DTI评价心壁运动和激动顺序的实验研究

目的：本文采用超声心动图彩色多普勒组织成像（ＤＴＩ）新技术对６条开胸犬正常心脏运动进行研究。方法：通过用速度、加速度显示方式分析心脏各标准切面的室壁运动。结果：发现，ＤＴＩ能对心脏各室壁节段的运动作出正确的彩色编码，心脏各节段及心肌各层运动速度并非一致，左室后壁的运动速度高于前壁及前间隔的运动速度，室间隔左室面高于右室面，以左室后壁心内膜面运动速度最高，反映了心肌各节段的收缩能力的不一致性，这种不一致性也可能与心肌纤维特殊的排列方式有关。结论：因此在分析室壁运动时，尤其是定量分析时，应考虑到室壁运动的这种差异。从加速度显示方式分析，能够直视心肌传导上的差异，再现心肌激动的顺序，与心肌传导的电生理研究结果基本相符，为今后评价心脏传导系统的疾病提供客观的依据。     

房室结多径路的射频消融治疗

阵发性心动过速是临床上最常见的心律失常之一，其机制主要以房室结折返(AVNRT)或房室折返性(AVRT)等较常见，其它类型较少见。其中AVNRT由多径路同时存在国内文献报道极少。我们在临床心脏电生理检查和射频消融术(RFCA)中发现62例，现报告如下。     

应变率成像评价孤立性阵发性房颤患者左心房主动泵血功能

目的 应用应变率成像技术定量评价孤立性阵发性房颤(paroxysmal atrial fibrillation,PAF)患者左心房(leftatrial,LA)的主动泵血功能及经导管射频消融治疗的影响.方法 选取成功接受首次经导管射频消融术并维持窦性心律半年以上的孤立性PAF患者20例作为PAF组,平均年龄(59±11...     

芪苈强心提取物对缺氧大鼠心肌微血管内皮细胞VEGF及HIF-1α表达作用的研究

目的观察芪苈强心提取物对缺氧诱导的大鼠心肌微血管内皮细胞VEGF及其上游调控因子HIF-1α表达的影响,探讨芪苈强心胶囊抗心力衰竭作用的相关机制。方法植块法培养2周龄SD大鼠心肌微血管内皮细胞并鉴定,传代后将第二代细胞随机分为三组：空白对照组,缺氧干预组,缺氧干预＋芪苈强心组。干预6h后收集细胞上清,提取细胞核蛋白及胞浆蛋白,利用ELISA,WesternBlot分别检测细胞上清液中VEGF含量及细胞内VEGF上游调控因子HIF-1α的表达。结果与对照组比较,缺氧干预组心肌微血管内皮细胞VEGF、HIF-1α表达增加,与缺氧干预组比较,芪苈强心干预组VEGF含量均进一步升高,HIF-1α也表现出相同趋势。结论芪苈强心提取物能够通过促进缺氧状态下心肌微血管内皮细胞HIF-1α诱导的VEGF表达,这可能是芪苈强心发挥抗心力衰竭作用的机制之一。     

血管紧张素Ⅱ受体阻滞剂在慢性心力衰竭治疗中的新地位

慢性心力衰竭（CHF）是各种心血管疾病发展的终末阶段，有很高的死亡率和致残率。在CHF的发生和发展过程中，肾素-血管紧张素-醛固酮系统（RAS）的激活发挥着重要的作用。RAS的作用主要通过血管紧张素Ⅱ（AngⅡ）来实现。阻断RAS的药物，如血管紧张素转化酶抑制剂（ACEI）抑制AngⅠ向AngⅡ的转化，已证明可以减少CHF的病残率和死亡率。理论上，阻断AngⅡ1型（AT。）受体的药物AngⅡ受体阻滞剂（ARB）可以更完全的阻断RAS，从而发挥对CHF的治疗作用。近来大型临床研究不断完善ARB治疗CHF的证据，使ARB在CHF治疗中的地位得到了进一步提高。     

