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双心诊疗亟待突破传统中药异军突起——众专家呼吁关注冠心病的中西医结合治疗顺应新的"生物-心理-社会"医学模式转变,推行"双心医学"服务新模式,对患者进行个性化的心脏以及心理治疗,控制过度医疗,改善患者的生活质量,减轻家庭与社会的负担,实现心脏与心理和谐势在必行     

冠心病猝死的相关因素分析

目的探讨冠心病患者心脏性猝死的发生率及其相关因素。方法回顾分析46例冠心病患者住院期间发生心脏性猝死的有关临床资料,男性32例,女性14例,年龄38-83（49．5±10．7）岁。收集患者的诱因、心电图（ECG）、超声心动图、动态心电图、X线胸片、心电监护、电解质等资料,根据患者相关项目逐项进行分析。结果46例猝死患者占同期冠心病总住院数的2．2％。多数发生猝死的冠心病患者存在一定高危因素,电解质紊乱、Lown3-5级室早、高度房室传导阻滞、束支传导阻滞、心脏扩大、左室肥厚、心功能不全、持续心肌缺血等因素均可触发致命性心律失常;猝死起始的ECG类型及其演变过程多有一定规律性。结论冠心病患者的心脏性猝死发生率为2．2％。冠心病患者发生猝死与电解质紊乱、Lown3-5级室早、高度房室传导阻滞、束支传导阻滞、心脏扩大、左室肥厚、心功能不全、持续心肌缺血等高危因素密切相关。有效控制危险因素能大大降低冠心病猝死发生率。     

扎根理论联合知信行护理模式对冠心病PCI术后患者的影响

目的 探索基于扎根理论联合知信行护理模式对冠心病行PCI手术患者的心脏康复知信行水平、生活质量和自我管理能力的影响。方法 选取我院2022年6-12月住院患者共86例,两组患者基础资料无差异,将患者随机分为观察组和对照组,对照组予常规护理,观察组在此基础上同时给予扎根理论联合知信行模式护理,比较两组患者的心脏康复知信行水平、生活质量和自我管理能力的差异。结果 经过干预后,观察组患者心脏康复相关的知识、信念和行为水平明显高于对照组;生理功能、精神健康、情感职能等生活质量指标明显高于对照组;饮食管理、运动管理等自我管理能力也明显高于对照组（P<0.05）。结论 扎根理论联合知信行护理模式能够有效提高冠心病行PCI手术患者的心脏康复知信行水平、改善患者生活质量和提高患者的自我管理能力,有利于患者的康复治疗。     

自我管理模式在冠心病PCI术后出院患者心脏康复中的应用

目的探讨规范化自我模式对冠心病PCI术后出院患者心脏康复的影响。方法将100例冠心病PCI术后患者根据出院日期分为对照组和实验组,对照组予常规出院指导和门诊随访方式,干预组在此基础上实施规范化的自我管理模式,比较两组患者出院时、出院后1年评价患者康复知识知晓情况,危险因素控制达标率,药物使用依从性,主要心脏不良事件发生率。结果两组患者出院时心脏康复知识知晓情况,危险因素控制达标率,无显著差异性(P0.05),出院后1年实验组各项指标优于对照组(P0.05)。结论规范化的自我管理模式干预有助于冠心病PCI术后出院患者保持良好的健康行为,促进患者心脏的康复,改善患者预后。     

BNP与冠状动脉病变及心脏变时性相关性研究

目的探讨冠心病患者血浆脑钠肽（BNP）与冠状动脉病变严重程度及心脏变时性的相关性。方法记录冠心病患者血浆BNP水平及心脏变时性指标,包括r HR和HRR,并记录冠状动脉造影（CAG）结果,计算Gensini评分,对比分析无症状性心肌缺血、稳定型心绞痛及不稳定型心绞痛3组患者血浆BNP水平及心脏变时性指标差异。评价血浆BNP水平与冠状动脉病变严重程度及心脏变时性指标相关性。结果本研究共纳入462例冠心病患者,单因素方差分析结果显示各组间BNP水平差异均有统计学意义（均P〈0.05）;无症状性心肌缺血与不稳定型心绞痛心脏变时性指标r HR比较差异有统计学意义（P〈0.05）。Person相关分析显示,冠心病患者血浆BNP水平与冠状动脉病变Gensini评分呈正相关（r=0.43,P〈0.05）,与心脏变时性指标r HR及HRR均呈负相关（r=-0.34,-0.40,均P〈0.05）。结论冠心病患者血浆BNP与冠状动脉病变程度及心脏变时性指标r HR和HRR密切相关,对于评价冠心病心脏功能的改变有重要的临床价值。     

