DMT Application in Cardiovascular

·135·大 医 生D O C T O R2020年第23期作者简介：陈晓波，本科，中级检验师，研究方向：临床免疫学检验。

通信作者：唐海妹，本科，副主任医师，研究方向：心血管疾病，E-mail：******************。

免疫比浊法检验血浆D-二聚体在心脑血管疾病中的临床价值体会陈晓波 唐海妹 （如东县中医院，江苏南通 226400）摘要：目的 探究免疫比浊法检测血浆D-二聚体水平在心脑血管疾病中的临床应用价值。

方法 选取2019年11月至2020年9月如东县中医院收治的150例心脑血管疾病患者作为研究对象。

共分为冠心病组、急性心肌梗死组、脑梗死组，每组50例。

另选取同期在如东县中医院体检的50例健康者作为对照组。

三组患者均在如东县中医院接受治疗，对四组受试者均以免疫比浊法进行血浆D-二聚体的检验，对比三组患者在治疗前及治疗后的血浆D-二聚体水平，同时比较三组患者治疗前后与对照组受试者的血浆D-二聚体水平。

结果 与对照组相比较，三组患者治疗前及治疗后的血浆D-二聚体水平均明显高于对照组（P ＜0.05）；但治疗后，三组患者的血浆D-二聚体水平与治疗前比较均明显降低（P ＜0.05）。

结论 以免疫比浊法检测血浆D-二聚体水平，有着较高的临床应用价值，可用于疾病诊断参考。

关键词：血浆D-二聚体；免疫比浊法；心脑血管疾病Clinical Value of Immunoturbidimetry in Detection of Plasma D-dimer in Cardiovascular and Cerebrovascular DiseasesCHEN Xiaobo TANG Haimei（Rudong Hospital of Traditional Chinese Medicine，Nantong，Jiangsu 226400，China）Abstract：Objective To explore the clinical application value of immunoturbidimetry in the detection of plasma D-dimer in cardiovascular and cerebrovascular diseases. Methods From November 2019 to September 2020，150 patients with cardiovascular and cerebrovascular diseases in Rudong Hospital of Traditional Chinese Medicine were selected as the research objects. The patients were divided into coronary heart disease group，acute myocardial infarction group and cerebral infarction group with 50 cases in each group. Another 50 healthy people in Rudong Hospital of Traditional Chinese Medicine in the same period of time were selected as the control group. Three groups of patients were treated in Rudong Hospital of Traditional Chinese medicine. The Four groups of subjects were tested for plasma D-dimer by immunoturbidimetric method. The plasma D-dimer levels of the three groups of patients before and after treatment were compared，and the plasma D-dimer levels of the three groups of patients before and after treatment were compared with those of the control group. Results The plasma D-dimer levels of the three groups of patients were significantly lower than before treatment（P ＜0.05）；compared with the control group，the plasma D-dimer levels of the three groups of patients before and after treatment were significantly higher than those of the control group（P ＜0.05）. Conclusion The immunoturbidimetric method for detecting plasma D-dimer levels has high clinical application value and can be used as a reference for disease diagnosis.Keywords：plasma D-dimer；immunoturbidimetry；cardiovascular and cerebrovascular diseases在机体内发生纤维蛋白降解之后，血浆内就会产生一种特异性物质，即为D-二聚体，在血栓的形成中，纤维蛋白发挥了重要作用，简单来说就是纤维蛋白的沉淀、聚集，使得血栓逐渐形成[1-2]。

基金项目：中央高校基本科研业务费（２０４２０２１ｋｆ０１３２）通信作者：蒋学俊，Ｅ ｍａｉｌ：ｘｊｊｉａｎｇ＠ｗｈｕ．ｅｄｕ．ｃｎ药物涂层球囊在冠状动脉慢性完全闭塞病变介入治疗中的应用菲尔凯提·玉山江　蒋学俊（武汉大学人民医院心内科武汉大学心血管病研究所心血管病湖北省重点实验室，湖北武汉４３００６０）【摘要】药物涂层球囊（ＤＣＢ）已成为冠状动脉介入治疗的有效手段之一，目前在支架内再狭窄、小血管病变、分叉病变中得到了广泛的应用。

但在慢性完全闭塞（ＣＴＯ）病变中应用的相关研究较少，现结合ＤＣＢ的作用机制和ＤＣＢ在ＣＴＯ病变中应用的相关报道，阐述ＤＣＢ在ＣＴＯ病变中可能发挥的作用。

【关键词】药物涂层球囊；慢性完全闭塞病变；经皮冠状动脉介入治疗【ＤＯＩ】１０ １６８０６／ｊ．ｃｎｋｉ．ｉｓｓｎ．１００４ ３９３４ ２０２４ ０１ ０１６ＡｐｐｌｉｃａｔｉｏｎｏｆＤｒｕｇ ＣｏａｔｅｄＢａｌｌｏｏｎｉｎＩｎｔｅｒｖｅｎｔｉｏｎＴｒｅａｔｍｅｎｔｏｆＣｈｒｏｎｉｃＴｏｔａｌＣｏｒｏｎａｒｙＯｃｃｌｕｓｉｏｎＦｅｉｅｒｋａｉｔｉ·Ｙｕｓｈａｎｊｉａｎｇ，ＪＩＡＮＧＸｕｅｊｕｎ（ＤｅｐａｒｔｍｅｎｔｏｆＣａｒｄｉｏｌｏｇｙ，ＲｅｎｍｉｎＨｏｓｐｉｔａｌｏｆＷｕｈａｎＵｎｉｅｒｓｉｔｙ；ＣａｒｄｉｏｖａｓｃｕｌａｒＲｅｓｅａｒｃｈＩｎｓｔｉｔｕｔｅ，ＷｕｈａｎＵｎｉｖｅｒｓｉｔｙ；ＨｕｂｅｉＫｅｙＬａｂｏｒａｔｏｒｙｏｆＣａｒｄｉｏｌｏｇｙ，Ｗｕｈａｎ４３００６０，Ｈｕｂｅｉ，Ｃｈｉｎａ）【Ａｂｓｔｒａｃｔ】Ｄｒｕｇ ｃｏａｔｅｄｂａｌｌｏｏｎ（ＤＣＢ）ｈａｓｂｅｃｏｍｅｏｎｅｏｆｔｈｅｍａｉｎｍｅｔｈｏｄｓｆｏｒｃｏｒｏｎａｒｙａｒｔｅｒｙｉｎｔｅｒｖｅｎｔｉｏｎｔｈｅｒａｐｙ，ａｎｄｉｓｗｉｄｅｌｙｕｓｅｄｉｎｉｎ ｓｔｅｎｔｒｅｓｔｅｎｏｓｉｓ，ｓｍａｌｌｖｅｓｓｅｌｌｅｓｉｏｎｓ，ａｎｄｂｉｆｕｒｃａｔｉｏｎｌｅｓｉｏｎｓ．ＴｈｅｒｅｉｓｌｉｍｉｔｅｄｒｅｓｅａｒｃｈｏｎｔｈｅｕｓｅｏｆＤＣＢｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆｃｈｒｏｎｉｃｔｏｔａｌｏｃｃｌｕｓｉｏｎ（ＣＴＯ）ｌｅｓｉｏｎｓ．Ｔｈｅｒｅｆｏｒｅ，ｔｈｉｓａｒｔｉｃｌｅｗｉｌｌｄｉｓｃｕｓｓｔｈｅｐｏｔｅｎｔｉａｌｒｏｌｅｏｆＤＣＢｉｎＣＴＯｌｅｓｉｏｎｓｂｙｃｏｍｂｉｎｉｎｇｔｈｅｉｒｍｅｃｈａｎｉｓｍｏｆａｃｔｉｏｎａｎｄｒｅｌｅｖａｎｔｓｔｕｄｉｅｓｃｏｎｄｕｃｔｅｄｉｎＣＴＯｐａｔｉｅｎｔｓ．【Ｋｅｙｗｏｒｄｓ】Ｄｒｕｇ ｃｏａｔｅｄｂａｌｌｏｏｎ；Ｃｈｒｏｎｉｃｔｏｔａｌｏｃｃｌｕｓｉｏｎｌｅｓｉｏｎｓ；Ｐｅｒｃｕｔａｎｅｏｕｓｃｏｒｏｎａｒｙｉｎｔｅｒｖｅｎｔｉｏｎ 慢性完全闭塞（ｃｈｒｏｎｉｃｔｏｔａｌｏｃｃｌｕｓｉｏｎ，ＣＴＯ）病变被认为是介入心脏病学中最复杂的冠状动脉病变。

