目的 观察诊室血压正常的代谢综合征(MS)患者的血压波动情况,分析MS发生的影响因素及其对心脑血管事件的影响.方法 选择2015-02～ 2017-09在该院心内科住院的可疑冠心病患者125例,根据MS的发生情况将其分为非MS组(n=60)和MS组(n=65),比较两组一般临床指标及动态血压参数的差异,分析MS发生的影响因素及其对主要心脑血管事件(MACCE)发生的影响.结果 MS组腰围、体质量指数(BMI)、三酰甘油(TG)、空腹血糖和糖化血红蛋白(HbA1c)水平高于非MS组,合并糖尿病、隐蔽性高血压(MH)人数比例大于非MS组,但HDL-C水平低于非MS组(P＜0.05).MS组24h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白天收缩压平台、夜间收缩压平台及清晨收缩压上升速度、24h平均动脉压(24hMAP)、白天平均动脉压(dMAP)及夜间平均动脉压平台均显著高于非MS组(P＜0.05).Logistic回归分析结果显示,较大的腰围、更高水平的BMI及清晨收缩压上升速度是促进MS发生的危险性因素,而较高水平的HDL-C是抑制MS发生的保护性因素(P＜0.05).以发生MACCE为结局进行生存分析,结果显示MS组发生MACCE的风险显著高于非MS组(P＜0.05).结论 MS的发生会升高收缩压水平和加剧清晨血压波动,并可能会进一步增加MACCE发生的风险.

目的 应用结构方程模型(SEM)对徐州市某三甲医院医务人员归属感的影响因素进行分析,对于采取有效措施提升医院医务人员归属感、促进医院和谐稳定发展提供依据.方法 采用自行设计"医院医务人员归属感调查量表"对徐州市某三级甲等综合性医院对医务人员归属感进行调查,运用Liser 8.7对医务人员归属感影响因素进行结构方程模型分析.结果 压力因素对医务人员归属感的直接效应系数是-0.59,间接效应系数为-0.137,总效应系数为-0.73.对医院评价因素对医务人员归属感的直接效应系数是0.42,间接效应系数为0.338,总效应系数为0.73.医务人员满意度对医务人员归属感直接影响因素系数为0.72.结论 使用SEM可以筛选出对医务人员归属感的影响因素,发现并定量分析因素直接存在的直接和(或)间接效应,并为今后相关研究提供方法上的借鉴.

Objective To investigate the relationship between central arterial pressure ( CAP) and severity of coronary artery lesions,and predictive value of CAP. Methods The 98 coronary heart disease ( CHD) patients proved by coronary angiography were enrolled in this study from November 2011 to October 2012 in our hospital. The average age was ( 65. 7 ± 9. 8 ) years old. The 54 patients combined with hypertension. There were two groups according to the number of lesional vessels:single vessel group ( n=48) and multi-vessels group (n=50). Ascending aortic pressure was measured by catheter during coronary angiography,and brachial blood pressure ( BP) was measured by a standard sphygmomanometer. BP data was collected for all participants. MACE was recorded during two years follow up. Results CASP,CAPP, SBP and DBP were all higher in multi vessels group than those in the single vessel group ( all P<0. 05 ) . Kaplan?Meier survival curves showed that MACE was significantly higher when CAPP was≥49 mmHg (χ2 =11. 216,P=0. 001). MACE was obviously higher in multi-vessels group than in single vessel group (χ2 =7. 716,P=0. 005). CAPP was the risk factor for MACE after adjustment by age,BMI,smoke and BP (RR:1. 095,95%CI:1. 030-1. 165,P=0. 004). Conclusions There is a close relationship between CAP and severity of coronary artery lesion. CAPP is a main risk factor for MACE in patients with CHD.

