The effects of anger management and social contact on risk of myocardial infarction in type as and type bs

Abstract

The risk of myocardial infarction (MI) associated with Type A behaviour, anger management and social contact was examined using a retrospective case-control design. Binary multiple regression analyses were used to compare 206 male and 67 female MI cases with 454 male and 316 female controls. To examine the potential moderating role of sex and Type A behaviour, moderated and subgroup regressions were run. Type A behaviour was significantly more prevalent in cases than controls. MI risk was further increased in males who combined Type A behaviour and aggressive expression of anger. In females MI risk was associated with the combination of Type A behaviour and not expressing anger. In addition female cases were significantly less likely than controls to discuss their anger, and reported fewer available social contacts. Discussion of results includes consideration of the problems generated by the retrospective case-control design.     

急性心肌梗死患者直接经皮冠状动脉介入治疗前后窦性心律振荡的临床观察

探讨急性心肌梗死（AMI）患者直接经皮冠状动脉介入（PCI）前后窦性心律振荡（HRT）的变化及意义.选择伴室性早搏的AMI患者（观察组）和无器质性心脏病的室性早搏患者（对照组）各42例,PCI前伴室早的观察组患者,用节律Ⅱ导联记录室早的心电图,PCI后2周时观察组及对照组均记录24h动态心电图（AECG）,计算其震荡初始（TO）和震荡斜率（TS）,并行心脏彩色多普勒超声检查,测定左室射血分数（LVEF）.结果观察组PCI后2周时和对照组LVEF分别为：（59.1＆#177;7.5）%和（61.3＆#177;8.4）%.观察组PCI前TO显著升高,TS显著降低,差异有统计学意义（P＜0.05）;观察组PCI后2周TO较前降低,TS较前升高,但和对照组相比差异仍有统计学意义（P＜0.05）;观察组PCI后2周时和对照组左室射血分数（LVEF）相比无差异.提示AMI患者HRT减弱,PCI后2周HRT改善但和观察组相比仍有统计学意义,提示AMI患者PCI后早期仍存在心脏自主神经功能下降,HRT可作为评价AMI患者预后的一个指标.     

Brief strategic therapy in first myocardial infarction patients with increased levels of stress: a randomized clinical trial

Background: Little is known about the impact of interventions targeting chronic stress levels on clinical outcomes among myocardial infarction (MI) patients with increased levels of stress. Objectives: To examine the impact of the addition of brief strategic therapy (BST) to usual care (UC) on clinical outcomes in first MI patients with increased levels of stress. Design: Eighty-one patients were randomly assigned to BST in conjunction with UC (medical treatment, risk factor information, and guidance on unhealthy behavior change) or to UC. Methods: The outcome measures were scores on the Perceived Stress Scale, reinfarction and cardiac mortality rates, and scores on the Health Survey. Measures were taken before, post-treatment, and at two follow-ups. Results: Patients subjected to BST showed reduced perceived stress at post-treatment and maintained decreased levels at follow-ups. At 1-year follow-up, they had a lower rate of non-fatal reinfarction, and at 2.5-year follow-up, they had a lower rate of fatal reinfarction. Their mental and physical health was improved at post-treatment and this was sustained at follow-ups. Conclusion: The addition of BST to UC favorably influences the disease course after MI in patients with increased levels of stress.     

急性心肌梗死早期康复治疗的探讨

遵循生物 -心理 -社会医学模式 ,结合传统康复治疗从生物功能、心理功能、社会功能三方面去探讨急性心肌梗死的早期康复治疗是切实可行的 ,而且明显优于传统的康复治疗 ,实行早期康复治疗时应从生物功能、心理功能、社会功能三个方面综合考虑 ,不宜偏废任何一方     

急性心肌梗死复杂冠脉病变延迟支架植入治疗策略

目前我国临床实践中,急性心肌梗死的急诊介入治疗几乎均以一次性植入支架为手术终点。然而急性心肌梗死患者常伴有复杂冠脉病变,此类患者一次性植入支架常出现“慢血流”或“无复流”现象,导致心肌微循环灌注障碍,直接影响患者的预后。本文从临床策略的角度出发,探讨此类患者急诊冠脉介入治疗中延迟植入支架治疗的策略及可行性。     

腹内压的变化对肠道氧合及功能的影响

以胃黏膜pH值及血浆D-乳酸为监测指标,观察腹高压患者的腹内压变化前后胃肠道氧合及功能的变化。本研究提示胃黏膜pH值可以反映胃肠道的缺血,且早于腹腔间隙综合征出现,可敏感反映腹高压时肠道氧舍情况;血浆D-乳酸可反映肠缺血再灌注时肠屏障功能状态。以上观察为临床提供简便易行的监测手段及治疗思路。     

心肌缺血再灌注损伤治疗新策略——胆碱能抗炎通路

缺血再灌注损伤（ischemia／reperfusion injury,IRI）是在组织器官缺血恢复血流后,细胞代谢功能障碍及结构破坏反而加重的现象。炎症及其介质可诱发、加重心肌缺血再灌注损伤,已证明与其关系密切。胆碱能抗炎通路是新发现的一条与神经免疫机制相关的抗炎通路,通过分泌乙酰胆碱,抑制炎症因子释放,为防治心肌缺血再灌注损伤提供新的治疗策略。     

缺血后适应脑保护的耗散结构基础与脑缺血损伤的非线性特征

脑缺血损伤的机制十分复杂,主要内容涉及谷氨酸兴奋毒性、Ca2＋毒性、自由基损伤、一氧化氮损伤、炎性反应以及内质网和线粒体功能障碍等,这些复杂的机制网络具有耗散结构的非线性特征。近年发现缺血后适应可能通过P13K、Akt、MAPK、PKC等通路,KATP通道,抗凋亡等方式阻止或减轻损伤,从而实现脑保护,而形成一个复杂的信号转导体系。而对复杂的生命系统的研究起着指导作用的耗散结构理论是从更高水平层次研究复杂系统的系统科学,文中将从哲学的角度阐释缺血后适应产生大脑保护的耗散结构基础。     

35岁～64岁糖尿病患者1O年内心肌梗死＼中风发病和死亡危险评估

应用《未来10年内心肌梗死、中风发病和死亡危险的科学预测量表》,对某社区335例35岁～64岁糖尿病患者进行了评估。结果显示,35岁～64岁糖尿病人群未来10年内严重心血管事件发生风险甚高,对可逆危险因素的评估和调整刻不容缓。     

定量组织速度成像评价酒精性心肌损害左室功能的价值

为了评估定量组织速度成像(QTVI)在评价大量饮酒后心肌损害左室功能改变方面的价值,我们对饮酒量符合酒精性心肌病诊断标准患者21例(B组,每日饮白酒≥150g或啤酒4瓶,每周6天~7天,10年以上),30例健康志愿者(A组,正常对照组)进行常规超声参数及QTVI参数测定,包括:二尖瓣环收缩期峰值速度(Vs)、舒张早期运动速度(Ve)、舒张晚期运动速度(Va)等。结果显示,B组常规各超声参数与A组比较差异有显著性统计学意义(P0.01)。QTVI参数与A组比较Va减低(P0.05),Vs、Ve、Ve/Va显著减低(P0.01)。提示QTVI技术能够有效地评估酒精性心肌损害病左室功能的改变。