心血管功能英语作文初中标题，The Importance of Cardiovascular Health。

Nowadays, cardiovascular health has become a hot topic in our society. With the rapid pace of modern life and the prevalence of sedentary lifestyles, more and more people are facing the risk of cardiovascular diseases. Therefore, it is crucial for us to understand the significance of cardiovascular health and take proactive measures to maintain it.First and foremost, let's delve into what cardiovascular health encompasses. The cardiovascular system consists of the heart and blood vessels, which work together to pump blood throughout the body. When this system functions efficiently, it ensures that oxygen and nutrients are delivered to every cell while waste products are removed. A healthy cardiovascular system is essential for maintaining overall well-being and vitality.Regular physical activity plays a pivotal role in promoting cardiovascular health. Engaging in activitiessuch as jogging, swimming, or cycling not only strengthens the heart muscle but also improves blood circulation and lowers blood pressure. Moreover, exercise helps to control weight, reduce stress, and enhance mood, all of which contribute to a healthier heart.In addition to exercise, a balanced diet is equally important for maintaining cardiovascular health. Consuminga variety of fruits, vegetables, whole grains, and lean proteins provides essential nutrients that support heart function and lower the risk of heart disease. It is advisable to limit the intake of saturated fats, trans fats, cholesterol, and sodium, as they can increase thelikelihood of developing cardiovascular problems.Furthermore, avoiding harmful habits such as smokingand excessive alcohol consumption is crucial for protecting cardiovascular health. Cigarette smoke contains numerous toxins that damage blood vessels and increase the risk of atherosclerosis, a condition characterized by the buildupof plaque in the arteries. Similarly, excessive alcohol consumption can raise blood pressure and contribute to heart disease. Therefore, quitting smoking and moderating alcohol intake are essential steps towards maintaining a healthy heart.Moreover, regular health check-ups are essential for early detection and prevention of cardiovascular diseases. Routine screenings for conditions such as high blood pressure, high cholesterol, and diabetes can help identify risk factors before they escalate into serious health issues. By monitoring key indicators of cardiovascular health, individuals can take proactive measures to address any concerns and make necessary lifestyle changes.In conclusion, cardiovascular health is paramount for overall well-being and longevity. By adopting a proactive approach that includes regular exercise, a balanced diet, avoidance of harmful habits, and routine health screenings, we can safeguard our heart health and reduce the risk of cardiovascular diseases. Let us prioritize ourcardiovascular health today for a healthier and happier tomorrow.。

frontiers in cardiovascular medicine 文献格式【实用版】目录1.引言：介绍 Frontiers in Cardiovascular Medicine 的重要性和主题2.主题一：心血管疾病的预防和治疗3.主题二：心血管疾病的诊断和检测4.主题三：心血管疾病的研究进展和未来方向5.结论：总结 Frontiers in Cardiovascular Medicine 对心血管疾病研究的贡献正文心血管疾病是全球范围内的主要死亡原因之一，对公共卫生造成了严重的影响。

Frontiers in Cardiovascular Medicine 是一本开放获取的科学期刊，致力于发表关于心血管医学的最新研究成果。

本文将从三个主题来介绍该期刊的研究内容。

首先，心血管疾病的预防和治疗是 Frontiers in Cardiovascular Medicine 关注的重点之一。

该期刊发表了大量关于心血管疾病风险评估、预防策略以及新型治疗方法的研究文章。

这些文章为心血管疾病的防治提供了重要的理论依据和实践指导。

其次，心血管疾病的诊断和检测也是该期刊的重要主题。

期刊内收录了许多关于心血管疾病诊断新技术、新型生物标志物以及无创检测方法的研究成果。

这些成果有助于提高心血管疾病的早期发现和诊断准确性，从而改善患者的预后。

最后，心血管疾病的研究进展和未来方向也是 Frontiers in Cardiovascular Medicine 关注的焦点。

期刊发表了许多关于心血管疾病发病机制、疾病进展和转归的研究文章，以及针对未来心血管疾病研究的趋势和挑战的讨论。

这些文章有助于全面了解心血管疾病研究的最新动态，并为未来研究提供方向。

总之，Frontiers in Cardiovascular Medicine 为心血管疾病研究领域提供了一个重要的学术交流平台。

该期刊发表的大量研究成果为心血管疾病的预防、诊断和治疗提供了有益的参考，展示了心血管疾病研究的最新进展和未来方向。

摘要高血压是心脑血管疾病的重要危险因素。

动态血压监测已成为识别和诊断高血压、评估心脑血管疾病风险、评估降压疗效、指导个体化降压治疗不可或缺的检测手段。

本指南对2015年发表的《动态血压监测临床应用专家共识》进行了更新，详细介绍了动态血压计的选择与监测方法、动态血压监测的结果判定与临床应用、动态血压监测的适应证、特殊人群动态血压监测、社区动态血压监测应用以及动态血压监测临床应用展望，旨在指导临床实践中动态血压监测的应用。

关键词 动态血压监测；血压管理；指南；高血压2020 Chinese Hypertension League Guidelines on Ambulatory Blood Pressure MonitoringWriting Group of the 2020 Chinese Hypertension League Guidelines on Ambulatory Blood Pressure Monitoring.Corresponding Author: WANG Jiguang, Email: jiguangwang@2020中国动态血压监测指南中国高血压联盟《动态血压监测指南》委员会指南与共识AbstractHypertension is an important risk factor for cardiovascular and cerebrovascular diseases. Ambulatory blood pressure monitoring (ABPM) has become an indispensable technique for the detection of hypertension, risk assessment of cardiovascular and cerebrovascular diseases, therapeutic monitoring, and guidance of the individualized treatment. Based on the “2015 expert consensus on the clinical use of ambulatory blood pressure monitoring”, the current guideline updates recommendations on the major issues of ABPM, such as the device requirements and methodology, interpretation of the reported results, clinical indications, application on special populations, the utility in the community and future perspectives. It aims to guide the clinical application practice of ABPM in China.Key words ambulatory blood pressure monitoring; blood pressure management; guideline; hypertension(Chinese Circulation Journal, 2021, 36: 313.)高血压是心脑血管疾病的重要危险因素，与心脑血管疾病发病和死亡密切相关[1-3]。

