多普勒超声获取左室射血时间与二尖瓣返流持续时间比值评价左室收缩功能

本文探讨应用多普勒获取左室射血时间与二尖瓣返流持续时间比值评价左室收缩功能。４７例接受彩色多普勒检查存在返流者，根据返流大小分为轻、重度返流者。结果表明：应用多普勒获取校正ＬＶＥＴ／ＭＲ－ｄ比值与超声心动图双平面面积－长度Ｓｉｍｐｓｏｎ法估测ＬＶＥＦ在全部受检者及轻、重度返流组分别存在较好相关性（ｒ＝０．６５、ＳＥＥ１７％；ｒ＝０．８０ＳＥＥ９％；ｒ＝０．６８ＳＥＥ１９％），同时根据校正ＬＶＥＴ／ＭＲ－ｄ比值估测左室收缩功能障碍存在较高的敏感性、特异性及准确率。因此用校正ＬＶＥＴ／ＭＲ－ｄ比值可用于评价左室收缩功能。     

Presumptive Tricuspid Valve Malfunction Induced by a Pacemaker Lead: A Case Report and Review of the Literature

A 23-year-old woman developed 3 degrees AV block with syncope. Insertion of a permanent pacemaker lead was followed by the onset of a persistent murmur in late systole preceded by single or multiple clicks. The murmur was best heard at the left sternal edge, grade 3-4/6 with two major frequencies (60-250 Hz), increased with inspiration and on assuming the erect posture. It was considered to be tricuspid in origin and related to interference of the tricuspid valve apparatus by the pacemaker lead resulting in tricuspid regurgitation. No tricuspid valve prolapse or flutter was seen on echocardiography. Withdrawal of the pacemaker lead resulted in immediate disappearance of the new auscultatory findings. Review of the literature suggests that the appearance of such a murmur following pacemaker insertion could be associated with later complications in relation to tricuspid valve dysfunction. It is therefore recommended that, under these circumstances, permanent pacemaker leads should be appropriately repositioned.     

LEJ-1全方向M型超声心动图系统对左室局部与整体 收缩功能量变关系的研究

目的 采用全方向M型超声心动图测定左室局部室壁的收缩功能指标。观察局部室壁的收缩功能与整体收缩功能的量变关系。方法 研究对象为正常组及不同心功能状态的心梗组。采用福州大学无线电系研制的LEJ-1全方向M型心动图系统，对胸骨旁左心室短轴二尖瓣水平、乳头肌水平、心尖水平的二维图像进行采集和定标，用手动分析法对左心室前、侧、后、下、前间隔和后间隔16个室壁节段的运动曲线测量收缩幅度(R)，收缩末厚度(Ts)，舒张末厚度(Td)，每个测值取连续三次测量的平均值，并计算室壁增厚率(△T％)。结果 心梗各组受累节段的局部收缩幅度R和室壁增厚率△T％的平均测值均较正常组小；而且各组所有节段R和△T％的平均测值与整体收缩功能指标具有良好的相关性；以△T％的结果来看Ⅰ组受累面积平均约10．63％(1．7段)，Ⅱ组约14．38％(2．3段)，Ⅲ组约26．25％(4．2段)，Ⅳ组约53．75％(8．6段)，说明随着局部收缩功能受累范围的扩大，整体收缩功能下降；当明显受累室壁节段达2个(面积约12．5％)以上时，整体收缩功能指标EF才会低于正常。结论 左室局部收缩功能受累范围和程度与左室整体收缩功能减退程度存在明显正比例量变关系。     

收缩期喀喇音82例分析

本文报告经心音图证实的收缩期喀喇音82例,经超声心动图证实绝大多数(82％)伴有二尖瓣脱垂。喀喇音可由多种病因引起,但多属特发性。本文从临床特点,心音图,心电图及心动图等方面进行分析,并作扼要讨论。     

单纯性收缩期高血压患者的亚临床炎症状态

目的探讨单纯性收缩期高血压患者的亚临床状态及其与血压高低的关系。方法采用分组对照研究方法，测量80例单纯性收缩期高血压患者（研究组）的超敏C-反应蛋白（Hs-CRP）水平，并与80例血压正常且年龄、性别与研究组匹配者（正常对照组）进行对照比较。根据80例单纯性收缩期高血压患者收缩压高低进一步分为3组，同时对血清Hs-CRP水平进行比较。结果研究组的血脂及Hs—CRP水平与正常对照组比较差异均有显著性，研究组中平均收缩压高低与Hs—CRP成正比关系。结论单纯性收缩期高血压患者存在亚临床炎症状态，且与收缩压高低有相关性。     

Left atrial systolic function is depressed in idiopathic and preserved in ischemic dilated cardiomyopathy

