二尖瓣反流程度与急性冠状动脉综合征预后评价的相关性分析

目的对MR在急性冠脉综合征中的发生率及程度对于心脏功能和患者预后的影响进行研究,以期为临床诊断治疗及预后评估提供新的参考。方法选择2006年12月-2011年12月于某院治疗的486例急性冠脉综合征的患者,依据其超声检查分为非返二尖瓣返流(MR)组轻、中、重度MR组,并分别比较各组性别、糖尿病患病率、冠状动脉造影结果、肌钙蛋白T、射血分数、死亡率和再住院率指标。结果 MR与性别无关,与糖尿病、冠状动脉梗塞数、肌钙蛋白T含量、射血分数、死亡率和再住院率指标均有相关性。结论 MR对心脏收缩功能及血流动力学均会产生不良影响,与其他指标一样,是判断预后的预测指标之一。     

超声斑点追踪及成像技术评价主动脉瓣反流患者左室扭转运动

内容:目的:本研究旨在应用二维斑点追踪及成像技术评价主动脉瓣反流(AR)患者左室二维应变及扭转运动,以期探讨其左室功能改变.方法:95例经二维超声心动图诊断为单纯性AR患者,按照反流程度分为轻、中、重度组.30例健康志愿者.行常规二维超声心动图并二维斑点追踪成像检查,采集左室心尖四腔及短轴各节段动态图像,应用EchoPAC工作站软件行脱机分析.比较不同程度AR患者和健康志愿者左室功能改变.结果:①各组间年龄、性别、身高、体重、体表面积和心率的差异均无统计学意义(P>0.05).②轻度AR组与正常对照组比较舒张末期左室内径、收缩末期左室内径、舒张末期左室容积、收缩末期左室容积、左室射血分数、二尖瓣口舒张期E峰、A峰及E/A比值差异均无统计学意义(P>0.05).中度AR组及重度AR组与正常对照组相比,舒张末期左室内径、舒张末期左室容积增大(P<0.05).中度AR组与对照组相比左室射血分数、二尖瓣口舒张期E、A峰及E/A比值的差异均无明显统计学意义(P>0.05).重度AR组左室射血分数与对照组相比有显著差异(P<0.05),但二尖瓣口舒张期E、A峰及E/A比值的差异则无明显统计学意义(P>0.05).③轻度AR组心底、心尖部旋转及扭转曲线与正常对照组差异无明显统计学意义(P>0.05).中度AR组心底、心尖部旋转及扭转角度较正常对照组明显增大(P<0.05).而重度AR组心底、心尖部旋转及扭转角度则较正常对照组明显减小(P<0.05).     

Micromax 1型等3种便携式超声与常规超声心动图对老年心脏病住院患者心脏检查的对比研究

评价了3种便携式超声(Hand-carried ultrasound,HCU)在老年心脏病住院患者的临床应用价值。以常规超声心动图(comprehensive echo-cardiography,CE)为评判标准,对401例老年心脏病住院患者进行左室、左房、主动脉根部内径,室间隔与左室后壁厚度,二、三尖瓣反流的检测。两种技术在心脏腔径大小及左室射血分数的检测上无明显差异,关于室壁节段运动异常评价HCU相对于CE的检出率为92.15%。对于检测二尖瓣反流,三尖瓣反流两种技术均具有较好的符合率(符合率分别为93%与91.4%)。HCU对于老年心脏病诊断及病情监测具有一定实用性。     

