胺碘酮联合缬沙坦治疗阵发性房颤的疗效分析

目的探讨胺碘酮联合缬沙坦治疗阵发性房颤的临床疗效。方法58例阵发性房颤患者随机分为两组,各29例,对照组给予胺碘酮治疗,治疗组在对照组的基础上联合应用缬沙坦治疗,疗程18个月,比较两组的疗效、复发情况、治疗前后左心房内径的变化情况。结果治疗组总有效率显著高于对照组,差异有统计学意义（P〈0．01）;治疗组的复发次数明显低于对照组,差异有统计学意义（P〈0．01）;治疗12个月和治疗18个月后,治疗组左心房内径明显少于对照组,差异有统计学意义（P〈0．01）。结论胺碘酮和缬沙坦联合治疗阵发性房颤疗效优于单一用药,且复发次数少,值得推广和应用。     

气腹对心功能不全的影响

腹腔镜手术因其创伤小 ,恢复快等特点 ,已为广大外科界同行所接受 ,随着腹腔镜技术的不断提高 ,手术适应征也不断扩大。人们开始注意到气腹对重要脏器的影响。心脏功能正常的患者由于其心脏具有潜在的功能可以发挥作用 ,一般不会出现心功能方面的并发症 ,对于心功能不全的患者     

血浆儿茶酚胺水平对脓毒症患者心功能不全的影响

脓毒症相关的心功能不全的病理生理学机制是比较复杂的．近年来被认为涉及多个机制。脓毒症时儿茶酚胺的过度产生和外源性儿茶酚胺的输注可能对脓毒症相关的心功能不全的发生有关。高水平的血浆儿茶酚胺直接对心脏有毒性作用,其中涉及儿茶酚胺诱导的心肌毒性的病理生理学机制涉及炎症,氧化应激．导致心肌顿抑．凋亡、坏死的异常钙转运。     

沙库巴曲缬沙坦用于治疗慢性心力衰竭合并肾功能不全老年患者的疗效

目的:探讨沙库巴曲缬沙坦用于治疗慢性心力衰竭合并肾功能不全老年患者的疗效。方法:采用随机数字表法将127例慢性心力衰竭合并肾功能不全老年患者分为两组,两组患者均接受常规抗心力衰竭治疗,对照组在此基础上给予口服贝那普利治疗,观察组给予沙库巴曲缬沙坦治疗,对比分析两组患者左心室功能参数、肾功能指标、血清学指标及不良反应。结...     

LC术中CO_2气腹对心功能不全患者心功能的影响

目的 :探讨腹腔镜手术时不同气腹压力对心功能不全患者心功能的影响。方法:选取2005年1月—2013年12月在我院择期行腹腔镜胆囊切除术(LC)的患者,按心功能等级分组,分别采用标准压力气腹和低压力气腹,观测患者血浆脑钠肽(B N P)及左室射血分数(LV EF)的变化。结果:心功能正常和心功能Ⅰ、Ⅱ级患者行LC时,所有时间点标准压力气腹组(H组)和低压力气腹组(L组)患者LV EF值差异无统计学意义(P0.05);心功能Ⅲ级患者采用低压力气腹在术后24、72 h的LV EF明显高于H组(P0.05)。心功能正常和心功能Ⅰ级患者行LC时,所有时间点H组和L组患者B N P值差异无统计学意义(P0.05),心功能Ⅱ级采用低压力气腹的患者在气腹后30 m in时B N P值明显高于H组(P0.05),心功能Ⅲ级患者采用低压力气腹在气腹40 m in和气腹后30 m in时B N P值明显高于H组(P0.05)。结论:对于N Y H A分级较高的心功能不全患者,采用低压力气腹行LC可能减轻C O2气腹对其心功能的影响。     

L—精氨酸和牛磺酸治疗40例慢性心功能不全

慢性充血性心功能不全（ＣＨＦ）冠脉存在ＮＯ缺陷。本研究以ＮＯ前体Ｌ－Ａｒｇ作为ＮＯ药物治疗观察４０例ＣＨＦ。结果显示，静滴Ｌ－Ａｒｇ和牛磺酸治疗ＣＨＦ，显效率达９２．５％，症状及心功能各项指标改善，血小板，ｃＧＭＰ较对照组升高５０％，与对照组比较有较显著差异（Ｐ〈０．０５）。这提示Ｌ－精氨酸和联用牛磺酸治疗ＣＨＦ可能与其促进ＮＯ释放有关，同时推测血管紧张素转换酶抑制剂治疗ＣＨＦ也与促进ＮＯ释放有关     