心血管功能英语作文高中Cardiovascular Function。

Cardiovascular function refers to the ability of the heart and blood vessels to efficiently transport blood and oxygen throughout the body. A healthy cardiovascular system is essential for overall health and well-being.There are many factors that can affect cardiovascular function, including diet, exercise, stress, and genetics. A diet high in saturated and trans fats can lead to the buildup of plaque in the arteries, which can increase the risk of heart disease and stroke. Regular exercise can help improve cardiovascular function by strengthening the heart and blood vessels, lowering blood pressure, and reducing the risk of obesity and diabetes.Stress can also have a negative impact on cardiovascular function. Chronic stress can cause the release of hormones that increase heart rate and bloodpressure, which can lead to damage to the heart and blood vessels over time. Genetics also play a role in cardiovascular function, as certain genetic mutations can increase the risk of heart disease and other cardiovascular conditions.There are many ways to improve cardiovascular function, including making healthy lifestyle choices such as eating a balanced diet, getting regular exercise, managing stress, and avoiding tobacco and excessive alcohol consumption. In some cases, medication or surgery may be necessary to treat cardiovascular conditions.Overall, maintaining a healthy cardiovascular system is essential for a long and healthy life. By making healthy lifestyle choices and seeking medical care when necessary, individuals can improve their cardiovascular function and reduce their risk of developing cardiovascular disease.。

心血管功能英语作文Title: Understanding Cardiovascular Function: A Comprehensive Overview。

Introduction:The cardiovascular system plays a pivotal role in sustaining life by facilitating the circulation of blood throughout the body. Comprehending its intricate mechanisms is crucial for maintaining overall health and preventing cardiovascular diseases. In this essay, we will delve into the fundamentals of cardiovascular function, exploring its anatomy, physiology, regulation, and common disorders.Anatomy of the Cardiovascular System:The cardiovascular system comprises the heart, blood vessels, and blood. The heart, a muscular organ, functions as a pump that propels blood throughout the body. It consists of four chambers: two atria and two ventricles.The atria receive blood returning to the heart, while the ventricles pump blood out of the heart to the rest of the body.Blood vessels form a network that transports blood to various tissues and organs. Arteries carry oxygen-richblood away from the heart, while veins return oxygen-depleted blood back to the heart. Capillaries, the smallest blood vessels, facilitate the exchange of nutrients, oxygen, and waste products between blood and tissues.Physiology of Circulation:The cardiovascular system operates through a series of coordinated events known as the cardiac cycle. During systole, the ventricles contract, pumping blood into the arteries. This is followed by diastole, during which the ventricles relax and refill with blood. This rhythmic cycle ensures continuous blood flow to meet the body's metabolic demands.Blood pressure, the force exerted by blood against thewalls of blood vessels, is regulated by various factors, including cardiac output, peripheral resistance, and blood volume. Maintaining optimal blood pressure is vital for ensuring adequate perfusion to organs and tissues.Regulation of Cardiovascular Function:The autonomic nervous system plays a central role in regulating cardiovascular function. The sympathetic nervous system stimulates the heart to beat faster and increases peripheral resistance, thereby elevating blood pressure. In contrast, the parasympathetic nervous system slows heart rate and promotes relaxation, lowering blood pressure.Hormones such as adrenaline and noradrenaline, released during times of stress or exertion, also influence cardiovascular function. Additionally, hormones like aldosterone and antidiuretic hormone regulate blood volume and electrolyte balance, further modulating blood pressure.Common Cardiovascular Disorders:Despite its remarkable resilience, the cardiovascular system is susceptible to various disorders. Cardiovascular diseases, including coronary artery disease, hypertension, and heart failure, are leading causes of morbidity and mortality worldwide.Coronary artery disease results from the accumulation of plaque within coronary arteries, leading to reduced blood flow to the heart muscle. Hypertension, or high blood pressure, strains the heart and blood vessels, increasing the risk of heart attack, stroke, and other complications. Heart failure occurs when the heart is unable to pump blood efficiently, often due to weakened heart muscle or other underlying conditions.Conclusion:Understanding the intricacies of cardiovascularfunction is essential for maintaining heart health and preventing cardiovascular diseases. By adopting a healthy lifestyle, including regular exercise, a balanced diet, and stress management, individuals can support optimalcardiovascular function and reduce their risk of developing heart-related conditions. Additionally, early detection and management of risk factors can significantly improve outcomes for those affected by cardiovascular diseases. Through continued research and education, we can strive towards a world where cardiovascular health is prioritized, leading to longer, healthier lives for all.。

DOI：10.16659/ki.1672-5654.2023.10.084基于公立医院绩效考核下住院病案首页质量分析郭秀阳1，张彦红21. 德州市第七人民医院病案科，山东德州 253009；2. 德州市第七人民医院公共卫生科，山东德州 253009[摘要] 目的基于公立医院绩效考核下分析住院病案首页质量。

方法选取2021年12月—2022年5月期间德州市第七人民医院120份医院出院病案，根据国家公立医院绩效考核标准以及住院病案首页填写质量规范对住院病案首页内容进行逐条检查，统计并分析住院病案首页存在的缺陷项目。

结果住院病案首页总体缺陷率出现持续下降，从35.00%下降到10.00%。

患者住院病案首页基本信息填写缺陷总计15份，占病案总数的12.50%。

按照缺陷比例由高到低的顺序进行排序，分别是患者工作单位、职业未填写（3.33%）、身份证号码未填写或错填（2.50%）、患者联系人填写为本人（2.50%）、新生儿体重未填写（1.67%）、患者婚姻未填写（0.83%）、患者年龄与实际不符（0.83%）、联系人相关信息未填写（0.83%）。

按照科室分类进行汇总，产科、妇科、儿外科、烧伤科、生殖科、心血管内科均存在缺陷，病理缺陷的总占比为12.50%；主要诊断项目中选择错误总占比为5.83%，漏填总占比为2.50%；手术治疗中选择错误总占比为5.88%，漏填信息总占比为2.94%，其他错误总占比为8.82%。

结论住院病案首页质量控制效果已经成为公立医院绩效考核的重点项目之一，住院病案首页的质量工作需要多部门不断努力以及持续改进，促使住院病案首页数据质量持续提高，确保公立医院绩效考核大数据的准确，帮助医院提高绩效管理工作。

[关键词] 公立医院；绩效考核；住院病案首页；质量分析[中图分类号] R19 [文献标识码] A [文章编号] 1672-5654（2023）05（b）-0084-04Quality Analysis of the First Page of Inpatient Medical Records Based on the Performance Appraisal of Public HospitalsGUO　Xiuyang1, ZHANG　Yanhong21. Department of Medical Records, Dezhou Seventh People's Hospital, Dezhou, Shandong Province, 253009 China;2. Department of Public Health, Dezhou Seventh People's Hospital, Dezhou, Shandong Province, 253009 China[Abstract]Objective To analyze the quality of the first page of inpatient medical records based on the performance appraisal of public hospitals. Methods From December 2021 to May 2022, 120 hospital discharge records of Dezhou Seventh People's Hospital were selected, and the contents of the first page of inpatient medical records were checked one by one according to the performance appraisal standards of national public hospitals and the quality specifications for filling in the first page of inpatient medical records. The defects in the first page of inpatient medical records were counted and analyzed. Results The overall defect rate of inpatient medical records homepage continued to decrease, from 35.00% to 10.00%. There were 15 defects in filling in basic information on the home page of hospitalization medical records, accounting for 12.50% of the total number of medical records. In order of defect proportion from high⁃est to lowest, the patient's work unit and occupation were not filled in (3.33%), the ID number was not filled in or was incorrectly filled in (2.50%), the patient's contact person was myself (2.50%), the newborn weight was not filled in (1.67%), the patient's marriage was not filled in (0.83%), the patient's age was not consistent with the actual situation (0.83%), and the relevant information of the contact person was not filled in (0.83%). According to the classification of departments, there were defects in obstetrics, gynecology, pediatric surgery, burn, reproduction and cardiovascular [作者简介]郭秀阳（1973-），女，本科，副主任技师，研究方向为病案信息管理。