BACKGROUND: Left atrial systolic dysfunction, unexplained by altered loading conditions, has been reported in idiopathic dilated cardiomyopathy suggesting left atrial involvement in the myopathic process. MATERIALS AND METHODS: Seventeen patients with idiopathic dilated cardiomyopathy, 16 with ischemic dilated cardiomyopathy and 18 normal controls were studied with transthoracic echocardiography and cardiac catheterization. Transmitral diastolic flow was evaluated with pulsed Doppler. Left atrial volume (cm3/m2) at mitral valve opening (maximal, Vmax.), onset of atrial systole (P wave of the electrocardiogram, Vp), and mitral valve closure (minimal, Vmin. ) was determined with two-dimensional echocardiography using the biplane area-length method. The left atrial active emptying fraction (ACTEF = [Vp-Vmin.] x 100/Vp) served as an index of systolic function. RESULTS: The peak early diastolic transmitral flow velocity (cm/sec) was similar in the three groups (idiopathic: 60 +/- 16, ischemic: 58 +/- 20, control: 56 +/- 22; P = NS), whereas the late diastolic transmitral flow velocity was lower but not significantly different in idiopathic compared to ischemic cardiomyopathy, and in both was lower than control (26 +/- 12 vs. 34 +/- 13 vs. 44 +/- 14, respectively; P < 0.05). Vmax. and Vp were similar in idiopathic and ischemic cardiomyopathy and greater than control (44.6 +/- 13.6 vs. 48.2 +/- 18.3 vs. 26.9 +/- 6.2; P < 0.05, and 34.6 +/- 13.4 vs. 30.8 +/- 10.9 vs. 16.7 +/- 3.7, respectively; P < 0.05). ACTEF was lower in idiopathic than in ischemic cardiomyopathy and in the latter it was similar to control (18 +/- 10% vs. 32 +/- 10% vs. 36 +/- 10%, respectively; P < 0.05). Moreover, ACTEF was inversely related to left atrial tension at end-of atrial systole both in idiopathic and in ischemic cardiomyopathy (r2 = 0.52, P = 0.001 and r2 = 0.57, P = 0.0007, respectively). However, at any given level of left atrial tension at end of atrial systole, ACTEF was lower in idiopathic than ischemic cardiomyopathy. CONCLUSION: Left atrial systolic function is depressed in idiopathic and preserved in ischemic dilated cardiomyopathy despite similar left atrial loading conditions. This finding suggests left atrial myopathy in the former, and may be related to the differences in the response to medical treatment and clinical outcome observed between the two conditions.     

多普勒组织成像评价陈旧性前间壁心肌梗死患者的左室收缩功能

目的采用多普勒组织成像技术(TDE)测量二尖瓣环收缩期下行速度,评价陈旧性前间壁心肌梗死患者的左室收缩功能。方法对30例正常人和38例陈旧性前间壁心肌梗死患者的二尖瓣环收缩期下行速度(MAV)进行测量,取样容积分别置于心尖四腔心切面及两腔心切面上的二尖瓣环间隔、侧壁、前壁和下壁处,并计算各点均值。结果陈旧性心肌梗死患者各点的收缩期下行速度均较正常对照组下降(P<0.01),以前壁、间壁处为明显。其二尖瓣环下行速度的均值(MAV-m)与Simpson方法测量的左室射血分数EF值有良好的相关性,相关系数为0.91(P<0.01)。结论采用多普勒组织成像技术测量二尖瓣环收缩期下行速度,可作为评价陈旧性心肌梗死患者的左室收缩功能的新指标。     

超声检查对乳腺实性肿块内血液动力学研究

目的　评价多普勒血流显像技术检测乳腺实性肿块内血流对乳腺实性肿块的定性诊断。方法　对乳腺实性肿块患者 97例进行超声检查及肿块内血流检测 ,并与术后组织病理学诊断对照。结果　 2 4例乳腺恶性肿块 2 2例测及动脉血流 ,收缩期最高峰速 (PSV)平均值 (30 .2 8± 2 0 .13) cm/s,阻力指数 (RI)平均值 0 .84 9±0 .0 98,73例乳腺良性肿块 4 4例测及动脉血流 ,收缩期最高峰速 (PSV)平均值 (2 0 .4 4± 11.4 3) cm/s,阻力指数 (RI)平均值 0 .6 12± 0 .0 98。当以 PSV=12 cm/s为乳腺良、恶性肿块的界限时 ,PSV诊断乳腺良、恶性肿块的敏感性率和特异性率分别为 87.5 %及 5 7.5 % ,当以 RI=0 .70为乳腺良、恶性肿块的界限时 ,RI诊断乳腺良、恶性肿块的敏感性率和特异性率分别为 87.5 %及 87.7%。二者敏感性率无显著差异 ,而 RI诊断乳腺恶性肿块的特异性率明显高与 PSV,差异具有显著性 (P<0 .0 1)。结论　用多普勒血流显像技术检测乳腺实性肿块的异常血流的 RI对乳腺实性肿块的性质预测具有一定的临床意义     

