Arterial hypertension and electrocardiographic diagnosis of left ventricular hypertension in the group of geriatric patients with coronary heart disease living in the far north

As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.

Relationship between the Self-Efficacy and Mental Health of Elderly Patients with Coronary Heart Disease in Rural Hebei Province

Objective:To investigate the self-efficacy and mental health of elderly patients with coronary heart disease(CHD)in rural Hebei Province as well as to analyze the relationship between them.Methods:From June 2021 to December 2021,480 elderly patients with CHD from rural areas,who had been discharged by the Department of Cardiology from three tertiary hospitals in three cities with different economic levels in Hebei Province for more than a year,were selected as the research subjects.The general self-efficacy scale(GSES)and symptom self-rating scale(SCL-90)were used to investigate the self-efficacy and mental health of these patients.SPSS 25.0 was used for data analysis.Results:The total mean self-efficacy score of elderly patients with CHD in rural Hebei Province was 17.18±4.68,which is lower than the international norm(t=-32.067,P=0.000)and the national norm(t=-28.783,P=0.000);the total average SCL-90 score was 148.64±55.13,which is higher than the national norm for adults and the reference norm for ordinary elderly people;except for hostility and psychosis,the other dimensions were significantly higher than the national norm for adults(P<0.05);except for psychosis,the other dimensions were significantly higher than the reference norm for ordinary elderly people(P<0.05);the self-efficacy score was found to be negatively correlated with the total SCL-90 score and the score for each dimension(P<0.05).Conclusion:Elderly CHD patients with higher self-efficacy in rural Hebei Province have higher mental health level.It is suggested that the mental health of elderly patients with CHD in rural areas can be improved by improving their self-efficacy.

A Readmission Risk Prediction Model for Elderly Patients with Coronary Heart Disease

Objective:To analyze the independent risk factors and establish a risk prediction model by investigating the readmission of elderly patients with coronary heart disease(CHD)within 1 year after discharge.Methods:A total of 480 CHD patients,who were hospitalized in the Affiliated Hospital of Hebei University from October 2019 to December 2020,were included in this study.A general data scale,mental health status scale,the Clinical Frailty Scale,Pittsburgh Sleep Quality Index,as well as the Family Adaptability and Cohesion Evaluation Scale were used to collect data.According to the number of readmissions due to CHD within 1 year after discharge,the patients were divided into two groups:the readmission group(n=212)and the no readmission group(n=268).General data,laboratory examination indicators,frailty,mental health status,sleep status,as well as family intimacy and adaptability were compared between the two groups.Logistic regression was used to analyze the independent risk factors for the readmission of these patients,and R software was used to construct a line diagram model for predicting readmission of elderly patients with CHD.Results:Five factors including body mass index(OR=1.045),low density lipoprotein(OR=1.123),frailty(OR=1.946),mental health(OR=1.099),as well as family intimacy and adaptability(OR=0.928)were included to construct the risk prediction model for the readmission of elderly patients with CHD within 1 year after discharge.The ROC curve showed that the area under the curve for predicting readmission of elderly patients with CHD was 0.816;Hosmer-Lemeshow goodness of fit test showed X2=1.456 and P=0.989;the maximum Youden index corresponding to the predicted value of risk was 0.526.The results showed that the model could accurately predict the risk of readmission in elderly patients with CHD within 1 year after discharge.Conclusion:This study constructed a line diagram model based on five independent risk factors of the readmission of elderly patients with CHD:body mass index,low density lipoprotein,frailty,mental health status,as well as family intimacy and adaptability.This model has good discrimination,accuracy,and predictive efficiency,providing reference for the early prevention and intervention of readmission in elderly patients with CHD recurrence.

Feasibility of percutaneous coronary intervention via transulnar artery approachin selective patients with coronary heart disease

