63例非典型急性下壁心肌梗死临床分析

目的：研究评价各种常见诱因对急性下壁心肌梗死（IAMI）患者误诊判断的临床意义。方法：选择2002年1月-2009年12月我院急门诊IAMI患者63例,对其首发症状、心电图资料进行回顾性分析。结果：63例中,以头晕乏力首诊19例（30．16％）,以晕厥首诊11例（17．46％）,以上腹痛伴恶心呕吐,偶腹泻首诊13例（20．63％）,以咽痛或牙痛首诊10例（15．87％）,以呼吸困难首诊8例（12．70％）,以左心衰竭首诊2例（3．17％）。结论：对急性下壁心肌梗死患者,常规心电图检查是必要的。再结合心肌坏死生化标志物指标,早诊断,早治疗。     

急性肺栓塞的心电图表现特点分析

目的:探讨急性肺栓塞的心电图表现特点,提高急性肺栓塞的诊断水平。方法:选取我院急诊收治的急性肺栓塞患者79例,进行床旁心电图多次动态检测,观察急性肺栓塞患者心电图的基本特点,分析心电图对急性肺栓塞的临床诊断意义。结果:在79例患者中,发生心电图改变者72例(91.14%),其中窦性心动过速者63例(79.74%),为最常见的心电图改变;Ⅰ导联S波较深者51例(64.56%);Tv1-v3倒置者45例(56.96%);Tv1-v2倒置者31例(39.24%);右束支传导阻滞改变者27例(34.17%);Tv1-v4倒置者18例(22.78%)。典型的肺栓塞SⅠQⅢTⅢ心电图表现少见,仅14例(17.72%),而心电图表现为QⅢTⅢ者49例(62.02%)。结论:急性肺栓塞的心电图改变具有非特异性和复杂多变性,临床医生应将心电图检查结果作为诊断依据之一,仍需结合患者的临床表现,进行综合分析判断,再给予合理诊断及时治疗,以改善急性肺栓塞患者的预后。     

急性心肌梗死患者心电图碎裂QRS波与左心室收缩功能、心率变异性及心脏事件的关系研究

目的:探讨急性心肌梗死患者心电图碎裂QRS(f QRS)波与左心室收缩功能、心率变异性及心脏事件的关系。方法:收集2018年1月～2020年1月期间于本院进行治疗的急性心肌梗死患者124例,对患者行心电图检查,根据患者心电图是否出现f QRS波分成f QRS组(59例)和无f QRS组(65例),采用多普勒超声诊断仪对两组患者的左心室收缩功能进行检测对比,并对两组患者进行24h动态心电图检查,对两组患者的心率变异性指标进行统计对比。对两组患者进行为期3个月的随访观察,统计对比两组患者随访期间心脏事件的发生率。结果:f QRS组患者的左室射血分数(LVEF)低于无f QRS组,左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)均高于无f QRS组(P0.05)。f QRS组患者总标准差(SDNN)、两个相邻RR间期互差(PNN50)、差值均方根(RMSSD)均低于无f QRS组(P0.05)。随访期间f QRS组患者的心脏事件发生率为35.59%(21/59),高于无f QRS组患者的13.85%(9/65)(P0.05)。结论:伴有心电图f QRS波急性心肌梗死患者的左心室收缩功能降低,心率变异性指标降低,且心脏不良事件发生率增加,心电图f QRS波在一定程度上可作为急性心肌梗死患者心功能、心率变异性及心脏事件发生的监测手段。     

