Analysis of the Effect of Humanistic Care in the Process of Pre-Hospital Emergency Care

Objective:To explore the effectiveness of humanistic care in pre-hospital emergency care.Methods:From April 2020 to January 2021,80 pre-hospital emergency patients were studied.The patients were randomly divided into two groups:a control group(n=40),which received conventional care,and an experimental group(n=40),which received humanistic care.The effects of nursing care and psychological state were compared between the two groups.Results:The experimental group showed better nursing outcomes and a more positive psychological state compared to the control group(P<0.05).Conclusion:Humanistic care in pre-hospital emergency settings is more effective in reducing patients’anxiety and depression,enhancing the operational abilities and service attitudes of nursing staff,and increasing the emergency success rate.

Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature

BACKGROUND Extensive research revealed the absence of reports documenting hypertensive emergencies precipitated by changes in the cervical spine posture.CASE SUMMARY We here present a 57-year-old woman diagnosed as having cervical spondylotic radiculopathy(CSR)who was scheduled for anterior cervical decompression and fusion.During post-anesthetic positioning,a sudden hypertensive surge was observed when the patient was in a supine position with the neck being slightly extended.This surge was promptly reversed through cervical flexion and head elevation.This event however required an alternate surgical approach for recovery—posterior laminoplasty and endoscopy-assisted nucleus pulposus removal.Following the 6-month outpatient follow-up period,cervical flexion and extension activities substantially improved in the patient without any episodes of increase in acute blood pressure.CONCLUSION Maintaining a safe hypotensive posture and performing rapid,thorough deco-mpression surgery may serve as effective interventions for patients presenting symptoms similar to those of CSR accompanied by hypertensive emergencies(HE).This would mitigate the underlying causes of these HEs.

Clinical, Therapeutic and Evolutionary Profiles of Hypertensive Emergencies in the Cardiology Department of the Ignace Deen National Hospital (Conakry)

Introduction: Hypertensive emergencies are a reality in the cardiology department of the Ignace Deen National Hospital. The aim of this study was to determine the clinical, therapeutic and evolutionary profile of hypertensive emergencies in the cardiology department of the Ignace Deen National Hospital. Methods: This was a longitudinal descriptive study of patients admitted to the cardiology department of the Ignace Deen National Hospital for hypertensive emergencies, over a period of six (6) months from 1 October 2020 to 31 March 2021. Results: Among the 638 patients admitted to the cardiology department during the study period, 102 cases of hypertensive emergencies were identified, representing a frequency of 15.99%. The mean age of the patients was 56.65 ± 13.33 years, with extremes of 23 and 90 years, and the sex ratio was 1.91 in favour of men. The associated cardiovascular risk factors were: age (76.47%), smoking (41.18%), sedentary lifestyle (31.37%), obesity (16.67%), dyslipidaemia (12.75%), diabetes (11.76%) and excessive alcohol consumption (11.76%). The various clinical pictures found were: acute pulmonary oedema 39 cases (38.23%), acute coronary syndrome 31 cases (30.39%), stroke 17 cases (16.67%), hypertensive encephalopathy 11 cases (10.78%), acute renal failure 3 cases (2.94%) and aortic dissection 1 case (0.98%). The drugs used on admission were calcium antagonists (Nicardipine 10mg) in 58 cases (56.86%), diuretics (Furosemide 20mg) in 44 cases (43.13%), nitrates (Risordan 20mg) in 39 cases (38.23%) and beta-blockers in 31 cases (30.39%). In terms of outcome, 88 (86.27%) patients had improved. However, 12 (11.76%) deaths were recorded. Conclusion: Hypertensive emergencies are a worrying condition with a high prevalence in the cardiology department of the Ignace Deen National Hospital.

Current pre-hospital traumatic brain injury management in China

BACKGROUND: Traumatic brain injury(TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, prehospital service can signifi cantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China.DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure(CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identifi ed articles.RESULTS: Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions.CONCLUSION: Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China.

Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices

AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool.The gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage route.The sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon occlusion.In patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following day.Patients were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo thereafter.RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices.These patients underwent a second BRTO on the next day,and additional sclerosant was injected through the catheter.Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the varices.None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the procedure.However,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.

Overview of the Shenzhen Emergency Medical Service Call Pattern

BACKGROUND：In Shenzhen, the Emergency Medical Service （EMS） system has been in service since 1997. This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.BACKGROUND：In this retrospective quantitative descriptive study, the data from the Shenzhen 120 EMS registry in 2011 were analyzed.RESULTS：Shenzhen 120 EMS center is a communication command center. When the number of 120 are dialed, it is forwarded to the closest appropriate hospital for ambulance dispatch. In 2011, the Shenzhen 120 EMS center received 153 160 ambulance calls, with an average of 420 calls per day. Calling emergency services was mainly due to traffic accidents. Trauma and other acute diseases constituted a majority of ambulance transports. The adult patients aged 15-60 years are the principal users of EMS. There are no recognized ＇paramedic＇ doctors and nurses. The pre-hospital emergency service is under the operation of emergency departments of hospitals. Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in posttrauma management. Moreover, specialized pre-hospital training, financial support, and public health education on proper use of EMS should be emphasized.CONCLUSION：The Shenzhen 120 EMS center has its own epidemiology characteristics. Traumatic injury and traffic accident are the main reasons for calling ambulance service. In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS.

Feasibility study of emergency intervention for vascular injury outside the hospital

Background: Minimally invasive surgery in the field of traumatic vascular injury diagnosis and treatment has achieved good results. This study was designed to determine whether pre-hospital emergency intervention is feasible for vascular injury in a field intervention cabin under the condition of war or a disaster site.Methods: Different types of animal experiments of vascular injury intervention were performed in a field intervention cabin. Treatment capacity was evaluated by data collection, including duration of surgery, clinical evaluation, image clarity, and equipment handling. Environmental adaptability and mobility were evaluated by maneuverability and long-distance mobility.Results: A total of 56 surgeries(7 types) were performed in the field intervention cabin. Digital subtraction angiography(DSA) had good imaging performance. A total of 4800 km of long-distance mobility was performed, and all the equipment operated normally without any equipment failure. We participated in the medical service maneuver twice. The cabin unfolded and worked properly. There was no equipment damage during the medical service maneuver.Conclusion: Use of a field intervention cabin under the conditions of war or disaster is feasible for pre-hospital emergency intervention of vascular injury.

First Masquerading as Gallstones, Pulmonary Hypertension Mimics PE

Patients presenting to emergency and urgent care centers with calf pain after long and short-haul flights are a common presentation throughout Europe. Patients fitting an epidemiological risk profile for cholelithiasis and presenting with right upper quadrant abdominal pain can also be a common presentation fitting of a specific patient profile. However, pulmonary hypertension can present in a nuanced and possible missed chronic and acute presentation. The patient case we present profiles a mildly obese 54-year-old Caucasian woman and recent holiday maker with unilateral calf pain and shortness of breath after traveling on a long-haul flight with tertiary symptoms of indigestion and epigastric discomfort indicative of gastroenteritis. This case highlights the required diligence for emergency physicians to maintain a high index of suspicion and broad differential diagnosis in the undifferentiated patient with seemingly common or classic presentations. We find that a serendipitous definitive diagnosis is made by following a systematic and organized approach.

舒血宁注射液联合卡托普利治疗原发性高血压急症患者的临床效果

目的:探讨舒血宁注射液联合卡托普利治疗原发性高血压急症患者的临床效果。方法:选择2022年3月—2023年5月黑龙江省医院收治的82例原发性高血压急症患者作为研究对象,按随机分配原则将患者为对照组和观察组,各41例。对照组给予卡托普利治疗,观察组在对照组基础上联用舒血宁注射液,比较两组临床疗效、血压、血清血管内皮细胞功能指标、不良反应及生活质量。结果:观察组总有效率为92.68%,高于对照组的70.73%,差异有统计学意义(P<0.05);治疗后,两组收缩压、舒张压降低,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组血管内皮素-1(ET-1)水平下降,一氧化氮(NO)水平上升,且观察组ET-1水平低于对照组,NO水平高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为4.88%,低于对照组的19.51%,差异有统计学意义(P<0.05);治疗后,两组生活质量(QOL)评分升高,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:原发性高血压急症患者应用舒血宁注射液联合卡托普利能提高临床效果,降低血压,改善血清血管内皮功能指标,减少不良反应,提高生活质量。

