High Physical Activity is Associated with an Improved Lipid Profile and Resting Heart Rate among Healthy Middle-aged Chinese People

Objective To investigate the effects of physical activity (PA) on dyslipidemia and elevated resting heart rate (RHR) in a large-scale cross-sectional study in China. Methods We recruited community-based individuals who were 40-60 years old using a cluster sampling method. The PA levels of the participants were classified as low, moderate, or high, using the International Physical Activity Questionnaire. Dyslipidemia was defined as the detection of abnormalities in lipid indicators, and 4 lipid parameters were evaluated using fasting blood samples. Multivariate logistic regression analyses were used to evaluate the associations of PA with dyslipidemia and RHR. Results A total of 10,321 participants (38.88% men) were included in this study. The percentages of individuals with high, moderate, and low PA levels were 46.5%, 43.9%, and 9.6%, respectively. In both men and women, high PA provided odds ratios of 0.88 [95% confidence interval (CI): 0.83, 0.94] for dyslipidemia and 0.82 (95% CI: 0.73, 0.92) for elevated RHR, compared to participants with low PA. Conclusion Our data suggested that substantial health benefits (related to dyslipidemia and elevated RHR) occurred at higher intensity PA, with greater energy consumption, in middle-aged Chinese people, and particularly in men.     

增强型体外反搏治疗慢性心衰的临床疗效观察

目的探讨增强型体外反搏治疗慢性心衰的临床疗效.方法选择慢性心衰患者106例,随机分为对照组及观察组,分别有53例.对照组采用常规治疗,观察组在此基础上加用增强型体外反搏治疗,分别检测血EDF、CTGF、Np、Hcy及超声心动图.结果对照组及观察组患者EDF、CTGF水平治疗后较治疗前均出现显著性降低(P＜0.05),观察组患者治疗后EDF、CTGF较对照组患者均出现显著性下降(P＜0.05).观察组患者Np、Hcy水平治疗后较治疗前均出现显著性降低(P＜0.05),对照组患者Hcy水平治疗后较治疗前均出现显著性降低(P＜0.05),观察组患者治疗后Np、Hcy较对照组患者均出现显著性下降(P＜0.05).对照组及观察组患者LVEF、E/Et水平治疗后较治疗前均出现显著性差异(P＜0.05),观察组患者治疗后E/E较对照组患者均出现显著性下降(P＜0.05).结论增强体外反搏治疗慢性心衰,可通过改善EDF、CTGF、Np、Hcy水平起到改善心功能状态的作用.     

慢性病轨迹模式对射血分数保留型心力衰竭患者预后的影响

目的：探讨慢性病轨迹模式（CITM）管理在射血分数保留型心力衰竭（HFpEF）患者中的应用效果。方法：本研究共纳入458例HFpEF患者，按随机数字表法分为2组：CITM组226例（给予以指南为导向的CITM管理，n=226）和对照组232例（给予常规诊疗和随访管理，n=232）。随访12个月，比较两组患者干预前后的自我管理量表（SCHFI）、生活质量量表（KCCQ）、负性情绪评分以及再住院率和病死率情况。结果：干预前，两组患者的SCHFI、KCCQ以及负性情绪评分均无明显差异（P > 0.05）。干预后，两组患者的SCHFI及KCCQ评分明显提高，负性情绪评分均明显降低，且与对照组比较，CITM组改善更加显著（P <0.05）。随访12个月，CITM组和对照组分别有36例（15.9%）和83例（35.8%）患者因心衰而再次住院（P <0.05）。Cox模型分析结果显示，CITM组患者心衰再住院率较对照组显著降低 [风险比（HR）=0.448，95%可信区间（CI）：0.322~0.661，P= 0.003）]。结论：CITM可以显著提升HFpEF患者的疾病管理质量，明显降低HFpEF再住院率，是一种切实可用的管理模式。     

经导管封堵动脉导管未闭介入治疗后残余分流

目的探讨经导管封堵动脉导管未闭(PDA)介入治疗后残余分流的可行性和临床疗效。方法自1997年3月至2001年8月16例PDA介入治疗后残余分流的患者,其中男4例,女12例,平均年龄5.9±2.4岁(2～9岁),平均体重17.7±5.4kg(9～28kg),应用不同介入方法经动脉或静脉途径封堵残余分流,首次介入治疗与再次介入治疗的时间间隔平均为1.5±1.1年(1天～3.5年)。结果残余分流直径平均为2.7±0.9mm(1.2～5.0mm)。15例成功完成残余分流封堵术,1例失败,技术成功率为94%(15/16)。单纯应用Cook可控弹簧圈9例(其中双弹簧圈2例),Rashkind双面伞2例,Sidris纽扣式补片1例,Amplatzer蘑菇伞2例,同时应用Cook可控弹簧圈和Sidris纽扣式补片1例。封堵术后即刻造影,3例仍有少量残余分流,完全闭合率为80%(12/15)。平均手术时间为75.0±22.8min(45～120min),平均X线透视时间为10.4±3.9min(5～20min)。股动脉并发症1例,其余无并发症出现。封堵术后24h复查超声心动图,所有残余分流均完全闭合(100%),在平均2年随访中未出现残余分流再通、封堵器移位和左右肺动脉狭窄。结论经导管封堵PDA介入治疗后残余分流安全、疗效确切、创伤小,可作为外科手术治疗PDA介入治疗后残余分流的一种替代方法。     