心电图对应导联出现ST段压低对于急性心肌梗死患者的临床意义分析

[目的]探讨心电图对应导联出现ST段压低在急性心肌梗死患者诊断中的临床意义。[方法]回顾性分析2008年1月～2010年3月,我院收治的急性心肌梗死患者中,66例心电图对应导联出现ST段压低患者,设为观察组;选取同期诊断为急性心肌梗死患者但心电图对应导联未出现ST段压低的50例患者,设为对照组。统计两组患者出现其他冠脉病变、临床心功能分级、左心射血分数、严重心律失常、死亡发生率,总结心电图对应导联出现ST段压低在急性心肌梗死患者诊断、治疗中的临床意义。[结果]经研究显示,两组患者中,观察组患者的冠脉病变率、严重心律失常发生率、死亡率均明显高于对照组患者,P值均﹤0.05,差异有统计学意义;心功能分级、左心射血分数均较对照组差,P值均﹤0.05,差异有统计学意义。[结论]心电图对应导联出现ST段压低是急性心肌梗死患者合并其他冠脉病变的重要信号,临床应及早采取干预治疗措施,以降低死亡率。     

冠心病合并完全性右束支传导阻滞患者静息射血分数影响因素的超声心动图分析

目的通过超声心动图测定静息射血分数，以分析冠心病合并完全性右束支传导阻滞患者影响左室功能的因素，为冠心病的治疗提供依据。方法利用超声心动图对93例冠心病合并完全性右束支传导阻滞且心电图无异常Q波的患者按左心室容量公式，分别计算出舒张末期容量（vd）及收缩末期容量（Vs），得出其静息射血分数，选择经临床体检、心电图、胸部X线及超声心动图排除其他心血管疾病，静息射血分数大于50％的221例体检者为对照组。结果完全性右束支传导阻滞组患者平均年龄[（64．0±9）岁]大于对照组[（53．0±10）岁]，差异有统计学意义（P〈0．01）。完全性右束支传导阻滞组患者左室静息射血分数（0．57±0．12）明显低于对照组（0．64±0．09），男性完全性右束支传导阻滞组患者左室静息射血分数（0．56±0．11）明显低于对照组（0．62±0．08），差异均有统计学意义（P〈0．01）；女性完全性右束支传导阻滞组患者左室静息射血分数（0．65±0．07）与对照组（0．66±0．10）的差异无统计学意义（P〉0．05）。性别和年龄是冠心病合并完全性有束支传导阻滞患者静息射血分数的影响因素（r值分别为3．20和3．84，P〈0．01）。结论临床工作中应对冠心病高发环境中年龄偏大且合并完全性右束支传导阻滞的男性患者高度重视，合理安排治疗以减少死亡率。     

心衰伴二尖瓣返流患者脑钠肽与左室射血分数等参数的研究

目的:研究慢性心力衰竭(选择心功能Ⅱ、Ⅲ、Ⅳ级)伴中重度二尖瓣返流(MR)患者与无二尖瓣返流心衰患者血浆中脑钠肽(BNP)水平的差异及其与左室射血分数(LVEF)、左室舒张末期内径(LVEDD)之间的相关性。方法:选择心力衰竭患者128例,入院后均经心脏彩超检查。按NYHA分级,Ⅱ级39例,其中伴二尖瓣返流患者19例,无二尖瓣返流患者20例;Ⅲ级55例,其中伴二尖瓣返流患者27例,无二尖瓣返流患者28例;Ⅳ级34例,其中伴二尖瓣返流患者16例,无二尖瓣返流患者18例。采用美国雅培I2000SR全自动化学发光分析仪测定血浆BNP水平。结果:BNP数值、LVEDD及LVEF在NYHA分级Ⅱ、Ⅲ、Ⅳ各组间(包括有、无二尖瓣返流患者)有统计学差异(P<0.05)。BNP数值在NYHA分级Ⅱ级伴有二尖瓣返流及无二尖瓣返流患者之间有统计学差异(P<0.05)。结论:脑钠肽的升高、左室射血分数及舒张末期内径与NYHA分级相关,脑钠肽在NYHA分级Ⅱ级有二尖瓣返流患者中高于无二尖瓣返流患者。     

