冠状动脉介入治疗的合理应用

近年来我国的冠心病介入治疗迅速发展,但有许多问题必须引起注意。本文讨论了我国目前冠脉介入治疗存在的问题;如何正确选择冠心病介入治疗、冠状动脉搭桥和药物治疗;重视冠脉介入手术病人的综合治疗等问题。     

冠脉介入治疗合理临床应用的思维基础

冠心痛的发病率逐年升高,死亡率居高不下,成为威胁人类健康的重要疾病.人们为了攻克这一难题进行了不懈的工作,溶栓、监护及介入治疗的出现挽救了众多生命.随着冠状动脉介入治疗方法的不断完善和广泛开展,冠状动脉介入治疗越来越成为冠心病治疗的主要临床手段.但随之而来的手术并发症、支架在狭窄等问题成为不得不考虑的问题.治疗策略的选择成为治疗成败的关键.如何通过合理的思维方式采取正确治疗策略成为临床医生必须面对的问题.有进行深入探讨的必要.     

冠状动脉介入治疗的合理应用

近年来我国的冠心病介入治疗迅速发展,但有许多问题必须引起注意.本文讨论了我国目前冠脉介入治疗存在的问题;如何正确选择冠心病介入治疗、冠状动脉搭桥和药物治疗;重视冠脉介入手术病人的综合治疗等问题.     

冠心病治疗方法的比较思考

冠心病是严重影响人类健康的疾病。冠心病的治疗方法主要为:药物治疗、介入治疗及冠状动脉旁路移植术等。通过比较各种治疗方法,说明药物治疗是基础,在此基础上,合理选择介入治疗和冠状动脉旁路移植术。     

冠心病治疗方法的比较思考

冠心病是严重影响人类健康的疾病.冠心病的治疗方法主要为:药物治疗、介入治疗及冠状动脉旁路移植术等.通过比较各种治疗方法,说明药物治疗是基础,在此基础上,合理选择介入治疗和冠状动脉旁路移植术.     

介入治疗后血管再狭窄的哲学思考

众所周知 ,介入治疗是心血管疾病治疗学中极其活跃、进展迅速的分支。如经皮腔内冠状动脉成形术 (ＰｅｒｃｕｔａｎｕｏｕｓＴｒａｎｓｌｕｍｉｎａｌＣｏｒｏｎａｒｙＡｎｇｉｏｐ ｌａｓｔｙ ,ＰＴＣＡ)是冠心病治疗学中最令人兴奋的进展 ,在 1977年首次应用于临床之后 ,疗效极其显著。曾几何时 ,冠心病治疗专家自豪地宣称 :人类已经找到了对付“第一杀手”的基本方法。在 80年代 ,ＰＴＣＡ成为发达国家治疗冠心病的首选方法 ,全球每年有数万人接受ＰＴＣＡ ,它被认为是疗效显著优于冠状动脉搭桥术的介入治疗方法 ,并且极大限度地丰富了介…     

导言:冠心病的抗血小板治疗越来越重要

正众所周知,各种类型冠心病的发病、并发症的发生以及动脉硬化的进展过程都有血小板的参与,因此冠心病的抗血小板治疗已成为冠心病尤其是急性冠脉综合征治疗的基石,抗血小板治疗的重点应是急性冠脉综合征的患者[不稳定型心绞痛(UA);非ST段抬高型心肌梗死(NSTEMI);ST段抬高型心肌梗死(STEMI)]、经皮冠状动脉介入治疗(PCI)围手术期治疗、STEMI溶栓治疗的辅助治疗、冠状动脉旁路移植术(CABG)术后的治疗结合个体参照     

冠状动脉造影及介入治疗选择的临床决策

冠心病是当今威胁人类健康的重要疾病之一,其主要病理生理机制是冠状动脉狭窄或闭塞所致的心肌缺血或坏死.目前,冠状动脉造影(CAG)及经皮冠状动脉介入治疗(PCI)已广泛应用于冠心病的确诊和治疗,众多患者为之受益.然而,我们也发现其中部分患者可能不必要接受CAG,或CAG后可能不必要或不宜接受PCI.鉴于此类技术的有创性、风险性、高费用等因素,同时为避免过度诊疗,充分评估已知冠心病介入治疗的选择及未知胸痛或其他情况CAG的选择,正确进行临床决策十分必要.     

