非缺血性心脏病并慢性充血性心力衰竭患者血清心肌肌钙蛋白Ⅰ的变化及意义

目的探讨非缺血性心脏病并慢性充血性心力衰竭 ( CHF)患者血清心肌肌钙蛋白 I( c Tn I)水平的变化 ,以指导非缺血性心脏病并 CHF的治疗和判断预后。方法 40例非缺血性心脏病并 CHF患者 ,分别于第 2天和心力衰竭稳定 5～ 7天各抽血 2 ml,用化学发光分析法测定 c Tn I水平 ,并与对照组进行比较。结果 CHF组血清 c Tn I水平为 1.16± 0 .77μg/L ,对照为 0 .2 0± 0 .0 8μg/L ( P<0 .0 1) ;CHF组阳性者治疗前 c Tn I水平为 1.38± 0 .75μg/L,治疗后为 0 .35± 0 .11μg/L,P<0 .0 1;血清 c Tn I水平随心力衰竭的程度加重而升高 ,血清 c Tn I持续阳性者 ,其预后不佳。结论非缺血性心脏病并 CHF患者存在心肌细胞损伤或坏死 ,血清 c Tn I水平是反映非缺血性心脏病并 CHF严重程度的一个可靠指标 ,同时识别其高危患者     

心肌肌钙蛋白I在急性心肌梗死溶栓治疗中的临床意义

目的观察急性心肌梗死 (AMI)溶栓后血管再通和未通者与未溶栓者血清肌钙蛋白的动态变化。方法定量测定 93例 AMI患者的心肌肌钙蛋白 I(c Tn I) ,以 >10 0 ng/ L作为阳性判定值。结果溶栓再通者 c Tn I峰值较未通组与未溶栓组显著增高 (P<0 .0 5 ) ,且峰值增大 ,峰值时间提前 8小时 ,再通组 c Tn I恢复正常时间平均为 (13 0± 3 8)小时 ,较未通者提前 60小时。结论溶栓后动态测定血清c Tn I浓度、峰值时间 ,可作为判断溶栓成功的指标之一。     

不稳定型心绞痛患者血清肌钙蛋白Ⅰ的变化

目的 :对比观察不稳定型心绞痛与稳定型心绞痛患者血清中肌钙蛋白 (c Tn )升高与心脏事件的关系。方法 :对 5 0例不稳定型心绞痛患者 (U AP)、2 0例稳定型心绞痛患者及 2 0例健康人分别进行血清 c Tn 及肌酸激酶同工酶 (CK MB)测定 ,并观察住院期间心脏事件发生率。结果 :12 0例稳定型心绞痛患者 c Tn 定量为 (8.6 4± 3.12 )μg/ L ,CK MB值为 (14.5 0± 4.5 0 ) U / L ;U AP组 c Tn 定量为 (14.2 1± 4.2 6 )μg/ L ,CKMB值为 (16 .5 2± 5 .46 ) U / L ,c Tn 比较 P<0 .0 1,而 CK MB比较 P>0 .0 5。 2以 c Tn ≥ 10μg/ L为分界值 ,则 5 0例 U AP患者中 19例 c Tn 明显升高〔(16 .78± 4.5 2 ) μg/ L〕,同时测定 CK MB值为 (16 .82±4.2 1) U/ L;余 31例 c Tn 为 (9.12± 0 .18) μg/ L,其 CK MB值为 (16 .13± 4.5 0 ) U/ L;c Tn 比较 P<0 .0 1,而CK MB比较 P>0 .0 5。 3不稳定型心绞痛患者中 c Tn 升高组急性心肌梗死、心脏性猝死、顽固性心绞痛的发生率明显高于 c Tn 正常组。结论 :c Tn 对判断 UAP患者预后具有较高的预测价值。     