别嘌呤醇治疗对伴高尿酸血症慢性心衰患者心功能的影响

[目的]探讨高尿酸血症的慢性心衰患者,别嘌呤醇治疗对其心功能的影响。[方法]56例心功能II～III级慢性心衰患者分为别嘌呤醇治疗组和对照组。所有对照组患者均于入院后给予常规抗心衰治疗,治疗组在对照组治疗基础上加用别嘌呤醇300mg/d,治疗12周。分别检测治疗前、后血尿酸、左心室舒张末期内径和左心室射血分数的变化。[结果]与治疗前相比,别嘌呤醇组治疗后左心室舒张末期内径明显降低,左心室射血分数升高(P﹤0.05)。与对照组相比,别嘌呤醇组治疗后左心室舒张末期内径,左心室射血分数的改善更为明显(P﹤0.05)。[结论]别嘌呤醇能降低体内氧化应激水平,改善心功能。     

组织多普勒Tei指数在评价慢性肺源性心脏病患者左心功能中的价值

目的探讨组织多普勒Tei指数评价慢性肺源性心脏病患者左心功能的临床价值。方法受试者分肺心病组（40例）和正常对照组（20例）,常规超声心动图检查,测量左室射血分数（EF）、二尖瓣口血流舒张晚期（A峰）和舒张早期（E峰）峰值比A/E及二尖瓣前环、后环组织多普勒Tei指数。结果肺心病组EF较正常组降低,差异显著,P〈0.05;肺心病组A/E较正常组增高,差异显著,P〈0.01;肺心病组二尖瓣环组织多普勒Tei指数较正常组显著增加,P〈0.01。结论左室Tei指数是反映左心整体功能的敏感指标,组织多普勒Tei指数可综合评价肺心病患者的左心功能。     

老年人房颤复律后心功能变化的临床分析

目的通过对26例老年人心房颤动患者多普勒超声心动图检测左心房内径(LAD)、左室舒张末期容积(SV)、射血分数(EF),探讨老年人房颤复律前、后心功能的变化.方法测定患者房颤发作期间与复律后一个月的左心房内径、左心室舒张末期容积、射血分数的超声指数,以评价心功能的改善程度.结果复律前、后心功能得到明显改善.左房内径复律前、后无明显改变(P＞0.05),左心室舒张末期容积和射血分数改善显著(P＜0.05).结论治疗老年房颤患者,早期复律并维持窦性节律,对于改善临床症状,有效地减少血液动力学障碍,预防血栓性栓塞非常重要.     

扩张型心肌病合并二尖瓣关闭不全行二尖瓣成形术的中期效果观察

目的评价扩张型心肌病同时合并二尖瓣关闭不全时,行二尖瓣成形术的中期临床效果。方法对12例扩张型心肌病合并二尖瓣关闭不全患者行二尖瓣成形术并进行术后随访,评估患者的左室射血分数、二尖瓣关闭不全程度以及心功能分级情况。结果全组患者无手术死亡,术后随访12～21（17．33±11．74）个月,术后1个月内死亡1例,术后1、3、6、12个月行心脏超声检查,同时按照纽约心功能分级标准进行心功能分级,术后6个月左室射血分数由术前的（38±6）％上升至（40±5）％;术后12个月时,左室射血分数上升至（43±8）％,NYHA心功能分级为2．72±0．31,与术前的3．37±0．12相比,差异有统计学意义（P〈0．05）。结论扩张型心肌病合并二尖瓣关闭不全行二尖瓣成形术能取得良好的效果,在纠正二尖瓣返流的同时,患者的心功能可以得到逐步改善。     

Mitral regurgitation: current trends in diagnosis and management

Mitral regurgitation is the most prevalent heart valve disorder in the United States. Individuals with mitral regurgitation may be asymptomatic or may present with dyspnea, orthopnea, fatigue, and/or heart rhythm disturbances. Long-standing mitral regurgitation causes chronic left ventricular volume overload, which leads to left ventricular dilation and contractile dysfunction. Without treatment, mitral regurgitation results in biventricular failure and death. Echocardiography is the preferred diagnostic test to assess the presence and severity of mitral regurgitation. Mitral valve surgery, the only effective treatment for patients with severe mitral regurgitation, is recommended early in the course of the disease to prevent the development of heart failure. Early recognition of mitral regurgitation and timely referral for mitral valve surgery significantly improve symptoms and long-term survival.     

