结肠镜检查前肠道准备清洁效果的临床对比研究

目的：观察不同方法对结肠镜检查前肠道准备的清洁效果及其副作用。方法：312例结肠镜检查者肠道清洁前随机分为口服甘露醇组（A组）、口服番泻叶组（B组）、结肠循环冲洗组（C组）及联合B方法与C方法（D组）。据结肠镜检查中肠道清洁程度（I－Ⅲ级）和清洁范围（0－4度）评价肠道清洁效果。结果：D组肠道清洁程度和清洁范围最理想，其肠道清洁程度满意－比较满意率（I＋Ⅱ：96．2％）显著高于A组（82．1％；P＜0．01）、B组（85．7％；P＜0．05）和C组（69．3％，P＜0．01）。C组降结肠以下清洁率（65．4％）显著高于A组（37．1％，P＜0．01）和B组37．7％，P＜0．01），同时其肠道清洁失败率（30．8％）也显著高于B组（14．3％，P＜0．01）。此外，C组副作用发生率（3．8％）显著低于其他三组（A组43．6％，B组54．5％和D组58．2％，P均＜0．01）。结论：口服水泻剂联合结肠途径治疗机循环冲洗法是比较理想的全结肠清洁方法，单纯结肠循环冲洗法适合于乙状结肠镜检查前肠道准备。     

血脂和雌性激素水平与胆囊结石的关系

目的探讨血脂和雌性激素水平与胆囊结石的关系方法选择经B超、手术证实的胆囊结石患者104例（A组）进行血清雌二醇（EZ）、孕酮（P）、总胆固醇（TC）、甘油三酯（TG）测定，并与54例（B组）健康人进行对比分析．结果男性A组E2，P水平明显高于B组（P＜0．05～0．01），女性育龄期E2水平A,B两组相比差异无显著性（P＞0．05），P高于B组（P＜0．01）．绝经期A组E2，P均高于B组（P＜0．01），女性两组E2／P比值A组均显著低于B组（P＜0．01）.而血清TG，TC及TG／TC比值在男女性A组均高于B组（P＜0．01）。结论胆囊结石患者存在雌性激素及脂类代谢紊乱．     

心导纳微分环Ⅰ相缺蚀评分对冠心病诊断的价值

目的：探讨心导纳微分环Ⅰ相（CADL－Ⅰ）缺蚀评分对冠心病（CHD）诊断的价值。方法：35例CHD（A组）、33例其他心脏病（B组）、31例健康（C组）行心导纳检查，CADL－Ⅰ相离心或归心支近Y轴内、中、外1／3段出现缺蚀分别评为1、2、3分，比较3组分值差异。结果：A组CADL－Ⅰ相出现缺蚀的评分明显高于B组及C组（P均＜0．01），B组评分与C组无显差异（P＞0．05）。结论：CADL－Ⅰ相出现缺蚀的评分越高预测CHD的价值越大，其可作为CHD诊断的重要参考。     

低分子量肝素、肝素钙对不稳定性心绞痛患者凝血系统影响的对比研究

目的：比较不稳定性心绞痛患不同分子量肝素治疗后体内凝血系统的变化。方法：63例不稳定性心绞痛患随机分为皮下注射低分子量肝素组（A组，依诺肝素组）33例和皮下普通肝素组（B组，肝素钙组）30例，疗程为5d，观察临床效果、不良反应及凝血指标。结果：治疗后A、B组缓解心绞痛总有效率分别为97％和80％（P＜0．05），出血发生率显性差异（P＞0．05）。治疗5d后两组血浆抗因子Xa活性（anti-Xa）、抗因子IIa活性（anti-IIa）均明显升高（P＜0．01），anti-Xa活性A组明显高于B组（P＜0．01），而anti-IIa活性B组明显高于A组（P＜0．05）。血浆抗凝血酶Ⅲ（AT－Ⅲ）活性在A组无明显变化（P＞0．05），B组明显下降（P＜0．01）。血浆凝血酶原片段1＋2（F1＋2）水平两组均明显下降（P＜0．01）。血浆激活部分凝血活酶时间（APTT）A、B组均明显延长（P＜0．01），第5天时B组APTT稍长于A组（P＝0．05）。结论：治疗5d后，普通肝素以抗因子IIa为主，低分子量肝素以抗因子Xa为主；普通肝素导致血浆AT－Ⅲ活性明显下降，而低分子肝素则无此不良作用；低分子量肝素抑制凝血酶产生的作用明显优于普通肝素。低分子量肝素组心绞痛的缓解率明显高于肝素钙组，与凝血系统的变化相符合，两组出血倾向差异无显性。     