Objective To probe the clinic feasibility of percutaneous coronary intervention(PCI) via transulnar artery approach (PCI TRU).Methods Fourty patients with unstable ischemic manifestation(male 34,female 6;age 59.3 ±9.10 years)whose radial artery of right hand was thin with a weak pulse that was not suitable to transradial artery PCI while whose ulnar artery was thick with a strong pulse based on their larger diameter in ulnar artery as compared with those in radial artery ( 3.30 ±0.22mm vs 2.43 ±0.33 mm, P <0.05 ) by the investigation of vessel echography,but revesered Allen’s test for radial and ulnar artery was positive,were selected as the subjects for PCI TRU. The radio of ulnar artery versus radial artery was 1.35:1.00 and the time of Allen’s test in ulnar artery side was shorter than that in radial artery side ( 2.70 ±0.36 s vs 4.68 ±0.52s , P <0.05 ) before PCI. The efficiency of PCI TRU was evaluated. The time of manipulative duration for each procedure of PCI TRU was recorded. The time of Allen’s test, luminal diameter (mm) , cross area of vessel lumin (mm 2), blood velocity (Vs max), blood resistance (RI) in ulnar artery and radial artery and the level of blood oxygen in finger (PaO 2、SatO 2) were measured and recorded , respectively , as well were compared quantitatively before and after 1 month of procedure . Results Fourty eight lesion segments of 42 vessels in all patients were angioplasticized successfully via TRU by 6F guiding catheter including 23 segments of type B1 , 14 segments of type B2 and 11 segments of type C. PCI TRU in all of 40 patients was performed successfully. Fourty eight stents were implanted including 2 lesions of intrastent restenosis angioplasticized with cutting balloon technique before re stenting . The average time of manipulative duration of guiding catheters engaging in osicum of target coronary, crossing the vessel lesions of guidewire, dilatation and implantation of stents,and under X ray fluoroscopy were 4.30 ±0.59 min , 2.52 ±0.40min , 2.66 ±0.40 min ,and 25.9 ±0.49 min , respectively, and the total time of the whole procedure was 56.6 ±14.8 min . When the ulnar introducer was taken off, the access site in ulnar artery was suppressed by tourniquet with no bleeding in the access site and no limitation of physical activation under maintaining infusion of heparin immediately after procedure . There was no significant change in the diameter of ulnar artery and the time of Allen’s test after 1 month of PCI procedure as compared with those before procedure ( 3.22 ±0.48mm vs 3.26 ±0.22 mm , P >0.05 ; 2.96 ±0.98 s vs 2.72 ±0.47 s , P >0.05 ). No significant change was found in the parameters of blood velocity , cross area of vessel lumin, blood resistance and the level of blood oxygen in finger after 1 month of PCI procedure. The average total hospital stay was 5.21 ±0.43 days. Following up 1 month, no complications such as occlusion of ulnar artery, abnormal sensitivity and movement disability were found in right hands in all patients.Conclusions The ulnar artery might be selected as one approach of antebrachial artery for PCI in the patients with coronary heart disease whose radial artery was difficulty as access vessels of PCI, while reversed Allen’s test for radial and ulnar artery are positive and the luminal diameter of ulnar artery was larger than that of radial artery.

Change and significance of fibrinolysis in coronary heart disease patients with angina pactoris

Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA),fibrinogen(FIB) in 110 CHD patients with AP and 20 normal cases as control group were analyzed in the same ways.Results Levels of PAI-1,FIB in CHD patients with AP were significantly higher than those in control cases,and those of t-PA were significantly lower than control cases;Levels of PAI-1,FIB in UA patients with UA heart events were significantly higher than those in patients with SA,and those of t-PA were significantly lower than patients with SA;Levels of PAI-1,FIB in patients with AP events were significantly higher than those in patients without AP events,and those of t-PA were significantly lower than patients without AP events.Conclusions There was abnormal of fibrinolysis function in CHD patients with AP, specially in patients with UA or with AP events,the abnormal of fibrinolysis might be play an important rule in coronary heart disease(CHD) patients with angina pactoris.

Research Progress on the Depression Status and Nursing Intervention in Patients after Percutaneous Coronary Intervention

Percutaneous coronary intervention(PCI)is an effective treatment method for myocardial ischemic necrosis.Postoperative depression caused by PCI stress will adversely affect the prognosis of patients.This article reviews the current status and influencing factors of postoperative depression after PCI and summarizes the corresponding nursing interventions,to provide a literature reference to implement effective nursing interventions for depressed patients after clinical PCI.

