早期诊断和纠正肺心病高凝状态的临床意义

对我院收治的肺心病急性发作期伴高凝状态患者应用抗凝与改善微循环治疗进行疗效观察，旨在评价早期诊断及纠正肺心病高凝状态的临床意义。对象与方法符合1980年全国第三次肺心病专业会议诊断标准的慢性肺心病急性发作期患者60例，随机分为治疗组与对照组各30例，两组患者的年龄、性别、心衰与呼衰程度无显著差异。     

丹红注射液联合卡托普利治疗慢性肺源性心脏病急性发作期的疗效观察

目的探讨丹红注射液联合卡托普利治疗慢性肺源性心脏病(肺心病)急性发作期的临床疗效。方法35例慢性肺心病急性发作期患者为对照组,使用抗炎、解痉、氧疗、强心利尿等常规治疗及卡托普利治疗;另一组35例为观察组,在对照组基础上加用丹红注射液,观察两组的心功能改变情况。结果治疗组总有效率明显优于对照组,差异有统计学意义(P<0.05)。结论丹红注射液联合卡托普利治疗慢性肺心病急性发作期疗效明显。     

参芪扶正注射液治疗慢性肺心病并发心衰临床观察

目的观察参芪扶正注射液治疗慢性肺心病并发心衰的疗效。方法将52例肺心病并发心衰患者随机分为治疗组与对照组,每组26例。两组均接受常规治疗,治疗组在常规治疗的基础上加用参芪扶正注射液250 mL(含党参、黄芪各10 g),每日1次,两组疗程均为15 d。心、肺、肝、肾、凝血功能及症状、体征为参照指标。结果治疗组心功能改善均优于对照组(P0.05),血气分析指标改善与对照组比较无统计学意义(P0.05)。临床总有效率治疗组为92.31%,高于对照组的73.08%(P0.05)。结论参芪扶正注射液作为常规治疗的辅助药物,能够安全有效缓解肺心病急性发作期的心功能衰竭。     

东菱克栓酶改善肺心病高凝状态临床观察

东菱精纯克栓酶 (DF- 5 2 1 )因具有改善循环作用而广泛用于急性缺血性脑血管疾病、突发性耳聋及慢性动脉闭塞症等治疗。我们对收治的 30例肺心病急性发作期伴高凝状态患者 ,在以常规方法治疗的同时加用 DF- 5 2 1 (日本东菱药品工业株式会社生产 ) ,并与同期应用常规方法治疗的 30例同类患者进行比较 ,以探讨 DF- 5 2 1对改善肺心病高凝状态的应用价值。1　对象与方法1 .1　病例选择　取同期收治的 6 0例慢性肺心病急性发作期住院患者 ,均符合 1 980年全国第三次肺心病专业会议诊断标准。随机分为两组 :1克栓酶组 (30例 ) :男 1 6例 ,女…     

肺心病患者血清hs-CRP与心肌酶的临床观察

目的探讨血清hs-CRP(超敏C反应蛋白)、CK-MB(磷酸肌酸激酶同工酶MB)、CK(磷酸肌酸激酶)、LDH(乳酸脱氢酶)、AST(天门冬酸氨基转移酶)在慢性肺心病患者急性发作期及治疗缓解期的变化情况。方法测定95例确诊为肺心病急性发作期患者治疗前后、60例肺心病治疗缓解期患者及30例正常人血清hs-CRP、心肌酶水平。结果肺心病患者血清hs-CRP、心肌酶明显高于健康人群,且急性发作期明显高于临床缓解期(P<0.05);急性发作期患者治疗前后血清hs-CRP、心肌酶差异显著(P<0.05);死亡组血清hs-CRP、心肌酶明显高于存活组(P<0.05)。结论血清hs-CRP与心肌酶的变化可作为肺心病患者的预后及疗效判断的有效指标。     