超声心动图声学定量技术评价苯那普利对陈旧性心肌梗塞患者左心室功能的影响

将42例陈旧性心肌梗塞（OMI）患者随机分为A、B两组，A组仅在必要时给予洋地黄、利尿剂和抗心绞痛治疗，B组患者在这些治疗的某础上加服苯那普利5～10mg，qd，用药前和用药后6个月分别进行一次超声心动图声学定量（AQ）技术检测。结果：A组中2例在随访中死亡，B组中1例在前3个月内未规则服药，3个月后停药者在随访中死亡。A组中用药6个月后除EDV增大，差异有显著性意义（P＜0．05）外，其他AQ指标差异无显著性意义（P＞0．05）；B组中EDV、EDA、AFFAC等指标用药后降低（P＜0．05），PFFAC、RFFAC／AFFAC、PFR、EF、FAC等指标增大（P＜0．05），而SV改变无显著性意义（P＞0．05）。提示：苯那普利可有效控制OMI患者的左心室功能，而且有可能降低该病患者的病死率。     

不同程度肝硬化患者PG I、PG II及G-17的表达

目的：研究观察肝硬化患者血清中胃蛋白酶原（PG I、PG II）及胃泌素-17（G-17）的血清浓度变化。方法应用ELISA法检测凌源市中心医院2012年10月至2013年10月住院的肝硬化患者空腹血清中PG I、PG II及G-17浓度。结果肝功能Child-Pugh C级患者的肝硬化患者PG I、PG II及G-17浓度高于A级（P＜0．05）;PG I及G-17浓度在肝功能Child-Pugh B级高于A级（P＜0．05）。结论肝硬化患者PG I、PG II及G-17浓度可作为疾病评估的指标。     

COPD急发期患者血清尿酸水平的相关性研究

目的分析COPD患者急性期及缓解期血清中尿酸的水平，及其与肺功能、氧合指数的相关性。方法将47名COPD急性期患者分为A、B组（A组22名FEV1％〉50％，B组25名FEV1％〈50％），C组为血氧正常的对照组。测量三组及COPD组治疗后血尿酸，血肌酐，肺功能FEV1％值、氧合指数。结果治疗前，COPD的A、B组血尿酸／肌酐值高于对照组（P〈0．01），而A、B组间无明显差异（P〉0．05），A、B、C三组间FEV1值及氧合指数有明显差异（P〈0．01）。治疗后A组尿酸水平明显下降（P〈0．05），而B组变化不明显（P〉0．05）。二者间有明显差异（P〈0．05）。治疗后A组肺功能FEV1％明显改善（P〈0．05），B组改善不明显（P〉0．05）。二者间有明显差异（P〈0．01）。治疗后A、B组氧合指数明显改善（P〈0．01）。COPD患者UA／Crea值与FEV1值及氧合指数无明显相关（分别r=0．096及r=0．137，P〉0．05）。但治疗前后UA／Crea值变化与FEV1变化呈明显负相关（r=0．258，P〈0．05）。结论COPD急发期患者血清UA／Crea水平是增高的，随病情缓解而下降，其变化与肺功能相关，而与血氧合不相关。可作为病情监测的指标之一。     

老年慢性心力衰竭患者血清激活素A水平的变化及意义

目的探讨老年慢性心力衰竭（CHF）患者血清激活素A水平的变化及意义。方法ELISA法测定老年CHF患者87例及健康对照组32例血清激活素A的水平。结果心功能Ⅲ级和Ⅳ级组与对照组及心功能Ⅰ级和Ⅱ级组之间比较，差异显著（P〈0．05）。激活素A水平在左心室射血分数（LVEF）〈30％组和30％～40％组之间比较差异显著（P〈0．05），LVEF〈30％组与对照组比较差异非常显著（P〈0．01），LVEF30％～40％组与对照组比较差异不显著（P〉0．05）。血清激活素A水平在贫血组与对照组之间比较差异非常显著（P〈0．01），贫血组与非贫血组之间比较差异显著（P〈0．05），而非贫血组与对照组比较差异不显著（P〉0．05）。结论老年CHF患者血清激活素A水平在心功能差及贫血者有明显增高。     