Objective To observe the improvement effect of alprostadil based on routine therapy for chronic congestive heart failure (CHF), and investigate further the risk factors influencing the prognosis in patients with CHF.Methods CHF patients (n=130, male 45, female 85, aged from 53 to 79, and average age=68.5±7.8) were chosen from May 2013 to Jun. 2014, and then randomly divided into control group and treatment group (each n=65). The control group was treated with routine anti-CHF drugs and treatment group was additionally treated with alprostadil (10 μg) once a day for 7 d. The changes of 6-minute walk test (6MWT), plasma N-terminal pro brain natriuretic peptide (NT-proBNP), hospitalization duration, left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), left ventricular end-diastolic inner diameter (LVEDd) and left ventricular end-systolic diameter (LVESd) were compared in 2 groups before and after treatment. All patients were followed up for 120 d, and numbers of re-hospitalized cases due to progressive CHF and hospitalization duration were recorded.Results Compared with control group, 6MWD increased [(359.9±144.4) mvs. (414.9±145.1) m] and NT-proBNP decreased [(3120.0±1811.6) ng/Lvs. (2350.1±1731.1) ng/L] in treatment group (allP<0.05). The first time hospitalization duration was shorter in treatment group than that in control group [(11.2±2.6)vs. (12.3.±3.5),P<0.05]. After treatment, LVEF [(42.6±7.9)%vs. (45.7±7.7)%] and LVFS [(33.3±4.1)%vs. (35.1 ±4.3)%] increased and LVEDd decreased [(52.3±5.8) mmvs. (49.9±6.0) mm] in treatment group compared with control group (P<0.05). After followed up for 120 d, there were 26 cases re-hospitalized, and 15 in control group and 11 in treatment group. The interval between discharge and re-hospitalization was longer in treatment group than that in control group [(101.6±19.0)vs. (69.5±16.0),P<0.01]. The level of NT-proBNP (RR=7.395, 95%CI: 1.881~29.073) and COPD (RR=7.120, 95%CI: 2.762~18.349) were risk factors of progressive CHF. Theadministration of alprostadil based on routine therapy might improve the prognosis in CHF patients (RR=0.253, 95%CI: 0.096~0.666).Conclusion The administration of alprostadil based on routine therapy can further improve heart function and prognosis in CHF patients.

Objective : To study the effects of morning and bedtime intake of nifedipine controlled release tablets on blood pressure, and the relationship between morning blood pressure surge and cardio-cerebral vascular events.Methods: One hundred and ten newly diagnosed hypertensive patients, aged from 32 to 76 years, were randomly divided into morning and bedtime groups in which the patients took a 30 mg nifedipine controlled release tablet at 6:00 am to 8:00 am and 7:00 pm to 9:00 pm, respectively (n = 55 per group).All patients underwent 24-hour ambulatory blood pressure monitoring before and after 8 weeks of treatment.The difference of 24-hour ambulatory blood pressure value between the 2 groups and its association with cardio-cerebral vascular events in 18 months of follow-up were analyzed.Results: The 24-hour, daytime, and nighttime mean systolic blood pressures (24hSBP, dSBP, and nSBP) in the bedtime group were significantly lower than the morning group (P < 0.01).The rate of morning increase in SBP in the bedtime group was significantly lower than the morning group (P < 0.01) and was positively correlated with daytime SBP plateau, dSBP, and 24hSBP (r = 0.383, 0.206, and 0.212, all P < 0.05).Logistic regression analysis showed that the rates of morning increase in SBP and daytime SBP plateau were independent risk factors for cardio-cerebral vascular incidents (odds ratio = 1.20, 95% confidence interval = 1.06-1.35;odds ratio = 1.13, 95% confidence interval = 1.01-1.26,both P < 0.05).Conclusion: Administration of nifedipine controlled release tablets at bedtime is more effective in reducing blood pressure and morning blood pressure surge.The rate of morning increase in SBP is possibly an important risk factor for cardio-cerebral vascular events.

Currently,expenses for medical treatment grow very fast and the problem of"difficulty in seeing a doctor and costliness in seeking medical treatment"is still extruding. Since 2012,to control medical expenses,the overall prepayment of medical insurance has been carried out in settling medical insurance in Xvzhou City. Facing the changes in paying medical insurance,all medical institutions take corresponding methods to meet the challenge. The authors expound the influence of the overall prepayment on hospitals and the new changes in hospital operation,and put forw ard suggestions as revelation for hospital management and medical insurance department.

