目的 观察多巴胺联合硝普钠治疗心梗后左心衰的疗效.方法 我院2018年1月～2018年12月收治的68例心梗后左心衰患者为本次研究对象,按照患者是否给予多巴胺联合硝普钠治疗将所有患者分为对照组(34例:硝普钠治疗)与实验组(34例:多巴胺联合硝普钠治疗),比较两组患者预后.结果 实验组患者治疗1w后左室舒张末期内径(LVDD)、左室射血分数(LVEF)、左室收缩末期内径(LVDS)以及左室短轴缩短率(FS)等相关心功能参数均明显优于对照组,差异有统计学意义(P<0.05).实验组患者治疗1w治疗后显效率、有效率均高于对照组,差异有统计学意义(P<0.05).结论 心梗后左心衰患者单纯硝普钠治疗效果明显高于多巴胺联合硝普钠治疗效果.

Objective To summarize and analyze the characteristics and differences of coronary angiography (CAG) findings in coronary artery disease patients of various age groups to help make decision-making for clinical diagnosis and treatment. Methods A retrospective analysis was made on 2742 patients who underwent CAG at the Fifth Affiliated Hospital of Kunming Medical University/Hong-He Central Hospital of Southern Yunnan from January 2013 to December 2016. The patients were divided into a youth group [n=126; age, 18-40 years; mean age, (35.10±4.91) years], middle-aged group [n=1774; age, 41-65 years; mean age, (55.00±6.60) years], and old age group [n=842; age, ≥66 years; mean age, (71.68±4.49) years]. The self-developed CAG Epidata database was used to collect basic information and the data for coronary artery lesions, including the lesion characteristics of the left main coronary artery (LM), left anterior descending branch (LAD), left circumflex branch (LCX), and each vessel of the right coronary artery (RCA), TIMI blood flow, placement of stents, and surgery. Gensini score was calculated according to the American Heart Association′s evaluation criteria for coronary stenosis. Results The composition ratios of patients in the young, middle-aged, and elderly groups were 4.6%, 64.7%, and 30.7%, respectively, with middle-aged and elderly patients accounting for the highest proportion (95.4%). The ratios of males (84.1%, 65.8%, 58.7%), age [(35.10±4.91) years, (55.00±6.60) years, (71.68±4.49) years], LM lesions (0.8%, 5.4%, 12.4%), RCA lesions (38.9%, 62.5%, 77.7%), LAD lesions (55.6%, 81.0%, 92.2%), and LCX lesions (23.0%, 52.5%, 71.1%) differed significantly among the three groups (P 0.05). The percentages of patients with grade 3 TIMI blood flow in RCA, LAD, and LCX lesions [RCA: 61.1%, 86.0%, 84.9%; LAD: 54.8%, 75.2%, 82.5%; LCX: 75.4%, 47.9%, 62.6%, grade 0 TIMI blood flow in LAD lesions (15.1%, 7.7%, 7.6%), grade 1 TIMI blood flow in LCX lesions (1.6%, 0.3%, 1.7%), and grade 2 TIMI blood flow in LCX lesions (15.9%, 1.5%, 2.0%) differed significantly among the three groups (P 0.05). Conclusion Coronary lesions are different in different age groups. The incidence of coronary artery lesions increases with age. The ratios of LM, RCA, LAD and LCX coronary lesions as well as the percentages of patients with diffuse lesions, calcification lesions, collateral circulation, and severe lesions differ significantly in different age groups. Gensini score increases with age. Patients of different ages have the highest rate of LAD lesions among different arteries. LCX lesions have the most significant difference in grades 1 and 2 TIMI blood flow. Key words: Different ages; Coronary angiography; Characteristics of coronary lesions; TIMI blood flow grading; Gensini score

目的:探讨拘禁球囊技术(JBT)用来治疗非左主干分叉病变的效果.方法:选取2016年1月—2018年3月接受我院介入治疗的60例非左主干分叉病变病人.通过随机方式划分出对照组和观察组,两组在性别、年龄与病史等基线资料方面,无显著差异(P>0.05)两组病人具备可比性.经冠状动脉造影确诊每例研究对象均患真性分叉病变,两者病人的主支均接受单支架置入术治疗,其中对照组采取传统分支导丝保护技术(JWT),观察组则采用JBT.对比分析两组患者介入治疗参数、术中并发症、术后半年病变血管狭窄情况以及心血管事件的发生情况.结果:在术后半年病变血管狭窄状况方面,两组研究对象差异不具备统计学意义(P>0.05);在介入治疗参数、术后半年内发生不良心血管事件概率、术中并发症等方面,两组差异具有统计学意义(P<0.05).结论:在通过介入法治疗冠状动脉分叉病变方面,JBT操作更为简单,且病人发生不良心血管事件概率更低,差异具有统计学意义,可推行于临床领域.

