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Objective To investigate the relationship between mean platelet volume(MPV)and saphenous vein graft restenosis in patients receiving coronary artery bypass grafting(CABG),and to analyze the clinical significance of MPV in the prediction of restenosis after CABG.Methods A total of 354 patients admitted into Tianjin chest hospital from September 2009 to September 2014 with suspected myocardial ischemic events 3 to 5 years after CABG treatment was enrolled for a retrospective analysis.According to the coronary angiography(CAG)results,patients were divided into the vein bridge vascular lesion group(saphenous vein graft diseases,SVGD)(n=233)and the venous bridge vascular patency group(saphenous vein graft,SVG)(n=121).Paired t test was used to analyze the relationship between different factors and the bridge vascular patency.The binary logistic regression was used to analyze the effects of MPV and other factors on bridge vascular patency.Venous bridge stenosis ＞ 50％ was considered to be clinically significant and to damage myocardial blood supply.Results The MPV was higher in the SVGD group than the SVG group [(10.2±1.5)fl vs.(9.6±1.5)fl,P＜0.01].The logistic regression analysis showed that MPV(OR =1.268,95％CI:1.053-1.570,P=0.014),age(OR =1.007,95％CI:1.038-1.117,P=0.000),gender (OR=0.452,95％CI:0.250-0.816,P=0.008),diabetes mellitus(OR=2.319,95％CI:1.221-4.405,P =0.010)were the independent risk factors for venous bridge stenosis in the two groups,gender(OR=0.495,95％CI:0.251-0.976,P=0.042),diabetes mellitus(OR =2.237,95％CI:1.105-4.527,P =0.025),MPV(OR=1.334,95％CI;1.050 1.694,P=0.018),fibrinogen(OR=1.654,95％CI:1.020-2.682,P =0.041)were the independent risk factors for venous bridge stenosis in non-elderly patients,and age(OR =1.178,95％CI:1.116-1.244,P =1.178)was an independent risk factor for vein graft stenosis in elderly patients.The restenosis rate was higher in patients with MPV ≥ 12 fl(92.6％ or 25/27) than in the patients with MPV ＜ 12 fl(63.6％ or 208/327).The receiver operating characteristics(ROC) curve showed that the areas under the curve of MPV,age,gender,diabetes,fibrinogen were 0.610,0.657,0.394,0.626,0.654,respectively,and the area under the curve of joint diagnosis was 0.796,showing that joint prediction value was higher than any single prediction value(P＜0.01).Conclusions MPV level is an independent risk factor for vein graft stenosis,and has higher predictive value in combination with age,gender,diabetes and fibrinogen.
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Objective:To observe the clinical efficacy of traditional tuina plus modern rehabilitation in the treatment of lower limb extensor spasticity during stroke recovery.Methods:A total of 93 stroke patients who met the inclusion criteria were randomly divided into an observation group and a control group.Forty-four patients in the observation group were treated with traditional tuina plus modern rehabilitation,and 49 patients in the control group were treated with modern rehabilitation.The modified Ashworth scale (MAS),the Fugl-Meyer assessment scale (FMA) and the modified Barthel index (MBI) were used to evaluate the knee extensors state,lower limb motor function and activities of daily living (ADL) of the two groups.Results:After treatment,the overall efficacy of the observation group was better than that of the control group,and the difference was statistically significant (P＜0.05).After treatment,the MAS scores of both groups were significantly lower,FMA and MBI scores were significantly higher,and the differences were statistically significant in each group (P＜0.01).After treatment,the MAS score of the observation group was lower than that of the control group,and the difference between the groups was statistically significant (P＜0.01).The MBI score of the observation group was higher than that of the control group,and the difference between the two groups was statistically significant (P＜0.05).There were significant differences in the post-treatment changes in MAS,FMA and MBI scores between the two groups (all P＜0.05).Conclusion:Traditional tuina plus modern rehabilitation therapy can effectively alleviate or prevent lower limb extensor spasticity after stroke,and improve limb mobility and ADL.Hence,it is worthy of clinical promotion.
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Objective To investigate the relationship between vascular lesion and serological changes in patients with coronary heart disease (CHD) complicated with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods According to the standard, a total of 168 patients of OSAHS complicated with CHD were selected in this study. Those patients were divided into 3 groups according to the apnea hypopnea index (AHI) level:light group (AHI, 5-14/h), moderate group (AHI, 15-30/h) and severe group (AHI,>30/h). Syntax scores were performed on three groups according to coronary angiography results. The data of hemoglobin (Hb), platelet count (PLT), fibrinogen (FIB), D-Dimer (DD), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triacylglycerol (TG), alanine aminotransferase (ALT), aspartate transaminase (AST), uric acid (UA), creatinine (Cr) and echocardiographic examination index were collected and analyzed in three groups. Results The Syntax score was significantly higher in severe group than that in mild and moderate groups (P 0.05). Conclusion The serology and cardiac structure can change gradually in severe OSAHS patients, and the coronary artery lesion will be more complex. Therefore, the clinical treatment should pay attention to screening for OSAHS in patients with coronary heart disease.
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Objective To explore the incidence and risk factors of depression in coronary heart disease patients who underwent revascularization therapy. Methods A total of 493 patients who were admitted in Tianjin chest hospital from April 2012 to February 2013 were enrolled, among whom 258 patients acceptted coronary artery bypass grafting (CABG) and the rest 235 patients underwent percutaneous coronary intervention (PCI). Self-rating depression scale (SDS) was employed to assess the state of patients at both1 day before and 7 days after the operations. According to the postopera?tive scores, CABG group was divided into the depression group (n=90) and non-depression group (n=168) while PCI group was also divided into depression group (n=54) and non-depression group (n=181). Basic clinical datum of patients were col?lected and analyzed and independent risk factors of depression was analyzed though logistic multi-variant regression. Results The incidence of postoperative depression among CABG patients was significantly higher than that in PCI patients (P<0.05).(1)In the CABG group, age, ratio of female gender, alcohol intake, rate of past depression, length of anaesthesia, length of staying in ICU and incidence of postoperative cognitive dysfunction(POCD)were all higher in depression subgroup than those in non-depression subgroup. Female and preoperative depression were both independent risk factors for postoper?ative depression in patients underwent CABG.(2)In PCI group, ratio of female gender, blood pressure, incidence of Diabe?tes Mellitus, the rate of past Myocardiac infaction (MI), length of intervention therapy and the number of planted stents were all higher in depression subgroup than non-depression subgroup. Female, past MI and length of intervention therapy are all independent factors of post-operative depression in patients underwent PCI. Conclusion Incidence of depression in pa?tients underwent revascularization is high. Female is the dependent risk factor in both CABG group and PCI group. Com?pared with PCI, CABG had greater influence on development of depression in postoperative patients.