内镜干预时机对肝硬化食管胃静脉曲张出血患者近期预后的影响及死亡相关因素分析

目的 探讨内镜干预时机对食管胃静脉曲张出血(EGVB)患者近期预后的影响,分析EGVB患者术后6周死亡的独立相关因素并构建预测模型。方法 连续纳入从2021年6月至2023年12月因EGVB在武汉大学人民医院行急诊内镜干预的患者,根据内镜干预时间分为紧急内镜组(会诊后6 h内,n=94)和早期内镜组(会诊后6~24 h,n=76)。所有入组患者术后接受6周随访。以1∶1进行倾向评分匹配(PSM),比较两组患者匹配前后基线特征,匹配后手术相关情况及短期预后。应用二元logistic回归分析EGVB患者术后6周死亡的相关因素,并构建预测模型列线图,通过ROC曲线、校准曲线和决策曲线评估预测模型预测效能。结果 匹配前,两组终末期肝病模型(MELD)评分、总胆红素水平、收缩压<90 mmHg比例、合并糖尿病比例和首次出血比例差异有统计学意义(P<0.05)。匹配后,紧急内镜组(n=53)和早期内镜组(n=53)基线指标、手术相关指标、术后并发症、术后6周死亡率等差异均无统计学意义;紧急内镜组血液制品消耗量大于早期内镜组(P=0.046)。多因素分析结果显示,首次出血、查尔森合并症指数(CCI)较高、活动性出血和手术持续时间较长是EGVB患者6周死亡的独立相关因素(P<0.05),内镜干预时机非6周死亡相关因素。预测模型ROC曲线下面积为0.790,准确性和临床实用性均较高。结论 内镜干预时机与EGVB患者术后6周死亡无明显相关性;基于首次出血、CCI评分、活动性出血和手术持续时间构建的模型对EGVB患者6周死亡有较高预测价值。

Risk Stratification in Obstetrics: An Integrated Approach to Maternal Health

Introduction: Prenatal care is crucial for maternal and fetal health, highlighting the importance of obstetric risk stratification. This enables personalized care, avoiding unnecessary interventions and reducing costs. Conditions such as first trimester bleeding, spontaneous abortion, gestational trophoblastic disease, and ectopic pregnancy require specific approaches. Early identification of these complications is vital, especially in urgent and emergency obstetric cases, which demand immediate hospital attention. Objective: Comprehensive review of first trimester pathologies and gestational hypertension, focusing on obstetric risks and personalized prenatal management. Methods: Literature review on bleeding and gestational hypertension. Results: The study provides a detailed analysis of pathologies associated with first trimester uterine bleeding and hypertensive disorders, focusing on obstetric risk stratification. The main causes of maternal and fetal mortality are hypertensive disorders, hemorrhages, infections, childbirth complications, and abortion. Spontaneous abortion is common, with different classifications, ranging from threatened to missed abortion. Infected abortion is a severe complication. Brazil has restrictive abortion laws, but many unsafe abortions occur, resulting in high public health costs. Pharmacological treatment with misoprostol is a safe option. Other pathologies include gestational trophoblastic disease, ectopic pregnancy, and placenta previa. Preeclampsia and eclampsia are severe conditions requiring immediate treatment to avoid complications. Conclusion: Early identification and management of obstetric risk factors, such as uterine bleeding, are essential for positive maternal and fetal outcomes. A multidisciplinary approach is fundamental.