目的:探讨瑞舒伐他汀钙治疗老年冠心病合并高脂血症的疗效及安全性.方法:选取2016年4月-2017年4月笔者所在医院收治的78例老年冠心病合并高脂血症患者作为研究对象,随机分为观察组和对照组,每组39例,对照组给予常规治疗,观察组在常规治疗的基础上给予瑞舒伐他汀钙治疗,比较两组患者的临床症状改善情况.结果:治疗前,两组患者的TC、TG、HDL-C、LDL-C等指标比较差异均无统计学意义(P>0.05);治疗后,观察组患者的TC、TG、HDL-C、LDL-C等指标均优于对照组,比较差异均有统计学意义(P<0.05);观察组的治疗总有效率为87.18％,高于对照组的64.10％,比较差异有统计学意义(P<0.05);观察组的不良反应发生率为7.69％,低于对照组的28.21％,比较差异有统计学意义(P<0.05),全部不良反应均在治疗结束后消失.结论:采用瑞伐他汀钙片治疗冠心病合并高脂血症能有效改善患者的血脂情况,提高患者的生活质量,临床疗效显著,值得在临床上广泛推广.

目的:探讨心肌钙蛋白T对急性心肌梗死的诊断价值.方法:收治慢性心衰患者51例、心肌梗死患者47例及健康体检患者50例,测定血清心肌钙蛋白T含量.结果:对照组、心衰组和心梗组患者的平均心肌钙蛋白T含量存在明显差异;心功能分级越严重,其血清内心肌钙蛋白T的含量越高.结论:测定心肌钙蛋白T在急性心肌梗死诊断中具有较高的准确性和灵敏性,能够有效反映患者病情严重程度.

目的 探讨主动脉球囊反搏(IABP)在老年急性心肌梗死(AMI)并心源性休克(CS)患者治疗中安全性及有效性.方法 回顾性分析收集我院心内科2010年10月～2016年3月行冠状动脉介入治疗年龄大于65岁的老年急性心肌梗死合并心源性休克的患者为研究对象.分为置入IABP组为试验组及未置入IABP组为对照组.比较实验组患者使用IABP前后血流动力学各项指标及心功能的变化;比较两组患者多巴胺使用时间、休克纠正时间、在ICU治疗时间、血乳酸水平、30 d死亡率.结果 实验组在使用IABP后血流动力学各项指标及心功能较使用前有显著改善(P＜0.05或P＜0.01);两组患者多巴胺使用时间、休克纠正时间、在ICU治疗时间、血乳酸对比,差异有统计学意义(P＜0.05);IABP组30 d死亡率较对照组明显降低(P＜0.05).结论 在老年急性心肌梗死并心源性休克的患者中使用IABP,能迅速稳定血流动力学及改善心功能.缩短患者治疗时间及稳定内环境,降低死亡率.IABP安全性及有效性高,值得临床推广.

目的 研究冠状动脉机桥与冠状动脉硬化狭窄的相关性,并分析原因. 方法 统计我院近5年来,经冠脉造影诊断为冠脉肌桥的281例病人合并同一支及其他冠状动脉硬化狭窄的情况,并进行相关性分析.结果 冠状动脉机桥与同一支冠脉硬化狭窄不存在线性相关关系.而与冠脉不发生有意义的硬化狭窄呈高度线性相关. 结论 冠脉机桥的病人更少发生冠状动脉硬化狭窄.

Objective To investigate the three-dimensional mapping system in the application of paroxysmal supraventricular tachycardia. Methods From December 2010 to August 2013, 69 patients are enrolled for the radiofrequency ablation of supraventricular tachycardia. They were sent to either three-dimensional mapping method or traditional two-dimensional mapping method. Result We compared the procedure time, Fluorescence exposure in two groups. And we compared their success rate after follow up visit. Conclusion With three-dimensional mapping system in the application of paroxysmal supraventricular tachycardia, the high success rate and safety are noticed. Meanwhile, procedure time and fluorescence exposure are reduced by using this technique.