小儿急性心力衰竭心肌肌钙蛋白I的变化

198 7年 Commins将心肌肌钙蛋白I( c Tn I)用于临床诊断心肌损伤 ,有较高的灵敏度和特异性 〔1〕。国内外有 c Tn I在成人急性心力衰竭 (心衰 )有应用价值的报道〔2 ,3〕 ,在小儿心衰中的变化尚未见报道。为此我们对心衰患儿血清 c Tn I进行定量测定 ,观察 c Tn I与心衰的关系 ,探讨其临床价值 ,报告如下。1　资料与方法1.1　病例 :34例患儿为 1998年 6月～2 0 0 0年 6月收住我院儿科心血管病房诊断急性心衰者。诊断依据 1985年小儿心衰座谈会制订的标准〔4〕。男 19例 ,女15例 ;年龄 4个月～ 13岁 ,平均 ( 5 .7±2 .6 )岁 ;先天性心脏…     

甲状旁腺激素对大鼠心肌c-myc基因表达的影响

目的 :研究不同浓度的甲状旁腺激素 (PTH)对成年大鼠心肌c -mycmRNA的影响。 方法 :采用逆转录多聚酶链反应 (RT -PCR)技术 ,比较正常对照组、低剂量PTH组 (1μg/10 0 g体重 )、高剂量PTH组 (3 μg/10 0g体重 )大鼠心肌c -mycmRNA表达。结果 :①正常成年大鼠心肌c-mycmRNA不表达 ;②静脉注射 2种剂量PTH组大鼠心肌中均见c -mycmRNA表达 ;③c -mycmRNA表达在低剂量组和高剂量组之间存在显著差异 (分别为 1 49± 0 0 7和 2 19± 0 2 2 ,P <0 0 0 1)。结论 :高浓度PTH可刺激心肌c -mycmRNA表达 ,且与剂量呈正相关性。     

血清肌钙蛋白I在新生儿心肌损伤诊断中的应用

目的 探讨血清心肌肌钙蛋白I在新生儿心肌损伤诊断中的价值.方法 选择儿科2010年1月至2011年4月诊治的窒息新生儿40例为实验组,其中轻度窒息24例,重度窒息16例;对照组选择同期40例的正常足月新生儿,进行血清心肌肌钙蛋白I检测.结果 实验组新生儿轻度、重度窒息患儿的血清肌钙蛋白I检测结果均明显高于对照组,两组比较差异显著(P＜0.05);实验组患儿7天后血清肌钙蛋白I含量明显降低,轻度窒息患儿组7 d后恢复正常,而重度窒息患儿7 d后血清肌钙蛋白I高于对照组(P＜0.05);新生儿窒息患儿中血清心肌肌钙蛋白I阳性率为47.5%,心肌损伤阳性率为75.00%,非心肌损伤阳性率占6.25%.结论 血清心肌肌钙蛋白I是反映心肌损伤的最佳标志物.     

心肌肌钙蛋白I对小儿心肌炎的诊断价值及与肌酸激酶同功酶MB的对比研究

目的评估血清心肌肌钙蛋白 I( c Tn I)对小儿心肌炎的诊断价值 ,并与肌酸激酶同功酶 MB( CK-MB)进行对比研究。方法全自动生化分析仪对 c Tn I及 CK-MB进行定量检测。结果 1心肌炎组 c Tn I及 CK-MB均明显高于正常对照组 ( P<0 .0 0 1)。 c Tn I升高 2 2例 ,占 73% ,CK-MB升高 15例 ,占 5 0 % ,c Tn I与 CK-MB呈正相关。 2治疗 2周后 c Tn I与对照组比较有显著性差异 ( P<0 .0 0 1) ,CK-MB与对照组无显著性差异 ( P>0 .0 5 )。 3心肌炎组 13例 ST-T改变患儿测 c Tn I升高 12例 ( 92 % ) ,CK-MB升高 6例 ( 4 6 % )。结论 c Tn I及 CK-MB对小儿肌炎的诊断均较敏感。 c Tn I诊断时间窗宽于 CK-MB,特异性高于 CK-MB     