高血压脑出血患者急诊开颅术前凝血功能与预后的相关性研究

目的探讨高血压脑出血患者急诊开颅术前凝血功能与预后的关系。方法回顾性选取82例急诊行开颅手术治疗的高血压脑出血患者(观察组)和50名健康志愿者(对照组)作为研究对象。观察组患者根据入院时格拉斯哥昏迷评分法(GCS)评分又分为轻中度组31例和重度组51例,根据格拉斯哥预后评分(GOS)又分为预后不良组37例和预后良好组45例。比较不同组别患者的术前凝血功能指标差异,分析各凝血指标对患者预后的预测价值。结果观察组的凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)、国际标准化比值(INR)、血栓调节蛋白(TM)及纤溶酶原激活物抑制剂-1(PAI-1)水平均显著高于对照组,差异有统计学意义(P<0.05)。重度组患者的PT、APTT、INR、TM、PAI-1水平高于轻中度组,差异有统计学意义(P<0.05)。与预后良好组相比,预后不良组患者的年龄更大,出血时间更长,收缩压(SBP)、舒张压(DBP)、PT、APTT、INR、TM、PAI-1水平更高,差异有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析显示,PT、APTT、INR、TM、PAI-1对高血压脑出血患者预后不良均有一定的诊断效能[曲线下面积(AUC)值均>0.7],单项指标以INR的诊断效能最高(AUC=0.833),PT最低(AUC=0.762)。与单项指标相比,5项凝血功能指标联合检测诊断患者预后不良的AUC为0.942,诊断敏感度、特异度分别为100.00%和97.22%。结论高血压脑出血患者在急诊开颅术前普遍存在不同程度的凝血功能异常,凝血功能异常与脑损伤程度及预后不良密切相关,联合检测凝血功能指标(PT、APTT、INR、TM、PAI-1)可为临床评估患者病情提供参考依据。

急诊重症监护室急性失代偿性肺高压患者的预后及其危险因素分析

目的探讨急性失代偿性肺高压患者的预后及其危险因素,旨在为急性失代偿性肺高压患者的临床管理提供依据。方法选取2015年4月至2020年4月我院急诊重症监护室诊治的287例急性失代偿性肺高压患者。根据是否发生院内死亡将患者分为生存组(n=140)和死亡组(n=147)。比较2组患者临床特征、实验室检查、治疗方案、临床事件及预后情况。利用多因素回归分析评价患者院内死亡率与欧洲心脏学会/欧洲呼吸学会(ESC/ERS)风险评估体系及SOFA评分的相关性。利用受试者操作特征(ROC)曲线分析ESC/ERS风险评估体系及SOFA评分对患者临床预后的评价效能。结果与生存组比较,死亡组ERS/ESC危险分层中、高危险及纽约心脏学会心功能分级Ⅲ、Ⅳ级比例显著增加;平均肺动脉压和N末端B型利钠肽原(NT-proBNP)明显升高;动脉血氧分压(PaO2)及三尖瓣环收缩期运动幅度(TAPSE)明显降低,差异均有统计学意义(均P<0.05)。多因素分析结果显示,SOFA评分≥8、ESC/ERS危险分级高危、NT-proBNP和PaO2是急性失代偿性肺高压患者院内死亡的独立危险因素(均P<0.05)。ROC曲线分析结果显示,ERS/ESC危险分级高危联合SOFA评分≥8的曲线下面积最大,为0.877;灵敏度为92.5%,特异度为83.0%。结论ERS/ESC危险分级高危及SOFA评分≥8是预测急性失代偿性肺高压患者院内死亡的独立危险因素。ERS/ESC危险分级及SOFA评分可以作为评价重症监护病房中急性失代偿性肺高压患者预后的指标,且二者联合的预测效能更高。