A Nurse with Neck Pain and Fever After a Needle-Stick

Abstract

Mitral regurgitation is the most prevalent heart valve disorder in the United States. Individuals with mitral regurgitation may be asymptomatic or may present with dyspnea, orthopnea, fatigue, and/or heart rhythm disturbances. Long-standing mitral regurgitation causes chronic left ventricular volume overload, which leads to left ventricular dilation and contractile dysfunction. Without treatment, mitral regurgitation results in biventricular failure and death. Echocardiography is the preferred diagnostic test to assess the presence and severity of mitral regurgitation. Mitral valve surgery, the only effective treatment for patients with severe mitral regurgitation, is recommended early in the course of the disease to prevent the development of heart failure. Early recognition of mitral regurgitation and timely referral for mitral valve surgery significantly improve symptoms and long-term survival.     

影响冠状动脉旁路移植术手术死亡的危险因素分析

目的：观察分析影响冠状动脉旁路移植术手术死亡的危险因素,对预防检查和治疗方案提供针对性的帮助和改善。方法：回顾性分析本院心血管科2010年1月-2013年12月收治住院并接受冠状动脉旁路移植术的137例冠心病患者的临床资料,选择可能导致患者死亡的危险因素为研究对象并调查收集资料,进行单因素与多因素分析,选出影响冠状动脉旁路移植术手术死亡的危险因素。结果：137例接受冠状动脉旁路移植术的患者手术中有5例患者死亡,占总数的3.65%。单因素与多因素分析显示影响术后死亡的危险因素包括：年龄、围手术期心肌梗死、心功能不全、室壁瘤、心力衰竭、左主干病变大于50%、心律失常、肺动脉瓣反流、二尖瓣反流、心源性休克、左心室射血分数、术前血红蛋白值、术前肌酐值和合并主动脉瘤手术。手术前后针对带有以上单个或多个危险因素的患者进行重点监测,以减少患者死亡率。结论：影响冠状动脉旁路移植术手术死亡的危险因素较多,需及时干预。     

Chronic aortic regurgitation with left ventricular dysfonction

We studied fifty one patients (40 men and 11 women) under going valve replacement from 1990 to 2002 for aortic regurgitation and had left ventricular dysfunction. 45% patients were in class III or IV of New York Heart Association (NYHA). All patients were investigated by echocardiography (left ventricular ejection fraction [LVEF] < 50%) - Peroperative mortality was 5.8% due to myocardial failure. 81.4% of survivors were followed duering a mean period of 24 months (rangis from 3 to 67 months) after valve replacement.     

不同中医证型房颤患者心脏超声的相关性研究

目的：探讨心房纤颤（简称房颤）不同中医证型与心脏超声指标的相关性,结合病因分析,使中医辨证分型更加客观化、科学化,从而提高房颤中医辨证论治水平。方法：选取2013年8-12月期间在本院住院、经多导联心动图检查诊断为心房纤颤患者48例,经中医辨证分型,其中心血瘀阻23例,心脾两虚11例,心阳不振8例,水饮凌心6例,对其进行多普勒超声心动图检查。结果：水饮凌心及心脾两虚证的左房增大、二尖瓣返流面积增多,高于其他证型（P〈0.05）,多见于风湿性心瓣膜病（简称风心病）;心阳不振证的左室射血分数、短轴缩短率、二尖瓣舒张早期流速峰值E峰、二尖瓣舒张晚期流速峰值A峰及E/A比值均低于其他证型（P〈0.05）,多见于肺心病;心血瘀阻证的左房、左室增大,室间隔、左室后壁增厚（P〈0.05）,多见于高血压及冠心病。48例患者中有9例并发左房附壁血栓。结论：心脏超声能够分析房颤患者不同中医证型与病因的相关性,提高房颤中医辨证论治水平。     

