目的 探讨精神疾病患者无抽搐电休克治疗(modified electroconvulsive therapy,MECT)术后谵妄发生的危险因素.方法 纳入接受MECT治疗的1001例精神疾病患者,收集一般人口学资料、临床特征、MECT治疗参数、脑电监测中的抽搐发作情况、术后谵妄发生情况等,对谵妄发生的相关危险因素进行分析.结果 1001例接受MECT治疗的精神疾病患者中,发生谵妄者102例(10.2％).logistic回归分析示抽搐发作时间长(OR=1.037)、低氧血症(OR=9.052)、共患高血压(OR=6.564)与术后谵妄发生相关(P<0.01).抽搐发作时间≥70 s者术后谵妄发生率(46.7％)显著高于其他抽搐发作时间者(P<0.01).结论 抽搐发作时间长、低氧血症、共患高血压是精神疾病患者MECT术后谵妄发生的危险因素.

Objective To explore clinical features and influence factors on the prognosis in type 1 cardiorenal syndrome (CRS) patients treated with continuous renal replacement therapy (CRRT).Methods Fiftythree patients admitted to Beijing Anzhen Hospital due to type Ⅰ CRS and treated with CRRT from January 2008 to March 2016 were enrolled in this retrospective study.They were divided into two groups according to survival or death.Patients in the survival group were further divided into two subgroups according to their prognosis,renal replacement therapy (RRT) independent subgroup and RRT dependent subgroup.Baseline features,diagnosis,complications,combined drug therapy,cardiac function and renal function before CRRT and at the beginning of CRRT were compared respectively between the two subgroups.Results The average age of the 53 patients (36 males and 17 females) was 65.8 years old.Thirty of them were survival with the mortality rate of 43.4％.Twenty-one of the 30 survival patients improved without the need of dialysis anymore,and 9 cases must rely on maintenance dialysis.Compared with the patients in the survival group,patients in the death group had lower urine volume before CRRT (t=-2.336,P=0.023),later CRRT beginning time (t=2.187,P=0.038),higher prevalence of intradialytic hypotension (x2=16.246,P＜0.001),higher proportion of using vasoactive drugs (x2=12.106,P=0.001),and less decrease of serum BNP after CRRT (t=15.931,P＜0.001).In the RRT independent subgroup,serum creatinine at baseline (t=-4.796,P=0.001) and before CRRT (t=-2.502,P=0.018) were significantly lower than those in the RRT dependent subgroup.Conclusion The mortality was relatively high in type Ⅰ CRS treated with CRRT.The risk factors for death were lower urine volume,late beginning of CRRT,intradialytic hypotension,and persistent higher BNP level after CRRT.The risk factor for RRT dependence was the higher baseline serum creatinine before CRRT.

目的 心脏外科术后急性肾损伤(CSA-AKI)实施连续性肾替代治疗(CRRT)的患者预后分析. 方法 回顾首都医科大学附属北京安贞医院2013年1月～2013年12月实施CRRT的114例CSA-AKI患者的临床资料.结果 114例患者中男性73例,年龄21～83岁,平均55.8±13.1岁.通过首都医科大学附属北京安贞医院创建的“成人心脏外科手术后急性肾损伤的预警评分系统”进行评分,≥12分的高危患者占64.9％ (73/114),平均12.9±3.3分.开始CRRT的时机在术后2～144h,中位数26.5 h (20.0,68.0),CRRT的总治疗时间24～692h,中位数77 h (36.0,148.5).114例患者中死亡63例(55.3％)、肾功能恢复36例(31.6％)、进入维持性肾替代治疗15例(13.1％).死亡组63例患者与存活组51例患者在年龄、预警评分、CRRT的总时间存在显著性差异(P＜0.05);死亡组患者接受联合手术机率(17.5％比3.9％)及低心排综合征等并发症的发生率明显多于存活组(P＜0.05);114例患者中早期实施CRRT的54例患者比晚期CRRT的60例患者有显著的肾功能恢复率(P＜0.05).多元Logistic回归分析显示,术后肺机械通气＞24h、术后低血压是CSA-AKI实施CRRT患者死亡的独立危险因素(P＜0.05). 结论 CSA-AKI的死亡率非常高,尤其接受肾替代治疗的患者.预警评分能预测AKI的发生及死亡的风险.术后肺机械通气＞24h、术后低血压是死亡的独立危险因素.患者高龄、接受联合手术、术后发生低心排综合征等因素也与其死亡有关.早期实施CRRT能促进CSA-AKI患者肾功能恢复.