院前急救护理干预对治疗高血压脑出血的效果及对患者预后的影响

目的分析高血压脑出血治疗中院前急救的应用效果。方法选取2019年8月至2020年8月在石阡县人民医院进行救治的100例高血压脑出血患者,根据急救方式的不同分为研究组与对照组,研究组采用院前急救,对照组未采取院前急救,每组各50例。比较两组各项急救反应所需时间、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)以及临床疗效和并发症。结果研究组各项急救反应所需时间均显著短于对照组患者(P<0.001)。治疗后,两组患者NIHSS评分均降低,GCS评分均升高(P<0.001),且研究组NIHSS评分显著低于对照组(P<0.001),GCS评分显著高于对照组(P<0.001)。研究组临床有效率为90.00%,显著高于对照组的64.00%(P<0.05),差异有统计学意义。研究组并发症的发生率为4.00%,显著低于对照组的18.00%(P<0.05),差异有统计学意义。结论及时有效的院前急救护理干预,可缩短高血压脑出血患者急救反应时间,改善神经功能损伤程度,减少并发症的发生。

急性心衰合并高血压危象急救中乌拉地尔与硝酸甘油效果对比

目的探究乌拉地尔与硝酸甘油在急性心力衰竭(简称心衰)合并高血压危象急救中的应用效果。方法回顾性选取2020年10月—2023年10月安溪县医院收治的100例急性心衰合并高血压危象患者的临床资料,根据不同急救治疗方案分组,采用硝酸甘油治疗的50例患者为药物1组,采用乌拉地尔治疗的50例患者为药物2组。观察两组患者的血压值、心功能指标及药物不良反应。结果治疗前,两组患者的血压值和心功能指标对比,差异无统计学意义(P均>0.05)。治疗后,两组患者的舒张压及收缩压水平降低,但组间差异无统计学意义(P均>0.05);两组患者左心收缩末期内径(Left Ventricular End-systolic Dimension,LVESD)、左室舒张末期内径(Left Ventricular End-diastolic Diameter,LVEDD)降低,心输出血量(Cardiac Output,CO)、每搏输出量(Stroke Volume,SV)及左心室射血分数(Left Ventricular Ejection Fractions,LVEF)升高,且药物2组LVESD、LVEDD均低于药物1组,CO、SV、LVEF均高于药物1组,差异有统计学意义(P均<0.05)。药物2组的药物不良反应总发生率为4.00%,低于药物1组的18.00%,差异有统计学意义(χ^(2)=5.005,P<0.05)。结论乌拉地尔与硝酸甘油在急性心衰合并高血压危象急救中降压疗效一致,乌拉地尔心功能改善效果更佳,且不良反应较少。

耳穴压豆联合耳尖放血治疗高血压急症临床观察

目的观察耳穴压豆联合耳尖放血治疗高血压急症的临床效果。方法采用随机数字表法将90例高血压急症患者分为两组,各45例;对照组采用西医常规治疗,观察组在对照组基础上采用耳穴压豆联合耳尖放血治疗,两组均治疗48 h。观察并比较两组临床疗效及治疗前后症状评分、血压情况。结果治疗后,两组患者头痛、眩晕、急躁的症状评分均低于治疗前,且观察组各症状评分均低于对照组(P<0.05);两组患者治疗后0.5 h、1 h、6 h、24 h、48 h收缩压及舒张压均低于治疗前,且观察组各时间点收缩压及舒张压均低于对照组(P<0.05)。观察组临床总有效率为97.78%(44/45),高于对照组的93.33%(42/45)(P<0.05)。结论耳穴压豆联合耳尖放血治疗高血压急症患者能够快速改善其临床症状,平稳、有效降低血压,提高临床效果。

乌拉地尔注射液在高血压急症治疗中的临床效果

目的探讨高血压急症治疗中乌拉地尔注射液的临床效果。方法回顾性选取2021年1月—2023年1月本院收治的高血压急症患者72例,依据用药方法分为乌拉地尔注射液组、硝酸甘油注射液组,两组各36例。统计分析两组血压、心率、心肝肾功能指标、生活质量、临床疗效、不良反应发生情况、症状缓解时间。结果乌拉地尔注射液组患者的舒张压、收缩压、心率均低于硝酸甘油注射液组(P<0.05),QOL-BRIEF评分高于硝酸甘油注射液组(P<0.05),但两组患者的AST、ALT、GGT、SCr、BUN水平之间的差异均不显著(P>0.05)。乌拉地尔注射液组患者的总有效率高于硝酸甘油注射液组(P<0.05)。乌拉地尔注射液组患者的不良反应发生率低于硝酸甘油注射液组(P<0.05)。两组患者在胸闷、胸痛、心悸、头晕、恶心、呼吸困难缓解时间之间的差异均不显著(P>0.05)。结论高血压急症治疗中乌拉地尔注射液的临床应用效果较硝酸甘油注射液好,能更有效地降低患者血压、心率,改善患者心肝肾功能,提高患者生活质量、临床疗效,减少患者不良反应的发生,但对患者症状缓解时间无显著影响。