心血管内科流程诊疗规范English Answer:Cardiovascular Inpatient Treatment Process Standard Operating Procedure.1. Admission.1.1 Upon admission, the patient will be assessed by a cardiologist or a physician extender to determine the need for hospitalization.1.2 The following information will be collected:Vital signs.Medical history.Physical examination.Laboratory tests.Electrocardiogram (ECG)。

Chest X-ray.1.3 The patient will be assigned a room and a bed.1.4 The patient will be provided with a hospital gown and other necessary supplies.1.5 The patient will be given a brief orientation to the unit.2. Treatment.2.1 The patient's treatment plan will be developed by the cardiologist in consultation with the patient and their family.2.2 The treatment plan may include:Medications.Surgery.Cardiac rehabilitation.2.3 The patient will be monitored closely for any changes in their condition.2.4 The patient will be educated about their condition and their treatment plan.3. Discharge.3.1 The patient will be discharged when they are medically stable and able to care for themselves at home.3.2 The patient will be provided with discharge instructions, including:Medications.Activity restrictions.Follow-up appointments.3.3 The patient will be encouraged to contact their cardiologist if they have any questions or concerns.中文回答：心血管内科流程诊疗规范。

·临床论著·七氟醚吸入麻醉与瑞芬太尼静脉麻醉对无张力疝修补术老年患者应激的影响王展【摘要】目的比较七氟醚吸入麻醉与瑞芬太尼静脉麻醉对无张力疝修补术中老年患者应激的影响。

方法选取2016年1月至2018年7月，江苏省南通市中医院接受无张力疝修补术治疗的66例老年腹股沟斜疝患者为研究对象，随机分为2组，每组患者33例。

对照组采用瑞芬太尼静脉麻醉，而试验组采用七氟醚吸入麻醉。

比较2组患者的血流动力学、应激指标、麻醉诱导和苏醒时间。

结果在T1、T2、T3及T4时间点，2组患者SPO2水平比较，差异无统计学意义（P＞0.05）；在T1、T3时间点，2组患者HR及MAP水平比较，差异无统计学意义（P＞0.05）；在T2及T4时间点，试验组患者HR及MAP水平低于对照组，差异有统计学意义（P＜0.05）。

试验组的诱导时间及苏醒时间分别（67.24±7.03）s和（13.53±4.57）min均低于对照组（71.74±9.34）s和（16.34±5.22）min，差异均有统计学意义（t=2.211、2.327，P=0.031、0.023）。

在T1时间点，2组患者皮质醇（Cor）、去甲肾上腺素（NE）及甲肾上腺素（E）水平比较，差异无统计学意义（P＞0.05）；在T2、T3及T4时间点，试验组患者Cor、NE及E水平均低于对照组，差异均有统计学意义（P＜0.05）。

结论接受无张力疝修补术中老年患者应用七氟醚吸入麻醉，可缩短麻醉诱导时间及苏醒时间，还可增加心血管系统稳定性，抑制应激反应，值得临床推广。

【关键词】疝修补术；七氟醚；瑞芬太尼；麻醉；应激指标；血流动力学Effects of sevoflurane inhalation anesthesia and remifentanil intravenous anesthesia on stress inelderly patients undergoing tension-free hernia repair Wang Zhan. Department of Anesthesiology,Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu Province, 226001, China.Corresponding Author: Wang Zhan, Email: camous2005@【Abstract】Objective To compare the effects of sevoflurane inhalation anesthesia andremifentanil intravenous anesthesia on stress in elderly patients undergoing tension-free hernia repair.Methods From January 2016 to July 2018, 66 elderly patients undergoing tension-free hernia repair inNantong Hospital of Traditional Chinese Medicine were randomly divided into the experimental group (33cases) and the control group (33 cases). The control group received remifentanil intravenous anesthesia,while the experimental group received sevoflurane inhalation anesthesia. The hemodynamics, stress index,anesthesia induction and recovery time were compared between the two groups. Results The inductiontime and recovery time in the experimental group[(67.24±7.03) seconds, (13.53±4.57) minutes]were lowerthan those in the control group [(71.74±9.34) s, (16.34±5.22) minutes, P<0.05]. There were no significantdifferences in the levels of Oxygen saturation (SpO2) between the two groups during anesthesia induction(T1), skin incision (T2), 5 minutes before operation (T3) and recovery (T4) (P>0.05). At T1 and T3 timepoint, there were no significant differences in the levels of heart rate (HR) and mean arterial pressure(MAP) between the two groups (P>0.05), but at T2 and T4 time points, the levels of HR and MAP in theexperimental group were lower than those in the control group (P<0.05). At T1 time point, there were nosignificant differences in the levels of cortisol (Cor), noradrenaline (NE) and epinephrine (E) between thetwo groups (P>0.05). At T2, T3 and T4 time point, the levels of Cor, NE and E in the experimental groupwere lower than those in the control group (P<0.05). Conclusion The application of sevofluraneinhalation anesthesia in elderly patients undergoing tension-free hernia repair not only has good anesthesiaeffect, but also can increase the stability of cardiovascular system and inhibit stress reaction, which isDOI:10.3877/cma.j.issn.1674-392X.2019.06.017基金项目：南通市科技项目（MS22016006）作者单位：226001 江苏省南通市中医院麻醉科通信作者：王展，Email: camous2005@worthy for clinical promoting.【Key words】Herniorrhaphy; Sevoflurane; Remifentanil; Anesthesia; Stress index; Hemodynamics无张力疝修补术具有时间短、周转快的特点，因此要求麻醉迅速、平稳，既要保持一定深度以减少患者术中的应激反应，又要苏醒迅速，利于患者的术后恢复[1-3]。