Biventricular resynchronization in the management of severe cardiac insufficiency

Heart failure is a major problem of public health, it represents a frequent status among patients with heart disease, and its implications in term of mortality and cost are high. Non Pharmacological treatment of heart failure most commonly designed as cardiac resynchronization therapy (CRT) has demonstrate efficacy to improve functional class, exertion capacity, left ventricular ejection fraction, reduction of mitral regurgitation, and probably mortality at midterm. The most recent studies emphasize on the role of implantable cardioverter defibrillate or (ICD) combined with CRT to reduce mortality. More trials are needed to valid this concept.     

Correlation of B-type natriuretic peptide (NT-proBNP) levels and conventional and tissue Doppler echocardiographic parameters of left ventricular diastolic function in patients with hypertrophic cardiomyopathy

INTRODUCTION: Preload-independent pulsed tissue Doppler echocardiography (TDI) and conventional pulsed Doppler echocardiography were used to assess the global left ventricular diastolic function in patients with hypertrophic cardiomyopathy (HCM). Levels of B-type natriuretic peptide (BNP) could be elevated in patients with isolated left ventricular diastolic dysfunction. AIM: The study was to investigate the correlation between BNP levels and the parameters measured by conventional echocardiography and TDI in patients with HCM. PATIENTS: 32 consecutive patients with HCM (21 male, 11 female, mean age 47 +/- 14 years) were studied. Inclusion criteria were: normal sinus rhythm; ejection fraction > or = 50%; absence of moderate to severe mitral regurgitation or prosthetic mitral valve. METHODS: In addition to the conventional transmitral flow patterns (E, A, E/A, DT, IVRT) myocardial early (Ea) and late diastolic (Aa) velocities were measured at the lateral and septal border of the mitral annulus by ATL HDI 5000 ultrasound system. Ea/Aa and E/Ea ratios were calculated. NT-proBNP levels were measured by Roche-Elecsys test (immunoassay). Because the distribution of BNP values did not appear to be normal, the values were transformed into a natural logarithm (InBNP). RESULTS: Mean BNP level was 543 +/- 845 pg/ml. BNP levels negatively correlated with lateral Aa values (r = -0.59, p < 0.001). No significant relationship was observed between BNP levels and other echocardiographic parameters. By stepwise multiple linear regression analysis the only significant predictor of InBNP was lateral Aa value, too (r = -0.467, p < 0.05). CONCLUSION: Significant correlation was found between BNP levels and a single TDI parameter characterizing left atrial systolic function, but there was no significant correlation between BNP levels and global left ventricular diastolic function characterized by either conventional echocardiographic or TDI parameters.     

比索洛尔治疗稳定性心力衰竭的临床疗效

目的观察比索洛尔治疗稳定性心力衰竭的临床疗效。方法76例稳定性心力衰竭患者在常规治疗心衰的基础上,随机分成比索洛尔组39例和对照组37例,治疗组口服比索洛尔1.25～5.00mg/天,对照组口服安慰剂,疗程6个月。观察治疗前后心率、左室舒张末期内径、左室射血分数和6min步行距离。结果比索洛尔治疗组2个月后气促症状明显改善、心率明显下降(p<0.05);4个月后左室射血分数和6min步行距离明显改善(p<0.05),6个月后左室射血分数和6min步行距离明显进一步改善(p<0.01);6个月后左室舒张末期内径明显缩小(p<0.05)。安慰剂对照组治疗4月心率才显著下降(p<0.05),左室射血分数和6min步行距离治疗6月明显改善(p<0.05),左室舒张末期内径随访有缩小,但无统计学差异(p>0.05)。与对照组比较,比索洛尔治疗组因心衰再次入院、心血管死亡率、总死亡率复合终点明显减少(p<0.05)。结论比索洛尔治疗稳定性心力衰竭有效安全。