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1.
《新乡医学院学报》2016,(10):887-890
目的探讨慢性心力衰竭(CHF)患者心脏同步化治疗(CRT)近期及远期效果与肺动脉收缩压(PASP)的关系。方法选择行CRT的42例CHF患者,根据术前PASP水平分为高PASP组(PASP≥45 mm Hg,1 mm Hg=0.133 k Pa)(n=15)和低PASP组(PASP<45 mm Hg)(n=27)。分别对2组患者CRT植入术前、术后6个月、1、2 a的心功能分级评估情况、PASP、左心室舒张末期内径(LVEDD)、QRS波、左心室射血分数(LVEF)、左心室短轴缩短率(FS)及血浆脑钠肽(BNP)水平进行观察比较。并对2组患者术后6个月的CRT反应率进行比较。结果 2组患者术前PASP水平比较差异无统计学意义(P>0.05);2组患者术后6个月、1、2 a的PASP水平均显著低于术前(P<0.05),2组患者术后1、2 a的PASP水平均显著低于术后6个月(P<0.05),术后2 a与术后1 a的PASP水平比较差异无统计学意义(P>0.05)。低PASP组患者术后6个月、1、2 a的PASP水平均显著低于相同时间点高PASP组(P<0.05)。2组患者术后6个月、1、2 a的心功能分级、LVEDD、QRS波、LVEF、FS及BNP水平均显著优于术前(P<0.05);术后1、2 a上述指标均优于术后6个月水平(P<0.05);术后1 a与术后2 a上述各指标比较差异均无统计学意义(P>0.05)。手术前2组患者各指标比较差异均无统计学意义(P>0.05);术后6个月、1、2 a,低PASP组患者的心功能分级、LVEF、BNP水平均显著优于低PASP组(P<0.05);LVEDD、QRS波及FS水平2组患者各时间点比较差异均无统计学意义(P>0.05)。高PASP组和低PASP组患者术后6个月CRT反应率分别为46.7%(7/15)和77.8%(21/27),低PASP组患者术后6个月的CRT反应率高于高PASP组(P<0.05)。结论 CRT植入术用于低PASP患者的近期和远期的心功能改善效果明显优于高PASP患者,且CRT反应率也显著高于高PASP患者。  相似文献   

2.
目的观察心脏再同步化治疗( CRT)前后心力衰竭患者血清氨基末端B型脑钠肽前体( NT-proBNP)及肌钙蛋白T( TnT)浓度,了解其变化水平对CRT术后疗效评价的可行性。方法根据行CRT效果,117例患者分为有反应组和无反应组。手术治疗前,治疗后6、12个月,分别采用ELISA法检测两组患者血清NT-proBNP及TnT的水平和动态;同时两组患者均进行心脏超声测量患者术前及术后6、12个月的左室射血分数( LVEF)、左室舒张末内径( LVEDD)、左室收缩末期容积( LVESV)。结果 CRT有反应组和无反应组患者在有反应组中行三腔起搏器植入术后6、12个月,有反应组血清NT-proBNP及TnT的ELISA检测浓度显著低于无反应组(P<0.05);而LVEF均显著高于无反应组(P<0.05);LVEDD和LVESV均显著下降( P<0.05),而两组术前的左室整体功能差异无统计学意义。 CRT有反应组中,血清NT-proBNP和TnT的水平与患者的心功能改善密切相关。结论通过检测患者术前及术后血清中NT-proBNP和TnT水平变化可以对CRT临床疗效做出评价。  相似文献   

3.
《中国现代医生》2017,55(34):14-16
目的探讨慢性阻塞性肺疾病合并肺动脉高压患者血浆中肌肉生长抑制素(myostatin,MSTN)表达水平及临床意义。方法选取2016年6月~2017年6月我院呼吸内科门诊随访的68例慢性阻塞性肺疾病稳定期患者,并按照是否合并肺动脉高压(pulmonary hypertension,PH)分为COPD合并PH组(n=32)、COPD组(n=36),且选择同期我院体检中心健康体检的40例无相应症状的健康者作为对照组,比较各组患者肺功能、6 min步行距离、SPAP及Myostatin水平。结果COPD合并PH组患者6MWD、FEV1、FEV1/FVC均显著低于COPD无肺动脉高压组和对照组,差异均有统计学意义(P0.01);COPD合并PH组患者血浆中MSTN水平、NT-Pro BNP水平均显著高于COPD无肺动脉高压组和对照组(P0.01)。MSTN水平与NT-Pro BNP水平、SPAP之间呈显著正相关。结论MSTN可以作为慢性阻塞性肺疾病患者合并肺动脉高压的一个预测因子。  相似文献   