血浆miRNA-497在小儿脓毒症心肌损伤早期诊断中的应用价值

目的 探究生物标志物血浆miRNA-497在小儿脓毒症心肌损伤早期诊断中的价值。方法 回顾性分析2017年8月至2020年4月海南省妇女儿童医学中心收治的186例小儿脓毒症患者的临床资料,根据是否发生心肌损伤分为研究组(n=111,无心肌损伤组)和对照组(n=75,心肌损伤组)。比较两组患儿的血浆miRNA-497和常规心肌损伤实验室指标[心肌肌钙蛋白I(c Tn I)、肌酸激酶同工酶(CK-MB)、降钙素原(PCT)、左心室射血分数(LVEF)和C反应蛋白(CRP)]水平,并经受试者工作特征曲线(ROC)评估血浆miRNA-497对于小儿脓毒症心肌损伤的诊断价值,且经Pearson法分析血浆miRNA-497与c Tn I、CK-MB、LVEF和CRP的相关性。结果 研究组患儿的血浆miRNA-497(1. 61±0. 55 vs. 4. 35±0. 63)、cTnI(0. 06±0. 01 ng/ml vs. 4. 37±0. 51 ng/ml)、CK-MB(20. 36±5. 72 U/L vs.35. 78±4. 17 U/L)、PCT(12. 69±1. 15μg/L vs. 18. 36±1. 87μg/L)、CRP(140. 57±9. 38 mg/L vs. 171. 36±10. 28mg/L)均低于对照组,且其LVEF(56. 89%±2. 36%vs. 37. 52%±3. 21%)高于对照组,差异均具有统计学意义(P 0. 001)。血浆miRNA-497的心肌损伤诊断曲线下面积(AUC)高于CK-MB(0. 935 vs. 0. 769)(P 0. 001),与c Tn I(0. 935 vs. 0. 944)的AUC比较,无显著差异(P0. 05)。血浆miRNA-497的最佳阈值为2. 09时,其诊断心肌损伤的敏感度及特异度分别为92. 8%、97. 2%。经Pearson分析,血浆miRNA-497与c Tn I呈正相关(r=0. 715,P 0. 001),与LVEF呈负相关(r=-0. 692,P 0. 001)。结论 血浆miRNA-497有可能会作为小儿脓毒症心肌损伤诊断指标,该指标与c Tn I呈正相关、与LVEF呈负相关,且其敏感度及特异度均较高,表现出良好的诊断价值。     

cTnI Mb定量检测对急性心肌梗塞所致心肌坏死面积的诊断价值

目的 :为了探讨肌钙蛋白 I(c Tn I)、肌红蛋白 (Mb)定量检测对急性心肌梗塞 (AMI)患者因缺血、缺氧所引起的心肌坏死面积大小的临床价值。方法 :健康对照组 6 0例 ,于 9:0 0空腹抽静脉血 3ml,AMI组于胸痛发作后分 3、6、9、12 h抽静脉血 3ml,采用全自动微粒子化学发光分析仪定量检测 c Tn I Mb。结果 :AMI组 c Tn I Mb于胸痛 3h后随时间增加而逐步增高 ,与正常对照组有显著差异 (P<0 .0 1)。结论 :当 c Tn I>0 .5μg/ L时确定为 AMI。c Tn I Mb增高越显著 ,心梗程度越深 ,心肌因缺血、缺氧而坏死的面积就越大。     

肌钙蛋白I水平与不稳定性心绞痛患者近期预后的关系

目的本研究旨在探讨血清肌钙蛋白 I(Tn I)水平与不稳定性心绞痛 (UA)患者近期预后的关系。方法对 3 8例 U A患者进行血清 Tn I定量测定 ,观察住院期间心脏事件发生率。结果 3 8例中 16例 (4 6% ) Tn I为 (0 .3 1± 0 .3 3 ) μg/L明显高于余 2 2例 Tn I(0 .0 3 3±0 . 0 2 7) μg/L(P<0 .0 1) ;Tn I升高组住院期间急性心肌梗死 (AMI) ,心脏性猝死、顽固性心绞痛的发生率明显高于 Tn I正常组(4 5 .2 %比 8.1% ,P<0 .0 1)。结论血清 Tn I值升高对判断 UA患者近期预后有较好的预测价值     

