目的 比较房颤患者PCI术后双抗联合达比加群与华法林的抗凝效果.方法 按照随机数表法将70例冠心病合并房颤患者分为观察组和对照组,各35例,两组患者术后均接受低分子肝素连续抗凝治疗、标准双联抗血小板治疗与美托洛尔控制房颤心室率治疗,对照组患者术后加用华法林,观察组患者术后加用达比加群,比较两组患者治疗前后凝血功能指标以及治疗后体循环栓塞事件和出血事件发生情况.结果 观察组治疗后1、6个月PT均低于对照组,差异有统计学意义(P<0.05);两组患者治疗前、后APTT、TT、FIB比较,差异无统计学意义(P>0.05).对照组治疗后体循环栓塞事件发生率为5.71％(2/35),出血事件发生率为17.14％(6/35);观察组治疗后体循环栓塞事件发生率为2.86％(1/35),出血事件发生率为2.86％(1/35).两组患者治疗后体循环栓塞事件发生率比较,差异无统计学意义(P>0.05);观察组治疗后出血事件发生率低于对照组,差异有统计学意义(P<0.05).结论 房颤患者PCI术后使用双抗联合达比加群抗凝效果更佳,可降低术后出血事件发生风险.

经皮冠状动脉介入手术(Percutaneous coro-nary intervention ,PCI)是治疗急性ST 段抬高型心肌梗死的主要手段 ,但术后心肌缺血再灌注损伤和微循环灌注对手术预后影响明显[1 ] .国内研究指出 ,PCI术后使用他汀类药物治疗在改善血管内皮功能、改善局部微循环、降脂、抗栓等方面有显著作用 ,但目前他汀类药物的用药剂量尚无明确标准[2 ] .本研究对急性S T 段抬高型心肌梗死患者PCI术后给予不同剂量瑞舒伐他汀的疗效及安全性进行了比较 ,以期为该病治疗方案的优化提供参考 ,现报道如下.

目的 探讨磷酸肌酸钠辅助治疗对心瓣膜病慢性心力衰竭患者心功能及BNP的影响.方法 选取180例心瓣膜病慢性心力衰竭患者,随机分为两组,对照组(90例)行常规抗心衰治疗,观察组(90例)在对照组基础上辅以磷酸肌酸钠治疗,对比两组心功能及BNP变化情况.结果 观察组临床总有效率明显高于对照组(P<0.05).治疗后观察组左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)变化均优于对照组(P<0.05),血浆BNP浓度改善明显优于对照组(P<0.05).结论 在常规抗心衰的同时辅以磷酸肌酸钠治疗,可取得显著治疗效果,有利于改善患者心功能与BNP浓度.

Objective To observe the efficacy of milrinone on intractable congestive heart failure(CHF). Methods From June 2009 to May 2013,a total of 96 patients with intractable CHF in our hospital were randomly divided into control group and test group,each of 48 cases. Both groups given conventional treatment,and control group given dobutamine,test group given milrinone on the basis of conventional treatment. The N - terminal pro - brain natriuretic peptide(NT - proBNP), left ventricular ejection fraction( LVEF),fraction shortening( FS),stroke volume( SV) and cardiac output( CO)were compared between the two groups. Results Before treatment,there was no significant differences of NT - proBNP,LVEF, FS,SV,CO between the two groups(P > 0. 05);after treatment,the NT - proBNP was lower in test group than that in control group(P < 0. 05),while LVEF,FS,SV,CO higher. The NT - proBNP after treatment was lower,LVEF and CO higher in both groups when compared to those before treatment,and FS,SV only in test group were higher(P < 0. 05). Conclusion Milrinone is safe and effective in the treatment of intractable CHF,and is worthy of promotion in primary hospitals.

目的总结过度换气综合征的治疗体会。方法回顾性分析我院2008年5月至2010年6月共126例过度换气综合征患者的临床资料。结果 57例患者经过心理疏导、暗示疗法、增加吸入气体的二氧化碳,浓度达临床治愈,69例患者辅以药物镇静治疗达临床治愈。结论对于过度换气综合征的患者,暗示疗法、心理疏导是关键,药物治疗为辅助。

Objective To explore the curative effect and the value of clinical application of cerebrospinal fluid replacement by lumbar puncture in subarachnoid hemorrhage(SAH).Methods Fifty-one cases of SAH were randomLy divided into two groups:treatment group with 26 cases in it and control group with 25 cases in it.Both groups were given conventional treatment and the cerebrospinal fluid by lumbar puncture was added to the treatment group.Results Duration of headache and disappeared time of meningeal stimulation symptom and time of CSF returning to normal in the treatment group were less than those in the control group,with a significant difference between the two groups(P0.01).The rates of hydrocephalus,cerebral vasospasm(cvs)and death were decreased obviously,with a significant difference(P0.05).Conclusion The cerebrospinal fluid replacement for subarachnoid hemorrhage is safe and effective,and can reduce the incidence of complications and mortality.