㊃综述㊃铁死亡调控机制及其在心血管疾病中的研究进展马赛㊀左庆娟㊀和丽丽㊀张国瑞㊀郭艺芳050051石家庄,河北省人民医院疼痛科(马赛),老年心血管内一科(左庆娟㊁和丽丽㊁郭艺芳);050011石家庄市第三医院心血管内科(张国瑞)通信作者:郭艺芳,电子信箱:yifangguo@DOI:10.3969/j.issn.1007-5410.2023.06.013㊀㊀ʌ摘要ɔ㊀铁死亡是一种近期发现的可调节的程序性细胞坏死方式,涉及铁代谢㊁脂质代谢㊁氨基酸代谢等多种代谢过程,其主要特征为脂质过氧化物生成㊁活性氧超载和谷胱甘肽消耗等㊂研究证实铁死亡参与了多种心血管疾病病理生理过程㊂本文总结了铁死亡调控机制及国内外关于铁死亡在心血管疾病中的研究进展,旨在为心血管疾病的预防和治疗提供新思路㊂ʌ关键词ɔ㊀铁死亡;㊀心力衰竭;㊀心肌病;㊀心血管疾病基金项目:河北省创新能力提升计划项目(199776249D);河北省重点研发计划项目(19277787D)Ferroptosis homeostasis regulation and its research progress in cardiovascular diseases㊀Ma Sai,ZuoQingjuan,He Lili,Zhang Guorui,Guo YifangDepartment of Pain,Hebei General Hospital,Shijiazhuang050051,China(Ma S);Ward1,Department ofGeriatric Cardiology,Hebei General Hospital,Shijiazhuang050051,China(Zuo QJ,He LL,Guo YF); Department of Cardiology,The Third Hospital of Shijiazhuang,Shijiazhuang050011,China(Zhang GR)Corresponding author:Guo Yifang,Email:yifangguo@ʌAbstractɔ㊀Ferroptosis is a recently discovered regulated form of programmed cell death,involvingvarious metabolic processes such as iron metabolism,lipid metabolism,and amino acid metabolism.Its mainfeatures include lipid peroxide generation,oxidative stress,and glutathione depletion.Studies have confirmed the involvement of ferroptosis in various pathophysiological processes of cardiovascular diseases.This article summarizes the regulatory mechanisms of ferroptosis and the research progress on ferroptosis in cardiovascular diseases both domestically and internationally,aiming to provide new insights for the prevention and treatment of cardiovascular diseases.ʌKey wordsɔ㊀Ferroptosis;㊀Heart failure;㊀Cardiomyopathy;㊀Cardiovascular diseaseFund program:Hebei Province Innovation Capability Enhancement Plan Project(199776249D);Hebei Province Key Research and Development Plan Project(19277787D)㊀㊀铁是机体维持正常氧气运输㊁脂质代谢㊁氧化磷酸化等线粒体功能,DNA㊁蛋白质生物合成功能以及其他细胞生物学进程必不可少的微量元素㊂机体内铁稳态维持受多方因素调控,过量的游离铁可与过氧化氢发生芬顿反应,形成羟基自由基及活性氧(reactive oxygen species,ROS),从而造成核酸㊁蛋白质及细胞膜等损伤,水解酶转移,进而引发细胞死亡[1]㊂1981年Sullivan等[2]提出了 铁源性心脏病 假说,阐明铁超载在心血管疾病进程中发挥着重要作用㊂2012年Dixon等提出了 铁死亡 的概念,铁死亡是一种铁依赖的程序性细胞坏死方式,以脂质过氧化物生成㊁ROS超载和谷胱甘肽(glutathione,GSH)消耗等为标志性改变,参与了多种心血管疾病病理生理过程㊂但与其他细胞死亡方式不同,铁死亡既可由实验性小分子物质(如埃拉斯汀㊁原癌基因致死性小分子3和磺胺嘧啶等)以及某些药物(如柳氮磺吡啶㊁索拉非尼和青蒿琥酯等)所诱导,亦可被铁抑素1(ferrostatin-1,Fer-1)和脂血抑素1等物质所抑制[3]㊂即铁死亡机制本身具有可调控性,其中正向调节生物分子包括电压依赖性阴离子通道(voltage-dependent anion channel,VDAC)2/3㊁原癌基因㊁还原型烟酰胺腺嘌呤二核苷酸磷酸(reduced nicotinamide adenine dinucleotide phosphate,NADPH)氧化酶㊁p53等,负向调节生物分子包括谷胱甘肽过氧化物酶4 (glutathione peroxidase4,GPX4)㊁溶质载体家族7成员11 (solute carrier family7-member11,SLC7A11/xCT)㊁热休克蛋白B1㊁核因子E2相关因子2(nuclear factor E2related factor 2,Nrf2)等[4]㊂现将铁死亡调控机制及其在心血管疾病中的研究进展做一综述㊂1㊀铁死亡调控机制1.1㊀铁代谢转铁蛋白(transferrin,Tf)与细胞膜上转铁蛋白受体1 (transferrin receptor1,TFR1)结合后可将Fe3+由细胞外内吞至内含体中,经前列腺六跨膜表皮抗原3还原为Fe2+后,在二价金属离子转运体或锌铁转运蛋白的介导下释放到胞质内不稳定铁池中发挥其生理作用,多余的铁以Fe3+形式存储在铁蛋白中或经膜铁转运蛋白(ferroportin-1,FPN1)转至细胞外[5]㊂铁蛋白能够螯合4500个铁原子,从而保护细胞免受游离铁的干扰,维持铁稳态,铁反应元件结合蛋白2作为调控铁代谢的主要转录因子,可抑制其表达[6]㊂FPN1是目前唯一已知的铁输出蛋白[7]㊂在此过程中,TFR1是关键蛋白㊂Manz等[8]在对铁死亡敏感的原癌基因突变细胞的研究中发现,铁死亡细胞的TFR1表达升高,伴铁蛋白重链(ferritin