血栓通对慢性肺心病急性发作期疗效观察

目的探讨注射用血栓通对慢性肺心病急性发作期患者临床疗效及血液流变学的影响。方法对2007年1月～2008年3月我院呼吸内科收治慢性肺心病急性发作患者66例，随机分对照组32例，治疗组34例。对照组予常规治疗，治疗组加注射用血栓通。两组均治疗2周。观察两组疗效、血气分析、血液流变学指标。结果注射用血栓通对肺心病急性发作期有较好的临床疗效，可改善肺心病急性期血液高凝、高黏滞状态。     

慢性肺源性心脏病急性发作期患者神经肽的变化

神经肽Y(NPY)和降钙素基因相关肽 (CGRP)是由神经细胞分泌的调节血管功能的一对作用相反的神经肽。我们观察了慢性肺源性心脏病 (肺心病 )急性发作期、缓解期时NPY和CGRP的变化 ,以探讨其对肺动脉高压、肺心病心力衰竭 (心衰 )的影响 ,为肺心病的治疗提供可能的理论依据。对象与方法1.对象 :( 1)肺心病组 :3 2 8例 ,年龄 5 1～ 73岁 ,平均年龄62岁 ,男性 177例 ,女性 15 1例。 3 2 8例为 1998年 1月～ 2 0 0 1年 6月慢性肺心病急性期住院患者 ,均符合 1977年全国肺心病会议制定的诊断标准 ,均以急性加重伴心衰入院 ,均有反复咳嗽、咳…     

甲泼尼龙治疗慢性肺心病急性加重期的观察

目的观察甲泼尼龙治疗慢性肺心病急性加重期的疗效。方法 60例慢性肺心病急性发作期患者随机分为两组,治疗组在常规治疗的基础上加甲泼尼龙静点,5～7 d,对照组用地塞米松,7 d判断疗效。结果显效21例（70%）,有效8例（26.7%）,总有效率96.7%。和对照组比较有显著差异（P〈0.05）。结论甲泼尼龙治疗慢性肺心病急性发作期病人疗效显著。     

低分子肝素治疗老年慢性阻塞性肺疾病合并肺心病急性发作期效果

目的分析低分子肝素治疗老年慢阻肺合并肺心病急性发作期临床疗效。方法选取我院2012年8月-2013年8月90例接受治疗的老年慢阻肺合并肺心病患者,随机分为对照组和观察组,每组45例。对照组患者均进行常规治疗;观察组患者则在其基础上加以低分子肝素注射治疗;两组均治疗7天。观察两组患者治疗前后血气分析以及疗效的差异。结果观察组患者的血气分析和治疗总有效率明显优于对照组,结果有统计学差异(P0.05)。结论低分子肝素治疗老年慢阻肺合并肺心病急性发作期,在临床中具有积极有效的治疗作用。     

蝮蛇抗栓酶治疗急性发作期慢性肺心病146例

目的 探讨蝮蛇抗栓酶在慢性肺心病急性发作期的治疗作用.方法 将297例患者随机分为治疗组(146例)和对照组(151例).对照组应用常规治疗,治疗组在常规治疗的基础上加用蝮蛇抗栓酶0.75 U溶于250 mL生理盐水或5%的葡萄糖注射液中静脉输注,每日1次.两组均以15d为1个疗程,1个疗程后观察疗效.结果 治疗组总有效率90.4%,对照组为59.6%(P<0.05).治疗组治疗后全血黏度、红细胞比容、纤维蛋白原较治疗前明显下降,氧分压(PaO2)明显升高,二氧化碳分压(PaCO2)明显下降,明显优于对照组(P<0.05).结论 蝮蛇抗栓酶对改善慢性肺心病急性发作期的高黏滞状态有明显治疗作用.     