克塞灵与尿激酶治疗急性心肌梗死疗效观察

我院从 1 996年以来分别应用克塞灵、尿激酶(UK)静脉溶栓治疗急性心肌梗死 62例 ,取得了满意效果 ,现报道如下。1　临床资料1 .1　一般资料　 62例患者均发病 6h以内 ,经临床、心电图及血清酶学等检查后确诊为急性心肌梗死 ,70岁以下 (克塞灵组放宽为 75岁以下 ) ,无溶栓禁忌症。根据用药情况随机将患者分为克塞灵组与尿激酶 (UK)组。克塞灵组 36例 ,其中男 2 9例 ,女 7例 ,平均年龄 (59.5± 1 2 )岁。梗死部位 :前间壁 6例 ,前壁 1 1例 ,后壁 2例 ,下壁 1 1例 ,复合梗死 6例 (下壁 前间壁 2例 ,下壁 广泛前壁4例 )。 UK组 2 6例 ,其中…     

经血栓抽吸导管应用替罗非班及硝普钠对急性前壁ST段抬高型心肌梗死患者急诊PCI治疗效果的影响

目的:探讨经血栓抽吸导管应用替罗非班及硝普钠对急性前壁ST段抬高型心肌梗死患者急诊经皮冠状动脉介入(PCI)治疗效果的影响。方法:选取2013年5月～2018年5月期间我院收治的急性前壁ST段抬高型心肌梗死患者80例,根据随机数字表法分为对照组(n=40,血栓抽吸术后行PCI治疗)和研究组(n=40,血栓抽吸术后,经导管注入替罗非班及硝普钠后再行PCI治疗),比较两组患者心电图ST段回落变化、心肌梗死溶栓治疗(TIMI)血流分级情况、心功能指标及不良心血管事件发生率。结果:研究组完全回落发生率高于对照组(P0.05);两组部分回落、无回落发生率比较差异无统计学意义(P0.05)。对照组PCI术后TIMI血流分级为3级的例数少于研究组(P0.05)。两组患者术后7 d左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)降低,且研究组低于对照组(P0.05);左室射血分数(LVEF)升高,且研究组高于对照组(P0.05)。术后6个月内研究组不良心血管事件总发生率为7.50%(3/40),低于对照组的25.00%(10/40)(P0.05)。结论:急性前壁ST段抬高型心肌梗死患者经血栓抽吸导管应用替罗非班及硝普钠后行PCI,可提高心功能、心肌灌注状态及心电图ST段完全回落率,并减少不良心血管事件的发生率。     

急性肺栓塞心电图分析研究

目的:通过对急性肺栓塞患者心电图的观察,把握其特征和临床表现,提供诊断急性肺栓塞的依据。方法调查6年间我院30例急性肺栓塞患者的心电图资料,进行回顾性分析。结果:18例T波倒置(占60.00%),8例窦性心动过速(占26.67%),8例ST段下移或抬高(26.67%),8例Ⅲ导联Q波,I导联的S波加深(占26.67%),6例完全性右束阻滞(20.00%)2例心房震颤(占6.66%),3例顺时针向转位(10.00%),2例肺型P波(6.66%)。结论:对于急性肺栓塞,在心电图上表现出丰富的多样性和一过性,应在传统心电图检查的同时,结合临床症状,来诊断急性肺栓塞。     

血清胱抑素C水平对急性前壁心梗患者心功能有一定预测价值

为了探讨影响急性前壁心肌梗死患者经皮冠状动脉介入治疗术(PCI)后心力衰竭的因素,检测血清胱抑素C水平在用PCI术治疗急性前壁心梗患者心力衰竭术后影响,本研究选择2013年1月~2017年3月在我院接受PCI治疗的急性前壁心肌梗死患者287例作为研究对象,翻阅患者病历,记录患者性别、年龄、体质量指数、合并疾病、个人史、发病至手术时间、入院时血糖、血脂、血压、白细胞、受累导联数、术前用药、罪犯血管、术前LVEF、术后TIMI血流、病变血管术、BNP水平、CysC水平,观察上述指标与术后心力衰竭的相关性。结果本研究中287例急性前壁心肌梗死患者PCI术后出现心力衰竭71例,心力衰竭发生率为24.74%。单因素分析显示,年龄、糖尿病、高血压、梗死前心绞痛、术前血糖、白细胞、术前收缩压、术前舒张压、LDL-C、术前BNP、术前CysC、术前LVEF、术后TIMI分级是影响急性前壁心肌梗死患者PCI术后心力衰竭发生的危险因素(p0.05)。多因素分析显示,年龄73.6岁、高血压、术前血糖8.72 mmol/L、术前CysC1.57 mg/L是急性前壁心肌梗死患者PCI术后心力衰竭的独立危险因素(p0.05),LVEF48.57%、术后TIMI2级为急性前壁心肌梗死患者PCI术后心力衰竭的保护性因素(p0.05)。本研究表明,急性前壁心梗患者PCI术后心力衰竭是多种因素协同作用的结果,术前CysC水平升高对患者PCI术后心力衰竭具有一定预测价值,值得临床推广应用。     