Objective To evaluated the clinical characteristic and 30-day clinical outcomes of acute inferior wall ST-elevation myocardial infarction from occlusion of the left circumflex artery (LCX) and the right coronary artery (RCA).Methods From January 2008 to December 2011,621 acute inferior wall ST-elevation myocardial infarction patients who underwent primary pereutaneous coronary intervention(PCI) were enrolled in a single center retrospective study.Of621 cases,515 patients were enrolled in RCA group and 106 patients in LCX group.Results There were no significant differences between two groups in terms of age,sex,hypertension,diabetes,smoking,diastolic pressure,ischemia time ( all P ＞ 0.05 ).The proportion of combined with right ventricular acute myocardial infarction,the sum of ST-elevation and left ventricular ejection fraction were remarkably higher in group RCA than those in LCX group[29.3％ (151/515) vs 4.7％ (5/106),(11.0 ±2.8)mm vs (9.8 ±3.3) mm,(57 ± 12)％ vs (55 ± 10)％ ],while systolic blood pressure,the peak level of creatine kinase-isoenzyme,troponin Ⅰ and 30-day mortality in group RCA were lower[ ( 119 ± 29)mm Hg vs (126 ± 31 )mm Hg,(47 ± 30)μg/L vs (55 ± 33 ) μg/L,( 160 ± 71 ) U/L vs ( 176 ±73)U/L,3.9％ (20/515) vs 8.5％ (9/106) ] (all P ＜0.05).There were not significant difference in thrombolysis in myocardial infarction(TIMI) 0 flow,multiple-vessel disease,procedural time,door to balloon time,final TIMI 3 flow and intra-aortic balloon pump support between the group RCA and LCX group [64.5％ (332/515) vs 57.5％ (61/106),51.7％ (266/515) vs 49.1％ (52/106),(50 ± 22) min vs (55 ±27)min,(77 ± 13)min vs (79 ± 12)min,93.4％ (481/515) vs 92.5％ (98/106),8.2％ (42/515) vs 7.5％ (8/106),all P ＞0.05].Multivariate analysis demonstrated that LCX was a risk factor of 30-day mortality( OR =1.167,95％ CI:0.992-1.963,P =0.033 ).Conclusions The electrocardiograph of occlusion of the left circumflex artery is atypia.The 30-day prognostic outcome is poorer in LCX-related acute inferior wall myocardial infarction.

Objective To investigate the effect of intracoronary tlrofiban and nitroglycerol on slow blood flow after stent implantation during percutaneous coronary intervention(PCI).Methods Totally 201 patients with acute coronary syndrome(ACS)undergoing PCI were enrolled in this study from January 2008 to January 2011.The patients were divided into 2 groups according to intracoronary tirofiban and nitroglycerol(tirofiban group)or nitroglyc-erol only(control group).Results Tirofiban group had significantly increased risk of the rate of acute myocardial infarction,TIMI flow 0-1 before PCI[71 cases(76.3%)VS 66 cases(61.1%),47 cases(50.5%)VS 39 cases (36.1%),P=0.046,0.023],but lower rate of unstable angina pectofis(UA)than control group[22 cases(23.7%)VS 42 cases(78.9%),P=0.023].Tirofiban group had higher rate of TIMI flow 3 after PCI.Although the slight bleeding incidence in the control group Was less than that in the tirefiban group,no severe bleeding was observed between 2 groups.Conclusion Intracomnary timflban and nitroglycerol can safely and effectively reduce the incidence of slow flow in patients after stent implantation during PCI.

Objective To investigate the values of fatty acid-binding protein(FABP) in the diagnosis and short-term prognosis of patients with acute myocardial infarctions.Methods A total of 254 unselected consecutive patients(symptom-to-admission time≤4 h)with AMI treated at the emergency department of Beijing Anzhen Hospital from June.2009 to June.2010 were enrolled in this study.The patients were divided into the FABP positive group and the control group(the FABP negative group)according to FABP serum levels measured from the initial blood samples.Clinical features and prognosis were observed in the two groups.Results Of the 254 patients enrolled,179 were FABP positive cases and 75 were FABP negative.Baseline data(age,gender,hypertension history,diabetes history,smoking history,initial electrocardiographic findings,rates of coronary angiography,double-vessel disease and treatment) were not significantly different between the 2 groups(P0.05).FABP positive patients had significantly higher risk of multi-vessel disease and in-hospital mortality but lower LVEF and lower ratio of single-vessel disease(P0.05).Logistic analysis revealed that FABP was an independent predictor for in-hospital death(OR=1.329,95%CI(0.962,2.148),P=0.022).Conclusion FABP is identified not only as an early diagnosis indicator of AMI,but also an indicator for predicting the prognosis.

