目的：探讨沙库巴曲缬沙坦钠对慢性心力衰竭（CHF）患者心电稳定性及心脏负荷的改善作用。方法：病例纳入2023年10月~2025年5月收治的102例CHF患者为研究对象，依据就诊时间段及治疗方案不同，将2023年3月~2024年6月沿用缬沙坦+螺内酯+比索洛尔治疗的51例患者列为常规组，将2024年7月~2025年9月采用沙库巴曲缬沙坦+螺内酯+比索洛尔治疗的51例患者列为试验组，比较两组患者的心肌纤维化，心电稳定性，心脏负荷及治疗安全性。所有患者均接受为期半年随访，比较两组患者的预后情况。结果：治疗后，试验组的基质金属蛋白酶-2（MMP-2）、基质金属蛋白酶-9（MMP-9）、半乳糖凝集素-3（Gal-3）、可溶性生长刺激表达基因2蛋白（sST2）均低于常规组（t=5.045，2.889，4.115，4.582；P＜0.05）。试验组的校正QT间期（QTc）、QT离散度（QTd）、T波峰-末间期（Tp-e）、室性早搏次数分别为（405.39±40.26）ms、（45.25±5.33）ms、（90.33±5.28）ms、（80.36±5.39）次/24h，均低于常规组[（450.22±42.19）ms、（50.37±6.15）ms、（95.29±6.44）ms、（85.27±6.18）次/24h]（t=5.490，4.493，4.253，4.276；P＜0.05）。试验组的收缩期肺动脉压（sPAP）、三尖瓣反流峰值速度（TRVmax）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）分别为（20.48±5.26）mmHg、（2.13±0.25）m/s、（45.29±5.62）mm、（30.61±5.33）mm，均低于常规组[（25.35±6.29）mmHg、（3.22±0.47）m/s、（50.45±6.15）mm、（35.49±6.27）mm]（t=4.242，14.622，4.423，4.235；P＜0.05）。试验组的药物相关副反应发生率与常规组比较，差异无统计学意义（P＞0.05）。截至随访结束时，试验组的不良预后发生率9.80%（5/51）低于常规组27.45%（14/51）（x2=5.239；P＜0.05）。结论：沙库巴曲缬沙坦钠能延缓CHF患者的心肌纤维化进程并改善心电稳定性，在有效改善心电稳定性并降低不良预后发生风险同时未显著增加治疗风险。

Objective:To explore the improvement effect of sacubitril valsartan sodium on electrocardiogram stability and cardiac load in patients with CHF.Methods:A total of 102 CHF patients admitted from October 2023 to May 2025 were included in the study. Based on the treatment period and regimen, 51 patients treated with valsartan, spironolactone, and bisoprolol from March 2023 to June 2024 were classified as the conventional group, while 51 patients treated with sacubitril/valsartan, spironolactone, and bisoprolol from July 2024 to September 2025 were designated as the experimental group. The myocardial fibrosis, electrocardiographic stability, cardiac workload, and treatment safety were compared between the two groups. All patients underwent a six-month follow-up to assess their prognosis.Results:After treatment, the levels of MMP-2, MMP-9, Gal-3, and sST2 in the experimental group were lower than the control group (t=5.045，2.889，4.115，4.582; P<0.05). The QTc, QTd, Tp-e, and number of ventricular premature beats in the experimental group were (405.39 ± 40.26) ms, (45.25 ± 5.33) ms, (90.33 ± 5.28) ms, and (80.36 ± 5.39) beats per 24 hours, lower than the control group [(450.22 ± 42.19) ms, (50.37 ± 6.15) ms, (95.29 ± 6.44) ms, and (85.27 ± 6.18) beats per 24 hours] (t=5.490，4.493，4.253，4.276; P<0.05). The sPAP, TRVmax, LVEDD, and LVESD of the experimental group were (20.48 ± 5.26) mmHg, (2.13 ± 0.25) m/s, (45.29 ± 5.62) mm, and (30.61 ± 5.33) mm, lower than the conventional group [(25.35 ± 6.29) mmHg, (3.22 ± 0.47) m/s, (50.45 ± 6.15) mm, and (35.49 ± 6.27) mm] (t=4.242，14.622，4.423，4.235; P<0.05). The incidence of drug-related side effects in the experimental group was not significantly different from that in the control group (P>0.05). As of the end of follow-up, the incidence of poor prognosis in the experimental group was 9.80% (5/51) lower than that in the conventional group 27.45% (14/51) (x2=5.239; P<0.05).Conclusion:Sacubitril valsartan sodium can delay the progression of myocardial fibrosis and improve electrocardiogram stability in CHF patients, effectively improving electrocardiogram stability and reducing the risk of adverse prognosis without significantly increasing treatment risk.

