[目的]通过庞大的高血压人群,寻找并识别发生脑卒中的危险因素.[方法]采用多重抽样的方法,在天津市范围内整群抽中河东区,进而在河东区范围内随机抽取4个社区共计4093名高血压患者,填写统一的调查问卷,问卷内容包括:人口学基本特征、行为习惯、既往疾病史、家族史、高血压知信行测试得分等.根据问卷调查结果是否合并脑卒中分为脑卒中组和非脑卒中组,对组间比较出有差异的变量,进行Logistic回归分析.[结果]脑卒中组男性、年龄≥60岁、空巢状态、未接受高等教育的比例较高,脑卒中组合并冠心病、心力衰竭、心房颤动、糖尿病、高脂血症、高尿酸血症、肺源性心脏病的患者比例较高,脑卒中组中高血压、冠心病及脑卒中家族史的比例较高,与非脑卒中组相比,存在统计学差异(P＜0.05).Logistic回归分析显示:男性、年龄≥60岁、吸烟、存在高血压或脑卒中家族史的OR＞1,且P＜0.05.[结论]男性、年龄≥60岁、吸烟、存在高血压或脑卒中家族史是高血压患者发生脑卒中的危险因素.

Objective To compare the efficacy of left atrial posterior wall dual box ablation(PWDB) and pulmonary vein isolation(PVI)abtation for paroxysmal atrial fibrillation(AF) patients with left atrial diameter(LAD) enlarged.Method Sixty-five paroxysmal AF patients with LAD enlarged,who received treatment in affiliated hospital of the Armed Police Force Logistics College,were enrolled and randomly divided into PWDB group (n=34) and PVI group (n=31).In PWDB group,circumferential right pulmonary vein isolation was performed as a first step and subsequently underwent linear radiofrequency lesions from the superior pole of the right superior pulmonary veins to the left,creating a transverse roof line plus an left pulmonary vein anterior antrum line and an additional transverse linear lesion linking the inferior aspect of the inferior pulmonary veins to complete dual-box ablation on the left atrial posterior wall.In PVI group,bilateral PVI alone by circumferential ablation was done.The clinical general data,total procedure time,X-ray exposure time,ablation time and the cases of complication were observed.During a 12-month follow-up period,the success rate of ablation,LAD changes and adverse events were compared between both groups.Results The clinical general data had no difference in both groups.Compared to PVI group,the total time [(168.8 ± 20.8) min vs (140.3±22.5) min,P＜0.001],ablation time [(39.0±6.1) min vs (33.1±6.5) min,P＜0.001] were prolonged in PWDB group.X-ray exposure time [(21.6±4.3) min vs (20.1±3.5) min,P=0.132] and case of complication (1 case vs 0 case,P=I.000) had no difference.26 patients (76.5％) in PWDB group and 17 patients (54.8％) in PVI group were free from AF during the follow-up time,the difference was statistically significant (P =0.043).The adverse events had no difference (2 cases vs 3 cases,P =0.663).The LAD of those patients maintaining sinus rhythm within follow-up period in PWDB group had a decreasing trend (P =0.001),Which had no significant changes in the control group (P=0.583).Conclusion The PWDB strategy is safe and more effective than PVI alone for paroxysmal AF patients with enlarged LAD.

[Objective] To evaluate the safety and therapeutic efficacy of left atrial posterior wall dual-box ablation (PWDB) in the treatment for persistent atrial fibrillation (AF) combined with enlarged left atrial anteroposterior diameter.[Methods] A total of 44 persistent AF patients with enlarged left atrial anteroposterior diameter were randomly divided into PWDB group (n=23) and 2C3L group (n=21).In the PWDB group,patients underwent circumferential right pulmonary vein isolation and linear ablation lesions from the superior pole of the right superior pulmonary veins to the left atrial posterior wall,which was called dual-box ablation.The bilateral pulmonary-vein isolation plus additional linear ablation across the left atrial roof,mitral isthmus and tricuspid isthmus were performed in the 2C3L group.The clinical general data,total operation time,X-ray exposure time,ablation time,the cardioversion rate via ablation and the cases of perioperative complications were compared between the two groups.After 12-month follow-up,the success rate of ablation,the change of left atrial anteroposterior diameter and adverse events were observed.[Results] The clinical general data were not different in the two groups.Compared with the 2C3L group,the total operation time (166.9 ± 28.3) min vs (195.5 ± 23.4) min,P =0.001),X-ray exposure time (21.9 ± 3.6) min vs (25.9 ± 2.9) min,P＜ 0.0001) and ablation time (38.6 ± 4.5) min vs (43.9 ± 6.1)min,P=0.002) were shorter in the PWDB group.The cardioversion rate via ablation (26.1％ vs 33.3％,P =0.599) showed no difference in both groups.There were no perioperative complications in both groups.During the 12-month follow-up,13 patients (56.5％) in the PWDB group and 13 patients (61.9％) in the 2C3L group kept sinus rhythm and the difference was not significant (P =0.720).The adverse events (0 case vs 1 case,P=0.477) also showed no significant difference.[Conclusion] The 12-month success rate and safety show no difference between 2C3L and PWDB in the treatment for persistent AF patients with enlarged left atrial anteroposterior diameter.The operation efficiency of PWDB is higher.Therefore,it is of certain clinical value.

目的 探讨老年患者择期经皮冠状动脉介入治疗(PCI)中应用低剂量比伐卢定的安全性.方法 连续选取年龄＞65岁冠心病患者162例,随机分为标准剂量组(n=80)和低剂量组(n=82).PCI术前两组患者接受静脉推注负荷剂量比伐卢定0.75 mg/kg,术中标准剂量组以1.75 mg· kg-1·h-1加术后0.2 mg· kg-1· h-1剂量持续给药2h,低剂量组以1.5mg·kg-1·h-1加术后0.15 mg·kg-1·h-1剂量持续给药2h.对比分析两组患者给药后5 min、30 min、手术终止时、术后1h活化凝血时间(ACT)值以及术后1个月内出血事件、心肌梗死、靶血管重建、支架内血栓、不明原因卒中发生率.结果 低剂量组给药后30 min、手术终止时、术后1 h ACT值与标准剂量组相比均明显降低,分别为(331.2±53.5)s对(383.5±74.7)s、(324.9±47.6)s对(371.3±65.4)s、(289.6±34.9)s对(314.8±43.1)s,P值均＜0.001.两组患者术后1个月内心肌梗死、一般出血事件发生率比较,差异均无统计学意义(P＞0.05),未发生大出血、靶血管重建、支架内血栓和不明原因卒中事件.结论 老年冠心病患者择期PCI术中应用低剂量比伐卢定抗凝,具有良好的治疗效果及安全性.

目前,在40余种主要传染病中占首位的疾病传播媒介是空气.随着"非典"、"禽流感"等严重呼吸道传染病的局部流行,人们对空气质量的要求越来越高,作为预防疾病、防止交叉感染的重要措施之一的空气消毒也日益受到重视.