Objective To evaluate the glycosylated hemoglobin (HbA1c) level in patients with acute myocardial infarction.Methods The data of 474 in-hospital patients with ST-elevation myocardial infarction were collected from database of Beijing Anzhen Hospital from January to December 2008.The patients were divided into two groups according to the level of HbA1c:HbAlc≥6.5% group and control group (HbAlc＜6.5%).The prognosis of two groups were observed.Results Age,smoke,ischemic time,cases of coronary angiography,successful reperfusion rate,in-hospital drug us were no significant different between two groups(P＞0.05).Compared with the control group,history of hypertension(P=0.008) and diabetes (P=0.000),blood glucose (P=0.000),triplevessel disease (P=0.031),male (P=0.006),LVEF (P=0.023) and single-vessel disease (P=0.040) were significantly different in HbA1c≥6.5% group.In HbA1c≥6.5% group,there was higher incidence of heart failure (P=0.041),in-hospital mortality (P=0.033),cardiogenic shock (P=0.038).Logistic analysis showed that HbA1c≥6.5% were independent factors of in-hospital mortality(OR=0.932,95% CI:0.311-1.124,P=0.044) and the rate of heart failure (OR=1.467,95% CI:0.473-3.149,P=0.047).Conclusions The high level of HbA1c is a powerful predictor of in-hospital mortality and incidence of heart failure in patients with acute myocardial infarction.The prognosis of AMI can be improved by the control of blood sugar.

Objective To find the factors lowering the rate of effective thrombus aspiration in patients with STsegment elevation acute myocardial infarction (STEMI) treated with primary percutaneous coronary intervention(PCI). Method From January to December 2008 , a total of 226 AMI patients from Beijing Anzhen Hospital,treated with primary PCI to aspirate the thrombus from the infracted coronary artery via a cannula, were enrolled in a single center retrospective study. The criterion of successful thrombectomy (device success) was defined as the coronary blood flow of involved vessel after PCI resumed to greater than TIMI grade 1. One hundred seventy-eight patients were assigned to effective thrombus aspiration group, and 48 patients without improvement in coronary blood flow of involved vessel after PCI to control group. Data collected after PCI including the normalization of the elevated ST segment,the use of direct stent, ratio of no-flow/slow flow, intra-coronary administration of Tirofiban and the rate of thrombolysis in myocardial infarction (TIMI) flow grade 3 were analyzed with logistic analysis soas to find out the factors affecting the efficacy of thrombus aspiration. Results There were no significant differences in data before PCI between two groups ( P ＞0.05). Compared with the control group, the factors studied such as smoke, diabetes, the rate of pre-PCI TIMI flow grade 0,the post-PCI ratio of no-reflow/slow flow,and the intra-coronary administration of Tirofiban were fewer significantly in the effective thrombus aspiration group. And the rate of post-PCI TIMI flow grade 3, and the rate of direct stent were higher in the effective thrombus aspiration group. Logistic analysis showed that smoke ( OR = 1.551,95%CI: 1.018 ～ 2. 154, P = 0.012), diabetes ( OR = 1. 132,95%CI:0.276 ～ 3.562, P =0.044), and pre-PCI TIMI flow grade 0 OR = 0.544,95%CI:0.368 ～ 1.911,P = 0.035) were independent factors of effective thrombus aspiration. Conclusions Effective thrombus aspiration may improved the coronary blood flow to TIMI flow grade 3 after PCI and reduce the impaiment of myocardial perfusion, and the factors affecting the efficacy of thrombus aspiration should be paid more attention to and should be minimized to achieve the better clinical outcomes.

Objective:To investigate the effect of esmolol on myocardial ischemia reperfusion arrhythmia in patientswith acute myocardial infarction.Methods:The data of 622 in-hospital patients with ST-elevation myocardial infarction were collected from database of Beijing Anzhen Hospital during 2006-2007,which acceptd reperfusion treatment.The patients divided into 2 groups:In the esmolol group,an esmolol infusion was given when the diagnosis of AMI were made.In the control group,patients were given no β-blockade before or during reperfusion treatment.Reperfusion arrhythmias were recorded.Results:In the esmolol group,there were significant decreased in the rate of venericular and atrial arrhythmia:accelerated idioventricular rhythm(P=0.016),ventricular premature(P=0.000),ventrieular taehyeadria(VT)(P=0.009),ventrieular fiblliation(VF)(P=0.016),atrial premature(P=0.002)and atrial fibrillation(P=0.000).The rate of angina after infarction(P=0.005),reinfarction(P=0.019)and in-hospital mortality(P=0.038)were decreased.But there no significant difference in the rate of sinusarrest(P=0.355),high degree AV block(P=0.236).Multivariate analysis showed that esmolol was an independent effective factor for VT,VF during reperfusion and in-hospital mortality(OR=1.025,95%CI:1.008-1.043,P=0.005).Conclusion:Treatment with esmolol were useful to reduced the reperfusion arrhythmia and play an important role in protective action,so the prognosis of AMI were improved.