Objective To analyze the main influencing factors of the hospitalization expense of percutaneous coronary heart disease patients with medical insurance and to provide the theoretic evidences for the reasonable control of the medical ex-penses.Methods 1 851 urban medical insurance inpatients with percutaneous coronary heart disease were chosen and they were discharged from a first-rate hospital from January 1, 2012 to December 31, 2013 in Xuzhou city.The medical expenses were ana-lyzed with descriptive statistics, nonparametric test, stepwise multiple linear regression analysis methods.Results The average expenditure of percutaneous coronary heart disease patients with medical insurance was 50 966.01 Yuan.Medical consumables costs and drug costs made up the most expenses, accounting for 63.9% and 20.1% respectively.Hospitalization days was the primary affecting factor through multivariate analysis.Conclusion In order to control the growth of unreasonable medical costs, we should control medical consumables costs, drug costs and shorten the ineffective hospitalization days.

目的 观察硝苯地平控释片不同时间给药对血压、血压昼夜节律及血压晨峰的影响,进一步探讨清晨血压上升速度是否是发生心血管事件的危险因素.方法选择初诊高血压患者110例,年龄32～76岁,随机分为两组:清晨服药组(n=55,6:00-8:00服硝苯地平控释片30 mg)和夜间服药组(n=55,19:00-21:00服硝苯地平控释片30 mg),服药前及服药8周后由同一研究小组完成24 h动态血压监测.分析两组动态血压的差异及动态血压与随访18月后心脑血管事件(心肌梗死或脑卒中)的关系.结果 夜间服药组24 h平均收缩压(24hSBP)、白天收缩压(dSBP)、夜间收缩压(nSBP)低于清晨服药组(P＜0.01).夜间服药组清晨收缩压上升速度较清晨服药组降低[(7.3±4.8)比(11.3±9.6)mm Hg/h,P＜0.01].单因素相关分析显示,清晨收缩压上升速度与白天收缩压平台、dSBP及24hSBP呈正相关(分别r=0.383、0.206、0.212,均P＜0.05).Logistic回归分析结果显示,清晨收缩压上升速度及白天收缩压平台是心脑血管事件发生的危险因素(OR=1.20,95％ CI 1.06～1.35;OR=1.13,95％CI1.01～1.26;均P＜0.05).结论 夜间服硝苯地平控释片能更有效地降低血压水平及清晨血压上升速度;清晨收缩压上升速度加快可能是心脑血管事件的危险因素.

目的 分析徐州市医保冠心病非手术治疗患者住院费用的构成情况及基本特征,确定适合徐州市医保住院患者的疾病诊断相关组合(DGRs).方法 以徐州市某三级甲等医院2012-2013年12月出院的719例冠心病非手术治疗医保患者为样本,运用决策树卡方自动交互检验法(CHAID)进行分组.结果 医保冠心病非手术治疗患者分成7个相关诊断组.结论 运用决策树技术对制定医保冠心病非手术治疗患者标准住院费用具有参考价值.

患者是医院服务质量的重要评价者之一,患者的满意程度是反映医院服务质量的一个关键指标[1].患者满意度也称为医院顾客满意度,是指患者基于自己期望被满足的程度对医疗服务的评价,有的研究亦称其为"病人满意度".有学者认为"人们由于健康、疾病、生命质量等方面的要求而对医疗保健服务产生某种期望,在医疗服务消费的经历中,通过对医疗服务各方面的感知与这种期望的对比,产生的对医疗保健服务的综合性评价"就是患者满意度,更有的文章将它定义为公式:病人满意度=病人感受值/期望值[2].在发展和谐社会的大环境中,患者对医院服务的满意程度也是考核政府管理水平和反映社会稳定和谐程度的一个重要指标[3].

