulsation (IABP) is widely used in acute myocardial infarction patients combined with cardiogenic shock and refractory cardiac failure and the patients who need angioplasty and coronary artery bypass grafting (CABG).Remarkable effect of IABP has been achieved in clinical application.However,there have still been controversies on clinical indications and application time of IABP.This article summarizes the current clinical situation of IABP.

Objective To observe and explore clinical efficacy of ulinastatin injection ( UTI) combined with Xuebijing injection in treatment of elderly patients with severe pneumonia .Methods Total of 96 severe pneumonia patients in the Affiliated Hospital of Qingdao University from Jun .2013 to Apr.2015 were selected and assigned as a combination group(49 cases) and a control group(47 cases) according to the ran-dom number table method.All patients were given symptomatic treatment,the control group was added with Xuebijing injection,100 mL of Xuebijing injection added into 200 mL of 0.9% NaCl injection for intrave-nous drip,bid,,based on which the combination group was added with UTI injection,200 000 U UTI added into 50 mL of 0.9% NaCl injection for trace injection pump,bid,treatment course was 14 days for both groups,the mortality rate and invasive ventilation ratio were noted,and arterial blood gas index and peripheral blood medium concentrations were compared before and after treatment,besides,the clinical efficacies were determined.Results After treatment the PaO2(98 ±10) mmHg vs (92 ±9) mmHg,PaCO2(41 ±4) mm-Hg vs (43 ±3) mmHg,PaO2/FiO2 (283 ±40) vs (243 ±37) of the observation group were significantly better than the control group(P<0.05).The TNF-α(22 ±8) ng/L vs (38 ±12) ng/L,IL-6(56 ±15) ng/L vs (68 ±17) ng/L,IL-8(59 ±10) ng/L vs (69 ±11) ng/L,C reactive protein (12 ±3) mg/L vs (17 ± 5) mg/L of the observation group were all significantly lower than the control group(P<0.01).The differ-ences on invasive ventilation ratio,mortality rate between the two groups had no statistically significant differ-ence(P>0.05);total efficacy of the two groups had no statistically significance difference(P>0.05).Con-clusion Xuebijing injection and UTI injection have synergism in anti-inflammatory treatment of severe pneumonia,combination of Xuebijing and UTI injection compared with single application of Xuebijing can further inhibit inflammatory reaction and improve oxygenation function with good therapeutic effect .

目的：分析采用替罗非班治疗急性心梗冠脉介入术后C反应蛋白的变化情况，并分析其后期影响。方法：从某院接收的急性心梗并采用急诊冠脉介入手术的患者中抽取42例，将所有病例随机分为两组，对照组和治疗组，对照组采用常规性的抗心梗治疗方法；治疗组采用常规疗法的基础上，还增加了替罗非班治疗法，剂量控制400ml，每h注射12ml。治疗后观察两组病人血清中的C反应蛋白的含量，然后来判定病人心肌的受损状况。结果：通过一个月的治疗，治疗组中的C反应蛋白从原来的9.3±0.8mg/L降低到了5.4±0.9mg/L，而对照组的C反应蛋白从原来的9.5±0.7mg/L降低到了9.0±0.8mg/L，两组都存在C反应蛋白降低，但对照组变化较小，没有统计学意义（P＞0.05），两组之间的治疗效果存在较大差异（P＜0.01）。结论：在心肌梗死患者采用急诊介入术治疗后，采用替罗非班可以有效地降低C反应蛋白的含量，从而减少对心肌的损伤，改善患者的预后状况。

目的 分析接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者游离三碘甲状腺原氨酸(FT3)对其心功能及其近期死亡率的评价.方法 连续入选甲状腺功能正常的行直接PCI的STEMI患者102例,术后24 h内采集外周静脉血测FT3,根据FT3水平分为低FT3组(FT3～3.10 pmol/L)和正常FT3组(FT3 ≥3.10 pmol/L).所有患者于发病5～7d内行心脏超声检查,测左室射血分数(LVEF)反映患者心功能情况.随访6个月比较两组的生存率.结果 STEMI患者FT3与LVEF呈线性正相关(P＜0.001).随访6个月,低FT3组共7例死亡,生存率为83.3％,低于正常FT3组的96.5％(x2=4.493,P=0.034).结论 直接PCI的STEMI患者FT3水平与急性心肌梗死(AMI)后心功能严重程度相关,且低FT3的STEMI患者死亡率升高.

近年来,随着药物洗脱支架的广泛应用,众多临床研究1-2已证实其在稳定冠心病患者择期经皮冠状动脉介入治疗术(PCI)中应用可以明显降低再狭窄率.而在急性冠状动脉综合征(ACS),尤其是急性ST段抬高型心肌梗死(STEMI)患者PCI中应用药物洗脱支架仍存在争议.本研究通过对我院应用药物洗脱支架行急诊PCI的老年急性STEMI患者的1～3年的长期随访,进一步探讨其在急诊PCI中应用的有效性和安全性.