心脏直视手术中心脏复苏困难的处理

目的：为提高心脏直视手术中心脏复苏率。方法：总结２０例心脏直视手术中心脏复苏困难的处理经验。结果：胸内心脏挤压和中等剂量心脏兴奋剂有利于心脏手术中的心脏复苏；心肌出现粗颤即应尽早除颤，不宜片面追求较高的心脏自动复跳率。对复苏困难病例，依其不同情况，在常规复苏方法的基础上，可采用一些特殊复苏措施，包括消除导致复苏困难的原因、长时间心脏挤压和长时间体外循环辅助、采用外科手段等。结论：有多种因素影响心脏直视手术中的心脏复苏，正确分析判断复苏困难的特殊原因，恰当地采用综合性措施（包括外科手段）进行复苏可收到良好效果。     

心脏介入术中并发急性心脏压塞的抢救与护理

目的研究心脏介入术(CIO)中并发急性心脏压塞(ACT)的抢救与护理。方法将64例患者实施CIO时并发ACT,以数字法随机分成观察组及对照组各32例,2组均实施ACT抢救措施,对照组在此基础上另实施常规护理,而观察组则实施综合护理。对比2组ACT发现率及抢救成功率,2组护理满意情况以及HDL评分情况。结果观察组ACT发现率及抢救成功率均显著高于对照组,差异均有统计学意义(P0.05);观察组的护理满意情况显著优于对照组,差异有统计学意义(P0.05);观察组护理后的焦虑、抑郁评分及总分均显著低于护理前及对照组,差异有统计学意义(P0.05)。结论对CIO并发ACT患者,积极予以抢救措施及综合护理,可明显提升抢救成功率及护理满意率,降低HDL评分,减少医患纠纷。     

床旁球囊漂浮电极起搏在心脏术后缓慢性心律失常中应用

目的评估心脏外科术后缓慢性心律失常行床旁球囊漂浮电极导管紧急心脏起搏的可行性和有效性。方法心脏外科术后并发缓慢性心律失常患者21例,均给予漂浮电极导管临时起搏治疗,观察临时起搏手术入路、手术时间、电极导管放置部位及起搏阈值,评估治疗成功率和安全性。结果本组起搏器电极安置经右侧锁骨下静脉15例,经右侧颈内静脉6例;手术时间5-12min;电极导管置入右心室心尖部18例,右心室流出道3例;起搏阈值〈1.0mV;床旁球囊漂浮电极起搏治疗成功率100%,发生导管移位、感知起搏不良各2例,无严重并发症发生。结论床旁球囊漂浮电极起搏操作简单,用于治疗心脏术后缓慢性心律失常安全、可行,疗效确切。     

Transthoracic pacing in cardiac asystole

A total of 139 patients had transthoracic pacemakers introduced via a subxiphoid approach for asystole during advanced CPR in the emergency department of a large urban teaching hospital over a calendar year. Two groups were examined retrospectively, A) 34 patients who presented asystolic, and B) 99 patients who presented with ventricular fibrillation that became asystole. Age, sex, and etiologies for cardiac arrest were similar in both groups; there were no survivors. The mean duration of asystole before pacemaker insertion was 4 min (group A) to 7 min (group B). Temporary electrical capture was obtained in six patients from group B, but electrical-mechanical association could not be achieved in any of these patients.     

Effect of transvenous cardiac resynchronization therapy device implantation on cardiac troponin I release