缬沙坦对左室肥厚患者心功能及运动耐量的影响

目的:研究缬沙坦对左室肥厚患者心功能及运动耐量的影响.方法:采用缬沙坦治疗左室肥厚患者64例,并于治疗前及治疗后6个月进行6min行走试验及超声心动图检测;缬沙坦从小剂量开始口服,1个月后根据患者的心率、血压逐渐加量至目标剂量并长期服用,即80～160 mg/d.结果:与治疗前比较,治疗后6个月患者6 min行走距离增加,心脏功能各指标明显改善(P＜0.01),总有效率95%.结论:血管紧张素受体拮抗剂缬沙坦能改善左室肥厚患者的心功能状态,提高运动耐量,临床疗效较好.     

心房颤动的机制及预防

心房颤动是临床上最常见的心律失常之一,全球发病率高,严重威胁人们的健康与生命,因此对心房颤动的预防显得尤为重要。本文综述目前对心房颤动发生机制的认识及对其预防的最新进展,以为临床提供参考。     

老年心功能不全患者行胆总管探查术的麻醉体会

我科近两年对老年心功能不全行胆总管探查术的患者成功实施了13例麻醉。其中有1例女性患者，69岁，75kg，胆石症，阻塞性黄疸。患高血压20余年，偏瘫5年。查体：左侧上肢肌力0级，下肢肌力Ⅲ级，二尖瓣区、主动脉瓣区闻及3级收缩期吹风样杂音。ECG示：左心室肥厚，广泛性心肌缺血。心功能Ⅲ级。     

胺碘酮对体外循环后心脏复跳及自律性的影响

目的观察胺碘酮对体外循环术后心脏复跳及自律性的影响。方法择期二尖瓣置换的房颤患者64例随机分为三组,分别在体外循环期间静脉注射胺碘酮8mg/kg（A组）,4mg/kg（B组）或等量生理盐水（C组）。观察转流时间、心脏复跳时间、自律性、临时心脏起搏及血管活性药物使用情况。结果与A、B组相比,C组的后并行时间和转流时间显著延长（P〈0.01）,自动复跳、复跳后窦律比例显著降低（P〈0.05和P〈0.01）,停机后多巴胺使用量显著增加（P〈0.01）。A组临时起搏器使用比例较其它两组显著增加（P〈0.05）。各组复跳后窦律患者左房小于房颤患者（P〈0.01）,C组窦律患者左房小于其它两组（P〈0.01）。结论体外循环术中心脏复跳前使用胺碘酮可以增加房颤患者心脏自动复跳的成功率,更好地维持窦性心律,稳定血流动力学,减少多巴胺用量及体外循环时间。     

Paroxysmal atrial fibrillation is uncommon in outpatients with chronic heart failure

Objectives. The objective was to evaluate the prevalence of paroxysmal atrial fibrillation (PAF) in patients with heart failure (HF) due to systolic dysfunction. Design. We included 79 patients (age 68 years, LVEF 30%) with HF and sinus-rhythm (SR) referred to a HF outpatient clinic. A 48 hours Holter ECG and a follow-up ECG were performed. Results. One patient had one episode of PAF. Thirty-two (41%) patients had episodes of irregular atrial runs (AR). The numbers of QRS complexes during AR were 7.2±2.9 (mean±SD). Patients with AR were older than patients with SR, p =0.02 and more often of female sex, p =0.04. Multivariate logistic regression analysis showed that age and female sex were independently correlated with AR with adjusted OR of 1.1 (per year, 95% CI 1.02–1.14, p =0.01) and 4.0 (1.05–15.07, p =0.04), respectively. The presence of AR did not predict development of new-onset AF. Conclusion. Outpatients with HF due to systolic dysfunction did not present with PAF during 48 hours Holter, but had several episodes of AR. The clinical and prognostic importance of AR deserves further investigation.     