Long term results of heart transplantation in patients with amyloid heart disease

OBJECTIVE—To determine the outcome of heart transplantation for end stage amyloid heart disease in patients treated at a single centre.
DESIGN—Records of all patients with amyloid heart disease who underwent heart transplantation were examined to determine survival, graft involvement by amyloid, the course of systemic amyloid disease, and the cause of death.
PATIENTS—10 patients, mean (SD) age 54 (8) years, received transplants in the 13 year period 1984 to 1997.
RESULTS—Two patients, both with AL amyloid (primary systemic amyloidosis), died perioperatively. Mean follow up in the remaining eight patients was 49.9 (39.5) months (range 3-116 months). Amyloid deposits in the grafts became evident histologically in five patients with AL amyloid at 5, 11, 12, 28, and 30 months after transplantation, and in one patient with familial amyloid at 60 months. Echocardiography showed no evidence of left ventricular systolic impairment at the time of recurrence. Seven patients died, at 3, 11, 26, 32, 49, 85, and 116 months after transplantation; four of these deaths were related to amyloidosis. Actuarial survival at one and two years was 60% and at five years, 30%.
CONCLUSIONS—Heart transplantation for amyloid heart disease remains controversial because of the scarcity of hearts for transplantation, the systemic nature of amyloidosis, and the potential for amyloid deposition in the graft. Postoperative mortality was high (20%), reflecting extracardiac amyloid. Heart transplantation for end stage cardiac amyloidosis is feasible but, without treatment of the underlying process, it is a palliative procedure.


Keywords: heart transplantation; amyloid heart disease; heart failure     

重症肺炎大鼠心脏结构和功能的改变

目的研究重症肺炎大鼠心脏结构和功能的改变。方法50只大鼠，30只建立金葡菌肺炎模型，20只大鼠作对照，检测大鼠心肌病理积分及心脏结构和功能改变，并分析其相互关系。结果肺炎组大鼠有肺炎症状及肺脏病理变化，表明该肺炎模型建立成功。肺炎组大鼠左房内径（LA）、左室收缩末期内径（LVSD）、肺动脉内径（PA）、左房内径／主动脉内径（LA／AO）值较对照组显著增加，主动脉血流峰值流速（PFVA）、主动脉血流速度积分（Viao）、肺动脉血流峰值流速（PFVP）、肺动脉血流速度积分（Vipa）、左室射血分数（LVEF）、左室短轴缩短率（LVFS）较对照组显著降低（P均〈0．01）。结论肺炎大鼠存在心脏结构和功能改变，证明重症肺炎可并发心衰。     

Relationship of auscultatory fourth heart sound to the quantitated left atrial filling fraction

The fourth heart sound (S4) has been associated with vigorous atrial contraction. However, the presence of S4 has not been previously correlated with quantitated left atrial filling fraction. In this study, the presence of an auscultatory S4 was compared with the Doppler echocardiographically quantitated left atrial filling fraction in 41 consecutive patients in whom S4 was judged to be present or absent according to the consensus of cardiologists. Left atrial filling fraction in patients with S4 was 49% and was significantly greater than 33% found in patients without S4 (p less than 0.005). Using atrial filling fraction of 35% as a dividing line, S4 had a sensitivity of 84% and a specificity of 75% for determining left atrial filling fraction greater than or equal to 35%. Furthermore, of 25 patients with S4, 21 (84%) had atrial filling fraction greater than or equal to or less than 35%, and of 16 patients without S4, 12 (75%) had atrial filling fraction less than 35%. Thus, the presence or the absence of S4 is quantitatively related to the left atrial filling fraction and appears to predict atrial filling fraction greater than or equal to or less than 35% reasonably well.     

Recurrent nontraumatic aortic tears resulting in valvular avulsion and aortic insufficiency

A case of aortic insufficiency due to avulsion of two of three semilunar valves was remarkable because of the intimal and medial tears which caused it. The tears were in different stages of repair, suggesting repetitive injury. Antemortem steroid therapy and bouts of violent coughing may explain these unusual findings.     