心脏康复对老年稳定性冠心病患者血管内皮功能及炎性因子的影响

目的观察心脏康复对老年稳定性冠心病患者血浆内皮素(ET)-1和一氧化氮(NO)水平及相关炎性因子的影响。方法老年稳定性冠心病患者61例随机分为对照组和心脏康复组,两组给予常规药物治疗,心脏康复组同时进行6个月的心脏康复,分别于治疗前、治疗3个月、6个月比较两组心功能指标、血管内皮功能指标和血清炎性因子水平。结果与对照组比较,心脏康复组治疗6个月射血分数(LVEF)显著提高(P0. 05),ET-1、血清C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6水平均显著下降(P0. 05),NO水平虽有升高趋势,但差异无统计学意义(P0. 05)。结论心脏康复治疗6个月可明显改善老年稳定性冠心病患者心功能、调节血管内皮功能、降低血清炎性因子水平。     

冠心病心脏介入术患者心脏康复护理模式的效果评价

目的阐述冠心病心脏介入术患者心脏康复护理模式的建立方法,观察应用效果。方法根据护理方法的不同进行分组,对照组实施常规护理,观察组实施心脏康复护理模式,观察两组患者的心绞痛评分、康复护理依从性、患者满意度。结果观察组护理后活动受限(34.51±1.58)分、心绞痛稳定程度(3.00±0.41)分、发作频率(9.00±0.21)分、主观感受(9.34±0.13)分、饮食、运动、用药、心理康复依从性,分别为88.24%、91.18%、100%及94.12%、满意度94.12%,与对照组相比,差异显著(P0.05)。结论将心脏康复护理模式应用到冠心病心脏介入术患者的护理中,可有效提高患者康复护理的依从性,减轻心绞痛症状,提高护理满意度,促进术后康复。     

信息化随访系统在出院冠心病患者治疗依从性中的作用

目的:评估信息化随访系统对于出院冠心病患者治疗依从性的影响。方法:选择2013-01-2014-12确诊为冠心病的患者共382例,随机分为试验组及对照组,出院前均根据最新指南予以药物治疗及指导。试验组在出院后由专人运用信息化随访系统采用优化的依从性量表进行回访。对照组采用传统的随访模式,主要包括患者被动随访、门诊随访、电话随访等。采用调查问卷的方式了解两组患者的治疗依从性及主要心脏不良事件的发生率。结果:试验组第2次至第6次随访的服药依从性得分、生活方式改善得分及治疗依从性得分均高于对照组(P0.001)。两组患者服药依从性得分在所有的随访期间均达到了良好的标准。对于治疗依从性得分,在6次随访中对照组能够达到的良好比例少于试验组(P=0.003)。随访期间对照组主要不良心脏事件发生率高于试验组(P0.001)。多因素Logistic回归分析显示年龄、糖尿病、吸烟是发生不良心脏事件的独立危险因素。结论:信息化随访系统可以显著提高出院冠心病患者的治疗依从性,减少主要不良心脏事件发生率。     

非心脏手术围术期心血管并发症

非心脏手术围术期心脏事件是患者围术期并发症和死亡率增加的重要原因，Vonknorring报道，有冠心病的患者非心脏手术围术期急性心肌梗死（AMI）的发生率为2％-17％，而无冠心病者发生率为0．1％-0．2％。所以，对手术患者进行危险分层和必要的干预，具有重要的临床意义。作者复习文献结合临床实践对非心脏手术围术期心血管并发症的机制、临床评价、危险因素干预原则进行综述，供基层医院临床医生参考。     