目的 探讨应用别嘌醇降低血尿酸水平对控制不同程度的慢性肾功能衰竭进展的作用.方法 患者分两大组分别比较.轻中度慢性肾功能衰竭患者伴有高尿酸血症者51例,随机分为别嘌醇治疗组24例和对照组27 例;重度慢性肾功能衰竭患者(未行透析治疗或血清肌酐<707 μmmol/L)伴高尿酸血症患者48例,随机分为别嘌醇治疗组23例和对照组25例.别嘌醇治疗组患者给予别嘌醇200 mg/d,控制血尿酸于正常范围内;慢性肾功能衰竭药物治疗方案2组相同.观察期限12个月,比较两大组中别嘌醇治疗组与对照组患者慢性肾功能衰竭进展的差异.结果 轻中度慢性肾功能衰竭患者中,别嘌醇治疗组与对照组血肌酐和尿素氮水平均有升高,别嘌醇治疗组肌酐和尿素氮水平上升幅度低于对照组(P<0.05),同时别嘌醇治疗组血尿酸明显低于对照组(P<0.05).重度慢性肾功能衰竭患者中,别嘌醇治疗组与对照组血肌酐和尿素氮水平均有升高且上升幅度无明显差异(P>0.05),但别嘌醇治疗组血尿酸明显低于对照组(P<0.05).结论 别嘌醇通过降低血尿酸水平,可明显延缓轻中度慢性肾功能衰竭的进展,但不能控制重度慢性肾功能衰竭的进展.

Objective The aims of this study were to investigate the effect of smoking on circadian rhythm of ambulatory blood pressure(ABP) in male hypertension patients and to evaluate relation between the rate of systolic blood pressure(SBP) increase in the morning and target organ damage.Methods Based on smoking status,300 male hypertension patients were divided into non-smoking(n=100),smoking quitted(n=100) and smoking group(n=100).Twenty-four hours ambulatory blood pressure monitoring and body mass index(BMI),fasting blood glucose,serum total cholesterol,triglycerides,high density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C) were measured.A double logistic curve-fitting procedure was used to analyze ABP recordings and to determine the association between the rate of morning SBP increase and the incidence of myocardial infarction and stroke.Results ①The age,BMI,drinking habit,duration of hypertension,fasting blood glucose,serum total cholesterol,triglycerides,HDL-C,LDL-C and other parameters showed no significant differences(P0.05) among 3 groups.②The levels of 24 h mean systolic blood pressure(24hSBP),daytime mean systolic blood pressure(dSBP) and 24 h pulse pressure(24hPP) in smoking group were significantly higher than non-smoking and smoking quitted groups(P0.05).Non-smoking group and smoking quitted group showed no differences in all the parameters(P0.05).③The rate of morning SBP increase in smoking group was significantly higher than non-smoking and smoking quitted groups \[(16.5±1.2) vs(7.3±0.9) vs(9.8±0.9)mm Hg/h,P0.01\].④There was an association between the daytime SBP plateau(r=0.151,P0.05),24hPP(r=0.143,P0.05) and rate of morning SBP increase.After adjusted for age,BMI,24hSBP and other parameters,the rate of morning SBP increase was significantly correlated with daytime SBP plateau(rtotal=0.232,rnon-smoking=0.274,rsmoking=0.283,all P0.01).⑤Logistic regression analysis showed that the rate of morning SBP increase(OR=1.326,95% CI 1.083-1.624,P=0.001),and daytime SBP plateau(OR=1.292,95% CI 1.046-1.595,P=0.017) were independent determinants for target organ damage in male hypertension patients.Conclusion The rate of morning SBP increase and daytime SBP were significantly higher in male hypertensive patients with long time smoking and the rate of morning SBP increase may be the best predictor for target organ damage.

Background: Functional TRIB3 Q84R polymorphism has been associated with insulin resistance. Obestatin, improving insulin resistance, exerts obscure effects on metabolic syndrome (MetS) and carotid atherosclerosis. Aims to investigate whether the prevalent TRIB3 Q84R polymorphism has profound implications for alterations of serum obestatin and what effect obestatin exerts on carotid atherosclerosis.Methods: A total of 518 unrelated Chinese subjects consisted of control (n = 258) and MetS (n = 260) groups. Clinical and biochemical characteristics were collected. The level of serum obestatin was measured. Genotype the functional TRIB3 Q84R polymorphism. All subjects underwent ultrasonography to determine carotid intima-media thickness (IMT).Results: Serum obestatin was significantly decreased in MetS as compared with the control group (P = 0.042). Among the MetS group participants possessing RR84 genotype had significantly lower levels of serum obestatin than those with QQ84 or QR84 genotypes (P = 0.008, P = 0.043) with similar significant difference among the control group. Factorial analyses showed statistically significant interactions between MetS and RR84 genotype (P = 0.009 for interaction for obestatin). On correlation analysis, obestatin correlated negatively with homeostasis model assessment insulin resistance (r = -0.163, P = 0.010) and IMT (r = -0.256, P = 0.011). On partial analyses, obestatin negatively correlated with IMT(r = -0.259, P = 0.024) after controlling for the confounding factors.Conclusion: MetS individuals with TRIB3 RR84 genotype demonstrated further decreased serum obestatin. Decreased serum obestatin might in part exacerbate insulin resistance and carotid atherosclerosis.