对三例右冠状动脉开口于左冠窦的多支变介入治疗的体会

冠状动脉介入治疗是治疗冠心病的有效手段,挽救了不少患者的生命,特别是急性心肌梗死的患者,及时准确的介入治疗关乎患者生命.介入治疗成败的关键是要熟练的进行冠状动脉造影,获得清晰的影像资料.但是,一部分患者会发生解剖学变异,使得一部分患者冠脉走行异常,由于是少见人群往往被忽视,导致介入治疗失败,特别是急性心肌梗死患者进行急诊介入治疗时,由于找不到梗死相关血管而导致贻误治疗时机,甚至危及生命.因此详细了解冠脉解剖变异,掌握变异血管介入治疗技巧对冠脉介入治疗至关重要.     

遵循指南，恰当进行冠心病的介入治疗

如何遵循指南,结合冠心痛患者实际情况和具体病变,恰如其分地为患者实施经皮冠状动脉介入治疗（PCI）,使获益最大化,而风险最低化,是每一位心血管介入医生的追求和面临的问题。应正确和严格选择冠心病患者PCI适应证,合理运用PCI的各种手段,牢固树立冠心病全面治疗观念。PCI仅仅是冠心病全面治疗的一个组成部分,必要的介入、外科治疗和合理药物治疗的联合应用,是心血管疾病治疗的发展方向。     

亚临床甲状腺功能减退与冠状动脉粥样硬化性心脏病

对冠心病高危因素积极地预防及治疗,可降低冠心病的患病率和病死率。已经得到公认的临床甲状腺功能减退通过引起代谢及血流动力学紊乱而参与了冠状动脉粥样硬化的发生与发展。目前,国内外许多临床研究显示亚临床甲状腺功能减退通过多种途径参与冠心病的发生和发展,是冠心病的重要危险因素之一。     

治疗感染性骨不连伴大段骨缺损的探讨与思考

感染性骨不连伴大段骨缺损是目前临床骨科较为常见、多发、治疗极为棘手的病种之一,治疗方法多种多样,但疗效却不理想,且缺乏统一的诊治与疗效判断标准,总结、分析几种临床上主要治疗方法的利弊,为该病探寻一条微创、安全、并发症少及疗效确切的可靠治疗方法.随着对Ilizarov技术的基础与临床研究的不断深入,该技术在治疗传统方法难以治愈的疾病如四肢关节严重畸形、感染性骨不连或伴有骨缺损、皮肤软组织缺损等方面显示出自身的优势,为治疗疑难骨科疾病开辟了一条新的有效途径.     

The response of day and night wetting children and children who wet only at night to retention control training and the enuresis alarm

Forty-five children with night wetting only (NW) and 30 children with day and night wetting (DNW) were randomly assigned to 2 treatment groups: alarm only and alarm preceded by 4 weeks of retention control training (R.C.T.). Fewer children became dry at night in the DNW group than the NW group and DNW children relapsed earlier following treatment. The enuresis alarm was far superior to R.C.T. in reducing night wetting in both enuretic groups. It also reduced day wetting in some of the DNW children. Children who became dry in the NW group did not show significant changes in functional bladder capacity. Although changes in functional bladder capacity were seen in the DNW children who became dry, changes were only noticeable once dryness had been achieved.     

A functional analysis and treatment of the irrational and rational statements of an elderly woman with Alzheimer's disease

Speech problems are a hallmark of Alzheimer's disease. Although often attributed to neurological damage common to the disease speech problems have been successfully treated through the use of behavior analytic techniques. This study was a replication and extension of that line of research. The participant in this study was an elderly woman diagnosed with Alzheimer's who was referred for services due to frequent irrational statements and infrequent rational statements. Both standard functional analysis and modified functional analysis conditions were conducted. It appeared the irrational statements were controlled by social reinforcement. Several treatment packages consisting of differential reinforcement of incompatible behaviors and extinction components were implemented in an ABCDEAE treatment design. Results of the study suggest the intervention successfully increased rational statements but had no effect on irrational statements. These results indicate the need for further research on the conditions under which behavior analysis techniques will be most effective. Copyright © 2006 John Wiley & Sons, Ltd.     

QUESTIONING SCIENTIFIC FAITH IN THE LATE NINETEENTH CENTURY

The late nineteenth century was not only a time in which religious faith was questioned in light of increasing claims of natural science. It is more accurate to see the familiar Victorian crisis of faith as but one aspect of a larger historical phenomenon, one in which the methods of both religion and science came under scrutiny. Among several examinations of the status of scientific knowledge in the waning decades of the century, the treatment of the subject by the German theologian Wilhelm Herrmann and philosopher Hans Vaihinger rejected its objective nature and denied that either scientists or theologians had access to the truth of nature. Although this stance regarding the nature of science, religion, and their relationship was limited to intellectuals in German society at the time, it foreshadowed developments in our own day in which the traditional search for truth has been problematized.     