目的 探讨以整合照护理念为基础的综合干预体系对稳定性冠心病患者衰弱的影响。方法 选择2021年8月—2022年6月在驻马店市中医院诊治的老年稳定性冠心病患者78例,根据1∶1随机数字表法分为两组,每组各39例。常规组给予常规护理,整合组在常规组护理的基础上给予以整合照护理念为基础的综合干预体系,记录两组患者的预后情况。结果 两组患者在护理3个月后的平衡测试评分、座椅站立测试评分均低于护理前,整合组护理3个月后的平衡测试评分、座椅站立测试评分与常规组相比也降低（P<0.05）。整合组护理3个月后的躯体、心理、社会、精神等维度的生活质量评分均高于常规组（P<0.05）。整合组随访1年的靶血管重建、心肌梗死、心源性死亡、冠状动脉再狭窄等主要心血管事件不良事件发生率为5.13%,常规组为25.64%,整合组低于常规组（P<0.05）。结论 以整合照护理念为基础的综合干预体系能缓解老年稳定性冠心病患者的衰弱状况,改善患者的生活质量,降低主要心血管事件不良事件发生率。

Objective To explore and analyze the effects of a comprehensive intervention based on integrated care on the frailty of elderly stable coronary heart disease（CHD）patients．Methods From August 2021 to June 2022,78 cases of elderly stable CHD patients who were diagnosed and treated in Zhumadian City Hospital of Traditional Chinese Medicine were selected．According to a 1：1 random number table method,78 patients were divided into the integrated group and the traditional group,with 39 cases of each group．The traditional group was given routine care,while the integrated group was given a comprehensive intervention based on integrated care concepts on the basis of the traditional group's care,and the patients' prognosis was recorded．Results The balance test scores and chair stand test scores of both groups after 3 months of nursing care were lower than those before nursing care．The balance test scores and chair stand test scores of the integrated group after 3 months of nursing care were also significantly lower than those of the traditional group（P<0.05）．After 3 months of nursing care,the quality of life scores in physical,psychological,social,and spiritual dimensions in the integrated group were significantly higher than those in the traditional group（P<0.05）．The incidence of major cardiovascular adverse events such as cardiac death,myocardial infarction,target vessel reconstruction,and coronary artery restenosis during a one-year follow-up in the integrated group was 5.13%,compared to 25.64% in the traditional group．The integrated group was significantly lower than the traditional group（P<0.05）．Conclusions The application of a comprehensive intervention based on integrated care concept in elderly stable CHD patients can alleviate frailty,improve quality of life,and reduce the incidence of major cardiovascular adverse events．

目的 探讨实时超声弹性成像技术联合常规超声检查在评估脑卒中患者颈动脉粥样硬化斑块稳定性中的临床应用价值。方法 收集我院收治的临床确诊脑卒中患者(卒中组)34例作为研究对象,另抽取同期存在颈动脉斑块但未发生过脑卒中的人群(对照组)56例作为对照研究对象,进行超声弹性成像检测,并对检查结果进行统计分析。结果 34例脑卒中患者发现颈动脉粥样硬化斑块57个,其中低回声斑块29个,混合回声斑块21个,强回声斑块7个;56例对照组患者发现颈动脉粥样硬化斑块75个,其中低回声斑块22个,混合回声斑块25个,强回声斑块28个;两组间比较斑块数量之间、斑块大小之间差异有统计学意义(P<0.05)。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分依次升高,其斑块硬度值依次升高;两组间斑块的评分数量分布差异有统计学意义(P<0.05);对于同一类型斑块的硬度值两组间差异无统计学意义(P>0.05);脑卒中组不同类型斑块间的硬度值差异有统计学意义(P<0.05)。结论 超声弹性成像技术可对脑卒中患者颈动脉粥样硬化斑块的稳定性进行半定量评估,不同类型斑块因所含组织成分的不同其弹性应变率表现也不同,能有效补充常规超声检查的信息的不足,进而评估斑块的稳定性。

