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Objective To analyze the clinical characteristics of the elderly acute pulmonary embolism(APE) patients with normal blood pressure and right ventricular dysfunction(RVD).Methods A total of 133 elderly APE patients with normal blood pressure and RVD were retrospectively analyzed.According to whether or not to merge RVD,patients were divided into the RVD group(n=42)and the non-RVD group(n=91).The incidence of clinical symptoms and signs,the incidence of pulmonary embolism,clinical indicators after thrombolytic therapy,and the incidence of bleeding were compared and analyzed between RVD and non-RVD groups.Results The incidences of syncope(33.3％ or 14/42 vs.7.8％ 7/91),P2 accentuation(45.2％ or 19/42 vs.25.3％ or 23/91),tachycardia(40.5％ or 17/42 vs.20.9％ or 19/91),cyanosis(26.2％ or 11/42 vs.8.8％ or 8/91)and jugular vein filling(11.9％ or 5/42 vs.1.1％ or 1/91)had significant differences between RVD and non-RVD groups(x2 =4.928,4.644,5.410,4.971 and 4.163,all P＜0.05).The incidence of proximal pulmonary embolism was higher in RVD group than in non-RVD group[25(59.5％)vs.8(8.8％),x2 =13.636,P＜0.01],and the incidence of lobar artery embolism was higher in RVD group than in non-RVD group[32 (76.2％)vs.47(51.6％),x2 =9.530,P＜0.01].Thirteen RVD patients received low-molecular-weight heparin anticoagulation combined with thrombolytic therapy,and 29 RVD patients took low-molecular-weight heparin anticoagulant therapy.The pulmonary artery systolic pressure(PASP) and tricuspid regurgitation pressure levels were higher in the thrombolytic therapy group than in the anticoagulant therapy group(t =2.894,2.518 and 1.957,P =0.004,0.015 and 0.026).The incidence of bleeding was higher in the thrombolytic therapy group than in the anticoagulant therapy group (23.1％ vs.10.3 ％,x2 =3.498,P =0.015).Conclusions The right ventricular dysfunction should be confirmed in APE patients with embolism involving proximal pulmonary artery or(and)presenting clinical symptoms or signs such as syncope and tachycardia.The anticoagulation therapy is effective and safe for elderly patients with normal blood pressure and right heart dysfunction without risks for further deterioration.
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Objective To compare the efficacy and safety of interventional therapy and direct interventional therapy after thrombolysis in the treatment of senile acute myocardial infarction.Methods From January 2014 to July 2017,a total of 110 elderly patients with acute myocardial infarction admitted to the First People's Hospital of Hangzhou were enrolled in this study.The patients were randomly divided into two groups according to the digital table,with 55 cases in each group.The observation group received combination of intravenous thrombolysis and coronary intervention,and the control group received arterial intervention.The blood flow of IRA before and after treatment,TIMI level 3 open situation,cardiac function improvement (including LVEF,LVEDD),and electrocardiogram ST segment down after treatment,chest pain relief,stent implantation success or failure,incidence of complications were compared between the two groups.Results Before treatment,there were no statistically significant differences in the number of TIMI3 blood flow patients(10 cases,15 cases) and number of TIMI3 patients (12 cases,18 cases) between the two groups (P ＞ 0.05).After treatment,those in the observation group increased to 50 cases and 51 cases,respectively.Those in the control group only increased to 39 cases and 40 cases.The observation group increased more significantly (x2 =7.698,P ＜ 0.05).After treatment,the LVEF values of the two groups were increased,the LVEDD decreased significantly.The LVEF [(57.38 ± 4.23) ％] and LVEDD [(44.32 ± 2.93)mm] in the observation group were improved more significantly than those in the control group [(51.07 ± 4.17) ％,(50.09 ± 2.97) mm,t =7.878,10.257,all P ＜0.05].The incidence rate of ST segment depression(92.73％) and chest pain relief rate(90.91％) in the observation group after treatment were higher than those in the control group(65.45％,61.82％,x2 =12.369,12.894,2.633,all P ＜0.05).The total incidence rate of complications of the observation group was 9.09％,which was lower than that of the control group(29.09％),the difference was statistically significant(x2 =7.122,P ＜ 0.05).Conlusion Interventional therapy after thrombolysis in the treatment of elderly patients with acute myocardial infarction,can effectively improve the patients'cardiac function,the effect is significant,safe and reliable,it is worthy of further study.