heavy chain,FTH1)㊁铁蛋白轻链(ferritin light chain, FTL)表达降低,铁超载进而诱导铁死亡发生㊂铁调节蛋白与缺氧诱导因子1等均可增强TFR1的表达[9],热休克蛋白B1等可抑制TFR1的表达[10](图1)㊂1.2㊀脂质代谢细胞膜及细胞器膜上磷脂中多不饱和脂肪酸在酰基辅酶A合成酶长链家族成员4(acyl-CoA synthetase long-chain family member4,ACSL4)的作用下酰基化,在溶血磷脂酰胆碱酰基转移酶3的作用下酯化,生成含多不饱和脂肪酸磷脂㊂该物质结构不稳定,极易被脂氧合酶氧化为4-羟基壬烯醛(4-hydroxy-trans-2-nonenal,4-HNE)和丙二醛(malondialdehyde, MDA)[11]㊂其中ACSL4及脂氧合酶是限速酶,抑制其表达和生物活性可提高细胞对铁死亡的耐受性(图1)㊂1.3㊀氨基酸代谢在GPX4催化作用下GSH可将脂质过氧化产物转化为无毒的脂肪醇㊂GSH是由谷氨酸㊁半胱氨酸和甘氨酸组成的三肽,半胱氨酸由胱氨酸转化生成,胱氨酸经由xCT从胞外运输至胞内,此转运过程决定了GSH的合成效率㊂研究表明,铁死亡诱导剂埃拉斯汀靶向作用[12],p53抑制xCT转录[13],FTH1缺陷心肌细胞xCT表达下调[14]等,均可促进铁死亡发生㊂GSH还可通过NADPH氧化生成,NADPH作为清除脂质过氧化物所必需的还原剂,是铁死亡敏感性的生物标志物㊂GPX4是众所周知的铁死亡关键调节剂,各种内源性分子(如硒㊁多巴胺㊁维生素E㊁辅酶Q10等)和化学药品(如Fer-1㊁右雷佐生等)通过直接抑制或间接失活GPX4来激发铁死亡[15](图1)㊂1.4㊀甲羟戊酸途径甲羟戊酸途径是脂代谢中重要的生物合成途径,广泛存在于真核生物中,以乙酰辅酶A为原料,以类固醇等为主要产物㊂辅酶Q10作为该途径代谢产物之一,是铁死亡的内源性抑制剂,若消耗增多则可增加细胞对铁死亡的敏感性(图1)㊂1.5㊀铁自噬铁自噬的概念在2014年由Mancias等[16]提出,是指由核受体辅激活因子4介导的将铁蛋白靶向转运至自噬体中降解并释放游离铁的一种选择性自噬方式,是一种保守的细胞分解代谢过程㊂适当的铁自噬可以维持细胞内铁含量稳定,但是过度的铁自噬由于释放出大量游离铁而诱发铁死亡(图1)㊂1.6㊀电压依赖性阴离子通道VDAC是位于线粒体外膜的转运离子和代谢产物的跨膜通道蛋白,具有VDAC1㊁VDAC2和VDAC3三种亚型,可调AA/AdA:花生四烯酸/二十二碳四烯酸;CoA:辅酶A;GSS:谷胱甘肽合成酶;γ-GS:γ-谷胺酰半胱氨酸;GPX4:谷胱甘肽过氧化物酶4;ROS:活性氧;CoQ10:辅酶Q10;MVA:甲羟戊酸:HMG-CoA:3-羟基-3-甲基戊二酸单酰辅酶A;Acetyl-CoA:乙酰辅酶a羧化酶;ACSL4:酰基辅酶A 合成酶长链家族成员4;LPCAT3:溶血卵磷脂酰基转移酶3;ALOX15:15-脂氧合酶;VDAC:电压依赖性阴离子通道;NOX:NADPH氧化酶; DMT1:二价金属转运体1;ZIP8/14:锌-铁调节蛋白家族8/14;PCBP1/2:分子伴侣多聚结合蛋白1/2;LC3:微管结合蛋白1轻链3;NCOA4:核受体辅激活剂4图1㊀铁死亡调控机制模式图节线粒体代谢产能过程,参与细胞生存和死亡信号调控㊂有研究证明,铁死亡抑制剂脂血抑素1可通过下调VDAC1表达水平来抑制铁死亡[17]㊂铁死亡诱导剂埃拉斯汀可作用于VDAC2及VDAC3,使得线粒体通透性增加,进而诱导线粒体功能障碍和细胞铁死亡的发生[18]㊂敲低VDAC2和VDAC3基因可抑制铁死亡发生,但过表达VDAC2和VDAC3并没有显著诱发铁死亡,具体机制有待进一步研究[19](图1)㊂2　铁死亡在心血管疾病中的研究进展2.1㊀铁死亡与心力衰竭越来越多的证据表明,铁死亡是心力衰竭(heart failure, HF)病理生理机制中不可或缺的重要环节㊂Lapenna等[20]研究发现,老龄兔心脏组织中铁含量㊁氧化应激标记物等均明显高于正常成年兔,表明铁代谢可能与衰老㊁功能障碍等病理生理相关㊂Liu等[21]在体内通过主动脉缩窄术建立压力超负荷诱导大鼠HF模型,在体外培养经埃拉斯汀或异丙肾上腺素处理的H9c2心肌细胞,结果发现两者均可观察到以铁超载及脂质过氧化物生成增多为特征的铁死亡过程㊂在通过高盐饲料喂养盐敏感大鼠建立的射血分数保留HF模型中,铁死亡相关指标TFR1㊁ACSL4㊁4-HNE表达明显升高, FTH1㊁xCT表达明显降低,提示铁死亡是射血分数保留HF 发病机制之一[22]㊂为了探索铁死亡在HF中的调控机制, Zheng等[23]对GEO公共数据库进行了分析并发现,M2型巨噬细胞外泌体传递CircSnx12是参与铁代谢相关铁死亡的关键调节因子,可通过与miR-224-5p相互作用实现靶向调节与铁死亡相关的FTH1基因,进而调控诱导HF发生的铁死亡机制,所以环状RNA可能成为治疗HF的前瞻性靶标和新型药物研发的突破口㊂另外,阿尔茨海默病小鼠模型具有心脏结构和功能异常等特点,伴ACSL4㊁核受体辅激活因子4表达上调,xCT㊁GPX4表达下调,即存在脂质过氧化㊁氧化应激水平升高,GSH代谢异常以及铁死亡的激活㊂线粒体醛脱氢酶缺陷与阿尔茨海默病患者心功能不全相关,阿尔茨海默病小鼠铁死亡相关指标变化可通过线粒体醛脱氢酶转基因得以逆转,心脏结构和功能亦能得以改善[24]㊂这些发现表明铁死亡与HF㊁心功能不全密切相关㊂2.2㊀铁死亡与心肌缺血/再灌注损伤迄今为止,血运重建仍然是缺血性心肌病最有效的治疗方法,但心肌缺血/再灌注(ischemia/reperfusion,I/R)损伤不可避免,并会造成多种类型细胞死亡,包括铁死亡㊂我们知道,多元醇途径参与了I/R损伤诱导的心肌梗死,Tang等[25]研究发现抑制多元醇途径关键酶可减弱I/R损伤介导的缺氧诱导因子1α㊁Tf㊁TFR1和细胞内铁含量的增加,减少心脏梗死区域面积,过表达多元醇途径关键酶可激活缺氧诱导因子1α,诱导TFR1的表达和铁的积累,加剧脂质过氧化和氧化损伤,故多元醇途径参与调节了I/R损伤介导的铁死亡㊂还有研究发现,泛素特异性蛋白酶7在心脏I/R损伤期间通过激活p53/TFR1通路参与调节铁死亡[26]㊂铁死亡可通过TLR4/Trif/Type1IFN信号通路促进中性粒细胞向冠状动脉内皮细胞黏附以及向受损心肌募集,造成坏死性炎症,加重心脏移植后心肌损伤[27]㊂铁死亡抑制剂可减轻心肌I/R损伤[28]㊂Gao等[29]研究证明细胞内谷氨酰胺分解代谢在铁死亡机制中发挥了关键作用,抑制谷氨酰胺代谢可抑制铁死亡,改善离体心脏模型I/R损伤,为I/R损伤治疗提供了新策略㊂亦有研究表明铁死亡不是发生在心肌缺血阶段,而是发生在心肌再灌注阶段[30],可能与这一阶段氧化的磷脂酰胆碱生成相关[31],为I/R损伤甚至心肌梗死患者建立精准医疗奠定了基础㊂同时,雷帕霉素可通过其靶标哺乳动物雷帕霉素靶蛋白基因过表达抑制铁死亡[32],进而改