冠状动脉CT血管成像应用中的思考

随着科学技术的发展及医疗水平的提高,冠状动脉CT血管成像（CTCA）已成为诊断冠心病的金标准,该项技术微创、安全、简单、快捷,深受患者青睐。本文讨论该项技术应用中所贯穿的哲学思考与应有的人文关怀。     

冠脉支架术对冠心病患者心理及生活质量的影响

分析冠脉支架术对患者生活质量及心理情况的影响并探讨相应策略。采用横断面研究方法,调查2007年6月-2010年9月在我院行冠脉支架术患者768例,应用Zung焦虑、SAS、SDS自评表及SF-36生活质量问卷等方法采集相关资料,200名健康人为对照1组、未行支架置入的冠心病患者为对照2组,数据行统计学分析。支架植入患者...     

Aggression,self-confidence,and cardiovascular reactions in competitive performance in adolescent boys

Interactions between suggested risk factors for the development of coronary heart disease (namely aggression, competitive performance, and cardiovascular reactions) were studied in 36 adolescent boys. Different manifestations of aggression were measured using a structured interview, the aggression-impatience factor of the MYTH test, and observation. Self-confidence was assessed by means of an interview. The performance tests used were the Stroop Color Word test and the P-factor test. Cardiovascular reactions were measured using an automatic noninvasive sphygmomanometer with a continuous recording system. Results showed that the significance of aggression in performance or competition cannot be evaluated separately; aggression in itself had an injurious effect on performance, but when combined with high self-confidence it resulted in a high level of performance. High cardiovascular reactivity was related to competitiveness rather than aggression. The results emphasize that before intervention programs for behavioral risk factors of coronary heart disease are planned, there are many questions to answer.     

Post–traumatic stress disorder in patients with coronary artery disease: A review and evaluation of the risk

Psychosocial factors are known to impact on the prognosis of patients with coronary artery disease independently of disease severity. However, few studies have looked at whether these patients are at risk of developing post-traumatic stress disorder, and the potential implications for morbidity and mortality. Through a review of the empirical literature, the objectives were to investigate whether patients with coronary artery disease are at risk of developing this disorder, to look at relations between post-traumatic stress disorder and heart disease, and to stimulate further research. The review indicated that some patients with coronary artery disease are at risk of developing post-traumatic stress disorder, although the prevalence varied considerably. Methodological issues together with recommendations for future research are discussed. Although only some cardiac patients may develop post-traumatic stress, this disorder should not be overlooked due to its potential role in reinfarctions and mortality.     

稳定性冠心病介入治疗的理性思考

介入治疗是冠心病治疗的重要手段之一。但目前在稳定性冠心病的治疗中出现了过度使用的问题。因此我们必须理性地认识到,包括冠脉介入治疗（PCI）在内的血运重建措施只是重要的治疗手段之一,而绝非其全部。在稳定性冠心病治疗中,健康教育、改变生活方式、充分的药物治疗也是不可或缺的部分。     

冠心病的介入治疗——药物洗脱支架还是裸支架？

冠心病的治疗包括多种方式,在强化内科保守治疗的基础上,采用经皮冠状动脉介入治疗既可以改善患者的生活质量又能降低病死率。介入治疗中最重要的方式是支架植入。但应用药物洗脱支架,还是普通金属裸支架一直是近两年来的争论焦点。BASKET-LATE研究的发布,更给药物洗脱支架的应用蒙上了可怕的阴影。就我们现阶段的实际临床应用而言,只要服用足够长的至少双联抗小血板药物治疗,药物洗脱支架的应用还是安全的,而且临床主要心血管事件较裸支架明显降低。     

性激素替代治疗在冠心病防治中的作用

冠心病的发病率有着明显的性别差异,大量研究表明内源性雌激素和雄激素与冠心病的发生发展有着密切关系,它对于女性和男性分别有抗动脉粥样硬化作用,这提示人们可以通过恢复机体激素水平达到防治冠心病的作用。因此性激素替代治疗成为了对冠心病的防治研究的热点,本文主要综述性激素替代治疗在冠心病防治中的研究进展。     

Concurrent Validity of the Multidimensional Health Profile—Health Functioning Scales (MHP-H) in the Pre-operative Assessment of Applicants for Gastric Bypass Surgery

The concurrent validity of a brief screening test, the Multidimensional Health Profile-Health Functioning (MHP-H) was examined in conjunction with a much more lengthy pre-operative assessment procedure in 449 applicants for gastric bypass surgery (GBS). The MHP-H is a 69-item screening inventory that assesses five areas of health functioning: Adult Health History, Health Habits, Health Care Utilization, Health Beliefs and Attitudes, and Response to Illness. The more lengthy procedure included a comprehensive 273-item structured interview plus the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Basic Personality Inventory (BPI), and Beck Depression Inventory (BDI). The MHP-H showed significant correspondence with the more comprehensive assessment on measures of potential relevance to outcome in GBS, supporting the use of the MHP-H as a low-cost alternative to the more extensive procedure. The utility of the MHP-Psychosocial Functioning (MHP-P), a companion instrument to the MHP-H, was demonstrated in an earlier study.     

Thinking across species—a critical bioethics approach to enhancement

Drawing upon a concept of ‘critical bioethics’ [7] this paper takes a species-broad approach to the social and ethical aspects of enhancement. Critical Bioethics aims to foreground interdisciplinarity, socio-political dimensions, as well as reflexivity to what becomes bioethical subject matter. This paper focuses upon the latter component and uses the example of animal enhancement as a way to think about both enhancement generally, and bioethics. It constructs several arguments for including animal enhancement as a part of enhancement debates, and considers some connections between human and animal enhancement. The paper concludes in a plea for an ‘enhancement’ to our critical abilities to examine some of the underlying social, moral and ethical assumptions bound up in varied anticipated ‘enhanced’ futures.

冠心病患者的抑郁和焦虑

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状（如抑郁或/和焦虑）者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面：对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。