4.
目的:观察肺动脉收缩压对慢性心力衰竭患者心脏再同步化治疗(CRT)的影响。方法:对我院35例植入CRT/CRTD患者,根据患者术前肺动脉收缩压(PASP)将研究对象分为两组:PASP<45mmHg(A组)、PASP≥45mmHg(B组),观察两组患者术后6个月临床心功能,QRS波时限和左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室短轴缩短率(FS)及肺动脉收缩压等超声心动图指标的变化;观察两组患者对CRT治疗反应性的差异。结果:CRT术后6个月,两组患者PASP均显著降低;术后B组PASP仍显著高于A组;两组患者术后临床心功能均明显改善(P<0.01)及LVEF显著升高(P<0.05);A组临床心功能改善及LVEF升高明显优于B组;而两组术后QRS波时限、LVEDD及FS无显著差异。结论:轻度PASP患者对CRT反应要优于中重度PASP患者,术前PASP对CRT反应性具有一定预测价值。  相似文献   

5.
背景 左心房功能是心脏整体功能的重要组成部分,左心房容积能够独立影响心脏再同步治疗(CRT)疗效。目的 本研究试图通过二维斑点追踪技术量化评价左心房功能,评价左心房收缩期应变(Sa)和应变率(SRa)对CRT疗效的影响。方法 回顾性选取2015年5月-2018年1月因心力衰竭于中国科学技术大学附属第一医院心内科行CRT的患者共121例。CRT有反应定义为CRT术后6个月左心室收缩末期容积(LVESV)缩小≥15%,反之为无反应。根据CRT疗效将患者分为有反应组和无反应组。CRT术前和术后6个月应用二维斑点追踪技术评价左心房Sa和SRa,评价基线左心房Sa和SRa对CRT疗效的影响。结果 CRT术后共有70例(57.9%)患者纳入有反应组,51例(42.1%)患者纳入无反应组。有反应组术后6个月Sa和SRa较术前明显改善(P<0.05)。Spearman秩相关分析显示Sa与SRa呈负相关(rs=-0.770,P<0.001)。多因素Logistic回归分析显示SRa(OR=5.039,P=0.020)和Sa(OR=1.094,P=0.010)是CRT疗效的影响因素,其他影响因素包括左束支传导阻滞(OR=4.913,P=0.002)、QRS时限(OR=1.041,P=0.005)、E/A(OR=0.309,P=0.008)和肺动脉收缩压(OR=0.950,P=0.013)。结论 基线Sa和SRa是CRT疗效的独立预测因素,CRT术后有反应者左心房收缩功能改善。  相似文献   

6.
目的:探讨术前血清N-末端脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度与心脏再同步化治疗(cardiac resynchronization therapy,CRT)术后慢性心衰(chronic heart failure,CHF)患者心功能以及预后的关系?方法:选择2012年3月—2014年10月在本院植入CRT或CRT-D的CHF患者60例,术前测定血浆NT-proBNP水平;术前以及术后6个月测定超声心动图测定左心室射血分数(left ventricular ejection fraction,LVEF)?依据CRT植入后6个月随访时LVEF绝对值较基线增加≥5%为标准,分为有反应组和无反应组?随访期间观察CHF患者主要不良心血管事件(major adverse cardiovascular events,MACE)?结果:CRT术后有反应组术前NT-proBNP?随访MACE发生率明显小于CRT无反应组(P < 0.01)?以NT-proBNP 2 354.5 pg/mL为最佳分界点,预测CRT术后无反应的敏感度为95.0%,特异度为92.5%?以NT-proBNP 2 254.5 pg/mL为最佳分界点,预测发生心血管事件的敏感度95.2%,特异度92.3 %?Kaplan-Meier生存曲线显示NT-proBNP≤2 254.5 pg/mL患者生存时间高于NT-proBNP≥2 254.5 pg/mL者(P < 0.01)?结论:术前血清NT-proBNP水平与CHF患者CRT术后反应程度以及心血管不良事件相关?  相似文献   

7.
目的观察先天性心脏病(简称先心病)介入封堵术前后血浆血管紧张素Ⅱ(AngⅡ)的浓度变化,探讨其在先心病肺动脉高压(PH)中的作用及其临床意义。方法选取70例先心病患者,其中房间隔缺损30例、室间隔缺损30例、动脉导管未闭10例,依据心导管测压分为无PH组(20例)、轻度PH组(30例)和中重度PH组(20例)。分别用放射免疫法测定各组患者术前和术后24h、1个月、3个月、6个月血浆AngⅡ浓度。另选取年龄及性别与之相匹配的正常体检儿童30例作为对照组。结果术前先心病伴PH组患者血浆AngⅡ水平明显高于无PH组(P<0.01)。先心病有、无PH 患者介入封堵术后24h,AngⅡ开始缓慢下降,至6个月基本下降到正常水平(P<0.01)。术前血浆AngⅡ浓度与肺动脉压力呈显著正相关(r=0.715,P<0.05)。结论 AngⅡ可能参与了先心病PH的发生、发展过程。  相似文献   