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Objective To study the relationship between blood cell count and cardiac events in acute ST elevation myocardial infarction patients treated with reperfusion in the early stage. Methods In this study, we assigned 151 patients to whom reperfusion therapy had been delivered within 3 hours of STEMI symptom into two groups:primary percutaneous cor-onary intervention group and thrombolysis therapy group. Differences of cardiac events and white blood cell count in these two groups were analyzed in the first 4 days. Results In the second day and the forth day, cardiac events rate and white blood cell count were significantly lower in the primary percutaneous coronary intervention group than those in the thromboly-sis therapy group (P＜0.05). In the second day, white blood cell count has a positive correlation with cardiac events rate (r=0.226, P＜0.05). Conclusion Primary percutaneous coronary intervention decreased blood cell count and cardiac events rate. In patients with acute myocardial infarction, increasing white blood cell was related to cardiac events in the near future.
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Objective Influence of cover statement and clarity of the messages upon risk decision making about thrombolysis therapy in patients with cerebral infarction was discussed in the Scenarios of thrombolytic therapy for acute cerebral infarction.Methods Inpatients and outpatients with cerebral infarction were randomly divided into two groups:detailed / simple cover statement group.Every participant underwent obscure messages and clear messages with only one frame:positive or negative frame.Results In the simple cover statement group,both obscure messages subgroup and clear messages subgroup were not influenced by the framing effect with preference to the risk seeking.In the detailed cover statement group,participants in the clear messages group were not influenced by the framing effect(x 2 =0.19,P＞0.05),while the subjects in the obscure messages group were actually affected by the framing effect,with the preference to risk seeking in the positive framework (x 2=7.90,P＜0.01).Conclusion The risk decision making about thrombolysis therapy in patients with cerebral infarction is influenced by cover statements and clarity of the messages.To improve the rate of thrombolysis therapy,the patients should be exposed to the obscure messages in the positive framing information under the detailed cover statement.
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Objective To observe the efficacy of drug treatment of coronary aneurysm complicated with embolism in Kawasaki disease (KD). Methods The clinical data of eight KD children with coronary aneurysm and embolism were retrospectively analyzed. Results Eight KD children (six males and two females) at age of 0.25-5.2 years (mean=2.89) ,were diagnosed with gigantic coronary artery aneurysms. The diameter of aneurysm was around 8.3-13.8mm. Thrombosis appeared from 19 days to five months after coronary aneurysms formation. The onset manifestations included sudden chest pain and myocardial infarction with symptoms of heart failure in one case, shock in one case and no symptom in six cases. The maximum diameter of the thrombus was 2.8 mm×15.4 mm in the shape of funicular. Four cases had thrombus in the right coronary artery, two cases in the left coronary artery, and two cases in both sides. The patients underwent anticoagulant therapy taking heparin, urokinase, warfarin, aspirin and dipyridamole. Anticoagulant therapy was successful in 7 cases and the thrombus was completely dissolved in 7 days to more than 4 months. One case had recurrent coronary thrombosis after 4 months. One case died in 12 hours after thrombolysis. Conclusions Coronary thrombosis usually appears in the half year after the onset of KD coronary aneurysm. Thrombolysis therapy takes long time in Kawasaki patients. Breaking off of thrombus are rarely seen.
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All of the thrombolytic agents currently approved for use in humans are plasminogen activators, the application of which is limited by bleeding complications at vascular injury sites and plasminogen content in the thrombus. Plasmin is rapidly neutral-ized in the circulation by α2-antiplasmin and tolerated without bleeding. With the application of catheter-based delivery, the unique bio-chemical properties of plasmin make it a safe and effective direct fibrinolytics. Plasmin derivatives, including miniplasmin,Δ-plasmin and microplsmin, display more thrombolysis efficacy and better hemostatic safety in preclinical study and clinical trials. This review sum-marizes the current information on plasmin and its derivatives, including the advances on biochemical properties, preclinical and clinical trials.
