心血管疾病戒烟干预中国专家共识

吸烟是心血管疾病的独立危险因素,并且也是患者唯一能够自我控制的致病因素。许多心血管医生已经认识到吸烟的危害和戒烟干预的重要性,但尚缺乏相应的戒烟知识和戒烟技巧。本共识通过全面总结吸烟的危害和戒烟的益处,     

心房纤维化及重构与房颤发展的新视点

房颤的发生源于心脏电生理改变和心房结构重塑的共同作用。心房纤维化是一个有害的过程,会引起细胞外基质沉积与降解失衡及成纤维细胞的过度增值等。早期研究显示,心室纤维化会引起心室壁进行性硬化,进而引起心室功能不全和充血性心力衰竭。但随后的研究突出显示了心房纤维化与房颤的关系,与瓣膜病、高血压和老龄化的关系。     

以肠梗阻为首要表现的胆囊十二指肠瘘1例

病例：患者女,86岁,因＂间断腹痛、呕吐5 d＂于2010年12月23日就诊于我院消化内科。患者入院前5 d无明显诱因下出现上腹部疼痛,呈间断性发作,伴恶心、呕吐胃内容物,1~2次/d,约50 ml/次。患者发病期间无排便、排气,无发热、呕血,小便正常。门诊行腹部立位平片示,肠梗阻（见图1）。患者既往有胆囊结石病史20余年,曾于2010年9月28日行上腹部CT检查示,胆囊结石,胆囊壁增厚（见图2）。遂以肠梗阻、慢性胆囊炎收治入院。     

医师提供人文医学服务探究——不同医学模式的医疗服务差异性分析

近些年来,社会上呼唤人文医学或人文医生的声音很响,似乎而今的医疗服务使社会大众难于接受。对此,我们复习研究了许多相关文献,从远古时代的神灵主义医学模式发展到今天的生物一心理一社会医学模式各时段的医疗服务。这一文献复习始于朱宗涵教授于2001年在北京地区会议上讲话时提出的“人文医学”这一概念。     

海捷亚对原发性高血压的降压疗效及对左心室肥厚的影响

近年来,大量流行病学研究证明,高血压并发左心室肥厚（LVH）是增加心力衰竭、心肌梗死、心律失常、猝死等心血管事件的独立危险因素。研究证实,有效的抗高血压治疗是预防心血管事件的主要措施。对单一抗高血压药治疗未能达到目标降压的高血压患者主张联合用药或用复方制剂。     

血清瘦素与相关疾病

血清瘦素为脂肪组织分泌的具有内分泌激素特性的脂肪细胞因子,参与人体能量平衡的调节。近年来的研究显示,瘦素与某些疾病的发生、发展密切相关。现就瘦素的生物学特性及其与相关疾病的关系进行综述。     

美国肝病学会儿科肝移植患者长期医学管理实践指南推荐意见

<正>美国肝病学会(AASLD)与美国移植学会近期发布了关于儿科肝移植(liver transplantation,LT)患者的长期医学管理指南,同时北美儿科胃肠病学会也批准了这项指南。在此对指南的推荐意见进行翻译,以供临床参考。建议分级参考表1。     

中国女性心血管疾病预防专家共识

心血管疾病是当今威胁女性健康和生命的主要疾病,是导致中国女性死亡的首位原因。1999年,美国心脏病协会（AHA）第一次发表的女性心血管病预防建议,提高了美国民众对女性心血管疾病的公众意识,并促进了预防和治疗的进步。2007年,心血管疾病每分钟仍会导致一名美国女性死亡。2011年,AHA对女性心血管病预防指南进行了更新,并将“循证为基础”转化为“效果为基础”的指南,更加关注预防治疗的有效性。     

心肌梗死治疗中剩余风险的原因及对策

心肌梗死是高致死率和高致残率疾病之一。急性心肌梗死（AMI）诊疗指南从诊断、治疗及二级预防等方面均作出了详细的指导。AMI的治疗原则即挽救存活心肌,改善患者预后。欧洲和我国指南部推荐积极采取直接冠脉支架置入术或溶栓的再灌注,以期在最短的时间内实现闭塞的冠状动脉再通。国外研究证实,指南中推荐的常规用药在AMI治疗过程中的使用率与住院病死率与长期预后密切相关。多因素分析显示,高年龄、高血压、糖尿病与住院死亡有独立的联系。     

心肌结核的研究进展

心肌结核是由结核分支杆菌直接或间接感染机体引起的一种心脏病,虽然罕见却是引起心脏性猝死（suddencar-diacdeath,SCD）的重要原因之一,尤其是在年轻患者中。心肌结核与SCD有着密切关系,因而对心肌结核的研究除了能够降低人类结核病负担外,还能够降低猝死的发生率,具有重要的临床意义。目前,国内对心脏结核的研究仅仅局限于结核性心肌炎,而且缺乏大样本的基础实验和临床研究。故而本综述拟对心肌结核的国内外研究做一简要总结,主要阐述其发病机制、临床表现、病理和影像学及治疗等。     

