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急性肺栓塞患者规范抗凝中复发的特征及其相关因素 被引量:10
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作者 王丹丹 李雅敏 +3 位作者 米玉红 张晓丽 孟晶晶 米宏志 《中国急救医学》 CAS CSCD 北大核心 2020年第3期237-243,共7页
目的探讨无明确触发因素的肺栓塞(pulmonary embolism,PE)患者规范抗凝治疗中PE复发特征及其相关因素.方法连续收集2017年1月至2018年8月北京安贞医院急诊重症监护室(emergency intensive care unit,EICU)收治的无明确触发因素的急性PE... 目的探讨无明确触发因素的肺栓塞(pulmonary embolism,PE)患者规范抗凝治疗中PE复发特征及其相关因素.方法连续收集2017年1月至2018年8月北京安贞医院急诊重症监护室(emergency intensive care unit,EICU)收治的无明确触发因素的急性PE患者,病情稳定按照研究拟定的随访方案进行院外随访;记录患者抗凝治疗情况、急性期及抗凝治疗1年时肺灌注/通气显像(ventilation/perfusion scan,V/Q scan)结果及每3个月检测的血压、糖化血红蛋白、同型半胱氨酸及血脂等动脉硬化相关指标的结果.结果连续纳入175例急性PE患者中符合入选标准的急性PE患者共70例,平均年龄64(64.22±10.94)岁;70例急性PE患者中59例(84.3%)患者具有一个或多个动脉硬化的危险因素;PE复发组20例(复发率28.57%),V/Q scan明确提示原有部位加重或新发部位的灌注缺损,均为无症状PE复发,治疗后灌注缺损面积较治疗前有所减小,但差异未见统计学意义(P>0.05).50例无PE复发患者治疗后灌注缺损面积显著减小(P<0.001);冠状动脉危险因素中,低密度脂蛋白(low density lipoprotein,LDL)累积暴露水平与PE复发相关:LDL每增加1 mmol/L,PE复发风险增加了47.6%(OR 1.476,95%CI1.108~1.964,P<0.05).结论①亟需建立急性PE患者的院外随访策略;②V/Q scan可以确定抗凝期间无症状PE复发的患者,有助于抗凝1年后疗程的确定;③LDL增加与PE复发风险增加有关. 展开更多
关键词 肺栓塞 随访策略 复发 动脉硬化危险因素
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心力衰竭合并急性肺栓塞时血栓负荷与临床表现的相关性 被引量:2
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作者 王丹丹 米玉红 +1 位作者 马晓海 赵蕾 《中国急救医学》 CAS CSCD 北大核心 2018年第10期837-841,共5页
目的探讨心力衰竭合并肺栓塞(pulmonaryembolism,PE)时血栓负荷与右室功能不全(fightventriculardysfunction,RVD)的相关性。方法选择首次发病的急性中危PE患者,根据既往是否存在心功能不全病史分为存在心功能不全PE组(Ⅰ组)... 目的探讨心力衰竭合并肺栓塞(pulmonaryembolism,PE)时血栓负荷与右室功能不全(fightventriculardysfunction,RVD)的相关性。方法选择首次发病的急性中危PE患者,根据既往是否存在心功能不全病史分为存在心功能不全PE组(Ⅰ组)和无心功能不全PE组(Ⅱ组)。由两位经验丰富的医学影像医师读取肺动脉增强cT(computedtomographypulmonaryarteriography,CTPA)中肺动脉的阻塞指数(obstructionscore,OS)和右心室/左心室(RV/LV)。结果最终入选152例急性中危PE患者,其中Ⅰ组35例(23%),Ⅱ组117例(77%)。两组0s(I组29.4%,Ⅱ组32.4%,P=0.083)、呼吸频率及心率比较差异均无统计学意义(P〉0.05);I组LVEF显著低于Ⅱ组(Ⅰ组35.4%,Ⅱ组65.0%,P〈0.000),Ⅰ组低血压(P=0.031)、高脂血症(P=0.034)、冠状动脉粥样硬化性心脏病(P=0.045)、慢性肾病(P=0.024)和肺动脉高压(P=0.025)的比例显著高于Ⅱ组(P〈0.05);I组氧合指数、RV/LV和平均动脉压(meanbloodpressure,MBP)均低于Ⅱ组(I组285.9,Ⅱ组328.5,P〈0.000;Ⅰ组0.91,Ⅱ组1.39,P〈0.000;I组62.2mmHg,Ⅱ组65.8mmHg,P=0.002)。Ⅰ组OS与RV/LV无显著相关性(r=0.086,P=0.962),与HR(r=0.010,P=0.542)、RR(r:0.132,P=0.192)无显著相关性(P〉0.05),与氧合指数呈显著负相关(r=-0.637,P=0.025),与MBP呈显著负相关(r=-0.610,P=0.036)。Ⅱ组OS与RV/LV呈显著正相关(r=0.624,P=0.000),与氧合指数(r=-0.473,P=0.032)和MBP(r=-0.570,P=0.036)呈中度负相关(P〈0.05),与HR(r=0.266,P=0.025)及RR(r=0.321,P=0.028)的相关性较弱。结论对于阻塞程度相同条件下的PE患者,右室功能不全作为间接判断PE阻塞严重程度的指标能否反映患者病情的严重程度,取决于患者原有的左心功能状态。存在左心功能不全时,右室功能不全尚不能反映血栓负荷程度。 展开更多
关键词 急性肺栓塞 心力衰竭/心功能不全 肺动脉阻塞指数/肺血栓负荷 右室功能不全 临床表现
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Predicting value of serum soluble ST2 and interleukin-33 for risk stratification and prognosis in patients with acute myocardial infarction 被引量:27
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作者 ZHANG Kun ZHANG Xin-chao +1 位作者 mi yu-hong LIU Juan 《Chinese Medical Journal》 SCIE CAS CSCD 2013年第19期3628-3631,共4页