善心肌缺血,减少I/R损伤㊂在糖尿病心肌I/R损伤模型中,抑制铁死亡可减少内质网应激相关性心肌损伤[33]㊂故抑制铁死亡是I/R心肌损伤治疗的有效策略㊂2.3㊀铁死亡与蒽环类药物心脏毒性多柔比星(doxorubicin,DOX)是临床上常用的蒽环类化疗药物,具有心脏毒性,可造成DOX相关性心肌病,限制其临床应用并产生不良预后[34]㊂有研究表明,高铁基因可通过调节心肌细胞铁沉积来增加DOX诱导的心脏毒性的易感性[35]㊂Fang等[28]研究表明铁死亡机制在DOX诱导小鼠心肌病模型中发挥了关键作用,经Fer-1干预后可显著改善小鼠心肌病变及死亡率㊂通过全转录组测序发现DOX可通过Nrf2上调血红素加氧酶1表达,降解血红素铁,进而诱发铁死亡,且证实铁超载和脂质过氧化主要定位于心肌细胞线粒体,更加明确了线粒体损伤在DOX心肌损伤中的因果关系㊂Tadokoro等[36]同样证实线粒体依赖性铁死亡在DOX心肌损伤进展中的关键作用㊂Liu等[37]应用RNA测序方法发现,在DOX干预后小鼠心脏中,脂代谢途径中的Acot1基因明显下调,经Fer-1处理后部分逆转,且Acot1过表达可抑制铁死亡,进而实现心脏获益㊂因此,Acot1可能是通过抑制铁死亡来预防和治疗DIC的潜在靶点㊂2.4㊀铁死亡与糖尿病性心肌病糖尿病是心血管疾病常见的合并症,可增加心脏对I/R 损伤的易感性和糖尿病性心肌病(diabetic cardiomyopathy, DCM)的发生风险㊂氧化应激已被证实为DCM心脏结构和功能改变的重要因素㊂2022年发表的一项研究首次报道了铁死亡在DCM发病机制中起着至关重要的作用,萝卜硫素可通过AMPK激活NrF2,上调铁蛋白和xCT水平进而抑制铁死亡过程,改善DCM小鼠心脏病变[38]㊂2.5㊀铁死亡与败血症相关心脏损伤败血症致心脏损伤的发生率和死亡率均较高㊂盲肠结扎和穿刺是研究败血症最常用的造模方法,该模型可增加心脏铁含量和脂质过氧化水平,并降低GSH含量和GPX4表达水平,提示败血症引起的心脏损伤可能涉及铁死亡机制,而右美地托咪定可通过抑制铁死亡改善败血症引起的心脏损伤[39]㊂此外,铁死亡已被证明在脂多糖诱导的败血性心肌病模型中起重要作用[40]㊂2.6㊀铁死亡与心律失常目前,全球正面临新型冠状病毒(COVID-19)大流行,而COVID-19感染会导致小鼠心脏起搏细胞功能障碍并诱导铁死亡,酪氨酸激酶抑制剂伊马替尼和铁螯合剂去铁胺可阻断病毒感染和铁死亡相关过程,可能是改善病毒感染后心律失常的潜在机制[41]㊂另一项关于小鼠的研究亦表明铁死亡与心律失常相关,频繁过量饮酒会诱发铁死亡,并增加心房颤动发生率,而铁死亡抑制剂可部分逆转过量饮酒引起的不良反应[42]㊂2.7㊀铁死亡与心肌纤维化Wang等[43]发现在主动脉缩窄致压力超负荷HF模型中,HF晚期心肌纤维化主要由MLK3调节的JNK/p53信号通路介导的铁死亡引起,miR-351基因表达上调可抑制MLK3表达,进而改善心肌纤维化及心功能㊂xCT基因缺失亦可加剧血管紧张素Ⅱ介导的心肌纤维化和功能障碍,为铁死亡参与心肌纤维化提供了证据[44]㊂2.8㊀铁死亡与内皮功能障碍㊁动脉粥样硬化内皮功能障碍是糖尿病标志性病变,是糖尿病心血管并发症的起始和关键因素㊂有研究表明,在糖尿病db/db小鼠的主动脉内皮中观察到xCT表达下降㊁铁积累和脂质过氧化物生成增多以及去内皮化改变,且高糖和白细胞介素-1β可通过p53-xCT-GSH途径诱导静脉内皮细胞发生铁死亡[45]㊂高脂饮食可诱导ApoE-/-小鼠形成动脉粥样硬化,Bai等[46]发现在动脉粥样硬化血管中铁死亡相关蛋白明显上调,Fer-1干预后可部分抑制铁超载和脂质过氧化,并显著降低了xCT 和GPX4的表达水平,同时抑制铁死亡可改善主动脉内皮细胞的活力㊂另一项关于不同严重程度动脉粥样硬化的尸检报告数据表明,重度动脉粥样硬化患者的冠状动脉标本中前列腺素内过氧化物合成酶2㊁ACSL4表达上调,GPX4表达下调[47]㊂故铁死亡与内皮功能障碍和动脉粥样硬化病理学相关,并参与其发生及发展㊂2.9㊀铁死亡与其他镰状细胞病是一种以溶血㊁器官缺血和心血管并发症等为特征的遗传性疾病,该疾病小鼠血红素水平升高,导致心脏铁超载㊁脂质过氧化和铁死亡,抑制铁死亡减轻了与镰状细胞病相关的心肌病[48]㊂有研究发现,吸烟与腹主动脉瘤的发生㊁发展和破裂显著相关[49]㊂Sampilvanjil等[50]首次证实香烟提取物可引起血管平滑肌细胞发生铁死亡,并可能通过铁死亡机制诱导主动脉瘤或夹层㊂此外,Ma等[51]首次证实铁死亡是血管钙化发生的新机制㊂3㊀铁死亡抑制剂在心血管疾病中的应用由于铁死亡机制是治疗和预防心血管疾病的潜在靶点,铁死亡抑制剂在心血管疾病中的应用逐渐增多㊂UAMC-3203作为比Fer-1更稳定和有效的铁螯合剂,能更好地预防动物模型中铁死亡驱动的多器官功能障碍,可能更适合临床试验推广[52]㊂针对脂血抑素1的研究相对较少,但具有与Fer-1相似的保护作用,可显著减少棕榈酸诱导的心脏损伤[53]㊂抗氧化剂N-乙酰半胱氨酸可提高半胱氨酸的生物利用度,其抗铁死亡作用已得到证实[54],并可减少糖尿病大鼠心肌I/R损伤,为临床应用提供了理论基础[55]㊂去铁酮㊁化合物968在心脏I/R损伤中亦发挥了心脏保护作用[56,29]㊂右雷佐生是乙二胺四乙酸环状衍生物,是唯一一个被美国食品药品监督管理局批准的用来预防DOX相关性心肌病的铁螯合剂,可以直接进入心肌细胞线粒体并减少铁积累[57]㊂人脐带血中间充质干细胞的外泌体可通过抑制急性心肌梗死小鼠模型中的铁死亡来实现心脏保护作用[58]㊂卡格列净㊁葛根素㊁阿托伐他汀可抑制铁死亡改善心功能[21-22,59],为HF提供了潜在的治疗策略,而氧化锌纳米粒子可诱导铁死亡,促进内皮损伤发生㊂此外,常用的心脏药物可能具有未发现的抗铁死亡活性,如卡维地洛已被证明可以抑制铁死亡,而与其对β-肾上腺素能受体的作用无关㊂尽管抑制铁死亡已在多种动物模型中显示出心脏获益,但迄今为止尚未进行使用铁死亡抑制剂治疗心血管疾病的临床试验㊂4㊀小结铁死亡作为最近发现的程序性细胞死亡类型,是心血管疾病发生发展的关键机制之一㊂近年来日益引起人们的重视,相关研究不断增加㊂本文总结了铁死亡相关调控机制及其在心血管疾病中的研究进展和应用㊂但铁死亡研究领域的一些关键机制尚待研究和验证,需要我们进一步探索去揭示铁死亡的精细分子机制,从而为靶向铁死亡以减少主要不良心血管事件以及防治心血管疾病提供更加充分的理论依据,为预防和治疗心血管疾病提供新的生物标志物和前瞻性靶标㊂利益冲突:无参㊀考㊀文㊀献[1]Ward 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·护理研究·心血管疾病专科护理质量监测指标的构建与实施朱丽萍　任国琴　卢回芬　周焕芳　任玉娇南京医科大学附属无锡第二医院心内科　214002通信作者：卢回芬，Email：***************** 【摘要】　目的　探讨心血管内科疾病专科护理质量监测指标的构建和实施效果。