交感风暴的研究

交感风暴是由于心室电活动极度不稳定所导致的最危重的恶性心律失常,是心源性猝死的重要机制,本文对此作一综述。     

Hyperuricemia and severity of coronary artery disease in patients undergoing selective percutaneous coronary intervention

Background Hyperuricemia as an independent predictor for presence of coronary artery disease(CAD)has been studied insufficiently. In this study, we evaluated the predictive value of hyperuricemia for the severity of coronary artery disease. Methods A total of 683 patients undergoing elective percutaneous coronary intervention (PCI) were prospectively observed and were divided into two groups (hyperuricemic group, n = 216, and normouricemic group, n = 467). Hyperuricemia (HUA) was defined as an serum uric acid level 7 mg/dL in males and 6 mg/dL in females. Severe CAD was defined as triple-vessel disease or left main disease. Results One hundred and eighteen (55%) severe CAD occurred in the hyperuricemic group and 211(45%) in the normouricemic group (P = 0.02). The median uric acid levels of the severe CAD patients were significantly higher than secondary CAD (single vessel disease or two-vessel disease) patients (379 ± 111 vs 360 ± 105, P = 0.02). Multivariate logistic regression analysis, after adjusting for potential confounding factors, showed that HUA was an independent risk factor of coronary artery disease (odds radio = 1.63, 95% confidence interval, 1.02-2.61, P = 0.040). Moiety of in-hospital complications such as acute heart failure (17.6% vs. 6.2%, P 0.001), hypotension (3.8%, vs. 1.3%, P = 0.04), contrast induced nephropathy (CIN) (7.4% vs. 1.3%, P 0.001) after PCI, were significantly higher in hyperuricemic groups. Conclusions Hyperuricemia was an independent predictor for severe coronary artery disease (triple-vessel disease or left main disease).     

New Perspectives on Pharmacological Treatment of Atrial Fibrillation

Despite the huge development of radiofrequency catheter ablation, surgical operation, pacemaker implantation, and drug therapy remains the first line treatment of atrial fibrillation. Several new anti-arrhythmic drugs and anticoagulation drugs have come out recently, and have made the drug therapy of atrial fibrillation a more promising choice. This article provides a contemporary highlight on the new anti-arrhythmic agents of atrial fibrillation. （ S Chin J Cardiol 2009 ; 10 （4） ： 244 - 249 ）     

“非酒精性脂肪性肝病诊断和处理实践指南”导读

非酒精性脂肪性肝病（nonalcoholic fatty liver disease,NAFLD）的诊断标准是存在肝细胞脂肪变的影像学或组织学依据,并能除外过量饮酒、药物或遗传性疾病等其他病因,     

复杂危重病例抢救成功一例

1病例资料 患者男性,63岁,长期居住在养老院,主因“咳嗽、咳痰伴气喘2天,意识不清3小时”急诊入院。入院前2天养老院工作人员发现患者出现间断性咳嗽伴咳黄痰,痰黏稠不易咳出,咳嗽剧烈时出现严重气喘。3小时前出现意识不清,     

Cronkhite-Canada综合征1例

病例：患者男,65岁,因“间断腹胀、腹泻2年余,皮肤瘙痒1年余”于2009年8月21日入院。患者于2007年5月无明显诱因出现腹胀、腹泻,大便4—5次／d,黄色不成形,症状时轻时重,自行服用地衣芽孢杆菌活菌颗粒（商品名：整肠生）、蒙脱石散（商品名：思密达）后缓解,此后间断发作;     

《HBV／HCV相关性肝细胞癌抗病毒治疗专家建议》解读

肝细胞癌（HCC）既是慢性嗜肝病毒感染的延续,又有肝功能代偿／失代偿状态,更是实体肿瘤形成的特殊状态,需要多学科共同参与。（（HBV／HCV相关性肝细胞癌抗病毒治疗专家建议》（下文简称《建议》）强调的是抗病毒治疗的必要性,是在手术或射频治疗（RFA）等根治性手术或经皮肝动脉插管化疗栓塞术（TACE）、适应性放射性治疗、全身化疗等姑息性治疗方案的基础应用上,是综合治疗的一部分。     

Stanford B型主动脉夹层的腔内隔绝治疗体会

随着影像学的发展,主动脉夹层的病例越来越多,应用覆膜支架腔内隔绝术已成为治疗Stanford B型主动脉夹层的首选方法。我院于2006年1月至2009年10月应用腔内隔绝术治疗Stanford B型主动脉夹层26例,效果良好,现报道如下。     

Effects of Late Reperfusion on Left Ventricular Function and Its Relationship With Viable Myocardium After Acute Myocardial Infarction in Patients With or Without Diabetes

Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）     

血栓抽吸联合替罗非班成功抢救风心双瓣置换术后并发急性大面积心肌梗死一例

冠状动脉粥样硬化基础上斑块破裂继发血栓形成是导致急性心肌梗死（AMI）的主要原因,而冠状动脉栓塞引起的AMI临床上却罕见。现报道经导管血栓吸出术联合欣维宁治疗风湿性心脏病双瓣置换术后继发冠状动脉栓塞引起急性心肌梗死1例,取得良好效果,并对相关文献作一回顾。