声学定量技术评价陈旧性心肌梗塞患者的左室充盈形式

应用声学定量（AQ）技术和脉冲Doppler分析30例陈旧性心肌梗塞（OMI）患者和20例正常人的左室舒张功能。结果表明OMI组和对照组的AQ指标和Deppler指标间（即RFFAC与E峰分数、AFFAC与A峰分数、RFFAC：AFFAC与E、A峰分数之比）的相关性好（r分别为0．76、0．78、0．59，P＜0．001），根据室壁运动记分（WMI）将OMI组分为A（1＜WMI＜2）、B（WMI≥2）两组，A组的这些指标间相关性明显提高（r分别为0．91、0．90、0．75，P＜0．001），而在B组中的相关性明显变差（r分别为0．08、0．22，0．08，P＞0．05）。另外还发现A组的RFFAC、RFFAC：AFFAC比B组和对照组小，而AFFAC却比B组和对照组大。     

盐酸替罗非班在急性 ST 段抬高型心肌梗死非介入治疗中的效果观察

目的：观察盐酸替罗非班在急性ST段抬高型心肌梗死（ STEMI ）非介入治疗中的效果及安全性。方法选取急性STEMI患者162例,均未行介入治疗。随机分为两组：A组78例,常规治疗基础上加用盐酸替罗非班;B组84例,仅行常规治疗。治疗1个月后,观察两组临床有效率、心功能变化。随访6个月后,比较两组并发症发生率及病死率。结果 A组治疗总有效率为87．18％,B组为66．67％,两组比较P＜0．05。两组治疗后心功能较治疗前明显改善（P＜0．05或＜0．01）,且A组改善效果更明显（P＜0．05或＜0．01）。随访6个月,期间A组并发症发生率为16．67％、病死率为1．28％,B组分别为33．33％、10．71％;两组比较P均＜0．05。结论盐酸替罗非班可明显提高急性STEMI非介入治疗患者的心脏功能,降低心肌损伤。     

A pedunculated left ventricular hemangioma initially misdiagnosed as thrombus in a woman with atypical chest pain

The incidence of cardiac masses increased as echocardiography is becoming increasingly popular. Benign tumors of the heart constitute about 72% of all primary cardiac neoplasms and hemangioma accounts for 5–10% of benign cardiac tumors. Cardiac hemangiomas are generally asymptomatic and diagnosed incidentally during echocardiography or magnetic resonance imaging (MRI). We reported a 52-year-old woman presented with atypical chest pain and exertional dyspnea. The echocardiographic examination revealed a hyperechoic round mass in the left ventricle. With an initial diagnosis of left ventricular thrombus, the patient underwent cardiac MRI. The mass was found compatible with cardiac hemangioma. It was removed surgically and histopathologic evaluation identified a cardiac hemangioma. As reports of cardiac hemangioma are extremely rare and cardiac masses are mostly thought to be thrombi or myxomas (being the most common primary cardiac tumor), such hemangioma cases warrant attention as possibility of hemangioma should also be kept in mind.     

左心室室壁瘤所致心律失常的6例外科治疗

目的:对左心室室壁瘤合并心律失常的患者进行左心室室壁瘤切除,同时行射频消融心脏手术的结果资料进行临床分析,评价其手术疗效。方法:入选我院2008年1月至2011年5月间,接受左心室室壁瘤合并心律失常的患者进行心脏手术6例。心律失常均为药物无法控制的顽固性心律失常,心电图术前证实。结果:6例患者手术后均痊愈出院,治愈率100%。单纯行左心室室壁瘤切除的同时,2例施行左心室室壁瘤颈部内膜射频消融术,4例施行左心室室壁瘤颈部外膜射频消融术。体外循环时间(100.7±48.6)min,循环阻断时间(67.9±36.1)min。本组病例的术前与术后左心室射血分数分别为(35.3±10.2)%与(51.6±10.4)%,术前和术后相比,差异有统计学意义(P<0.05);术前和术后的左心室舒张末径大小分别为(60.5±4.5)mm与(51.2±5.5)mm,术前和术后相比差异有统计学意义(P<0.01);呼吸机辅助时间为(1.2±0.4)d,ICU时间为(1.5±0.8)d,住院时间为(23.3±10.2)d。心电图恢复窦性心律,无各种心律失常出现。随访5例,随访时间3～14个月,治疗效果良好,心电图显示为窦性心律,无心律失常复发,心脏超声示心功能正常,心功能均达Ⅰ～Ⅱ级,生活质量较术前明显提高。结论:左心室室壁瘤患者进行左心室室壁瘤切除,同时进行射频消融术,使患者摆脱心脏疾病症状,这种心脏手术是安全可行的。     