方法　心血管内科成立研究小组，查阅心血管内科专科疾病的诊疗及护理指南，参考已有的心血管内科专科护理质量相关指标，筛选出护理质量问题，制订出3项重点专科护理质量监测指标，即血管活性药及高危药物外渗率、低分子肝素注射致皮下出血发生率及介入穿刺伤口出血、血肿（动脉）主动发现率。

对专科护理质量指标进行监控、数据收集、分析、改进，进一步对科室内护士进行培训和实施持续质量改进。

观察2016—2018年度3项监测指标数据。

结果　心血管内科2017年3项指标相比2016年均有改进，差异均有统计学意义（均P＜0.05）。

2018年3项监测指标数据均较2017年得到改善，差异均有统计学意义（均P＜0.05）。

结论　建立心血管内科护理质量监测指标，制定有针对性的护理措施，对专科护理质量展开持续改进，能有效提升护理质量。

【关键词】　心血管内科；持续质量改进；专科护理；质量监测指标；护理管理 DOI：10.3760/cma.j.issn.1007-1245.2020.17.036Establishment and application of specific nursing quality monitoring indicators for Department of InternalMedicine-CardiovascularZhu Liping, Ren Guoqin, Lu Huifen, Zhou Huanfang, Ren YujiaoDepartment of Cardiology, Wuxi No.2 People’s Hospital, Wuxi 214002, ChinaCorrespondingauthor:LuHuifen,Email:***************** 【Abstract】Objective To explore the establishment and application of specific nursing qualitymonitoring indicators for Department of Internal Medicine-Cardiovascular. Methods Cardiovascular medicinesubject discussion group was constituted, referencing to cardiovascular medicine specific nursing quality relevantindicators and clinic guideline of diagnosis and treatment and nursing, to screen out nursing quality problems,and eventually identify three specific nursing quality indicators, namely vasoactive drugs and high-risk drugsexosmosis rate, incidence of subcutaneous hemorrhage caused by low molecular weight heparin injection, andrate of active hemorrhage discovery and hematoma in interventional puncture wound (artery). The indicators ofspecialized nursing quality were monitored, collected, analyzed, and improved, train of nurses and insisting onpersistent quality reform in our department. The three specific nursing quality indicators were observed in 2016-2018. Result The three specific nursing quality indicators were improved in 2017 compared with 2016, andmore improved in 2018, with statistically significant differences (all P<0.05). Conclusion The establishment andapplication of specific nursing quality indicators for Cardiovascular medicine help to establish targeted nursingmeasures and continuous improvement of nursing quality, and ensure the effective implementation of nursing care. 【Key words】 Cardiovascular medicine; Continuous improvement of nursing quality; Specific nursing;Nursing quality monitoring indicators; Nursing management DOI：10.3760/cma.j.issn.1007-1245.2020.17.036 护理质量管理是护理管理的核心。

【摘要】　心血管疾病已成为我国首位死亡原因，管理好高血压患者是遏制我国心脑血管疾病流行的核心策略之一。

基层医疗卫生机构通过国家基本公共卫生服务项目对高血压患者进行长期随访管理，本指南旨在为基层医务人员提供高血压防治管理的简单直接的操作指导。

在《国家基层高血压防治管理指南2017版》的基础上，基于政府部门的管理要求和新近发布的相关领域研究证据，本指南主要在高血压的基层管理、血压测量、降压目标值以及降脂治疗目标值等内容上进行了更新。

此外，首次增加了中医药在高血压领域的应用相关内容，为基层医务人员在高血压管理方面提供更全面的指导。

【关键词】　高血压；防治；管理指南；基层National clinical practice guidelines on the management of hypertension in primary health care in China (2020)The National Essential Public Health Service Program Office for Management of Hypertension in Primary Health Care, National Center for Cardiovascular Diseases, National Committee on Hypertension Management in Primary Health Care Correspondingauthor:LiJing,E-mail:********************【Abstract 】　Cardiovascular disease now rank the first causes of death in China, and hypertension is the most common risk factor for cardiovascular disease. Better management of hypertension is one of the key strategies to reduce the prevalence of cardiovascular diseases. At present, the long-term follow-up management of hypertension patients in China is under the charge of primary health institutions. These guidelines are intended to provide simple and practical instructions on prevention and treatment of hypertension for primary health care workers. On the basis of the National clinical practice guidelines on the management of hypertension in primary health care in China (2017), the experts update the guidelines according to the requirement from the government and the latest clinical evidence, mainly focus on hypertension management in primary health care, blood pressure measurement, blood pressure lowering target and lipid lowering target. In addition, the role of traditional Chinese medicine on hypertension management is introduced in this version, which would provide primary health care workers comprehensive recommendations in the field of hypertension management.【Key words 】　Hypertension; Management; Guideline; Primary health care国家基层高血压防治管理指南2020版国家心血管病中心　国家基本公共卫生服务项目基层高血压管理办公室，国家基层高血压管理专家委员会通信作者：李静　E-mail ：********************《中国心血管健康与疾病报告2019》显示，我国高血压患病人数已达2.45亿[1]。

•综述•讲座•药物洗脱支架在经皮冠状动脉介入治疗（PCI）中的应用与展望胡翔稳张恒【摘要】药物洗脱支架的出现是心血管介入治疗的一个革命性变化，为解决裸金属支架置入术后引起的支架内血栓形成和再狭窄提供了重要的解决方法。

本文主要介绍药物洗脱支架的应用现状,主流药物洗脱支架的作用机制。

总结目前药物洗脱支架存在的缺点，同时对药物洗脱支架及其分系统未来发展进行了展望。

【关键词】药物洗脱支架；应用；展望[中图分类号]R543[文献标识码]A D01：10.3969/j.issn.l002-1256.2019.11.041The application and forecast of drug-eluting stents in percutaneous coronary intervention HU Xiang-wen.Department of cardiovascular disease,the first affiliated hospital of Bengbu Medical College,Bengbu,A nhui,233000, China.[Abstract]The emergence of drug-eluting stents is a revolutionary change in cardiovascular interventionaltherapy,it provides an important solution to the stent thrombosis and restenosis after the implantation of baremental stent.The article mainly introduces the application of drug-eluting stents and the mechanism of action ofmainstream drug-eluting stents.The disadvantages of drug-eluting stents were summarized and the futuredevelopment of drug-eluting stents and subsystems were prospected.[Key words]Drug-eluting stents;Application;Prospect冠状动脉粥样硬化性心脏病是当今世界严重威胁人类健康的心血管疾病之一，其主要特点是受累动脉的病变从血管内膜开始，先后有脂质积聚、纤维组织增生和钙质沉着，并有动脉中层的逐渐退化和钙化，在此基础上继发斑块内出血、斑块破裂及局部血栓形成,病理生理机制为冠状动脉粥样硬化狭窄或阻塞所致的心肌缺血坏死。