Background Acute myocardial infarction (AMI) is a common cardiac emergency with high mortality.Serum soluble ST2 (sST2) is a new emerging biomarker of cardiac diseases.The present study is to investigate the predi... Background Acute myocardial infarction (AMI) is a common cardiac emergency with high mortality.Serum soluble ST2 (sST2) is a new emerging biomarker of cardiac diseases.The present study is to investigate the predictive value of sST2 and interleukin-33 (IL-33) for risk stratification and prognosis in patients with AMI.Methods Fifty-nine patients with AMI,whose chief complaint was chest pain or dyspnea,were selected for our study.Physical examination,chest radiograph,electrocardiograph (ECG),biomarkers of myocardial infarction,NT-proBNP,echocardiography and other relevant examinations were performed to confirm the diagnosis of AMI.Thirty-six healthy people were chosen as the control group.Serum samples from these subjects (patients within 24 hours after acute attack) were collected and the levels of sST2 and IL-33 were assayed by enzyme-linked immuno-sorbent assay (ELISA) kit.The follow-up was performed on the 7th day,28th day,3rd month and 6th month after acute attack.According to the follow-up results we defined the end of observation as recurrence of AMI or any causes of death.Results Median sST2 level of the control group was 9.38ng/ml and that of AMI patients was 29.06ng/ml.Compared with the control group,sST2 expression in the AMI group was significantly different (P〈0.001).In contrast,the IL-33 level showed no significant difference between the two groups.Serum sST2 was a predictive factor independent of other variables and may provide complementary information to NT-proBNP or GRACE risk score.IL-33 had no relationship to recurrence of AMI.Both sST2 and the IL-33/sST2 ratio were correlated with the 6-month prognosis; areas under the ROC curve were 0.938 and 0.920 respectively.Conclusions Early in the course (〈24 hours) of AMI,sST2 usually increases markedly.The increase of sST2 has an independent predictive value for the prognosis in AMI patients and provides complementary information to NT-proBNP or GRACE risk score.The IL-33/sST2 ratio correlates with the 6-month prognosis of AMI patients.However,there is no significant relationship between IL-33 and the prognosis of AMI patients. 展开更多
关键词 serum soluble ST2 interleukin-3 3 acute myocardial infarction risk stratification PROGNOSIS
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亚临界热电联产机组耦合吸收式热泵系统热经济性及环境效益分析 被引量:7
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作者 米玉鸿 冯林魁 +1 位作者 柏建华 赵凯 《热能动力工程》 CAS CSCD 北大核心 2022年第4期94-99,共6页
为了减少北方供暖能耗、提高热电厂余热利用效率,构建了亚临界热电联产机组耦合吸收式热泵系统,并实测其性能,详细对比分析亚临界机组在耦合和切除热泵两种运行工况下的经济性。试验表明:热泵机组性能系数(Coefficient of Performance,C... 为了减少北方供暖能耗、提高热电厂余热利用效率,构建了亚临界热电联产机组耦合吸收式热泵系统,并实测其性能,详细对比分析亚临界机组在耦合和切除热泵两种运行工况下的经济性。试验表明:热泵机组性能系数(Coefficient of Performance,COP)为1.74,且热泵机组的制热量和回收热量随着循环水温度和驱动蒸汽压力的增大而增加;对于2台330 MW汽轮机组,热泵机组的投入可以增加供热面积166.03万m^(2);每年节约循环水量47.75万t,煤炭4.03万t,经济效益良好;CO_(2)、SO_(2)和NO_(x)排放量分别减少10.47万t、966 t和281.75 t,节能减排效果显著。 展开更多
关键词 亚临界机组 吸收式热泵 热电联产 经济性 环境效益
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