新型主动固定起搏导线的临床应用

目的评估植入新型主动固定起搏导线的可用性和安全性。方法选择本中心植入永久性人工心脏起搏器患者101例,分为新型导线组（n=25）和传统导线组（n=76）,新型导线组患者植入Medtronic3830导线3根,5086MRI导线14根（包括心房、心室导线）,Boston Scientific4471导线15根;传统导线组患者植入心室主动固定导线76根,心房被动固定导线58根,测量植入后各相关起搏参数,手术时间,曝光时间及心室导线过三尖瓣的次数,并常规随访。结果两组导线的阈值[（0．62-4-0．14）V、（0．63-4-017）V]、振幅[（1129±4．28）mV、（12．74±6．08）mV]、阻抗[（76768±132．73）Q、（815．14±182．46）Q]、电流[（077±0．19）mA、（0．85±0．33）mA]、斜率（2．46±1．07、2．844-102）差异均无统计学意义（均P〉005）,两组起搏导线损伤电流[（6,83±1157）mV、（6．61±1187）mV]、植入手术时间[（44．204-4．65）min、（43．42±5．55）min]、曝光时间[（3．24±1．04）min、（3．33±1．05）min]、导线过三尖瓣次数（1．36±0．57、1．34±0．63）差异均无统计学意义（均P〉0．05）。三种新型起搏导线植入时均未发生并发症,4471导线出现1例术后完全脱位。1年时随访两组导线的阈值、振幅、阻抗异均无统计学意义（均P〉0．05o结论新型起搏导线均符合起搏器植入要求,未增加手术时间和曝光时间,植入安全。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

心脏再同步治疗的术中并发症及处理

充血性心力衰竭的药物治疗近年来虽取得了较大进展,但仍不能阻止心力衰竭进行性加重。心脏再同步化治疗（cardiac resynchronization therapy,CRT）不仅能改善伴有室内传导阻滞左心功能不全患者的心功能,提高运动耐量和生活质量,还可降低死亡率。CRT的关键是需要经冠状静脉窦植入左室导线以起搏左心室。此过程操作复杂,技术难度较大,植入风险高,手术并发症较高。     

前降支心肌桥静息心电图临床分析

冠状动脉主干及其主要分支一般均走行于心外膜下的脂肪组织内。如果动脉的一段经行中被浅层心肌所覆盖,则这段动脉称为壁冠状动脉,覆盖动脉的心肌称为心肌桥。壁冠状动脉多见于前降支,长度多为0．2～2．0cm。心肌桥的厚度也可有变异。壁冠状动脉的口径较其近侧或远侧段口径小,且管壁较薄。     

希浦系统起搏治疗慢性心力衰竭合并永久性房颤患者的疗效观察

目的探讨希浦系统起搏（HPCSP）治疗慢性心力衰竭合并永久性房颤患者的疗效。方法选取2018年1月至2020年2月浙江绿城心血管病医院收治的行起搏器植入术治疗的心力衰竭合并永久性房颤患者150例。其中95例患者采用HPSCP治疗,为HPSCP组;55例患者采用双心室起搏治疗,为双心室起搏组。观察并比较两组患者术前、术后心功能参数、起搏参数差异。结果组间比较,术前两组患者QRS时限、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、6min步行试验距离比较差异均无统计学意义（均P＞0.05）;术后HPCSP组QRS时限较双心室起搏组缩短（P＜0.05）,LVEF、LVEDD、6min步行试验距离均大于双心室起搏组（均P＜0.05）。组内比较,两组患者术后QRS时限均较术前缩短（均P＜0.05）,LVEF、LVEDD、6min步行试验距离也均较术前改善（均P＜0.05）。术后,HPCSP组患者LVEF、LVEDD、6min步行试验距离均大于双心室起搏组（均P＜0.05）。两组患者术前、术后的感知、阈值比较差异均无统计学意义（均P＞0.05）。与术前比较,HPCSP组患者术后阻抗降低（P＜0.05）。HPSCP组患者术后5个月心功能分级较术后即刻时降低（P＜0.05）,三尖瓣、二尖瓣反流患者比例与术后即刻时比较差异均无统计学意义（均P＞0.05）。HPCSP组患者中成功行希氏束起搏术71例（74.74%）,左束支区域起搏术24例（25.26%）。结论HPCSP可改善慢性心力衰竭合并永久性房颤患者心脏功能,且保证了心室同步性收缩,具有一定的短期效果,可应用于临床。     

实验犬左室扭转和旋转率特性及其与心脏功能相关关系

目的 采用斑点追踪显像(STI)技术研究正常实验犬左室旋转、旋转率、扭转特点及其与心功能的相关关系.方法 对10只健康杂种犬采用二维Simpson双平面法测量左室射血分数(EF)等评价左室收缩功能,并采集二尖瓣口血流频谱等指标评价左室舒张功能;同时采集二尖瓣、乳头肌及心尖3个短轴水平二维动态图像,分析心肌运动的最大旋转角度(Rot)、收缩期和舒张期峰值旋转率及其比值(PRRs、PRRe、PRRa 及PRRe/PRRa)及计算扭转度(torsion).同步进行左心导管测量左室压力变化,最后将旋转、旋转率、扭转指标与导管指标进行相关分析.结果 10只犬180个心肌节段中,可分析节段有152个,成功率为84%.正常犬基底部顺时针旋转(正值),心尖部逆时针旋转(负值),3个短轴节段达到收缩期和舒张期峰值旋转和旋转率的时间无显著性差异,并存在基底环至心尖环收缩的趋势.采用Simpson法测量的EF值与torsion相关性很好(r=0.941,P=0.005);而-dp/dtmax与二尖瓣短轴的舒张早晚期旋转率比值(PRRe/PRRa)存在相关性(r=-0.805,P=0.05);LVEDP与二尖瓣水平和乳头肌水平短轴的PRRe、PRRa亦有相关性(P值分别为0.018和0.033),但与torsion的相关性较差.结论 左室扭转(torsion)是评价左室收缩功能的良好指标,舒张期旋转率PRRe及PRRe/PRRa值亦可以用于评价心室舒张功能.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

植入具有完整心房诊断功能单腔心律转复除颤器一例

患者女,51岁,因"反复胸闷气促2个月,加重1d"收住院.既往有2型糖尿病史9年.心电图:窦性心律,V4～V6导联T波倒置,QRS时限110 ms.超声心动图:二尖瓣中重度反流;左心室舒张末期内径5.10 cm,左心房内径4.11cm,左心室射血分数(LVEF) 0.32.X线胸片:两肺纹理增多,心影偏大.入院后予常规抗心力衰竭等药物保守治疗后症状好转;2周后行冠状动脉造影提示冠心病,左主干及三支血管弥漫性病变;左心室造影提示LVEF 0.30,二尖瓣重度反流;未行介入治疗.