老年重度脓毒症合并心肌抑制患者心肌损伤标记物变化及价值

目的探讨老年重度脓毒症合并心肌抑制患者心肌损伤标记物肌钙蛋白I、T(cTnI、cTnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK—MB)变化及其判断预后的价值。方法43例老年重度脓毒症患者确诊后次日进行血浆心肌损伤标记物检测，连续3日行心脏超声监测其心功能，确定患者是否并发心肌抑制，比较两组心肌损伤标记物水平，并通过ROC曲线下面积比较心肌损伤标记物预测心肌抑制及不良预后的价值。结果并发心肌抑制者的血浆CK—MB、cTnI、cTnT水平明显升高，cTnI、cTnT预测心肌抑制的价值高于CK—MB。cTnI阳性患者死亡率高但无显著性差异。结论肌钙蛋白检测对预测老年脓毒症患者有无心肌抑制有较高价值，对不良预后无明显预测价值。     

Ethnic/racial differences in risk factors and clinical outcomes among patients with amyloidosis

BackgroundCardiac amyloidosis is caused by abnormal extracellular deposition of insoluble fibrils in cardiac tissue. It can be fatal when untreated and is often underdiagnosed. Understanding the ethnic/racial differences in risk factors is critical for early diagnosis and treatment to improve clinical outcomes.MethodsWe performed a retrospective cross-sectional study utilizing the National Inpatient Sample database from 2015 to 2018 using ICD-10-CM codes. The primary variables of interest were race/ethnicity and amyloidosis subtypes, while the primary outcomes were in-hospital mortality, gastrointestinal bleeding, renal failure, and hospital length-of-stay.ResultsAmyloidosis was reported in 0.17% of all hospitalizations (N  =  19,678,415). Of these, 0.09% were non-Hispanic whites, 0.04% were non-Hispanic blacks, and 0.02% were Hispanic. Hospitalizations with ATTR amyloidosis subtype were frequently observed in older individuals and males with coronary artery disease, whereas AL amyloidosis subtype was associated with non-Hispanic whites, congestive heart failure, and longer hospital length of stay. Renal failure was associated with non-Hispanic blacks (adjusted relative risk [RR]  =  1.31, p < 0.001), Hispanics (RR  =  1.08, p  =  0.028) and had an increased risk of mortality. Similarly, the hospital length of stay was longer with non-Hispanic blacks (RR  =  1.19, p < 0.001) and Hispanics (RR  =  1.05, p  =  0.03) compared to non-Hispanic whites. Hispanics had a reduced risk of mortality (RR  =  0.77, p  =  0.028) compared to non-Hispanic whites and non-Hispanic blacks, and no significant difference in mortality was seen between non-Hispanic whites and non-Hispanic blacks (RR  =  1.00, p  =  0.963).ConclusionsOur findings highlight significant ethnic/racial differences in risk factors and outcomes among amyloidosis-related US hospitalizations that can possibly be used for early detection, treatment, and better clinical outcomes.     

Sex-related differences in the prognosis of patients with cardiac sarcoidosis treated with cardiac resynchronization therapy

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机械扩张治疗贲门失弛缓症

采用纤维型金属贲门扩张器治疗贲门失弛缓症27例,男10例,女17例,年龄16～54岁。病史5个月～12年。贲门狭窄段横径0.1～0.4cm,平均0.2mm。扩张横径2.8～3.2cm,平均3.0cm。扩张后饮食改善26例(96.3％),无效1例(3.7％),与本院手术治疗组比较,无显著性差异(P>0.01)。本文阐述了纤维型金属贲门扩张器的结构特征,扩张方法,扩张前准备,扩张中与扩张后可能出现的问题及预防处理措施等,认为贲门失弛缓症如无食管溃疡等合并症,以先行扩张治疗为宜。     

Comparative effects of ventricular resynchronization therapy in heart failure patients with or without coronary artery disease