8.
《陕西医学杂志》2016,(4):393-394
目的:评价单向活瓣补片矫治先心病(CHD)合并重度肺动脉高压(PH)伴双向分流的效果及预后。方法:65例CHD+PH患者,采用单向活瓣技术修补畸形。观察术后疗效并随访。结果:术后24h内死亡3例,1周内死亡1例。随访3~120个月,远期死亡3例;术后肺动脉收缩压Pp[65.2±5.1mmHg]较术前Pp[80.3±7.6mmHg]明显降低(P<0.05),术后动脉血气PO2[71.4±3.8mmHg]较术前PO2[58.2±4.6mmHg]明显升高(P<0.05);术后心功能及6min步行实验(6MWT)较术前明显改善。结论 :应用单向活瓣补片技术治疗先心病合并重度肺动脉高压伴双向分流可获得较为满意的疗效。  相似文献   

9.
目的:探讨先天性心脏病(以下简称先心病)患儿血清中的基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制物-1(TIMP-1)及血管内皮生长因子(VEGF)表达水平及变化.方法:81例左向右分流型先心按治疗前肺动脉收缩压(SPAP)分为4组:非肺动脉高压(PH)组16例(SPAP<4.0 kPa)、轻度PH组21例(4.00 kPa≤SPAP<5.33 kPa)、中度PH组21例(5.33 kPa≤SPAP<9.33 kPa)、重度PH组23例(SPAP≥9.33 kPa);其中19例接受前列腺素E1(PGE1)治疗;24例接受手术治疗.对照组为21例同龄正常体检儿.用酶联免疫吸附法(ELISA)检测血清MMP-9、TIMP-1和VEGF含量,并计算MMP-9/TIMP-1值.结果:与对照组比较,先心病各组VEGF均显著增高,在出现PH后MMP-9、TIMP-1均显著增高;中度PH组MMP-9/TIMP-1显著增高;经PGE1治疗或手术治疗后,MMP-9、TIMP-1和VEGF比治疗前或术前均显著下降.结论:①左向右分流型先心病合并PH患儿血清VEGF与MMP-9可能协同地参与肺血管的重构;②PGE1可有效地降低先心病合并PH患儿血清VEGF、MMP-9 和TIMP-1的表达,这可能是PGE1逆转肺血管重构的又一机制;③在手术1周后,先心病轻、中度PH患儿血清VEGF、MMP-9和TIMP-1的表达显著降低.  相似文献   

10.
目的:研究心脏再同步化治疗(cardiac resynchronization therapy,CRT)前后血浆前体脑钠肽(NT-ProBNP)水平的变化是否能够反映CRT植入后心衰患者心脏结构和功能改善程度。方法:对本中心33例植入CRT/CRT-D患者的随访资料进行分析,随访时间均>6个月,根据治疗效果将患者分为有反应组和无反应组,有反应者定义为术后左室收缩末容积缩小≥15%,心功能分级NYHA下降≥1级;无反应者为术后左室收缩末容积缩小<15%,NYHA下降<1级、因心衰再入院或心源性死亡。结果:有反应组术后NT-ProBNP水平明显降低[(2.90±0.57)ng/L vs(3.38±0.47)ng/L,P=0.001]。随访时间≥6个月时,NT-ProBNP水平的降低幅度(ΔNT-ProBNP%)与左室舒张末容积缩小幅度(ΔLVEDV%)呈线性回归(b=-0.499,R2=0.489,P=0.001);无反应组术后NT-ProBNP与术前相比无显著性差别[(3.53±0.42)ng/L,P>0.05];NT-ProBNP水平的变化与ΔLVEDV%无线性回归关系(P>0.05)。结论:CRT/CRT-...  相似文献   

11.
Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P< 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P< 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.  相似文献   

12.
Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P < 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (>0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P <0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P < 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.  相似文献   

13.
Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.  相似文献   

14.
Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.  相似文献   

15.
Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.  相似文献   

16.
A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care(~'4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.  相似文献   

17.
Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.  相似文献   

18.
Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.  相似文献   

19.
目的:评价使用安心颗粒对急诊经皮冠状动脉介入术(PPCI)术后生活质量的影响.方法:将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组(术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次)和对照组(仅接受基础药物治疗).所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表(MIDAS)、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果:入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异(P>0.05);出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低(P<0.05);组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低(P<0.05).两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血(P>0.05).两组发生轻度血小板减少症的患者数比较无差异(P>0.05).结论:PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.  相似文献   

20.
Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P<0.01);the MAP decreased(P<0.01)and the HR increased drastically(P<0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.  相似文献   

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