Effect of St. John＇s wort extract on depressive disorder in elderly patients with unstable angina

The elderly patients with coronary heart disease （CHD） are often accompanied with depression. This study aimed to assess the effect of St. John＇s wort extract （SWE） on depressive disorder in elderly patients with unstable angina pectoris. Altogether 170 patients who met the set criteria were enrolled in this prospective study. They were randomly divided into SWE group （44 patients）, Deanxit group （44）, psychotherapy group （42）, and control group （40）. The effectiveness of SWE was evaluated by reduced percentage of Hamilton depression （HAMD） scale and reduced frequency of angina pectoris attack, which were measured before and at 12 weeks after the treatment with SWE. The reduced percentages of HAMD scale were 79.5%, 56.8% and 57.1% in the SWE, Deanxit and psychotherapy groups, respectively. Compared with the control, the three groups had significant differences in the percentages （P〈0.001）. The improvement after the treatment was more significant in the SWE group than in the Deanxit or psychotherapy group （P〈0,05）. The improvement of angina pectoris evaluated by the Canadian Cardiac Society Classification was significantly better in the treatment groups （88.7%, 65.9%, 57.1%） than in the control group, and it was marked in the SWE group （P〈0.001）. Angina pectoris attack, its frequencies, durations and electrocardiographic changes were significantly improved in the treatment groups than in the control group （F=6.05, 4.58, 5.12, P〈0.01）. They are markedly improved in the SWE group （P〈0.05）. SWE can improve depressive symptoms more significantly in elderly patients with unstable angina pectoris than Deanxit or psychotherapy, proving that SWE contributes to better treatment of angina attack as well.

A Pilot Study about the First Cases of Coronary Angioplasty in Democratic Republic of Congo/Kinshasa: Patient Profile

Background: The objective of this pilot study was to describe clinical profile, electric, echocardiographic and angiographic caracteristics with procedural outcome of congolease patients undergoing coronarography in the first and only one cardiac catheterization center opened in Kinshasa. Methods: An analytical cross-sectional study was carried out over a period from October 2019 (date of establishment of the first coronary angiography unit in DR Congo) to March 2021. We proceeded to a serial sampling of the consecutive cases of all the patients who have an angiographic exploration of coronary arteries. Clinical, ECG and cardiac ultrasound data were collected in all patients. The indications for the coronary angiography examination were set by differents cardiologists on the basis of repolarization troubles in the electrocardiogram, cinetic troubles in echocardiography, positive stress test and chest pain in patients with cardiovascular risq factors. Results: The serie (47 patients) was predominantly male with a sex ratio M/W of 2.6. The average age was 59.8 ± 10.5 years. Arterial hypertension (HBP) was the main risk factor (89.4%);followed by diabetes mellitus (14.9%). Chest pain was the main functional sign with an atypical character in 44.7%. The ECG showed ST segment depression (17%) and T wave inversion (17%), the anterior region being the most affected. Hypokinesia was the most common echocardiographic abnormality (34%), followed by akinesia (10.6%). The anteroseptal and apical territories were affected in 12.8%. Dilated myocardiopathy (DMC) was significantly predominant in the male sex (29.4% vs 7.7%;p = 0.011). With radial puncture as the main approach, coronary angiography was pathological in 44% revealing mono-truncal lesions. The left coronary network was the most affected: the middle inter ventricular artery (12.8%), the proximal interventricular artery (10.6%) and the proximal circonflex artery (10.6%). In multivariate logistic regression analysis, age (for age > 50 years for men and >60 years for women), arterial hypertension and dilated cardiomyopathy emerged as independent determinants of pathological coronary angiography. Transluminal angioplasty was performed in 27.7% of patients. The bypass indication was retained in 4.3% of cases and medical treatment in 68%. Conclusion: Coronary angiography was used to diagnose lesions responsible for ischemic heart disease and to treat 27.7% of patients locally. The young age of patients and limited financial resources encourage the strengthening of preventive measures against cardio vascular risq factors.

达格列净治疗糖尿病合并冠心病老年患者的效果及对心功能的影响

目的探讨达格列净治疗糖尿病合并冠心病老年患者的效果及对心功能的影响。方法选取2021年7月至2022年12月抚州市第一人民医院收治的80例糖尿病合并冠心病老年患者作为研究对象,按照随机数字表法分为观察组(40例)与对照组(40例),观察组采用达格列净治疗,对照组采用二甲双胍治疗。比较两组的治疗总有效率、氨基末端pro脑钠肽(NT-proBNP)、超敏C反应蛋白(hs-CRP)、心功能水平。结果观察组治疗后总有效率高于对照组,差异有统计学意义(P<0.05);观察组治疗后NT-proBNP水平低于对照组,差异有统计学意义(P<0.05);观察组治疗后hs-CRP水平低于对照组,差异有统计学意义(P<0.05);观察组治疗后左室舒张末期内径(LVEDD)低于对照组,观察组治疗后左室射血分数(LVEF)、舒张早期和舒张晚期二尖瓣口最大血流速度之比(E/A)、6 min步行距离高于对照组,差异有统计学意义(P<0.05)。结论达格列净治疗投入临床糖尿病合并冠心病老年患者治疗中,所得干预的评估结果更好。在实施治疗之后,患者的症状得到较好的改善,且NT-proBNP、hs-CRP指数减少,患者心功能水平得到一定的改善,值得被临床应用推广。

