20]0版欧洲心肌再血管化指南解读

2010年9月欧洲心脏病协会（ESC）和欧洲心胸外科协会（EACTS）领导下的联合项目组、指南委员会及其评审专家共N起草的一份经多方权衡、以患者为中心、以证据为导向的关于心肌再血管化治疗的操作指南。指南涉及冠心痛患者的评估、治疗决策、二级预防等,第一次将冠状动脉旁路移植和经皮介入治疗在同一指导性文件中加以讨论。为利于临床医师阅读,撰写本指南解读。     

孤立性心肌桥-壁冠状动脉患者的多层螺旋CT及临床分析

试图分析孤立性心肌桥-壁冠状动脉（MB—MCA）病变患者的多层螺旋CT（MSCT）的影像学特点与临床表现之间的内在联系。回顾性收集自2003年1月至2007年3月,在我院住院并行MSCT,保存有清楚影像学资料,临床排除有其他心脏病合并症的MB—MCA患者,共53例,发现MB—MCA病变65处。平均年龄（57．3±12．6）岁,其中男性27例,LAD病变59例。MCA长度（20．8±11．2）mm,MB厚度（2．0±1．6）mm。58．5％的患者有心电图改变,大部分为女性,有胸部不适症状者占90．6％。单纯应用非二氢吡啶类钙离子拮抗剂者15例,治疗有效率达到73．3％（11例）,单纯应用β受体阻滞剂者12例,症状缓解率达到66．7％（9例）。单纯应用硝酸酯类药物者16例,仅有2倒（12．5％）缓解。MB—MCA可能导致心肌缺血和临床症状,可进行干预性治疗;对硝酸酯类药物不能缓解的胸痛患者要想到MB—MCA可能,有条件者应该进行MSCT等影像学检查,诊断明确的可以试用β受体阻滞剂及非二氧吡啶娄拮抗剂．     

氯吡格雷在冠状动脉支架植入术前术后的应用

冠状动脉支架植入术是冠心病治疗的最有效手段之一,但术后支架内血栓形成及再狭窄等影响了其远期疗效。血小板激活是支架植入术后血栓形成过程中最关键的环节。氯吡格雷作为有效的抗血小板药物之一,近年来多个大规模临床试验已经逐渐确立了其在支架植入术前术后应用的地位,但其应用的量、时机、持续时间等问题尚存在争议。     

Psychosocial Variables as Predictors of Psychological Stress–Induced Ischemia in the Laboratory

This study examined ischemic reactivity to a psychological stress protocol and whether psychological variables could reliably classify individuals as ischemic reactors. Participants were 54 male Veterans Administration patients who had or were suspected of having CAD. Psychological inventories were administered prior to a psychological stress protocol consisting of a surgical video, the Stroop Color–Word task, an arithmetic task, and discussion of a stressful event. Cardiac functioning was evaluated using an ECG Holter monitor and 23.53% of participants were classified as reactors. Mean differences between reactors and nonreactors were found for State Anger, Health Locus of Control—Powerful Others (MHLC-PO), and Depression. State Anger and MHLC-PO emerged as significant predictors of reactor status in logistic regression analyses. Models based on individual scale items suggested three items could be used to achieve higher classification rates. Implications for revising screening procedures for determining risk and possible mechanisms underlying psychological stress–induced ischemia are discussed.     

中青年冠心病患者冠脉介入治疗后精神心理改变及影响因素调查分析

应用焦虑、抑郁自评量袁对84例行冠脉介入治疗的中青年冠心病患者分别进行术前、术后3个月的问卷调查,分析其变化的影响因素后进行综合评价。发现此类人群大多有焦虑、抑郁倾向,其发病率与性别有关而与年龄无关;其影响因素与对疾病的认识、医疗保险、家庭结构有一定相关性。     

Role of stiffness in weight perception

Abstract:  Here, we focused on a load-on task to clarify the judgment mechanism for weight perception. We measured hand trajectory and surface electromyography to estimate time-varying stiffness and torque patterns in joints. Our results showed that the goal of learning motor skills under load-on tasks is to maintain the hand position, and that humans produce force with cocontraction and increasing stiffness levels according to the weight of an object. Finally, we examined whether stiffness is an effective parameter as an efferent signal for weight perception and found that stiffness plays an important role in weight perception.     

Religious beliefs,patient–doctor interaction and resilience as predictors for treatment decisions and health outcomes of heart patients

Treatment decision-making in chronic illness poses long-lasting effects on the health status of patients. In Western individualistic cultures, they are independently taken by the individual in collaboration with doctors contrary to the collectivistic Indian context, where it’s decided by families with little or no involvement of patients. Religious beliefs, patient–doctor interaction, and resilience measures of 100 CAD patients were used to assess their religious beliefs, patient–doctor interaction, and resilience (predictors). Hierarchical Regression Analysis was conducted to test for the significance of the proposed model. Religious beliefs, patient–doctor interaction, and resilience collectively predicted the significant change in decision-making styles, somatic symptoms, anxiety, social dysfunctions, depression, and general health total of the participants. While the treatment decision-making is heavily contingent upon the social factors namely – religious beliefs, patient–doctor interaction, and resilience, there may yet be some underlying psychological factors that have not been explored in the present study.     

医患关系不和谐的原因

由于政府监管部门的缺位与越位导致医疗市场混乱,医疗资源配置不合理与效率低下,医院为了自身利益而鼓励医务人员多收费,医务人员成了给钱治病的经济人,再加上舆论的推波助澜,社会保障体系不健全,以及医疗需求的刚性,医患间的信息不对称,患者对医疗预期值超越了当今的科技水平,导致医患矛盾越演越烈.     

从现代系统科学角度看冠状动脉支架置入术后再狭窄

随着介入治疗技术在临床的广泛应用,目前已成为治疗冠心病（CAD）的主要方法之一。目前国内外指南一致推荐对于CAD的大多数de novo病变常规置入支架,可有效减少单纯球囊扩张的并发症和再狭窄的发生率,但支架内再狭窄的形成又日益突出,成为严重影响介入治疗远期疗效的主要问题。对再狭窄发生机制的研究近十年来取得诸多新进展,对其发生机制的研究和探索为解决这个世纪难题提供了理论基础和依据。本文应用现代系统科学的自组织理论,从哲学角度深入认识和理解这一病理过程。     

保留子宫动脉筋膜内子宫切除术对卵巢功能的影响

为了探讨保留子宫动脉上行支筋膜内子宫切除术对卵巢功能的影响,将90例符合条件的患者,随机分成研究组（行保留子宫动脉上行支筋膜内子宫切除术）和对照组（行筋膜内子宫切除术）,重点观察两组手术对卵巢功能的影响。对照组血卵泡刺激素（FSH）、雌二醇（E2）术后与术前相比,差异有统计学意义（P＜0．05）。两组更年期症状的发生率差异有统计学意义（P＜0．05）。保留子宫动脉上行支筋膜内子宫切除术术后近期卵巢功能影响小,远期效果有待观察。