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Objective To study and investigate the efficacy of alteplase combined with low molecular weight heparin sodium in the treatment of patients with submaximal pulmonary embolism and its influence on related indicators, and to guide clinical medication. Methods Eighty patients with large pulmonary embolism treated in our department from August 2013 to August 2017 were randomly divided into observation group and control group, with 40 cases in each group. The control group was treated with subcutaneous injection of low molecular weight heparin sodium. In combination with oral anticoagulation with warfarin, the observation group was treated with alteplase on the basis of the control group. After 1 week of continuous treatment, the clinical efficacy was compared between the 2 groups, and pulmonary function and arterial partial pressure of oxygen (PaO2) were compared before and after the treatment. The partial pressure of carbon dioxide (PaCO2) was used to compare the levels of serum B-type natriuretic peptide (BNP) , troponin Ⅰ (cTnⅠ) , homocysteine (Hey) , Ddimer (D-D) , and bleeding before and after the treatment in both groups. Results The total effective rate was97.50％ in the observation group, which was significantly higher than that in the control group of 75.00％ (P <0.05). There was no significant difference in terms of FEV1％, FEV1/FVC, PaO2 and PaCO2 between the two groups before the treatment (P> 0.05) , but FEV1％, FEV1/FVC, PaO2 in the observation group were significantly higher than those in the control group after the treatment, and PaCO2 was significantly lower (P <0.05); There was no significant difference regarding to serum BNP, cTnl, Hey and D-D levels between the two groups before the treatment (P> 0.05) , but after the treatment, the indexes of the observation group were significantly lower than those of the control group (P < 0.05). There was no statistical difference in the incidence of bleeding between the two groups (P> 0.05). Conclusion Alteplase combined with low-molecular-weight heparin sodium in the treatment of the next large-area pulmonary embolism can improve the efficiency of treatment, lung function and the prognosis, but will not inc-rease the risk of bleeding. It could be widely used in clinical practice.
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Objective To investigate the relationship between serum homocysteine ( Hcy ) and cognitive impairment in patients with cerebral infarction combined chronic obstructive pulmonary disease (COPD) after stroke, and observe the plasma Hcy levels and cognitive function improvement when treated with folic acid and vitamin B12 .Methods 87 acute cerebral infarction combined with COPD patients as the research object, then the general clinical data were recorded, hematology indexes ( Hcy, folic acid, vitamin B12 ) were determined, and their cognitive function with a simple mental state scale (MMSE) was assayed.According to the plasma Hcy levels, the subjects were divided into Hcy-normal group (n =21) and Hcy-increased group (n=66), then compare the cognitive function between the two groups.Hcy-increased subjects were randomly divided into intervention group (conventional treatment +folic acid 2.5 mg +VitB12 0.5 mg) and control group (conventional treatment).After six months follow-up, we retested plasma Hcy levels and MMSE assessment, comparison of plasma Hcy concentration change and cognitive function improvement between two groups.Results Compared with Hcy-normal group, plasma folic acid, VitB12 levels significantly decreased in Hcy-increased group (P<0.05).And Hcy concentration was negatively correlated with folic acid(r=-0.351,P =0.000)and VitB12(r=-0.242,P=0.015)levels.In addition, the MMSE, directional force and delayed recall score decreased in Hcy-increased group compared with the Hcy-normal group ( P<0.05 ).Hcy levels were significantly lower than the baseline level (P<0.05), MMSE and the sub-project of cognitive function score increased after treated with folic acid and VitB12 for six months, although there was no statistically significant difference.Conclusion Plasma Hcy level is associated with cognitive impairment in patients with cerebral infarction combined chronic obstructive pulmonary disease (COPD), patients treated with folic acid and VitB12 may help slow the recent cognitive dysfunction after stroke in the near future.
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Objective To investigate the clinical and pathological features of Wegener granulomatosis to improve the management of it. Methods Twenty-three patients with Wegener granulomatosis were analyzed retrospectively. Results The average age at onset was 37.2 years (range from 20~57 years). The average interval from clinical symptoms presentation to diagnosis was 5.8 months. The initial symptom of 23 cases was the upper respiratory tract involvement (48%). The patients had multiple system and organ involvement. 87% patients with WG had lung involvement and 78% patients had glucocorticoids. Seventeen out of 23 were cANCA (74%) positive. The pathological manifestations included necrotizing granulomatosis and vasculitis. Conclusion Clinical manifestation of WG is complicate, including multiple system and organ involvement. The upper and lower respiratory tract and kidney are the most commonly involved organs. Necrotizing granulomatosis and vasculitis are the pathological features of WG.