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Why Percutaneous Coronary Intervention Can’t Improve the Long-term Outcome of Medicare Patients with Acute Myocardial Infarction in USA?

急性心肌梗死室间隔穿孔介入封堵后残余分流致急性左心衰竭一例

Veno-arterial extracorporeal membrane oxygenation in salvage of cardiogenic shock

Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.

急性心肌梗死患者血浆P-选择素水平及临床意义

【摘要】　目的　探讨急性心肌梗死患者血浆P-选择素（P-selectin，Ps）的含量及其意义。　方法　2009年12月－2010年5月间采用酶联免疫吸附试验分别测定35例冠心病患者、30例急性心肌梗死患者急性期及恢复期两个时期血浆中Ps、血清心肌肌钙蛋白I（cTnI）和肌红蛋白（Myo）含量，与20例健康体检者作对照。　结果　急性心肌梗死急性期与恢复期比较，Ps、cTnI和Myo水平明显上升（Plt;0.05）；急性心肌梗死急性期与冠心病组比较也差异统计学意义（Plt;0.05），均高于对照组（Plt;0.05）。急性心肌梗死恢复期与冠心病组比较差异无统计学意义（Pgt;0.05）。　结论　Ps、cTnI和Myo水平升高与急性心肌梗死的进展有关，可作为鉴别诊断急性心肌梗死的指标。

A Comparison of Different Combination Regimens of Biochemical Markers in Diagnosing Acute Myocardial Infarction

Objective　To compare the diagnostic accuracy of different combination regimens of myocardial infarction markers in diagnosing acute myocardial infarction; and to estimate the effect of heart-type fatty acid-binding protein (H-FABP) in improving the diagnostic accuracy of the combinations. Methods　Patients with acute onset of chest pain were included randomly. Serum concentrations of H-FABP and other biochemical markers for myocardial infarction (cTnI, Myo) were determined immediately, and then acute myocardial infarction (AMI) patients were defined according to the WHO criteria. ROC curves for three biochemical markers were established respectively, and the cutoff values of the three markers were determined accordingly. Three combination regimens of myocardial infarction markers for AMI diagnosis were designed: cTnI+Myo, cTnI+H-FABP, cTnI+H-FABP+Myo. Diagnostic accuracy of the three regimens were then calculated and compared. Results　The AUCs for the three biochemical markers were AUCcTnI 0.938 (95%CI: 0.888-0.988), AUCMyo 0.743 (95%CI: 0.651-0.836), and AUCH-FABP 0.919 (95%CI: 0.873-0.964), respectively. AUCH-FABP was significantly larger than AUCMyo (Plt;0.01). The cutoff values of the three biochemical markers for diagnosing AMI were defined as CutoffcTnI 0.5 ng/mL, CutoffMyo 90 ng/mL, and CutoffH-FABP 5.7 ng/mL, respectively. The diagnostic accuracy of these markers and their combination regimens were calculated and presented as follows (cTnI, Myo, H-FABP, cTnI+Myo, cTnI+H-FABP, cTnI+Myo+H-FABP): sensitivity: 0.804, 0.674, 0.783, 0.957, 0.957 and 0.957; specificity: 0.966, 0.747, 0.954, 0.724, 0.92 and 0.724; diagnostic efficacy: 0.910, 0.722, 0.895, 0.805, 0.932 and 0.805, respectively. Compared with the combination of cTnI+H-FABP, the sensitivities of cTnI (Z=2.261, P=0.024), Myo (Z=3.497, Plt;0.001) and H-FABP (Z=2.478, P=0.013) were significantly lower; the specificities of Myo (Z=3.062, P=0.002), cTnI+Myo (Z=3.378, Plt;0.001) and cTnI+Myo+H-FABP (Z=3.378, Plt;0.001) were significantly lower; and the diagnostic efficacies of Myo (Z=4.528, Plt;0.001), cTnI+Myo (Z=3.064, P=0.002) and cTnI+Myo+H-FABP (Z=3.064, P=0.002) were significantly lower. Conclusion　The combination regimen of cTnI+H-FABP which includes H-FABP as the sensitive marker seems to be more effective than the currently used combinations in diagnosing AMI in patients with acute onset of chest pain.