急性心肌梗死患者的院前急诊护理研究

目的:研究分析急性心肌梗死患者的院前急诊护理方法和效果。方法:回顾我院2012年10月-2013年10月间收治的80例急性心肌梗死患者的资料,总结救治方法及护理效果。结果:急性心肌梗死患者的抢救成功率为92.5%(74/80),死亡率为7.5%(6/80)。结论:急性心肌梗死患者在入院前接受急诊护理,可以有效救治及护理,降低患者的死亡率,提高抢救的成功率。     

心肌带收缩率与急性心肌梗死患者左心室收缩功能关系

目的:急性前壁心肌梗死明显影响室间隔收缩率和左心室射血分数(left ventricular ejection fraction LVEF)。本文旨在探讨心肌带降段及升段收缩率与急性前壁心肌梗死患者LVEF的相关性。方法:收集2015年4月-2017年2月在心内科住院的急性前壁心肌梗死患者36例,正常对照组患者39例。所有患者取左心室长轴M型超声心动图,测量室间隔收缩率、升段收缩率及降段收缩率。心肌梗死左心室射血分数采用双平面Simpson's法计算。结果:与正常对照组相比,心肌梗死组患者舒张末期心肌带升段厚度没有统计学差异(P=0.69),收缩末期升段厚度(P=0.014)更薄、升段收缩率(P0.01)明显降低;心肌梗死组舒张末期降段厚度(P0.01)更薄、收缩末期降段厚度(P0.01)更薄、降段收缩率(P0.01)明显降低;心肌梗死组左心室射血分数与降段收缩率(r~2=0.13,P=0.026)、室间隔增厚率(r~2=0.19,P0.01)呈正相关,与升段收缩率没有相关性(P0.05)。正常对照组左心室射血分数与室间隔增厚率、降段增厚率及升段增厚率无相关性。经过相关分析,筛选出与心肌梗死LVEF的相关因素,进一步经逐步回归分析,得多元线性回归方程为LVEF=48.206+18.914*LVDD(cm)-25.414*LVSD(cm)。结论:急性前壁心肌梗死室间隔降段收缩率明显受损,与左心室射血分数降低有关。多元线性回归方程可估算前壁心肌梗死LVEF。     

蝮蛇抗栓酶联合硝酸甘油治疗高龄AMI疗效观察

栓酶联合硝酸甘油静脉滴注治疗60岁以上高龄急性心肌梗死(AMI)患者50例,取得满意疗效,现报告如下。1　资料与方法1.1　一般资料　所有病例均经临床、心电图及血清酶学检查,符合国际心脏协会(ISFC)与WHO关于AMI诊断标准。对60岁以上确诊为AMI患者(排除对蝮蛇抗栓酶过敏及有出血倾向者),随机分为治疗组和对照组。治疗组50例,其中男32例,女18例;年龄60～82岁,平均68.3岁。梗死部位:前间壁12例,前侧壁6例,广泛前壁7例,下壁9例,正后壁5例,双处梗死9例。并发心律失常35例,左心衰16例,肺部感染9例,休克3例。对照组30例,其中男17例,女13例;年…     

急诊昏迷患者的迅速分诊与急救方法探讨

目的:探讨急诊昏迷患者的迅速分诊与急救方法。方法:参照5级急诊预检分诊系统和急诊危重病降阶梯治疗方法,对我院2012年1月至2014年12月120例急诊治疗昏迷患者进行规范化分诊、急救护理,回顾性分析其诊疗效果。结果:120例昏迷患者有90例(75.00%)治愈出院,17例(14.17%)因病情平稳转至相关科室进行治疗,13例(10.83%)病死,急诊治疗总有效率和病死率分别为89.17%和10.83%。结论:分诊和急救处置的规范化对患者治愈和预后有重要影响。     

Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project.