医联体模式下院前急救联合急诊绿色通道在急性高血压脑出血患者临床救治中的应用效果

目的:探讨急性高血压脑出血患者应用医联体模式下院前急救联合急诊绿色通道的临床救治效果.方法:选取2021年1月—2022年12月遵义市习水县人民医院收治的急性高血压脑出血患者66例作为研究对象,以随机数字表法分为对照组、观察组,各33例.对照组行常规急救,观察组行医联体模式下院前急救与急诊绿色通道联合救治.比较两组日常生活活动能力量表(ADL)评分、美国国立卫生院卒中量表(NIHSS)评分、发病至入院时间.结果:入院时,两组ADL、NIHSS评分比较,差异无统计学意义(P>0.05);出院时,两组ADL评分高于入院时,NIHSS评分低于入院时,差异有统计学意义(P<0.05),且观察组ADL评分高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05).观察组发病至入院时间短于对照组,差异有统计学意义(P<0.001).结论:医联体模式下院前急救联合急诊绿色通道的应用,可进一步改善急性高血压脑出血患者的神经功能,促进日常生活能力提高,值得临床推广.

Clinical overview of hypertensive crisis in children

Hypertensive emergencies and hypertensive urgencies in children are uncommonly encountered in the pediatric emergency department and intensive care units, but the diseases are potentially a life-threatening medical emergency. In comparison with adults, hypertension in children is mostly asymptomatic and most have no history of hypertension. Additionally, measuring accurate blood pressure values in younger children is not easy. This article reviews current concepts in pediatric patients with severe hypertension.

高血压急症与亚急症患者血清同型半胱氨酸水平与心脑血管动脉粥样硬化的相关性

【目的】探讨高血压急症及亚急症患者血清同型半胱氨酸(Hcy)水平与心脑血管动脉粥样硬化的相关性。【方法】检测79例本院收治的高血压急症与亚急症患者的血清Hcy水平,评估所有患者心脑血管动脉粥样硬化发生情况,其中发生心脑血管动脉粥样硬化的患者为观察组(n=48),未发生心脑血管动脉粥样硬化的患者为对照组(n=31)。比较两组的一般资料及血清Hcy水平,采用Logistic回归分析心脑血管动脉粥样硬化的影响因素;采用受试者工作特征(ROC)曲线评估血清Hcy水平对心脑血管动脉粥样硬化的预测价值。【结果】两组患者的性别、年龄、体重指数(BMI)、吸烟史、合并糖尿病和合并高脂血症的比例、空腹血糖(FPG)、糖化血红蛋白(HbAlc)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较,差异均无统计学意义(P>0.05);观察组既往经皮冠状动脉介入手术(PCI)史占比、脑梗死史占比、肌酐(Cr)、尿素氮(BUN)、Gensini评分、Hcy水平均高于对照组(P<0.05);经Logistic回归分析,既往PCI史、脑梗死史、BUN、Gensini评分、Hcy均为高血压急症与亚急症患者心脑血管动脉粥样硬化的影响因素(P<0.05);经ROC分析显示,高血压急症与亚急症患者血清Hcy水平诊断心脑血管动脉粥样硬化的Cut-off值为8.76μmol/L,曲线下面积(AUC)为0.974,灵敏度为89.58%,特异度为96.77%。【结论】血清Hcy水平与高血压急症、亚急症患者心脑血管动脉粥样硬化密切相关,可为临床诊治提供依据。