心可舒联合乙胺碘呋酮治疗冠心病快速心房纤颤45例

目的：探讨心可舒联合乙胺碘呋酮治疗冠心病快速心房纤颤的临床疗效。方法病例选自我院2011年12月~2013年12月收治的冠心病快速心房纤颤患者共90例,分为两组,其中对照组（n=45）单纯给予乙胺碘呋酮治疗,观察组（n=45）采取心可舒联合乙胺碘呋酮治疗,观察并比较两组临床治疗效果及不良反应发生情况。结果观察组总有效率为91.11%,显著高于对照组的77.78%,两组比较差异有统计学意义（P＜0.05）;观察组不良反应发生率为6.66%,显著低于对照组的26.67%,两组比较差异有统计学意义（P＜0.05）。结论心可舒联合乙胺碘呋酮治疗冠心病快速心房纤颤疗效确切,可有效控制心室率,改善临床症状,且不良反应发生率低,安全性好,具有较好的临床应用价值。     

心脏超声对风湿性瓣膜病术后房颤自动复律的预测

目的对风湿性心脏病（风心病）心房颤动患者术后自动恢复窦性心律与不能恢复窦性心律患者的心脏超声指标进行对比分析，探讨自动恢复窦性心律的可能因素。方法选择风心病二尖瓣置换术患者515例，术前心电图检查均示有房颤，按照术后自动恢复窦性心律情况分为非自动恢复窦律对照组及自动恢复窦律组，对左房直径（LAD）、右房直径（RAD）、心脏射血分数（EF）、左室缩短率（FS）等超声指标进行比较分析。结果术后维持窦律时间较长组LAD、左房容积（LAV）明显低于非自动复律组（P〈0．01），而EF、FS则明显高于非自动复律组（P〈0．01）。结论从心脏超声指标分析，风心病瓣膜置换术后房颤自动恢复窦性心律及窦性心律维持时间与左房大小及心功能有密切关系。     

Prognostic impact of heart rate in elderly with systolic heart failure and concomitant atrial fibrillation

Objective: The present study aimed to investigate the impact of resting heart rate (HR) on 5-year all-cause mortality in patients ≥80 years with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant atrial fibrillation (AF) after optimal up-titration of beta-blockers (BBs).

Methods: Patients (n?=?185) aged ≥80 years with HF and left ventricular ejection fraction ≤40% were included between January 2000 and January 2008 from two university hospitals, Sahlgrenska and Östra and retrospectively studied from January 2 to May 30, 2013. Up-titrations of guideline recommended medications were performed at HF outpatient clinics.

Results: Of whole study population, 54% (n=?100) had AF. After optimal up-titration of BBs and angiotensin converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), mean HR in patients with AF was 73?±?15 beats/minute (bpm), 36% had resting HR?≤65 bpm. Five-year all-cause mortality among patients with AF was significantly lower in patients with HR?≤65 bpm (63%) compared to HR?>65 (80%). Cox proportional-hazard regression analysis adjusted for clinically important baseline variables and doses of ACEIs/ARBs and BBs demonstrated resting HR?≤65 bpm as an independent predictor of improved survival compared to resting HR?>65 bpm (HR 0.3, 95%CI 0.1–0.7, P 0.005).

Discussion: In octogenarians with HFrEF and concomitant AF, lowering resting HR to levels as low as HR?≤65 bpm was still associated with improved survival from all-cause mortality. Our data indicate that mortality in AF became comparable to SR when patients were on maximally up-titrated beta-blocker doses with HR as low as 75 bpm.     

Effect of biventricular pacing therapy in patients with dilated cardiomyopathy with severe congestive heart failure

Objectives: Biventricular pacing (BVP) therapy has recently emerged as an effective treatment for patients with moderate to severe congestive heart failure (CHF) and ventricular asynchrony all over the world. However, this therapy is not yet available in Japan. We evaluated the effects of BVP in patients with severe CHF due to dilated cardiomyopathy (DCM). Subjects: Four patients with medically refractory severe CHF due to DCM in New York Heart Association functional class III or IV heart failure underwent BVP therapy. We combined the implantation of the left ventricular (LV) epicardial lead via small thoracotomy following right atrial and ventricular intravenous leads under general anesthesia. We evaluated to determine whether improvements of ventricular function, ventricular size, mitral regurgitation, functional status, frequency of hospitalization, and quality of life were associated with BVP therapy. Results: BVP improved LV systolic function, decreased LV size and mitral regurgitation, and shortened prolonged QRS interval. The patients’ symptoms, exercise tolerance, frequency of hospitalization, and quality of life were also dramatically improved by BVP. Furthermore, combination of BVP and oral administration of amiodarone significantly prevented recurrence of ventricular tachycardia and paroxysmal atrial fibrillation, and maintained sinus rhythm for a long period. Conclusions: In view of these findings, BVP therapy may contribute to the development of new therapeutic method for patients with severe CHF due to DCM.     