In patients with advanced heart failure, intraventricular conduction delay (IVCD) and left ventricular systolic dysfunction (LVSD), multisite cardiac pacing can be proposed as an additive treatment. The aim of this study was to assess the clinical effectiveness of atrioventricular pacing according to the etiology of LVSD, by comparing the outcome of patients with and without coronary artery disease. Between August 1997 and November 1998, 103 patients were included in the InSync trial and received a biventricular pacemaker and a specifically designed left ventricular pacing lead. Baseline evaluation (12 lead ECG, New York Heart Association Class, quality of life (QOL) and distance walked during the 6 min walk test) was repeated in survival patients at 1, 3, 6 and 12 months after pacemaker implantation. Patients were split in two groups, ischemic (N = 48) and non-ischemic (N = 55), according the result of a recent coronary angiography, the existence of coronary angioplasty or coronary artery bypass or the history of a prior myocardial infarction. RESULTS: The mortality rate was similar in the two groups with a mean 12 months actuarial survival rate of 78%. Nevertheless, the delay between the death and the pacemaker implantation was significantly higher in the non-ischemic group. A significant reduction in QRS duration and a significant improvement in NYHA class (-1.5). QOL score (-50%) and 6 min walking test (+18%) were observed similarly in the two groups. CONCLUSION: This study shows that biventricular pacing improves significantly functional status of patients with LVSD, IVCD and advanced heart failure, regardless the etiology of the cardiomyopathy, ischemic or not, without over-mortality in ischemic patients.     

Use of a modified introducer sheath with a side-hole to improve access to left ventricular veins with proximal origin.

AIMS: Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy (CRT) devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very proximal origin of the lateral or postero-lateral cardiac vein. METHODS AND RESULTS: We describe an alteration of existing left ventricular (LV) lead delivery sheath with the creation of a side-hole 35-50 mm from its tip. This modification is made to provide access to proximal cardiac vein ostia, while maintaining adequate support for the delivery system. The modified introducer sheath was used in the implantation of six CRT systems (four defibrillators and two pacemakers) in patients who had a proximal origin of the lateral or postero-lateral cardiac vein, all of which were successful and without complications. CONCLUSION: In those patients with unusual proximal origin of target LV veins, modifications of the introducer sheath with the creation of a side-hole facilitate the successful implantation of the LV pacing lead. Until this modified sheath is tested, this technique is considered experimental and may carry unknown risks.     

Preoperative Management in Patients with Single‐ventricle Physiology

Objective. Advancements in the preoperative management of patients with single‐ventricle physiology continue to evolve. Previous reports have questioned the benefit of using inhaled nitrogen in single‐ventricle patients, suggesting that this therapeutic modality may not provide adequate systemic cardiac output. The objective of this study was to review our institutional experience managing preoperative patients with single‐ventricle physiology using a combination of afterload reduction and inhaled hypoxemic therapy. Design, Setting, and Patients. This is a retrospective review of 49 consecutive single‐ventricle patients admitted preoperatively between July 2004 and January 2009, to the cardiac intensive care unit at Children's Hospital of Pittsburgh who underwent single‐ventricle palliation, and treated preoperatively with milrinone and inhaled nitrogen. Therapeutic interventions and indirect indicators of cardiac output were collected on day of admission (time 0) and compared with those collected on the morning of surgery (time 1); data included clinical assessment, hemodynamic measurements, and laboratory values. Results. When comparing time 0 to time 1, there was a statistically significant decrease in lactate (from 2.2 to 1.8 mEq/L [P < 0.001]) and an increase in pH (from 7.36 to 7.41 [P < 0.001]), serum bicarbonate (from 24.16 to 27.55 mmol/L [P < 0.001]) and arterial PaO₂ (from 38.10 to 41.82 mm Hg [P= 0.027]). Preoperatively, there were no deaths, and only two patients had an evidence of multiorgan dysfunction on day of surgery (time 1). Conclusion. Our results suggest that a combination of afterload reduction and hypoxemic therapy was able to maintain an appropriate distribution of the cardiac output in the majority of preoperative patients with single‐ventricle physiology. An adequate balance of systemic and pulmonary blood flow was successfully achieved with an increase in arterial Pa0₂ values.     

Osteosarcoma with Cardiac Metastasis in a 22‐year‐old Man: A Case Report and Review of Cardiac Tumors

Primary osteosarcoma accounts for 3% of all childhood cancer. It commonly occurs during the adolescent growth spurt and is more common in boys than girls and in African Americans than white people. The 5‐year survival is approximately 79%. Cardiac metastasis of osteosarcoma is exceedingly rare; we present an unusual case in a 22‐year‐old man with significant intracardiac tumor burden. Additionally, we review the current pediatric cardiac tumor literature.