Objective To investigate the effects of hematodialysis and hematodiafiltration on anemia of the patients who were troubled in CRF.Methods Sixty patients with CRF were chosen and treated with maintenance hemodialysis and divided into HD group and HDF group randomly,the changes of Hb,HCT,Sf and hs-CRP of sufferers at the time of pretherapy and 12 weeks after therapy were recorded.Results The HDF group demonstrated a preferable amendment in the levels of Hb,HCT and Sf when compared with that of HD group after therapy.Conclusion The HDF outweighed the HD on the contributions to improve the anemia of the patients with CRF.

Objective:To investigate whether atorvastatin exerts an effect on glucose metabolism in metabolic syndrome patients with hypercholesterolemia.Methods:A randomized prospective study was conducted in 44,42,and 43 patients given daily atorvastatin 10,20,and 40 mg,respectively,during a 10-week treatment period.Results:Atorvastatin 10,20,and 40 mg significantly reduced total cholesterol and LDL cholesterol(P<0.05) after 10 weeks compared with baseline.Atorvastatin 20 and 40 mg significantly increased fasting plasma insulin(P<0.01).All treatment groups experienced significantly elevated insulin resistance and glycated hemoglobin levels(P<0.05) when compared with baseline.Atorvastatin 40 mg further increased insulin resistance(P<0.001) compared with atorvastatin 20 mg,however,only Atorvastatin 40 mg resulted in increased blood glucose(P<0.05).Conclusion:Despite beneficial effects on lipid profiles,atorvastatin treatment resulted in significant increases in insulin resistance and glycated hemoglobin levels consistent with impaired blood glucose in metabolic syndrome patients with hypercholesterolemia.

Objective:To investigate the effect of abdominal obesity on cardiac structure and function in overweight individuals.Methods:A total of 237 healthy volunteers were recruited and assigned to normal weight group(n=78),overweight group(n=87)and overweight with abdominal obesity group(n=72).All subjects underwent conventional echocardiography and tissue Doppler imaging(TDI).Results:Compared with the normal weight group,overweight and overweight with abdominal obesity groups showed thickened ventricular walls,augmented left ventricles,increased left ventricular mass index(LVMI)and enhanced mitral E/TDI Em(P<0.05),with TDI Em and TDI Em/Am ratio significantly reduced.Compared with those in overweight group,subjects in overweight with abdominal obesity group showed more significant alterations.Body mass index had significant positive correlation with IVSd(r=0.271),LVEDd(r=0.313),LVMI(r=0.429),LVPWd(r=0.455)and mitral E/TDI Em(r=0.379),but negative correlation with TDI Em(r=-0.362)and TDI Em/Am ratio(r=-0.298).Waist circumference was significantly positively correlated with LVPWd(r=0.347),LVEDd(r=0.435),LVMI(r=0.413),mitral A(r=0.338),TDI Am(r=0.422)and mtiral E/TDI Em(r=0.459),but negatively correlated with mitral E/A ratio(r=-0.287),TDI Em(r=-0.386)and TDI Em/Am ratio(r=-0.236).Conclusion:Alterations of cardiac structure and function in overweight subjects were similar to those in obese individuals,including augmented diameter,increased LVMI and decreased diastolic function,which would be exacerbated by abdominal obesity.Conventional echocardiography combined with tissue Doppler imaging would be effective to detect the alterations of cardiac structures and functions non-invasively.