康复运动护理对老年慢性充血性心衰患者焦虑和抑郁状态的影响

目的:探讨康复运动护理对改善老年慢性充血性心衰患者焦虑和抑郁状态的效果.方法:对32例病情稳定的老年慢性充血性心衰患者在接受常规药物治疗的基础上结合康复运动护理,半年为1个疗程.于康复运动前后对32例患者进行焦虑和抑郁自评量表测评,观察其焦虑和抑郁状态的改善情况.结果:康复运动护理后32例患者焦虑和抑郁自评量表评分均低于康复运动前,焦虑和抑郁情况明显改善(P＜0.05).结论:康复运动护理可有效改善老年慢性充血性心衰患者的焦虑和抑郁情绪.     

胺碘酮与普罗帕酮转复心房颤动临床比较

目的胺碘酮与普罗帕酮转复心房颤动临床比较。方法我院入选的74例患者按随机数字表法分为胺碘酮组和普罗帕酮组。胺碘酮组（37例）：将胺碘酮150mg加入葡萄糖20mL,15min左右缓慢静脉推注,继之胺碘酮300mg加入葡萄糖500mL,以0.5-1mg/min静滴维持。复律成功后,口服胺碘酮维持。普罗帕酮组（37例）：70mg普罗帕酮静脉注射,于15min左右完成。推注完毕尚未转复者,继之140mg以0.5-1mg/min静滴。复律成功后,口服胺碘酮维持。所有患者均予持续24h心电监护,记录房颤转复的时间,比较两组患者转复率。结果胺碘酮组37例转复成功27例（72.97%）;普罗帕酮组37例转复成功19例（51.35%）;转复成功率胺碘酮组高于普罗帕酮组,差异有显著性（P〈0.05）。两组均未出现明显不良反应。结论胺碘酮治疗心房颤动比普罗帕酮效果好且安全可靠。     

Anaemia and congestive heart failure early post-renal transplantation.

BACKGROUND: Anaemia is common following renal transplantation and is associated with the development of congestive heart failure (CHF). However the prevalence of anaemia in the first year following transplantation and the association between anaemia occurring early and the development of CHF have been understudied. METHODS: In this study, 132 incident patients undergoing tacrolimus and mycophenolate mofetil-based renal transplantation were studied for the prevalence of, and risk factors for, anaemia and CHF in the early period post transplantation. RESULTS: Anaemia occurred in 94.5% and 53.1% of patients at 1 week and 12 months, respectively, and was associated with allograft dysfunction, hypoalbuminaemia, higher mycophenolic acid (MPA) levels, bacterial infection and hypoalbuminaemia. The association with hypoalbuminaemia may reflect the presence of chronic inflammation post-transplantation. Of patients displaying haemoglobin <11 g/dl, 41.1% and 29.4% were treated with erythropoiesis stimulating agents (ESAs) at 1 and 12 months respectively. CHF developed in 26 patients beyond 1 month post-transplantation, with echocardiographic left ventricular systolic function preserved in all but one. CHF was associated with anaemia and lower haemoglobin, allograft dysfunction, duration of dialysis and left ventricular hypertrophy on echocardiography prior to transplantation, suggesting the aetiology of CHF may involve the interplay of diastolic cardiac dysfunction, pre-load mismatch and after-load mismatch. CONCLUSIONS: Modification of risk factors may improve anaemia management post transplantation. Reducing the prevalence of anaemia may in turn reduce the incidence of CHF-these observations support the need for clinical trials to determine how anaemia management may impact CHF incidence.     

导管射频消融治疗阵发性心房颤动两种术式疗效对比

目的比较节段性肺静脉电隔离术（SPVI）和环肺静脉前庭电隔离术（CPVA）对阵发性心房颤动射频消融治疗的临床疗效。方法选取68例行导管射频消融治疗的阵发性心房颤动患者,根据所采用的术式分为SPVI组（30例）和CPVA组（38例）,比较两组手术时间、X线暴露时间及复发率。结果CPVA组手术时间为（171．0±25．8）min,SPVI组为（168．2±21．7）min,两组比较差异无统计学意义（P：0．579）。CPVA组x线暴露时间为（38．5±8．4）min,SPVI组为（45．8±16．1）min,两组比较差异有统计学意义（P=0．019）。所有病例平均随访（17．1±7．8）个月,CPVA组复发率为5．3％,SPVI组为233％,两组比较差异有统计学意义（P=0．029）。两组均未发生严重并发症。结论导管射频消融治疗阵发性心房颤动,CPVA比SPVI具有更少的X线暴露时间和更低的复发率,且不增加手术时间和手术风险。