不同心房颤动类型患者合并缺血性卒中的危险因素分析

目的探讨不同心房颤动(房颤)类型患者合并缺血性卒中的危险因素。方法连续入选2016年1月至2021年4月于中国中医科学院广安门医院心内科住院的非瓣膜性房颤患者751例,分为阵发性房颤(367例)和持续性房颤(384例),将不同房颤类型患者分为缺血性卒中组和非缺血性卒中组,分析不同类型房颤合并缺血性卒中的危险因素。结果在房颤合并卒中患者中,持续性房颤患者比例大于阵发性房颤(P<0.05),在阵发性房颤患者中,卒中组合并高血压、冠心病、心力衰竭(心衰)、糖尿病比例高于无卒中组,CHA2DS2-VASc评分高于无卒中组[(5.92±1.41)分比(3.97±1.26)分,P<0.05]。多因素logistics回归分析显示,冠心病(OR=3.795,95%CI 1.011~14.241,P<0.05)、糖尿病(OR=2.121,95%CI 1.272~3.536,P<0.05)是阵发性房颤合并缺血性卒中的独立危险因素。持续性房颤患者中,卒中组女性(P<0.05)、合并高血压(P=0.012)比例高于无卒中组,年龄[(79.34±6.62)岁比(74.5±9.70)岁]、左心房内径(LAD)[(49.28±4.29)mm比(42.13±3.96)mm]、CHA2DS2-VASc评分[(3.97±1.38)分比(3.61±1.37)分]高于无卒中组(P<0.05),接受抗凝治疗患者比例低于无卒中组(P<0.05),多因素logistics回归分析显示,年龄(OR=1.062,95%CI 1.025~1.100,P<0.05)、女性(OR=2.917,95%CI 1.681~5.060,P<0.05)、LAD(OR=1.165,95%CI 1.105~1.230,P<0.05)是持续性房颤合并缺血性卒中的独立危险因素,接受抗凝治疗(OR=0.332,95%CI 0.194~0.566,P<0.05)是保护因素。结论冠心病、糖尿病是阵发性房颤患者合并缺血性卒中的独立危险因素,持续性房颤患者的年龄、女性、LAD、抗凝情况与缺血性卒中密切相关,抗凝治疗。因此,对于阵发性房颤制定相应的预防策略,或积极进行节律控制、抗凝治疗,以降低缺血性卒中风险。

早发女性冠心病患者单支病变的临床特点分析

目的 探索早发女性冠心病患者单支病变的临床特征。方法 本研究为回顾性研究,选取2017年1月至2019年12月于我院诊断为冠心病的早发女性患者(年龄<65岁)。根据冠脉CT/冠脉造影结果分为单支病变组和多支病变组。通过比较两组的基线资料、主要血液学检测指标、超声心动图指标、合并症等,探索冠脉特点为单支病变的早发女性患者的临床特征。结果 共纳入368例患者,其中单支病变组144例(39.1%),多支病变组224例(60.9%)。与多支病变组比较,单支病变组的发病年龄更小(P<0.05),吸烟史低(P<0.05),高密度脂蛋白胆固醇更低(P<0.05),同时单支病变组的患者诊断稳定型心绞痛患者数更多,而不稳定型心绞痛、心肌梗死的数量更少(P<0.05),且单支病变组左室射血分数更高(P<0.05)。结论 单支病变的早发女性冠心病患者的发病年龄更早,吸烟者更少,射血分数更高,多数为稳定型心绞痛患者,提示单支病变患者预后更好。