急诊经皮冠状动脉介入治疗术中再灌注心律失常的分析与急救护理

目的　总结急性心肌梗死急诊经皮冠状动脉介入治疗术中再灌注心律失常的特点及急救护理。 方法　2007年1月－2012年4月对179例急性心肌梗死急诊经皮冠状动脉介入治疗术中再灌注心律失常进行分析。 结果　心肌梗死血管为左前降支、左回旋支发生快速型心律失常的比例较高，右冠状动脉梗死发生缓慢型心律失常的比例高，具有统计学意义（P＜0.01）。发病至血管再通时间＜6 h易发生心律失常，具有统计学意义（P＜0.01）。 结论　护士应掌握心律失常的特点，做好充分护理评估和急救准备，可确保急诊经皮冠状动脉介入治疗手术得以顺利进行。

Research on the Correlation between Serum Level of Cystatin C and Acute Myocardial Infarction in Elderly Patients

【摘要】　目的　观察70岁以上老年心肌梗死急性期血清胱抑素C（cystatin C，CysC）水平，探讨急性心肌梗死后CysC水平变化的意义。　方法　顺序入选2010年7月-2011年7月期间70岁以上急性心肌梗死患者58例及正常对照58例。入选对象均经冠状动脉造影检查确诊或排除诊断，记录急性心肌梗死患者梗死部位和梗死相关血管，并计算Gensini积分。所有入选对象采血，使用乳胶增强免疫透射比浊法测定急性期血清CysC水平。　结果　心肌梗死急性期，血清CysC水平低于正常对照组（Plt;0.05）；不同冠状动脉病变评分与血清CysC水平呈负相关，Gensini积分越高，血清CysC水平越低。　结论　血清CysC与冠心病关系密切。检测CysC，为冠心病的风险预测、老年患者危险分层和治疗提供一条新的线索和途径。

急性心肌梗死溶栓过程中再灌注心律失常的特点分析

目的　总结急性心肌梗死溶栓过程中再灌注心律失常（RA）的特点，指导临床护理工作。 方法　回顾性分析2009年1月－2012年4月间152例静脉溶栓成功的急性心肌梗死患者，分析梗死部位和时间的特点。 结果　急性心肌梗死前壁梗死发生快速型心律失常的比例较高，下后壁梗死发生缓慢型心律失常的比例较高。RA的发生在溶栓后60～90 min时间段和30～60 min时间段的比例较高。 结论　临床护士应加强对RA特点的认识，重视早期预测和防治，可减少RA带来的危害，从而提高急性心肌梗死患者的抢救成功率。

非胸痛的急性心肌梗死48例临床分析

【摘要】　目的　总结非胸痛的急性心肌梗死的临床特点。　方法　对2008年1月-2010年12月48例非胸痛的急性心肌梗死患者出现的首发症状、危险因素等进行分析。　结果　年龄gt;65岁30例，lt;40岁3例，41～64岁15例。首发症状为消化道症状（腹痛腹胀、腹泻、呕吐等）24例，大汗淋漓5例，呼吸困难4例，剧烈咳嗽1例，头晕头痛2例，烦躁不安6例，手臂痛3例，低血压2例，心律失常1例。急性心肌梗死部位以后壁及下壁为主。　结论　通过对临床表现不典型的急性心肌梗死特点的分析，需重视非胸痛急性心肌梗死的误诊或漏诊，降低病死率。

Efficacy of Early Use of Heparin for Thrombolytic Therapy on Patients with Acute Myocardial Infarction: A Systematic Review

ObjectiveTo systematically review the efficacy of early use of heparin for thrombolytic therapy in patients with acute myocardial infarction (AMI). MethodsThe Chinese databases involving VIP, CNKI, WanFang Data, CBM and foreign language databases including PubMed and The Cochrane Library (Issue 1, 2013) were electronically searched from inception to January 2013. Randomized controlled trials (RCTs) on early use of heparin in the treatment of AMI were included. Two reviewers assessed the quality of each trial and extracted data independently according to the Cochrane Handbook. RevMan5.2 software was used for statistical analysis. ResultsA total of 23 RCTs involving 2 697 patients were included. The results of meta-analysis showed that the heparin group was superior to the control group in increasing of the rate of coronary artery recanalization, decreasing the time of recanalization, reducing the rate of re-infarction and the death rate, and decreasing the time of ST-T fell for 50%, the time of enzyme peak showed and the time of chest pain relief. There had no significant difference observed in the incidence of adverse reaction between the two groups. ConclusionIt is effective to use heparin before thrombolytic therapy in AMI.