目的 探究不同麻醉方式对患有冠心病的老年患者外科介入不良心血管事件作用的对比。方法 选取2020年1月—2021年1月,我院确诊的冠心病患者,且无心脏外科干预手术80 例,随机分为研究干预组(n=40)和空白对照组(n=40),研究组采用2%的七氟醚,对照组用丙泊酚联合瑞芬太尼,维持麻醉血浆靶浓度在3.0～6.0 mg/L 之间,方式为静脉泵注;分析2组病人外科术后负性心脏情况控制影响; 结果 研究组和对照组患者的肌酸激酶存在差异,同时心脏肌钙蛋白T的高低也存在差异(P均<0.05);研究组在术后的负性心血管情况发病率均低于空白对照组,其中研究组的心源性猝死、心律紊乱不齐和心脏源性的休克等的病变率要远低于对照组,统计学差异存在意义(P均＜0.05);而其中研究组的心力衰竭与对照组相比,差异不具有统计学意义(P＞0.05)。结论 相比于静脉麻醉,吸入式麻醉能够趋好性降低非心脏手术术后负性心脏相关风险的发生率,该研究对于临床实践有一定的参考意义和实践可操作性,可以考虑普及推广。

目的 探讨急性心肌梗死患者入院首次中心粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与院内主要不良心血管事件(MACE)发生的相关性。方法 回顾分析2016年1月—2016年12月入住我院的急性心肌梗死患者179例,分为发生院内不良事件组(n=46)和未发生组(n=133)。采用单因素及多因素Logistics回归分析评估NLR与MACE风险的相关性。结果 179例患者中,46例患者发生院内MACE。发生院内MACE组患者的淋巴细胞计数低于未发生组(P<0.05),NLR高于未发生组(P<0.05),发生院内MACE组患者入院时的心、肾功能较未发生组差(P<0.05)。单因素回归分析显示,NLR水平与院内MACE发病率相关(OR=1.079,95%CI:1.014～1.147, P＜0.05)。多因素logistic回归分析校正性别、年龄、高血压病史、糖尿病史、Killip II级以上、收缩压、入院首次白细胞、eGFR、超敏C反应蛋白、左室射血分数及多支病变后显示,NLR是院内MACE的独立危险因素(OR=1.182,95%CI:1.034～1.352,P＜0.05);此外,超敏C反应蛋白及LVEF<50也是院内MACE的独立危险因素(P＜0.05)。结论 入院首次高NLR与急性心肌梗死患者发生院内MACE相关,是患者发生院内MACE的独立危险因素。

Objective To explore the correlation between first neutrophil/lymphocyte ratio(NLR) and in-hospital major adverse cardiac events (MACE) in patients with in patients with acute myocardial infarction. Methods Total of 179 patients with acute myocardial infarction in Guangzhou First People's Hospital from Jan 2016 to Dec 2016 were enrolled. MACE was defined as malignant arrhythmia, recurrence of myocardial infarction, target vascular reconstruction, acute left heart failure, stroke, cardiac shock and death.Baseline data and in-hospital clinical adverse events were compared among two groups. All patients were divided into two groups:MACE(+) group and MACE(-) group. Univariate and multivariate logistic regression was used to assess the correlation between NLR and in-hospital MACE. Results In-hospital MACE occurred in 46(25.7%)patients. Univariate logistic analysis showed that NLR was strongly related with MACE incidence(OR=1.079,95%CI:1.014～1.147, P＜0.05). Multivariate logistic regression analysis found that after adjusting other traditional risk factors including female gender, age, hypertension,diabetes, overKillip II grade, systolic blood pressure,first white blood cells after admitted,basic renal dysfunction,Hs-CRP,LVEF and multivessel lesions. NLR was still a significant independent predictor of in-hospital MACE in patients with acute myocardial infarction. Additionally, hs-CRP and LVEF<50% were also associated with in-hospital MACE(P＜0.05). Conclusion NLR is the independent risk factor for in-hospital MACE occurrence in acute myocardial infarction at the early admission.