美托洛尔联合瑞舒伐他汀治疗老年冠心病并室性心律失常临床研究

目的探讨美托洛尔联合瑞舒伐他汀治疗老年冠状动脉粥样硬化性心脏病(简称冠心病)并室性心律失常的临床疗效。方法选取医院2020年1月至2023年2月收治的冠心病并室性心律失常老年患者98例,按随机数字表法分为观察组和对照组,各49例。两组患者均予利尿剂、血管扩张剂、抗血小板聚集药物等基础治疗,并口服瑞舒伐他汀钙片,观察组患者加服琥珀酸美托洛尔缓释片。两组患者均连续治疗3个月。结果观察组总有效率为95.92%,显著高于对照组的81.63%(P<0.05)。与治疗前比较,两组患者治疗后的室性期前收缩、成对室性期前收缩、短期阵发室性心动过速发作次数24 h内均显著减少,左心室射血分数显著升高,左心室舒张末期内径、左心室收缩末期内径均显著缩短(P<0.05);血管内皮生长因子、一氧化氮水平均显著升高,内皮素-1、可溶性生长刺激表达基因2蛋白、心肌肌钙蛋白I、N末端脑钠肽前体水平均显著降低(P<0.05);肿瘤坏死因子-α、髓过氧化物酶、超敏C反应蛋白、低密度脂蛋白胆固醇、甘油三酯、总胆固醇水平均显著降低,高密度脂蛋白胆固醇水平均显著升高(P<0.05);三水平五维健康量表中视觉模拟量表评分显著升高(P<0.05)。观察组以上指标改善幅度均显著大于对照组(P<0.05)。观察组与对照组不良反应发生率相当(12.24%比10.20%,P>0.05)。结论美托洛尔联合瑞舒伐他汀治疗老年冠心病并室性心律失常,能减少室性心律失常的发作次数,改善心功能、血管内皮功能及血脂水平,抑制心肌损伤及炎性反应,提高患者的生活质量。

Thinking on Treatment of Post-reperfusion Events in Patients with Coronary Heart Disease by Integrated Traditional Chinese and Western Medicine

In the 1970＇s, promoting blood circulation to remove blood stasis （PCRS） was the main method in integrative traditional Chinese and Western medicine （ICWM） in treating acute myocardial infarction （AMI）. It decreased the case fatality rate of AMI from 30% to 13%-16% as compared with that treated by simple Western internal medical conservative treatment. Later in the 1980＇s, such therapeutic approaches as infarction related arterial revascularization, thrombolysis and percutaneous coronary intervention （PCI） became the most effective means in treating AMI, which could re-canalize the obstructed coronary vessels, recover the blood perfusion of myocardium, and thus to save the ischemic myocardium, diminute the infarcted size, preserve the ventricular function and improve the patient＇s near and long-term prognosis, with the fatality rate reduced by 5%-7%. Hence, the some-time superiority of ICWM in treating AMI was overshadowed with no more luster left.

女性先天性心脏病患者生育体验的Meta整合

目的了解先天性心脏病女性患者生育体验,为先天性心脏病女性患者生育管理提供参考。方法系统检索中英文数据库中关于先天性心脏病女性患者生育相关体验的质性研究,检索时限为建库至2024年5月。根据澳大利亚JBI循证卫生保健中心质性研究质量评价工具对文献进行质量评价,并对结果进行Meta整合。结果共纳入6篇文献,提取21个研究结果,归纳为10个研究类别,4个整合结果:生育决策影响因素复杂;与生育相关的多重忧虑;生育相关管理经验不足及专业指导需求较高;与生育相关的成长与收获。结论先天性心脏病女性患者的生育决策受到多重因素影响,患者面对生育问题存在多方面的担忧与需求。医护人员应关注患者与生育相关的需求,为其提供专业的生育辅助决策,加强先天性心脏病生育相关的风险评估与宣教。