OBJECTIVE: To describe the immediate and long term risk of epileptic seizures after a first ever stroke. DESIGN: Cohort study following up stroke survivors for 2 to 6.5 years; comparison with age specific incidence rates of epileptic seizures in the general population. SETTING: Community based stroke register. SUBJECTS: 675 patients with a first stroke, followed up for a minimum of 2 years. MAIN OUTCOME MEASURES: Occurrence of single and recurrent seizures. RESULTS: 52 patients had one or more post stroke seizures; in 25 the seizures were recurrent. The 5 year actuarial risk of a post stroke seizure in survivors (excluding 19 patients with a history of epilepsy and 3 patients in whom the seizure occurred shortly before death from another cause) was 11.5% (95% confidence interval 4.8% to 18.2%). The relative risk of seizures, in comparison with the general population, was estimated at 35.2 in the first year after stroke and 19.0 in year 2. The risk of seizures was increased in survivors of subarachnoid and intracerebral haemorrhage (hazard ratio for intracranial haemorrhage v cerebral infarction 10.2 (3.7 to 27.9)). The risk of seizures after ischaemic stroke was substantial only in patients presenting with severe strokes due to total anterior circulation infarction. Only 9 of 295 patients (3%) independent one month after stroke suffered a seizure between 1 month and 5 years (actuarial risk 4.2% (0.1% to 8.3%)). CONCLUSION: Stroke patients have about an 11.5% risk of single or recurrent seizures in the first 5 years after a stroke. Patients with more severe strokes or haemorrhagic strokes are at higher risk.     

Immunochemical analysis of nineteen ornithine transcarbamoylase deficiencies

Western blot analysis of 19 human ornithine transcarbamoylase (OTC) deficiencies characterized by neonatal (13 patients: type I) or later onset of symptoms (6 patients: type II) are reported. All the patients studied here are hemizygous males. In the first group, most of the patients had no residual enzymatic activity (11 patients). In 8 cases this is correlated with a complete absence of protein, in 1 patient with a much reduced amount and in 2 others with 80% of an OTC-related protein of normal molecular weight. Only 2 patients with neonatal onset of symptoms had a detectable OTC activity which ranged from 0.5 to 1% of the control. Among the second clinical group of 6 patients with later onset of symptoms, the residual OTC activity was between 5 and 20% at pH 8.0; 3 of them had abnormal kinetics and 50% an OTC-related protein.     

Delays in the diagnosis of oesophagogastric cancer: a consecutive case series.

OBJECTIVES: To examine the time taken to diagnose oesophageal or gastric cancer, identify the source of delay, and assess its clinical importance. DESIGN: Study of all new patients presenting to one surgical unit with carcinoma of the oesophagus or stomach. SETTING: University department of surgery in a large teaching hospital. SUBJECTS: 115 consecutive patients (70 men, mean age 66 years) with carcinoma of the oesophagus (27) or stomach (88). MAIN OUTCOME MEASURES: Interval from the onset of symptoms to histological diagnosis, final pathological stage of the tumour, and whether potentially curative resection was possible. RESULTS: The median delay from first symptoms to histological diagnosis was 17 weeks (range 1 to 168 weeks). 25% (29/115) of patients had a delay of over 28 weeks (median 39 weeks). Total delay was made up of the following components: delay in consulting a doctor (29%), delay in referral (23%), delay in being seen at hospital (16%), and delay in establishing the diagnosis at the hospital (32%). No relation was found between delay in diagnosis and tumour stage in patients with gastric cancer, but for oesophageal cancer those with stage I and II disease were diagnosed within 7 weeks compared with 21 weeks (P < 0.02) for those with stage III and IV disease. CONCLUSIONS: Long delays still occur in the diagnosis of patients with cancer of the stomach or oesophagus. Streamlined referral and investigation pathways are needed if patients with gastric and oesophageal carcinomas are to be diagnosed early in the course of the disease.     