“他汀革命”——由表及里的探索和由点到面的应用

人们对他汀类药物的认识,经过由单一降低胆固醇作用的表象到深入疾病病理生理改变的探索而发现其多效性,从而使得临床应用从冠心病防治扩展至缺血性脑血管病、肾脏病、脂代谢紊乱疾病以及多种炎性疾病的治疗。     

Serotonin syndrome associated with the use of escitalopram

Escitalopram is the newest selective serotonin reuptake inhibitor (SSRI) available for use in the United States. It has been approved for the treatment of major depression and generalized anxiety disorder. It is the S-enantiomer of the SSRI citalopram and is highly serotonin specific as it has minimal effect on the reuptake of dopamine or norepinephrine. It is also a well-tolerated medication, with a side-effect profile comparable to the other SSRIs. While a number of side effects have been seen during escitalopram therapy, such as insomnia, nausea, and increased sweating, there are no reported cases of serotonin syndrome associated with escitalopram therapy to date. We present the case of a 24-year-old woman who developed serotonin syndrome after an increase in her escitalopram to 30 mg/day. We will review the diagnostic criteria of serotonin syndrome and the clinical scenarios in which serotonin syndrome can develop. We will also discuss the proposed treatments and role that polypharmacology may play in the development of this clinical entity.     

Neuroprogressive disease of post-infectious origin: a review of a resurging subacute sclerosing panencephalitis (SSPE)

Subacute sclerosing panencephalitis (SSPE) is a progressive, essentially untreatable, disease of the nervous system. When first described in the 20th Century, it was characterized more for its neuropathological features than for its pathophysiology or cause. It was not until the 1960s that a clear relationship to the measles virus was established. It is now thought that this uncommon infectious encephalopathy is caused by a "slow," altered or persistent form of the wild measles virus which has harbored in the nervous system for years. Then a "breakout" occurs and the more lytic and virulent organisms produce the progressive and spreading inflammatory and destructive lesions which are confined to the nervous system. Epidemiological study of the disease confirms its relationship to measles. In the years since the development of national measles immunization programs, there has been a dramatic decline in the incidence of measles exanthem and until recently a corresponding decline in the incidence of SSPE. In recent years there has been a mild to moderate increase in cases of SSPE as reported to the USA/International SSPE Registry. As yet, there has not been a totally effective treatment. The purpose of this paper is to give an overall review on SSPE and its relationship to measles. This review will include a prospectus of its history, considerations as to its etiology, correlation of clinicopathological features, and thoughts on the past and present epidemiology and treatment.     

Drivers' use of hand-held mobile phones in Western Australia

Using a hand-held mobile phone whilst driving has been linked to an increased risk of being involved in a road crash. Little research, however, has been done on actual road exposure rates to this potential safety problem. The main aim of this study was therefore to establish the number of drivers who use hand-held mobile phones while driving, and to discover if this number had increased as compared to similar observations obtained one year earlier. 40 roadside observations were made at major roads during daylight hours. On average approximately 1.5% of all vehicle drivers were observed using hand-held mobile phones. No significant difference was found between the percentage of drivers observed to be using phones in an earlier study and this current study. In addition, separate observations were undertaken at four sites at four periods of the `normal' working day to establish if a possible time of day effect existed. The data found that the level of mobile phone use did not significantly differ during the day, however, as a percentage of vehicle flow, the highest use period was between 11.00 and 12.00. Finally, for the same four sites, supplementary measures were taken to establish personal characteristics of the phone users. It was found that phone users were predominantly male (78%) and less than 40-years old (64%).     

临床决策中患者及其家属的地位与作用

医生、医院每天都在为患者做临床决策。而在各个决策中患者与家属应该处于什么地位的问题早有争论。除了疾病外患者性别、年龄、家庭、经济、社会地位的个体差异决定了医生决策的不同。患者要真正参与,就必须真正全面知情。关于患者参与多少的问题要因人而异,可能只是提出意愿,可能提出耗资的底线,可能权衡费效比,可能以生活质量为唯一原则。总之,临床决策中患者及其家属的地位因人而异。