冠心病射血分数降低心力衰竭患者预后影响因素分析及预测模型构建

目的探究合并冠心病的射血分数降低心力衰竭(HFrEF)患者预后影响因素,并构建对应的预测模型。方法回顾性分析2021年1月—2023年6月安徽省亳州市人民医院心内科诊治的合并冠心病的HFrEF患者219例的临床资料,经随机数字表法按照2∶1随机分为开发集146例、检验集73例。随访统计患者主要不良心血管事件(MACE)发生情况,将开发集中发生MACE、未发生MACE的患者分别纳入结局不良组(n=32)、结局良好组(n=114)。比较开发集、检验集及开发集结局不良组、结局良好组临床资料;采用Logistic回归模型分析合并冠心病的HFrEF患者预后影响因素,建立回归方程及预后预测模型;经受试者工作特征(ROC)曲线评估模型效能。结果开发集、检验集临床资料比较,差异无统计学意义(P>0.05)。结局不良组高尿酸血症、CONUT评分、UAC、SYNTAX评分、院外依从性不良构成比高于结局良好组(P<0.05),LVEF低于结局良好组(P<0.01)。Logistic回归模型分析显示,合并高尿酸血症、控制营养状况(CONUT)评分高、SYNTAX评分高、院外依从性不良是合并冠心病的HFrEF患者预后不良的危险因素[OR(95%CI)=2.561(1.272~5.155)、2.309(1.292~4.126)、3.048(1.360~6.831)、2.179(1.323~3.587)],左心室射血分数(LVEF)高是其保护因素[OR(95%CI)=0.532(0.353~0.801)]。基于开发集Logistic回归分析构建合并冠心病的HFrEF患者预后预测模型。ROC曲线显示,预测模型预测开发集患者预后不良的曲线下面积(AUC)为0.923(95%CI 0.867~0.960),敏感度为0.938,特异度为0.860,预测模型预测检验集患者预后不良的AUC为0.904(95%CI 0.812~0.960),敏感度为0.900,特异度为0.830。结论合并高尿酸血症、CONUT评分高、SYNTAX评分高、院外依从性不良是合并冠心病的HFrEF患者预后不良的危险因素,LVEF高是其保护因素,以上述因素为依据构建的预测模型在预测合并冠心病的HFrEF患者预后不良时具有良好的效能。

老年冠心病患者医养健康服务需求影响因素分析

目的分析老年冠心病患者医养健康服务需求影响因素。方法采用方便抽样法抽取山东省滨州市某三级甲等医院112名老年冠心病患者为调查对象,采用SPSS 26.0统计软件进行统计描述及Logistic回归分析。结果老年冠心病患者医养健康服务需求有93例(83.04%)。Logistic回归分析显示,经济状况、年龄、慢性疾病的困扰、认同医养结合养老模式对老年冠心病患者医养健康服务需求有影响。结论慢性疾病的困扰、经济状况、年龄、认同医养结合养老模式是老年冠心病患者医养健康服务需求的影响因素,应针对老年冠心病患者的需求及其影响因素,完善医养健康服务内容,提高老年冠心病患者的生活质量。

扶阳通络法联合常规西医疗法治疗冠状动脉粥样硬化性心脏病心力衰竭老年患者的疗效

目的探讨扶阳通络法联合常规西医疗法治疗冠状动脉粥样硬化性心脏病(简称冠心病)心力衰竭(简称心衰)老年患者的疗效。方法本研究为单盲随机对照研究,将96例老年冠心病心衰患者分为3组,每组32例。对照A组予以常规西医治疗(阿托伐他汀联合美托洛尔),对照B组予以扶阳通络法治疗,观察组予以扶阳通络法联合常规西医治疗。比较3组的疗效、中医证候积分以及治疗前后血白细胞介素(IL)-23、IL-17、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)。结果观察组临床总有效率为93.75%,高于对照A组(68.75%)和对照B组(65.63%)(P<0.05)。治疗4和8周后,观察组中医证候主症积分、次症积分、总积分以及LVESD、LVEDD、IL-23、IL-17均低于对照A组和对照B组(P<0.05)。结论扶阳通络法与常规西医疗法联合治疗老年冠心病心衰患者疗效良好,可抑制IL-23/IL-17炎症轴因子过量表达,促进心脏功能恢复。