BACKGROUND: Pacemaker and implantable cardioverter defibrillator (ICD) implantation increases cardiac troponin I (cTnI) levels which indicates myocardial injury. During implantation of a cardiac resynchronization therapy (CRT) device, balloon inflation for coronary sinus (CS) venogram, cannulation of CS side branch, and electrode advancement may interfere with CS drainage and, hence, may decrease the washout of toxic metabolites from the heart. Thus, CRT implantation may further increase cTnI levels. In this study, we investigated the effects of CRT implantation on cTnI release. METHODS: We included 10 patients (mean age = 57 +/- 15 years) in whom a successful transvenous CRT system was implanted (CRT group). Twenty patients (mean age = 65 +/- 10 years) who underwent a transvenous pacemaker or ICD implantation were included as the control group. Blood samples for cTnI were drawn at baseline and at six, 12, 18, and 24 hours thereafter. RESULTS: Baseline median cTnI levels were similar in CRT and control groups (0.03 ng/mL vs 0.02 ng/mL, respectively; P = 0.1). Postoperative cTnI levels during 24 hours were significantly higher in the CRT group (P < 0.05) by two-way repeated measures of analysis of variance. Post hoc analysis revealed that cTnI levels were higher at the 6th, 12th, 18th, and 24th hours compared to baseline levels (P < 0.001, P < 0.001, P < 0.01, and P < 0.01, respectively). There was a significant difference in the area under the curves (AUCs) of cTnI measurements (1.79 hr.ng/mL in the CRT group and 0.78 hr.ng/mL in the control group, P < 0.05). CONCLUSION: Postoperative cTnI levels were higher after CRT implantation than simple pacemaker/ICD implantation. This may be due to CS manipulation during CRT implantation.     

Electrocardiographic patterns during: pacing the great cardiac and middle cardiac veins

BACKGROUND: The electrocardiogram (ECG) patterns during pacing from the great cardiac vein (GCV) and the middle cardiac vein (MCV) are not well known. METHODS: We recorded 12-lead ECGs during GCV and MCV pacing in 26 patients undergoing implantation of a cardiac resynchronization device. The left ventricular (LV) lead was passed down the GCV (n = 19) or MCV (n = 7) prior to moving it to a lateral or posterolateral vein for permanent implantation. RESULTS AND CONCLUSIONS: Pacing within the GCV resulted in a left bundle branch block (LBBB) morphology with no or minimal R-wave in V(1) in 14 patients and a right bundle branch block (RBBB) pattern (R > S in lead V(1)) in four patients. In one patient, lead V1 during GCV pacing was isoelectric (R = S). A more distal pacing site in the GCV yielded a LBBB pattern in all the patients. All leads placed in the MCV resulted in a LBBB configuration. An ECG pattern with a RBBB pattern was invariably recorded during LV pacing in 125 consecutive outpatients with biventricular pacemakers and LV leads in the posterolatral and lateral coronary veins. Knowledge of the ECG patterns from various pacing sites in the coronary venous system may be helpful for troubleshooting all types of pacing systems, especially those where the coronary venous pacing site is unintentional.     

常用心肌标志物在儿童疾病中的应用进展

常见心肌标志物多用于成人急性冠脉综合征和心力衰竭的临床诊疗，而在儿童疾病中的相关研究较少。由于儿童心肌功能尚未成熟，以及不同生长发育阶段的特殊性，儿童心肌损伤的发病机制和病理生理过程与成人不尽相同。因此，心肌标志物的检测和结果解读在儿科领域中显得尤为重要。该文围绕临床常用心肌标志物在儿童心源性和非心源性心肌损伤疾病中的应用进展进行综述。     

Factors influencing referral of cardiac patients for cardiac rehabilitation.

This study asked the question: Are there differences in the characteristics and referral rates of men and women who are referred for cardiac rehabilitation? The sample consisted of 203 men (n = 148) and women (n = 55) who were hospitalized with at least one cardiac diagnosis and were eligible for Phase II cardiac rehabilitation. Hospital records were reviewed to obtain information on gender, age, ethnicity, insurance coverage, marital status, employment status, proximity to rehabilitation services, transportation availability, concurrent disease processes, domestic responsibilities, documentation of referral for cardiac rehabilitation, and the attending physician. A survey sent to the patients approximately 3 weeks after their discharge from the hospital also addressed these variables. Logistic regression analysis indicated only one predictor of referral: the gender of the physician. Male physicians were more likely to refer patients for cardiac rehabilitation. This finding must be viewed with caution because of the small number of female patients and female physicians included in the study. The current literature reflects conflicting findings about the proposed relationships; therefore, they merit further investigation.