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Objective To compare the safety and efficacy of intravenous thrombolysis for patients with acute cerebral infarction in a second-grand class-A hospital and a third-grand class-A hospital. Methods Twenty-one consecutive patients with cerebral infarction treated with alteplase for intravenous thrombolysis were enrolled in a second-grand class-A hospital (Fengtai Hospital,Beijing)prospectively from January 2012 to December 2013 as the study group,and 65 patients in a third-grand class-A teaching hospital (Xuanwu Hospital,Capital Medical University,Beijing)admitted at the same period for intravenous thrombolysis were used as a control group. The differences of efficacy and safety of intravenous thrombolysis in patients of both groups were compared. The primary outcome measures were Barthel Index (BI)at day14 after onset and the modified Rankin Scale (mRS)scores at discharge. The main safety indicator was the incidence of serious adverse events (SAEs)after thrombolysis (symptomatic intracranial hemorrhage and death). Results (1 )In the primary outcome measures,the proportions of mRS≤2 at discharge in the study group and the control group were 71. 4%(n=15)and 58. 5%(n=38)respectively. At day 14 after thrombolysis,the proportions of BI ≥60 were 61. 9%(n=13)and 64. 6%(n=42)respectively. There were no significant differences between the two groups (P>0. 05). (2)The incidences of the primary serious adverse events were 4. 8%(n=1)and 6. 2%(n=4). There was no significant difference (P>0. 05). Other secondary outcome measures,such as the early reperfusion rate,recanalization rate,and the proportion of neurological improvement at day 14 after thrombolysis and the overall incidence of cerebral hemorrhage had no significant differences. The case referral proportion (9. 5%,n=2)of the study group had a trend of lowering than the control group (27. 7%,n=18)P=0. 09. (3)The out-hospital time delay, in-hospital time delay,and overall time delay of the study group were less than those of the control group, and the mean time was 75 ± 33 vs. 102 ± 50 min,and 72 ± 41 vs. 111 ± 38 min,147 ± 41 vs. 212 ± 47 min. There were significant differences (P<0. 01). Conclusion The second-grand hospital selected by our study can relatively safely and effectively perform intravenous thrombolysis for acute cerebral infarction with alteplase. Moreover,the intravenous thrombolysis of the second-grand hospitals may reduce the case referral ratio and visiting time.
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All of the thrombolytic agents currently approved for use in humans are plasminogen activators, the application of which is limited by bleeding complications at vascular injury sites and plasminogen content in the thrombus. Plasmin is rapidly neutralized in the circulation by α2-antiplasmin and tolerated without bleeding. With the application of catheter-based delivery, the unique biochemical properties of plasmin make it a safe and effective direct fibrinolytics. Plasmin derivatives, including miniplasmin, {increment}-plasmin and microplsmin, display more thrombolysis efficacy and better hemostatic safety in preclinical study and clinical trials. This review summarizes the current information on plasmin and its derivatives, including the advances on biochemical properties, preclinical and clinical trials.
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By using thrombolysis therapy,34 patients suffering from acute myocardial infarction were treated.And by comparing iron.zinc,copper,manganese and selenium contents in serum of 34 patients suffering from acute myocardial infarction with that of control group and the contents between before-treating and after-treating,following results are revealed:before treating,iron,zinc,copper contents in serum of the patients increased while manganese and selenium contents decreased,there is great difference between the contents of the patients and control group(P
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By using thrombolysis therapy,34 patients suffering from actue myocardial infarction were treated .And by comparing chromium,cobalt,nickel,vanadium and molybdenum contents in serum of 34 patients suffering from acute myocardial infarction with that of contrast group and the contents between before-treatment and after-treatment,following results were revealed;treatment before chromium,cobalt,nickel,vanadium and molybdenum contents in serum of the patients were low and there is great difference between the patients and control groups(P0 05).
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Objective To discuss the clinic efficiency and value of intravascular infusion and PTA for treatment of acute and chronic arterial occlusion.Methods 37 patients,23 males and 14 females,aged 23～81 years,mean 52.9 years,underwent Seldinger techniqe.Percutaneous puncture femoral artery anterograde or retrocatheterism with pulsed-spray or injection thrombolysis.The concentration of urokinase was 10000 u/ml,total 300～800 thousands u,mean 550 thousands u.17 patients with chronic arterial occlusion were theated with PTA.Results The rate of success all patients with interventional therapy was 95 percent(35/37).The rate of success with acute arterial occlusion was 91 percent(21/23).In 23 cases,18 were obtained thrombolysis completely(78 percent )and thrombolysis partly were 3(13 percent )and unaffected were2(9 percent).In chronic patients thrombolysis partly was 93 percent.The rate of success with PTA was 100 percent(14/14).Conclusion The thrombolysis therapy is a first selection therapy for acute and chronic arterial occlusion and is a accessory treatment for PTA.