Objective To explore the clinical value of real-time ultrasound elastography combined with conventional ultrasound in assessing the stability of carotid atherosclerotic plaques in stroke patients. Methods Thirty-four patients with clinically confirmed stroke (stroke group) in our hospital were collected as the research object. Another 56 patients with carotid plaque but without stroke (control group) in the same period were selected as the control object for ultrasonic elastography detection, and the results were analyzed statistically. Results Thirty-four stroke patients were found 57 carotid atherosclerotic plaques, including 29 hypoechoic plaques, 21 mixed echoic plaques and 7 hyperechoic plaques; 56 control patients were found 75 carotid atherosclerotic plaques, including 22 hypoechoic plaques, 25 mixed echoic plaques and 28 hyperechoic plaques. There were significant differences between the number of plaques and the size of plaques (P<0.05). Carotid atherosclerosis low echo, mixed echo and strong echo plaque elasticity score increased in turn, the plaque hardness value increased in turn; the number of plaque scores between the two groups had statistical significance (P<0.05); for the same type of plaque hardness value between the two groups had no significant difference (P>0.05); There were significant differences in hardness values between the same types of plaques (P<0.05). Conclusion Ultrasound elastography may semi-quantitatively evaluate the stability of carotid atherosclerotic plaques in stroke patients. Different types of plaques have different elastic strain rates because of different tissue components. It may effectively complement the information deficiency of conventional ultrasound examination, and then evaluate the stability of plaques.

目的 探讨红细胞分布宽度(RDW)与稳定性冠心病的冠脉病变严重程度的关系,评价RDW对稳定性冠心病的预测价值。方法 收集我院2016年11月—2018年11月期间因胸痛住院的患者330例,根据冠脉造影确诊稳定性冠心病组200例,除外冠心病130例为对照组。比较2组RDW水平的差异,分析RDW与冠脉病变严重程度(Gensini评分)的相关性及稳定性冠心病的独立危险因素。结果 稳定性冠心病组RDW水平高于对照组(P<0.05),稳定性冠心病组RDW与 Gensini评分之间存在正相关(r=0.217,P=0.002);多因素logistic回归分析显示RDW(OR=2.950,95%CI: 1.986~4.381,P<0.001)是稳定性冠心病的独立危险因子。结论 RDW与稳定性冠心病的冠脉病变严重程度呈正相关,RDW是稳定性冠心病的独立危险因素,为稳定性冠心病的诊断提供一定预测价值。

Objective To investigate the relationship between the distribution width of red blood cells (RDW) and the severity of coronary artery disease in stable coronary artery disease(SCAD), and to evaluate the predictive value of RDW for SCAD. Methods Patients who were hospitalized for chest pain from November 2016 to November 2018 were enrolled (n=330). According to coronary angiography,200 patients were divided into SCAD group (n=200),except for the SCAD group, the remaining 130 cases were the control group(n=130). The differences of RDW levels between the two groups were compared, and the correlation between RDW and severity of coronary artery disease (Gensini score) and independent risk factors for SCAD were analyzed. Results The RDW level in the SCAD group was higher than that in the control group (P<0.05). There was a positive correlation between the RDW and Gensini scores in the SCAD group (r=0.217,P=0.002). Multivariate logistic regression analysis showed RDW (OR=2.950, 95% CI: 1.986~4.381, P<0.001) is an independent risk factor for SCAD. Conclusion RDW is positively correlated with the severity of coronary artery disease in SCAD. RDW is independent risk factor of SCAD and provides predictive value for the diagnosis of SCAD.