女性2型糖尿病合并冠心病的影响因素和患者肠道菌群特点及其与糖脂代谢的关系分析

目的分析女性2型糖尿病(T2DM)合并冠心病的影响因素和患者肠道菌群特点及其与糖脂代谢的关系。方法回顾性分析2019年1月至2021年12月九江市第一人民医院收治的60例T2DM女性患者的临床资料,其中合并冠心病(CHD)20例,单纯T2DM40例。所有患者均检测总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、载脂蛋白-B(APOB)、糖化血红蛋白A1c(HbA1c)及空腹血糖(FBG)水平。比较合并CHD与单纯T2DM患者肠道菌群相对含量、糖脂代谢相关指标,单因素及多因素Logistic回归分析女性T2DM合并CHD的影响因素,采用Pearson相关性分析T2DM合并CHD患者肠道菌群与糖脂代谢指标的关系。结果合并CHD患者拟杆菌属相对含量低于单纯T2DM患者,肠球菌属相对含量高于单纯T2DM患者,差异有统计学意义(P<0.05)。合并CHD患者HbA1c、TC、TG、LDL-C、HDL-C、APOB水平均高于单纯T2DM患者,差异有统计学意义(P<0.05)。单因素分析结果显示,合并CHD患者糖尿病病程≥10年、有高血压病史、有吸烟史、有高血脂病史、有CHD家族遗传史及HbA1c≥8%、TC≥5.72mmol/L、HDL-C<1mmol/L、LDL-C≥3.12mmol/L、TG≥2.25mmol/L、APOB>1.2g/L、拟杆菌属与肠球菌属相对含量异常均为女性T2DM合并CHD的影响因素(P<0.05)。多因素Logistis回归分析结果显示,有高血压病史、高血脂病史、TC≥5.72 mmol/L、LDL-C≥3.12 mmol/L、拟杆菌属和肠球菌属相对含量异常是女性T2DM合并CHD的独立危险因素(OR>1,P<0.05)。Pearson相关性分析结果显示,罗氏菌属与HbA1c、FBG均呈负相关(r<0,P<0.05),与HDL-C、LDL-C、TC、TG、APOB均无相关性;拟杆菌属与HbA1c、FBG、TC、TG均呈负相关(r<0,P<0.05),与HDL-C、LDL-C、APOB均无相关性;肠球菌属与HbA1c、FBG均呈正相关(r>0,P<0.05),与HDL-C、LDL-C、TC、TG、APOB均无相关性;乳酸杆菌属、双歧杆菌属、普雷沃菌属与糖脂代谢相关指标均无相关性。结论女性T2DM合并CHD患者存在糖脂代谢及肠道拟杆菌属、肠球菌属相对含量异常,且有高血压病史、有高血脂病史、TC≥5.72mmol/L、LDL-C≥3.12mmol/L、拟杆菌属和肠球菌属相对含量异常是女性T2DM患者合并CHD的独立危险因素,临床应根据上述因素制订相关预防措施。

参松养心胶囊联合美托洛尔缓释片治疗老年冠心病心律失常患者的临床效果

目的研究参松养心胶囊联合美托洛尔缓释片治疗老年冠心病心律失常患者的临床效果。方法回顾性选取2020年6月至2021年6月我院收治的96例老年冠心病心律失常患者作为研究对象,依据治疗方法不同将其分为联合治疗组(美托洛尔缓释片联合参松养心胶囊治疗)和单独治疗组(美托洛尔缓释片治疗),各48例。比较两组的治疗效果。结果联合治疗组的治疗总有效率高于单独治疗组(P<0.05)。治疗后,联合治疗组的心功能分级优于单独治疗组(P<0.05)。治疗后,联合治疗组的心排出量、心脏指数、射血分数均高于单独治疗组(P<0.05)。联合治疗组的室性期前收缩、房性期前收缩、交界性期前收缩、短阵心房颤动发生次数均少于单独治疗组(P<0.05)。治疗后,联合治疗组的缺血发生次数、缺血总负荷低于单独治疗组,缺血持续时间短于单独治疗组(P<0.05)。联合治疗组的不良反应总发生率低于单独治疗组(P<0.05)。结论参松养心胶囊联合美托洛尔缓释片治疗老年冠心病心律失常效果显著,可减少其心律失常发作频率,改善心功能。

标准化护理对老年冠心病伴心律失常患者生活质量的影响评价

目的:探究标准化护理对老年冠心病伴有心律失常患者生活质量的影响。方法:本次研究从云南省滇南中心医院2022年11月至2023年2月收入的老年冠心病伴有心律失常患者中随机抽取84例,按照随机数表法将其分为对照组和观察组。对照组接受常规护理,观察组接受标准化护理,对比护理效果。结果:干预后,观察组综合护理满意率显著高于对照组,差异有统计学意义(P<0.05)。干预前,两组生活质量、身心指标对比差异不显著(P>0.05);干预后,观察组指标显著优于对照组,差异有统计学意义(P<0.05)。结论:标准化护理可以提升老年冠心病心律失常患者生活质量,患者的综合护理满意率较高,值得推广。