Complete right bundle branch block after surgical closure of perimembranous ventricular septal defect. Relation to type of ventriculotomy

The ECGs of a 100 consecutive children who had surgical repairof their ventricular septal defects (VSDs) were analyzed forpostoperative right bundle branch block (RBBB). Seventy of themhad an atriotomy and the other 23 also a ventriculotomy. Theventriculotomy always consisted of a transverse incision a shortdistance below the pulmonary annulus. Of these children 93 hada perimembranous VSD and the other 7 a pure muscular defect.The ECG results of the 93 children with perimembranous VSDswere statistically analysed. The incidence of postoperativecomplete RBBB (CRBBB) in the ventriculotomy group was not higherthan in the atriotimy group. Infants operated in the first half year of life were more proneto the development of CRBBB than the older children probablybecause the VSDs were relatively larger in the younger thanthe older children. The risk of postoperative CRBBB was lessin the children who had direct suture closure of the VSD comparedwith those who needed a Dacron patch to close the defect. Thedata in the literature generally indicate a higher incidenceof CRBBB after a ventriculotomy than an atriotomy. The absenceof this difference and the lower incidence of CRBBB after aventriculotomy in our series compared with those of severalother author(4,6,7,8] are suggested to be due to the type ofventriculotomy     

慢性心力衰竭患者心率震荡检测及临床意义

目的观察慢性心力衰竭患者窦性心率震荡(HRT)现象的特征并探讨其临床意义。方法50例慢性心衰患者(心衰组)和30例非器质性心脏病患者(对照组)均接受24hHolter检查,分别计算HRT的初始值(TO)、震荡斜率(TS)及心率变异性的SDNN、SDANN、rMSSD值,并进行相关性分析。结果心衰组TO明显高于对照组(0.65±3.60%与-1.89±2.48%,P<0.01);心衰组TS明显低于对照组(2.96±1.23与10.24±4.47,P<0.001)。对照组TS与SDNN、SDANN、rMSSD的相关系数分别为-0.426、-0.385、-0.372(P均<0.05);心衰组TO与SDNN、SDANN、rMSSD的相关系数分别为0.489、0.465、0.436(P均<0.01),TS与SDNN、SDANN、rMSSD的相关系数分别为-0.745、-0.686、-0.597(P均<0.001)。结论慢性心衰患者中HRT现象明显减弱,TO与SDNN、SDANN、rMSSD值呈正相关,TS与SDNN、SDANN、rMSSD值呈负相关。     

Heart Rate Turbulence for Prediction of Heart Transplantation and Mortality in Chronic Heart Failure

Background: Previous studies have shown conflicting results about the value of heart rate turbulence (HRT) for risk stratification of patients (pts) with chronic heart failure (CHF). We prospectively evaluated the relation between HRT and progression toward end‐stage heart failure or all‐cause mortality in patients with CHF. Methods: HRT was assessed from 24‐hour Holter recordings in 110 pts with CHF (54 in NYHA class II, 56 in class III–IV; left ventricular ejection fraction (LVEF) 30%± 10%) on optimal pharmacotherapy and quantified as turbulence onset (TO,%), turbulence slope (TS, ms/RR interval), and turbulence timing (beginning of RR sequence for calculation of TS, TT). TO ≥ 0%, TS ≤ 2.5 ms/RR, and TT >10 were considered abnormal. End point was development of end‐stage CHF requiring heart transplantation (OHT) or all‐cause mortality. Results: During a follow‐up of 5.8 ± 1.3 years, 24 pts died and 10 required OHT. TO, TS, TT, and both (TO and TS) were abnormal in 35%, 50%, 30%, and 25% of all patients, respectively. Patients with at least one relatively preserved HRT parameter (TO, TS, or TT) (n = 98) had 5‐year event‐free rate of 83% compared to 33% of those in whom all three parameters were abnormal (n = 12). In multivariate Cox regression analysis, the most powerful predictor of end point events was heart rate variability (SDNN < 70 ms, hazard ratio (HR) 9.41, P < 0.001), followed by LVEF ≤ 35% (HR 6.23), TT ≥ 10 (HR 3.14), and TO ≥ 0 (HR 2.54, P < 0.05). Conclusion : In patients with CHF on optimal pharmacotherapy, HRT can help to predict those at risk for progression toward OHT or death of all causes. Ann Noninvasive Electrocardiol 2010;15(3):230–237