血管紧张素受体-脑啡肽酶抑制剂在心力衰竭治疗中的研究进展

心力衰竭治疗策略的变化与其病理生理机制的演变是统一的。现通过对神经内分泌机制中利钠肽系统的介绍增加对血管紧张素受体-脑啡肽酶抑制剂的认识,同时对其目前在随机对照研究及真实世界研究取得的进展进行汇总,最后对血管紧张素受体-脑啡肽酶抑制剂的临床应用提出一些思考,以供临床借鉴。     

超声心动图监测动脉导管未闭封堵治疗中残余分流及临床意义

目的:探讨二维超声心动图(2DE)及彩色多普勒血流显像(CDFI)实时动态监测动脉导管未闭(PDA)导管法封堵治疗过程中残余分流变化规律及临床意义。方法:选择2002年1月至2006年6月102例应用Amplatz-er封堵器进行封堵治疗并有术中超声心动图监测的连续性PDA患者为观察对象,年龄1~63,平均(9.2±8.2)岁,术前2DE和CDFI测量PDA的最小内径为2.0~14.2,平均(6.1±1.9)mm,长度为2.1~15.8,平均(10.0±2.5)mm。当封堵器到位后,应用2DE及CDFI对残余分流进行实时动态监测,记录即刻、5、10、15、20、25、30min共7个阶段的各项观察指标,包括残余分流类型、比例及分流束宽度的变化。结果:(1)封堵器定位后即刻,102例患者中19例(18.6%)无任何类型残余分流、83例(81.4%)患者仍有残余分流;在有残余分流的患者中,CDFI共检出中央型残余分流束41个、边缘型残余分流束133个(宽度<2mm者102个、宽度≥2mm者31个);(2)CDFI动态监测过程中,所有中央型残余分流束均在15min内、多数10min内可自行迅速消失;95%宽度<2mm的边缘性残余分流束25min时可自行消失,30min时5个尚未消失的残余分流束宽度均<1mm;而宽度≥2mm的边缘残余分流6%在30min时可自行消失,余94%不能自行消失,且其宽度在各阶段无显著变化;宽度<2mm和≥2mm的边缘性残余分流束在30min时尚存的残余分流分别为5%和94%(P<0.001)。结论:超声心动图动态监测PDA导管封堵治疗后残余分流变化简单可行,可替代X线造影;边缘性残余分流宽度≥2mm、持续时间30min而无明显变化者,应予更换封堵器,以免造成长期残余分流。     

Palliation via Hybrid Procedure of a 1.4‐kg Patient with a Hypoplastic Left Heart

Despite improvements in survival of patients with hypoplastic left heart syndrome (HLHS) with various palliative procedures, certain risk factors, such as weight less than 2.5 kg, continue to predict increased mortality. We report the palliation of a patient with HLHS weighing 1.4 kg via a hybrid procedure consisting of banding of the pulmonary arteries bilaterally, stenting the ductus arteriosus, and balloon atrial septostomy. We propose that this may be another alternative for palliation in this high‐risk patient group.     

卡维地洛治疗慢性充血性心力衰竭的临床观察

目的：探讨卡维地洛疗慢性充血性心力衰竭的有效性及安全性。方法：选择40例缺血性心肌病患者，随机分为卡维地洛治疗组和对照组，治疗12个月。治疗前、后分别应用超声心动图测量左室射血分数（LVEF）左室收缩末直经（LVESd）和左室舒张末直径（LVEDd）。结果：所有病例治疗后，LVEF升高，LVESd、LVEDd降低，与治疗前相比差异显著（P〈0．01）。与对照组相比，卡维地洛治疗组治疗后各参数明显改善，差异显著（P〈0．05）。结论：卡维地洛治疗慢性充血性心力衰竭安全有效。     

Nurses' decision making in heart failure management based on heart failure certification status

Background

Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown.

Psychometric characteristics of the mutuality scale in heart failure patients and caregivers

Background

Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.