内科学-专题定制-三峡大学图书馆

王振东凌峰王宁夫李佩璋高炎张邢伟金建芬

杭州市第一人民医院浙江省杭州市310006

摘要： 目的评价年轻人急性心肌梗死的风险因素以及对冠状动脉病变的影响。方法选取年龄≤45岁,并行冠状动脉造影的年轻急性心肌梗死患者36例成为年轻组;同时,连续选取同时间段50例50～70岁急性心肌梗死患者作为对照组。记录患者的临床病史、风险因素(吸烟史、高胆固醇血症、高血压、糖尿病、家族史)以及冠状动脉造影结果并进行分析。结果年轻组男性占91.7%,而对照组为72.0%;年轻组吸烟史占83.3%,家族史占47.2%,高胆固醇血症占44.4%,而对照组高血压占54.0%,糖尿病占42.0%,吸烟史占40.0%,高胆固醇血症占38.0%;年轻组罪犯血管在前降支占58.3%,右冠状动脉38.9%,回旋支为0,对照组前降支、右冠状动脉、回旋支所占比例分别为56.0%、42.0%,22.0%;年轻组单支、双支、三支血管病变分别为63.9%、27.8%、8.3%,对照组为42.0%、40.0%、18.0%。年轻组单支血管病变者平均风险因素为1.64±0.40个,而多支血管病变者为2.78±0.56个。结论吸烟、家族史、高胆固醇血症是年轻人急性心肌梗死的主要危险因素;年轻患者以单支血管病变占多,没有发现以回旋支为罪犯血管,没有发现住院死亡;多支血管病变者较单支血管病变者有更多风险因素。

脉搏波速度与冠状动脉粥样硬化的关系

曲娜刘晓方王淑霞

宁夏医学院附属医院心内科宁夏银川市750004

来源详细信息

关键词： 内科学全自动动脉硬化测定冠状动脉粥样硬化冠状动脉造影脉搏波速度危险分层

摘要： 目的为探讨脉搏波速度与冠状动脉粥样硬化程度的关系。方法本文选择行冠状动脉造影或介入治疗的患者104例,进行脉搏速度测量、血液生化检查、病史采集及冠状动脉造影。结果年龄、脉搏速度、脉压是显著性影响冠脉病变的危险因素(P<0.05);年龄、脉搏速度、高血压病史、收缩压、脉压、吸烟、胆固醇在冠状动脉病变程度组间差异有显著性(P<0.05);年龄、脉搏速度、脉压、总胆固醇、吸烟在多支病变组与正常组之间差异有显著性(P<0.05)。按照冠状动脉病变最大狭窄程度分组,冠状动脉病变程度间脉搏速度有显著性差异(P<0.05);狭窄1级、2级、3级、4级与0级,狭窄1级与2级脉搏速度比较差异有显著性(P<0.05)。按脉搏速度值≤14m/s和>14m/s分组,两组患者冠状动脉病变严重程度差异有显著性(P<0.05);脉搏速度>14m/s组的患者既往多数有高血压病史,3支血管病变在脉搏速度>14m/s组中显著增高;冠状动脉无病变者在脉搏速度≤14m/s组中显著性增多。冠心病合并高血压组与未合并高血压组患者的脉搏速度间差异有显著性意义(P<0.05)。在年龄与体重指数无明显差异的条件下,冠心病组、冠心病合并糖尿病组、冠心病合并高血压组、冠心病合并高血压及糖尿病组脉搏速度值逐渐升高(P<0.05);冠心病组患者随着病变支数的增多,脉搏速度值显著性升高(P<0.05)。结论提示脉搏速度与冠状动脉病变严重程度呈显著相关性,脉搏速度可综合反映高血压、高血糖等危险因素对血管的损伤,更能精确地对患者进行心血管危险分层,它可作为对冠心病患者危险分层的评估和冠状动脉严重程度识别的独立因素。

口腔内科学——龋病及牙体硬组织非龋性疾病

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兽医内科学教学改革研究

贺建忠白万胜陈瑛

塔里木大学动物科技学院新疆阿拉尔843300

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Physician knowledge levels and barriers to coronary risk prevention in women - Survey results from the women and heart disease physician education initiative

Barnhart, Janice Lewis, Vivian Houghton, Jan Laws Charney, Pamela

Albert Einstein Coll Med Dept Epidemiol & Populat Hlth Bronx NY 10467 USAUniv Rochester Sch Med & Dent Dept Obstet & Gynecol Rochester NY 14642 USAAlbany Med Coll Dept Med Albany NY 12208 USAAlbert Einstein Coll Med Dept Internal Med Bronx NY 10467 USAAlbert Einstein Coll Med Dept Obstet Gynecol & Womens Hlth Bronx NY 10467 USANorwalk Hosp Dept Internal Med Norwalk CT 06856 USA

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关键词： CORONARY heart disease PREVENTION of heart diseases PHYSICIANS SMOKING cessation

摘要： Background. Few studies have examined whether physician knowledge, attitudes, or practice patterns might contribute to gender disparities in the primary prevention of coronary heart disease (CHD), including among physicians caring for the largest number of reproductive-age women, obstetricians and gynecologists (OB/GYNs). We sought to identify barriers affecting the provision of recommended coronary risk factor therapies in women. Methods. We surveyed internists and OB/GYNs who attended Grand Rounds presentations developed for the New York State Women and Heart Disease Physician Education Initiative. This program was designed to improve screening and management of coronary risk factors in women. Attendees were asked to complete a 7-minute questionnaire. Results. The mean age of the 529 respondents was 40.3 years (standard deviation = 12.3), 75.1% were internists (n = 378), and 42.7% (n = 226) were women. Physicians correctly responded to 71.5% of the 13 questions assessing knowledge of coronary risk prevention (range, 4-13). Almost one third of internists and half of the OB/GYNs did not know that tobacco use was the leading cause of myocardial infarction in young women. For patients who smoked tobacco, only two thirds of internists and 55.4% of OB/GYNs reported suggesting a quit date (p =.007). After controlling for covariates, physicians who did not perceive time as a barrier were more likely to discuss smoking cessation (odds ratio = 1.7 [1.1-2.7]). Conclusions. Among the internists and OB/GYNs surveyed, time was perceived as a barrier to implementing risk prevention. These physicians also underestimated the impact of tobacco use as a risk factor for CHD in young women. To lessen gender disparities in CHD prevention, both specialties need time-efficient educational programs that reflect specialty differences.

肝病健康全书

杨旭

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