Marked improvement in survival among adult Croatian AIDS patients after the introduction of highly active antiretroviral treatment

We compared the survival of patients following the first AIDS event in Croatia from the period 1986-1996 to the period 1997-2000. A total of 72 (81.8%) out of 88 patients from 1986-1996 and 18 (32.1%) out of 56 from 1997-2000 died. Survival following the first AIDS-defining illness markedly improved in the period 1997-2000 compared to the period 1986-1996 (adjusted Hazard Ratio (HR) for patients surviving more than 6 months: 0.11, 95% confidence interval (95% CI) = 0.04-0.29). A CD4+ cell count of < 100 x 10(6)/L was an independent risk factor for patients surviving up to 2 years (adjusted HR = 1.96, 95% CI = 1.1-3.43, p = 0.02). Patients with tuberculosis or fungal infections had a longer survival when compared to other diagnosis (adjusted HR = 0.53, 95% CI = 0.32-0.90, p = 0.01). However, despite dramatic survival benefit of combination antiretroviral therapy, mortality at six months following the first AIDS event was similar in the two study periods and the one-year probability of death was still substantial (27.2%) in the period 1997-2000.     

The incidence of stroke in Baranya county (east Croatia)

The aim of this retrospective study was to provide a survey of the incidence of stroke in Baranya, Croatia, on patients examined at Beli Manastir Health Center Department of Emergency from November 1, 1997 (the time of Baranya reintegration into the legal system of the Republic of Croatia after the war) till December 31, 2001. A total of 513 patients with symptoms of cerebrovascular diseases, or one patient every third day on an average, were examined. Total incidence of stroke was 16.09 per 10,000 population. The majority of patients were in the 61-80 age group with an incidence of 46.94/10,000 after the age of 60, 15-fold that was recorded in younger age groups. The most common risk factors recorded in examined group included hypertension, heart diseases, hyperlipidemia and diabetes mellitus. Total stroke mortality was 38.38%, whereas mortality in patients with hemorrhagic and ischemic stroke was 62.85% and 33.52%, respectively. The ratio of ischemic and hemorrhagic stroke in study subjects was 5:1, and in the causes of death 2.5:1. Out of 81 deceased stroke patients, 96.3% died within first 28 of admission. All of the patients with hemorrhagic stroke died within first 28 days, most within first 7 days (81.8%), whereas 94.9% of patients with ischemic stroke died within first 28 days.     

Recanalization of chronic total coronary occlusions: the impact of a new specific guidewire on primary success rate

BACKGROUND: Although chronic total occlusions are encountered frequently in patients with coronary artery disease, an effective strategy to deal with them has yet to be devised. Various new guidewires have been designed in an attempt to negotiate chronic occlusions successfully. The authors have analysed the impact of the Athlete guidewire on procedural success in this lesion subset. METHODS: Sixty-two consecutive patients undergoing percutaneous intervention for chronic total occlusions over a two-year period were retrospectively studied. For the initial attempt, conventional guidewires were used. In case of failure, further attempts were made using the Athlete guidewire. Procedural success rates with the use of conventional and Athlete guidewires were assessed. RESULTS: Failure of the first attempt with the conventional guidewire occurred in 32 (51.6%) patients and success was achieved in 30 (48.4%) patients. In the former patients, a second attempt was made using the Athlete guidewire to cross the occlusion. The second attempt was successful in 20 patients (60%) in whom the first attempt was unsuccessful, while in the remaining 12 (40%) patients the occlusion could not be crossed even during the second attempt and the procedure was then terminated. Following the use of the Athlete guidewire, the success rate increased to 62% (p < 0.001). No complication occurred during the first attempt, while one patient had a coronary perforation using the Athlete guidewire, which was managed successfully without the need for bypass surgery. CONCLUSION: The use of the Athlete guidewire is feasible and safe, and enhances the chances of successfully treating chronic total occlusions during percutaneous coronary revascularization procedures.     