冠心病PCI术后心脏康复医学模式转变的研究进展

经皮冠状动脉介入治疗(PCI)适用于冠脉狭窄大于70%及有明显症状的冠心病(CHD)病人,血管再通率高,创伤小,术后生活质量可明显提高,但PCI术后冠脉极易再狭窄和支架内血栓形成,影响其介入疗效。随着生物-社会-心理医学模式转变,本研究从新医学模式角度综述PCI术后心脏康复治疗研究新进展。     

A heart within a heart

A 44‐year‐old man with a history of end‐stage dilated cardiomyopathy status‐post orthotopic cardiac transplant 14 years ago presented for coronary angiography in preparation for re‐operative tricuspid valve replacement. Coronary angiography revealed an anomalous origin of the left coronary artery, with a common coronary trunk arising from the right coronary cusp and bifurcating into right and left main coronary arteries. Interestingly, the right and left coronary arteries coursed to form the shape of a heart, hence, a heart within a heart! © 2017 Wiley Periodicals, Inc.     

冠心病和心力衰竭

冠心病心力衰竭（简称冠心病心衰）顾名思义是指由于冠心病引起的心力衰竭,据统计大约65％的心力衰竭由冠状动脉疾病引发的。冠心病心衰在临床上分急性和慢性两种,急性心衰主要由急性心肌梗死和急性冠脉缺血诱发的心肌收缩或舒张功能异常所致,慢性心衰主要是心肌梗死后心肌重塑和心肌的血供长期不足,心肌组织发生营养障碍和萎缩,以致纤维组织增生所致。由于冠心病导致心衰的成因不同,因此治疗上的侧重点就会有所不同,下面就对冠心病心衰发病机制及诊治作一浅谈。     

Congenital heart disease and heart failure

The syndrome of heart failure in adult non-congenital heart disease patients includes myocardial disease and ventricular dysfunction. In the presence of congenital abnormalities the cause of heart failure is often multi-factorial and can be a result of the underlying anomaly, surgical intervention, or ventricular dysfunction. Despite the possible clinical similarities, the two conditions are fundamentally different. In congenital heart disease the neurohormonal system is already abnormal even in the absence of clinical manifestations of heart failure and, in many cases, exercise intolerance is related to cyanosis. The approach to heart failure management in the two etiologies might be similar. Preventative attempts to preserve ventricular function in coronary or valve disease parallels early reparative therapy in congenital heart disease Pharmacological therapy is common for the two conditions, despite the limited number of evidence-based recommendations for congenital diseases. In drug-resistant patients, cardiac electrical resynchronization is an established therapy for treating ventricular asynchrony in non-congenital heart failure sufferers, but has only recently been adopted in selected congenital cases. Due to this, congenital heart disease patients are managed in highly specialized unites in close cooperation with cardiologists and surgeons. The ideal follow-up protocol for such patients remains to be determined, particularly in those individuals with subclinical signs of residual cardiac dysfunction. Heart Fail Monit 2008;6(1):2-8.     

Ischemic heart disease and heart weight

Separate weights for heart ventricle walls and interventricular septa were analyzed in 110 hearts with autopsy findings of ischemic heart disease (coronary atherosclerosis, recent or old myocardial infarcts) and with no other cardiac or systemic causes of cardiac enlargement. In hearts with coronary atherosclerosis alone (without old or recent myocardial infarcts) no weight increase was observed in the left ventricle when compared to 29 controls. Patients having infarcts associated with nonstenosing atherosclerosis (less than 50% of the luminal diameter narrowed) of the coronaries had normal heart weights as well. On the contrary, infarcts associated with stenosing coronary sclerosis (narrowing more than 50%) showed significant signs of left ventricular weight increase, which is interpreted as compensatory heart hypertrophy. The greatest degree of hypertrophy was observed in hearts with left ventricular aneurysms.     

Athletes' heart and echocardiography: athletes' heart

Sudden death of competitive athletes is rare. However, they continue to have an impact on both the lay and medical communities. These deaths challenge the perception that trained athletes represent the healthiest segment of modern society. There is an increasing frequency of such reported deaths worldwide and the visibility of this issue is underlined by the high-profile nature of each case. Differential diagnosis between pathological and the physiologic (nonpathological) responses to high levels of physical training has become clinically more important. The purpose of this review is to highlight the main echocardiograph characteristics related to different types of training/sports participation and to highlight already recognized and newer concepts in their clinical assessment.