Objective To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47). Conclusion Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.
目的 通过Narcotrend指导丙泊酚的靶控浓度来研究帕瑞昔布钠超前镇痛对宫腔手术患者术中和术后镇痛效果的影响。 方法 2012年1月－6月，60例实施宫腔手术的患者随机分为A、B两组，每组30例，A组为术前20 min静脉注射帕瑞昔布钠组，B组为术前20 min静脉注射等量生理盐水组。记录Narcotrend值D1，患者心率稳定时两组的靶控浓度、血压、心率、血氧饱和度（SpO2）及患者术苏醒后10 min镇痛效果视觉模拟评分（VAS）、Riker镇静、躁动评分（SAS）。 结果 A组患者的瑞芬太尼目标靶控浓度小于B组（P＜0.05），两组的丙泊酚靶控浓度差异无统计学意义（P＞0.05）。两组患者血压、心率均小于术前（P＜0.05），SpO2与术前比较差异无统计学意义（P＞0.05）。术后患者VAS评分A组低于B组（P＜0.05），SAS评分B组高于A组（P＜0.05）。 结论 帕瑞昔布钠对Narcotrend值无影响，帕瑞昔布钠能减少宫腔手术患者术中、术后的疼痛及术后的躁动。
目的 分析股动静脉插管在体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）抢救治疗中的临床应用。方法 回顾性分析笔者所在医院2002 年6 月至2010年7 月期间因重症心肺功能衰竭而施行股动静脉插管并进行静脉-动脉转流体外膜肺氧合（VA-ECMO）抢救的47例患者的临床资料。结果 本组47例患者均顺利施行ECMO支持，37例患者经过治疗后治愈出院，10例死亡。插管并发症有出血、肢体缺血等，均经相应处理后治愈。结论 ECMO对急性心肺衰竭是理想的支持方法，股动静脉为急救插管的首选通道。