Comparison of the immunosuppressive effect of fractionated total lymphoid irradiation (TLI) vs conventional immunosuppression (CI) in renal cadaveric allotransplantation

Beginning in November 1981, eight patients with end stage diabetic nephropathy underwent renal cadaveric transplantation after TLI. Transplantation was done between 2 to 11 days after the end of a fractionated TLI to a total dose of 20 to 30 Gy. During the same observation period, 60 nondiabetic patients with end stage renal disease of different origin also received a cadaveric kidney graft, with a conventional regimen of immunosuppression that consists of anti-lymphocyte-globulin, tapering high doses of prednisone, and azathioprine. In the TLI-treated group only a low maintenance dose of prednisone (15 mg) was given. Immunologic monitoring was performed after transplantation at regular intervals and was compared in both groups. Phytohemagglutinin (PHA)-, concanavalin A (con A)-, and pokeweed mitogen (PWM)-induced blastogenesis, as well as the mixed lymphocyte reaction (MLR) and the cell-mediated lympholysis (CML) decreased progressively during the first months after conventional immunosuppression to 50% of the pretransplantation level, and remained there for the first year after transplantation. These tests were much more impaired after TLI (less than 15% of pre TLI value) and again no recovery occurred during the first year. Natural killer (NK) cell activity progressively decreased from a mean value of 53% lysis before transplantation to 15% lysis at the end of the first year after transplantation in the conventionally treated patients. In TLI-treated patients, however, the NK activity, which declined during irradiation from 46% specific lysis to 12%, recovered rapidly after TLI to reach levels of 35 to 40% of specific lysis from the second month on after TLI. In both groups of patients the ratio of helper-inducer (TH) to suppressor-cytotoxic (TS) lymphocytes, as determined with monoclonal antibodies, progressively declined during the first 2 mo after transplantation to a low value of about 1.2. In TLI-treated patients however, this fall progressed further, so that very low levels (less than 0.6) were noticed from the third month on after TLI. The decline of the TH:TS ratio after TLI is due to an absolute increase in the number of suppressor cells. This is in contrast with the conventionally treated patients, where the low ratio is mainly provoked by a more important decrease of the helper cell population. These changes in the balance between TH and TS subpopulations are more frequently associated with positive functional suppressor cell assays in the TLI-treated patients.(ABSTRACT TRUNCATED AT 400 WORDS)     

Computer identification of neoplastic urothelial nuclei from the bladder.

OBJECTIVE: To introduce computer-based analysis of Feulgen-stained urinary bladder cell nuclei from voided urine to identify neoplastic urothelial nuclei. STUDY DESIGN: Nuclei from 23 healthy people and 33 patients with urinary bladder cancer were analyzed. The nuclei from 9 cancer patients with grade G1 (stage Ta), 17 with grade G2 (stages Ta, T1, T1a and T2) and 7 with grade G3 (stages Cis, Ta + Tis, T1 and T3b) were analyzed. Image analysis was carried out by means of a digital image processing system designed by the authors. Features describing nuclei were selected as the first step of the procedure. Then a multistage classifier was constructed to identify positive and negative cases. RESULTS: The results of this pilot study of a group of 56 patients yielded a 71% correct classification rate in the control group, while a 66% rate was obtained among the cancer patients. The sensitivity of the method was 100% and the specificity was 77%. CONCLUSION: This approach to the identification of neoplastic urothelial nuclei may be sufficiently well developed to be used successfully both in screening high-risk populations and in clinical practice.