Objective To compare the clinical efficacy of contact thrombolytic therapy between transradial artery intervention (TRI) and transfemoral artery intervention (TFI) pathways in patients with acute ischemic stroke (AIS). Methods The clinical data of 64 patients with AIS consistent with the indication of arterial thrombolysis in the People's Hospital of Huimin County of Shandong province from January 2010 to October 2017 were treated with arterial contact thrombolysis after exclusion of contraindications, including 42 cases treated with TRI (TRI group) and 22 cases treated with TFI (TFI group), and they were analyzed retrospectively. The differences in success rate of puncture, puncture time, the interval between the sheath set to the artery and the catheter reaching the diseased vessels, the re-canalization rate of occlusive vessels, surgical time, puncture site bleeding and intracranial bleeding complications and clinical outcomes in the patients were compared between the two groups. Results The comparisons of following indicators between the TRI group and TFI group were as follows: success rate of puncture [97.6% (41/42) vs. 100.0% (22/22)], puncture time (minutes: 5.5±2.0 vs. 5.4±2.3), the interval between sheath set to the artery and catheter reaching the diseased vessel (minutes: 6.2±3.8 vs. 6.7±3.9), occlusive vascular re-canalization rate [45.2% (19/42) vs. 40.9% (9/22)], operation time (hours: 1.50±0.38 vs. 1.45±0.32), incidence intracranial bleeding complications [9.52% (4/42) vs. 9.09% (2/22)], and the differences in above indicators in comparisons between the two groups had no statistical significance (all P > 0.05); however, the complication of bleeding at puncture site in TRI group was significantly lower than that in TFI group [0 vs. 22.7% (5/22), P < 0.05]. There was no statistical difference in clinical outcomes between the two groups. Conclusion It is safe and effective to treat patients with AIS by the TRI approach.

目的 探讨D-二聚体、分泌型卷曲相关蛋白5(SFRP5)、脂联素与内脏脂肪组织源性丝氨酸蛋白酶抑制剂(VASPIN)联合检测在冠心病临床诊断中的应用.方法 选择老年冠心病患者240例,其中急性心肌梗死(AMI)组80例、不稳定性心绞痛(UAP)组80例、稳定性心绞痛(SAP)组80例.另选取健康体检者80例为对照组.分析4项指标的差异及其与Gensini积分的相关性.结果 4组D-二聚体、SFRP5、脂联素与VASPIN水平及Gensini积分比较,差异有统计学意义(P＜0.01).与对照组比较,SAP组、UAP组和AMI组D-二聚体及Gensini积分明显升高,SFRP5、脂联素及VASPIN水平明显降低(P＜0.05).SAP组和UAP组D-二聚体及Gensini积分水平显著低于AMI组,SFRP5、脂联素及VASPIN水平明显高于AMI组(P＜0.05);SAP组D-二聚体水平及Gensini积分明显低于UAP组,SFRP5、脂联素及VASPIN水平明显高于UAP组(P＜0.05).Spearman相关性分析结果显示,SFRP5、脂联素及VASPIN水平与Gensini积分呈明显的负相关(r=-0.662,r=-0.532,r=-0.848,P＜0.01),D-二聚体与Gensini积分呈正相关(r=0.526,P=0.003).4项指标联合检测敏感性明显高于各项指标单独检测(P＜0.05).结论 4种指标联合检测可为老年冠心痛类型鉴别诊断和疾病严重程度评估的重要依据.

