史大卓教授运用降脂通脉方治疗代谢综合征临床经验举隅

代谢综合征(Metabolic Syndrome,MS)是一组以肥胖、高血糖、血脂异常以及高血压等聚集发病,严重影响机体健康的临床症候群,是一组在代谢上相互关联的危险因素的组合。MS患者是发生心脑血管疾病的高危人群,罹患心血管疾病和2型糖尿病的风险均显著增加。MS归属于中医学“肥胖”“消渴”“痰饮”“脾瘅”等范畴。史大卓教授从事中西医结合内科临床工作近40年,根据多年临床经验,认为MS主要病机为“痰瘀阻脉,郁久化热”,痰浊、瘀血、气滞、郁热交结体内,诱导MS的发生发展,拟降脂通脉方,以祛瘀血、化痰浊、畅血脉、清郁热,临床疗效显著。

冲击地压煤层局部保护层开采的减压机理研究

保护层开采是区域性防治冲击地压的有效方法,但当开采保护层不具有经济价值、不开采保护层又不能保证主采煤层防冲安全的条件下,提出了开采局部保护层的防冲方案并进行了防冲和防大变形灾害的机理研究。为了论证开采局部保护层防冲方案的安全性,通过建立局部保护层和被保护层的力学关系模型,推导了在局部保护层作用下岩体应力的计算公式,绘制了不同宽度局部保护层条件下引起冲击的垂直应力和剪应力分布云图,给出了发生冲击和大变形边界的应力判据,为设计被保护层巷道的安全位置提供了理论依据。结合河南某煤矿的实际情况,给出局部保护层减压效果的计算方法,计算结果在该煤矿强冲击危险工作面设计中得到了应用。

石墨消解-电感耦合等离子体质谱法测定土壤中铜、铅、镉、钴

建立快速石墨消解-电感耦合等离子体质谱法测定土壤中铜、铅、镉、钴4中重金属元素的方法。采用盐酸-硝酸-氢氟酸消解体系运用石墨消解仪进行快速消解,应用电感耦合等离子体质谱仪测定土壤铜、铅、镉、钴元素,结果表明,铜、铅、镉、钴的精密度及准确度均能满足测定要求,为土壤中铜、铅、镉、钴的测定提供了一种快速可靠的消解方法。

Effectiveness and Safety of Qishen Yiqi Dripping Pill in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention:3-Year Results from a Multicentre Cohort Study

Objectives:To evaluate the effectiveness and safety of Qishen Yiqi Dripping Pill(QSYQ)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods:This multicentre prospective cohort study was conducted at 40 centers in China.Patients with ACS after PCI entered either the QSYQ or Western medicine(WM)groups naturally based on whether they had received QSYQ before enrollment.QSYQ group received QSYQ(0.52 g,3 times a day for 12 months)in addition to WM.The primary endpoint included cardiac death,non-fatal myocardial infarction,and urgent revascularization.The secondary endpoint included rehospitalization due to ACS,heart failure,stroke,and other thrombotic events.Quality of life was assessed by the Seattle Angina Questionnaire(SAQ).Results:A total of 936 patients completed follow-up of the primary endpoint from February 2012 to December 2018.Overall,487 patients received QSYQ and WM.During a median follow-up of 566 days(inter quartile range,IQR,517–602),the primary endpoint occurred in 46(9.45%)and 65(14.48%)patients in QSYQ and WM groups respectively[adjusted hazard ratio(HR)0.60,95%confidence interval(CI)0.41–0.90;P=0.013].The secondary endpoint occurred in 61(12.53%)and 74(16.48%)patients in QSYQ and WM groups,respectively(adjusted HR 0.76,95%CI 0.53–1.09;P=0.136).In sensitivity analysis,the results still demonstrated that WM combined with QSYQ reduced the risk of the primary endpoint(HR 0.67,95%CI 0.46–0.98;P=0.039).Moreover,QSYQ improved the disease perception domain of the SAQ(P<0.05).Conclusions:In patients with ACS after PCI,QSYQ combined with WM reduced the incidence of the primary endpoint.These findings provide a promising option for managing ACS after PCI and suggest the potential treatment for reducing the risk of primary endpoint included cardiac death,non-fatal myocardial infarction,and urgent revascularization through intermittent administration of QSYQ.(Registration No.Chi CTR-OOC-14005552).

活血化瘀中药与抗血小板药物联合应用进展

抗血小板药物可抑制血小板活化、聚集、黏附,降低心脑血管事件,被广泛应用于心脑血管病的一、二级预防,但长期应用、多种药物相互作用及吸烟、肥胖等均可导致抗血小板药物作用减弱,增加出血风险[1,2]。近年来研究显示,多种活血化瘀类中药单体、复方及中成药都有抗血小板作用,且与抗血小板药物联用,不仅可增强抗血小板效应,还具有减少出血风险、保护血管内皮等作用[3]。

史大卓教授基于“虚”“瘀”“水”治疗慢性心力衰竭的临床经验

慢性心力衰竭(简称慢性心衰)是进展性疾病,由心肌细胞肥大、心室重构逐渐向心室收缩和(或)舒张功能障碍进展,临床表现为呼吸困难、运动耐量减退和水钠潴留[1]。慢性心衰为各种心脏疾病发展的终末阶段,其患病率近年来不断上升,调查显示,慢性心衰的患病率为1.5%~2.0%,且随年龄的增长呈上升趋势,70岁以上人群中,10%老年人患有心力衰竭[2]。据2018年《中国心血管报告》推算,我国慢性心衰患病人数达450万人[3]。

Long-Term Follow-Up of Chinese Herbal Medicines Combined with Conventional Treatment in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Multicenter Randomized Controlled Trial

Objective： To evaluate the prognosis effect of Chinese herbal medicines（CHMs） for benefiting qi and activating blood circulation adjunctive to conventional treatment in patients with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI）. Methods： A total of 702 patients with ACS who underwent PCI were enrolled and randomly assigned to receive conventional treatment plus CHMs for benefiting qi and activating blood circulation（treatment group, 351 cases） or conventional treatment alone（control group, 351 cases） for 6 months. Six months later, all patients received conventional treatment alone. Follow-ups were scheduled at 6th, 12 th, 18 th, 24 th month after enrollment in April 2008, and the final follow-up visit was during September 2011 and November 2011. The primary endpoint was the composite of cardiac death, nonfatal myocardial infarction or revascularization（PCI or coronary artery bypass grafting）; and the secondary endpoint was the composite of re-admission for ACS, congestive heart failure, nonfatal stroke or other thrombus events. Results： A total of 621（88.59%） patients completed 35.4±3.8 months follow-up, while 80（11.41%） patients withdrew from the trial（41 in the treatment group and 39 in the control group）. The incidence of primary endpoint was 5.7%（20 patients） in the treatment group versus 10.86%（38 patients） in the control group [relative risk（RR）： 0.53; 95% confidence interval（CI）： 0.30, 0.88; P=0.013; absolute risk reduction（ARR）： –0.052, 95% CI： –0.06, 0.01]. The incidence of secondary endpoint was 5.98%（21 patients） in the treatment group versus 10.28%（36 patients） in control group（RR： 0.58, 95% CI： 0.33, 0.97, P=0.037; ARR： –0.043, 95% CI： 0.06, 0.01）. Most of the primary and secondary endpoints were occurred in 18 months（84.50% in the treatment group versus 78.10% in the control group）. Conclusion： CHMs for benefiting qi and activating blood circulation adjunctive to conventional treatment improved clinical outcomes for patients with ACS after PCI in long-term follow-up.