心房颤动对不同心功能分级的患者血浆脑钠肽水平的影响

Objective To assess the effect of atrial fibriUation (AF) on plasma levels of NT-proBNP in patients with different cardiac functions. Methods One hundred and ninty-one patients with chronic heart failure (CHF) were divided into two groups: minor CHF group (NYHA Ⅰ/Ⅱ class) and sever CHF group (NYHA Ⅲ/Ⅳ class). In addition,84 patients without HF (non-HF group) were enrolled as control The plas-ma NT-proBNP were assayed and the effect of AF on the NT-proBNP levels was analyzed to determine inde-pendent of NT-proBNP levels in 3 groups. Results Patients with AF in non-HF had higher NT-proBNP levels than those with sinus rhythm (SR) [(2.95 ±0.41) vs (2.21±0.44) ng/L, P < 0.01], and multi-variables regression demonstrated that age, AF and left atrial diameter (LAD) were independent determinants of NT-proBNP levels (P <0.001). NT-proBNP levels in minor CHF were also higher in patients with AF than that in patients with SR [(3.26±0.40) ng/L vs (2.98±0.54) ng/L, P < 0.05] ; AF, LAD, left ventricular end-systolic dimension (LVESD) and left vontric-ular eject fraction (LVEF) were the independent factors of NT-proBNP levels (P < 0.05). However, there was no difference of NT-proBNP levels between patients with AF and patients with SR [(3.59±0.52) ng/L vs (3.56±0.55) ng/L,P =0.73] ; while age and LVEF were in-dependent factors (P < 0.05). In patients with LVEF < 0.40, AF had not significant affect on NT-proBNP lev-els [AF vs SR: (3.70±0.60) ng/L vs (3.46±0.56) ng/L,P >0.10]; however,AF patients with LVEF≥ 0.40, NT-proBNP levels were increased [AF vs SR: (3.08 ±0.57) ng/L vs (2.67±0.73) ng/L, P < 0.001]. Conclusion The effect of AF on plasma NT-proBNP was related with cardiac functions: in AF pa-tients without or with minor cardiac dysfunction (NYHA Ⅰ /Ⅱ class or LVEF≥0.40) ,NT-proBNP increased; in AF patients with sever cardiac dysfunction (NYHA Ⅲ/Ⅳ class or LVEF < 0.40), NT-proBNP had no sig-nificant changes.     

芪苈强心胶囊治疗心力衰竭机制的研究进展

芪苈强心胶囊属于通过中医理论研制而成的中成药,用于慢性充血性心力衰竭,增加心肌收缩力、心输出量和肾血流量,具有一定的临床疗效。但其治疗心力衰竭、抑制心脏重构的具体机制并不是十分清楚。本研究结合近年来国内外相关文献,就中药复方芪苈强心胶囊治疗心力衰竭的相关机制作一简单综述。     

持续性心房颤动射频消融术中不同抗凝方案与围术期血栓事件的关系

Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.     

冠脉慢性闭塞病变再通对心脏功能的影响

目的:评价冠脉慢性闭塞病变再通对患者心功能的影响。方法:对冠脉造影证实的冠脉≥1支慢性闭塞的35例患者,采用冠脉介入治疗(PCI:PTCA加支架植入术)或冠脉旁路移植术(CABG),使再血管化,比较治疗前和治疗后3～6个月患者的临床心功能状态和左室射血分数(LVEF)的改变。结果:22例患者行PCI治疗,13例患者行CABG。平均随访4.2个月。治疗后临床心功能状态改善2级以上者27例(77.1％),改善1级者6例(17.1％),无改善者2例(5.8％),总有效率94.2％。LVEF较术前显著改善(术前51.6％±5.8％,术后62.2％±11.3％,P<0.01)。结论:PCI和CABG开通慢性闭塞冠脉能够改善患者的心功能和LVEF。