<正>慢性充血性心力衰竭(CHF)时心脏负荷增加,心肌能量消耗并刺激心肌细胞生长,造成心肌失代偿性肥厚,导致能量缺乏状态加重。心肌能量代谢紊乱在充血性心衰发生、发展中起着关键的作用。左卡尼汀是广泛存在于机体组织内,尤其是心

Objective To evaluate the influence of chronic renal dysfunction on prognosis of patients with ST-segment elevated myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PCI).Methods Data of 743 STEMI patients undergoing primary PCI in Beijing Anzhen hospital were retrospectively collected.Patients were divided into the renal dysfunction group and control group according to estimated glomerular filtration rate(eGFR) < or ≥60 mL·min-1·1.73 m-2.Clinical characteristics,lesion characteristics and prognostic outcomes were compared between the two groups.Results Compared with control group,patients in renal dysfunction group were elder and less male patients,there were more patients with heart failure,hypertension,diabetus mellitus,previous myocardial infarction history,multiple vascular disease and cardiac inadequacy(Killip′s grade≥2)in renal dysfunction group(P<0.05).Major adverse cardiovascular event(MACE) rate and death rate were higher in renal dysfunction group than control group during the period of hospital stay and after following up for 2 years(P<0.05).The results of Logistic multifactor regression analysis showed that,eGFR<60 mL·min-1·1.73 m-2,age≥70 years,Killip′s grade≥2,diabetus mellitus,previous myocardial infarction history and multiple vascular disease were independent predictors of 2-year death(P<0.05),and the corrected relative risk of eGFR<60 mL·min-1·1.73 m-2 was 1.93(95%CI=1.24-4.56,P=0.01).Conclusion Prognosis of STEMI patient undergoing primary PCI combined with chronic renal dysfunction is bad.Estimated GFR<60 mL·min-1·1.73 m-2 is the strongest risk factor for unfavourable prognosis of the STEMI patients who undergo primary PCI.

Objective To evaluate the therapeutic effect of haemoperfusion (HP) in treating patients with pulmonary injury after Paraquat(PQ) poisoning. Methods Fourty-nine patients were studied retrospectively. Of them, 27 patients received HP therapy(HP group), and the other 22 patients did not (control group). Pulmonary function were evaluated by detecting PaO2, SaO2, PacO2,VC, FVC, FEV1, X-ray changes in chest before and after HP therapy, the incidence of ARDS and MODS were compared. Results In HP group, the incidence of hypoxemia and type I respiratory failure was lower than that in control group (P<0.05 and P<0.01 respectively), the incidence of restrictive hypoventilation and diffuse dysfunction dereased, and manifestions in chest X-ray were lightened after treatment. Patients with MODS with without ARDS when permitted aggravated rapidly and had a poor prognosis. Conclusion Performing HP as soon as possible can not only ameliorate the pulmonary injury but also promote the absorption of vesicle and interstitial exudates, decelerate the formation of pulmonary fibrosis.

目的通过对百草枯(paraquat,PQ)中毒后血液灌流(haemoperfusion,HP)治疗前后的临床观察和实验检查分析,评价其在改善PQ中毒后肺损伤的临床应用价值.方法回顾性分析了山东省惠民县人民医院肾内科49例PQ中毒患者,其中27例实施HP(治疗组),22例未实施HP(对照组),通过检测患者的动脉氧分压(PaO2)血氧饱和度(SaO2),二氧化碳分压(PaCO2),肺流量(VC),用力肺活量(FVC),1秒量(FEV1)及肺部影像学改变,比较两组ARDS及MODS发生率综合估价肺损伤的情况.结果在HP组,低氧血症、Ⅰ型呼吸衰竭发生率明显低于对照组(分别为P＜0.05和P＜0.01);影像学表现明显减轻;限制性通气障碍发生率明显降低.入院时即出现MODS伴(或不伴)ARDS者病情进展迅速,预后不良.结论尽早实施血液灌流不仅能减轻对肺组织的损伤,还能够促进肺泡或肺间质渗出液的吸收,减少肺纤维化的形成.

百草枯(又名克芜踪,属联吡啶类除草剂,化学名1,1-二甲基-4,4-联吡啶阳离子盐).人类中毒主要通过消化道吸收,多表现为多脏器损伤或功能衰竭.由于血浆致死浓度很低,目前尚无特效解毒剂,常规治疗病死率极高[1],我院自1999年开始采用血液灌流(HP)治疗,效果较满意.