拜心同、倍也乐克治疗老年收缩期高血压疗效观察

目的 :探讨拜心同、倍他乐克治疗老年收缩期高血压的疗效。方法 :选择单纯收缩期高血压病人 43例 ,用拜心同、倍也乐克治疗 6周后 ,以自身对照比较治疗前后患者临床指标 ,评估其临床有效性和安全性。结果 :服药 1周 ,有效率 76 .7% ,服药 6周 ,有效率 93 %。结论 :在应用拜心同     

矫正的主动脉血流参数在评价左室收缩功能中的价值

为了评价矫正后的主动脉血流参数，与左室收缩功能（LVEF）的关系，我们在25例上常人（A组）、30例陈旧性心梗（B组）和26例扩张型心肌病（C组）中，利用二维和多普勒超声技术，测量了左室射血分数（LVEF）、主动脉血流参数（Vp、MAC）及由容积和面积矫正后的主动脉血流参数结果显示，矫正后的主动及血流参数与LVEF高度相关（r=O．71～0．89、p＜0．001）。结论：矫正后的主动脉血流参数更能准确反映左室收缩功能。     

Usefulness of free-angle M-mode echocardiography in assessing left ventricular dimension and left ventricular systolic function

Objectives To assess the usefulness of free-angle M-mode echocardiography in measuring left ventricular (LV) dimension and global systolic function. Background The validity of conventional M-mode echocardiography in assessing LV dimension and global systolic function is well known; the incidental angle between the M-mode cursor and true LV minor axis diameter, however is a potential cause of measurement error. Free-angle M-mode echocardiography may overcome the limitation of M-mode cursor arrangement in conventional M-mode echocardiography. Methods Thirteen normal volunteers and 10 patients in whom abnormal left ventricular wall motion was not detected by echocardiography (mean age, 53±17 years) were enrolled in this study. Conventional and free-angle M-mode echocardiographic images of the LV were obtained by echocardiography (ALOKA SSD-5500) using a 2.5-MHz transducer, and the LV end-diastolic (LVDd) and end-systolic (LVDs) dimensions were measured by the leading edge method. LV end-diastolic and end-systolic volumes were calculated using a formula by Teichholz, and the LV ejection fraction (LVEF) was obtained. Data from conventional M-mode echocardiography and free-angle M-mode echocardiography were then compared. Results Measurements obtained with conventional M-mode and free-angle M-mode echocaardiography were strongly correlated. Correlation coefficients for LVDd, LVDs, and LVEF were 0.98, 0.98, and 0.96, respectively (p<0.001 in each case). Conclusions Assessment of left ventricular dimension, and global systolic function with free-angle M-mode can be as accurate as conventional M-mode in subjects in whom left ventricular wall motion abnormality is not detectable by echocardiogram. Moreover, when there is improper M-mode cursor direction in conventional echocardiography, free-angle M-mode echocardiography can assess global left ventricular systolic function more accurately and conveniently than conventional M-mode echocardiography.     

彩色室壁运动分析技术定量评价心肌梗塞患者局部收缩功能

目的： 探讨彩色室壁运动分析技术对心肌梗塞患者节段性室壁运动异常的诊断价值。方法： 用彩色室壁运动分析技术对２８ 例心肌梗塞患者和３０ 例正常人进行定量对比分析。结果：心肌梗塞组与正常对照组室壁运动幅度存在显著性差异 （Ｐ＜ ０００１）, 心肌梗塞组病变节段彩色位移消失或明显减弱, 易与正常节段鉴别。并可实时显示室壁位移及位移的时相。图像显示直观, 判断结果迅速。结论： 彩色室壁运动分析技术可作为定量评价室壁运动状态的指标之一, 为临床医生提供更详尽的信息。     

LEJ-1全方向M型超声心动图对正常人左室局部收缩舒张功能的研究

目的　采用全方向M型超声心动图测定左室各节段室壁的收缩、舒张功能参数 ,了解正常人左心室上、中、下三个节段不同室壁的短轴方向局部运动状况 ,作为进一步研究的正常对照。方法　国产LEJ 1全方向M型心动图系统 ,对胸骨旁左室短轴二尖瓣水平、乳头肌水平、心尖水平的二维图像进行采集和定标 ,用手动分析法对左室 16个室壁节段的运动曲线进行测量 ,测量参数包括 :收缩期最大运动幅度 (R) ,收缩末期室壁厚度 (Ts) ,舒张末期室壁厚度 (Td) ,舒张三分之一时室壁厚度 (T1/3d) ,心内膜舒张早期运动速度 (Vd)与收缩期最大运动速度 (Vs) ,以及心电图R波顶点到室壁舒张开始的时间间隔 (R d) ,每种测定取连续三次测量的平均值 ,并计算室壁增厚率 (△T % )、舒张早期运动速度与收缩期最大运动速度的比值 (Vd/Vs)及舒张三分之一时室壁变薄率 (△T1/3d % ) ,以及 16节段室壁R d的最大差值R D。结果　左室各节段室壁的局部功能指标平均测值 :R为 ( 8.97± 1.5 )mm ,△T %为 ( 5 6.47± 8.2 ) % ,Vs为 ( 3 8.0 7± 9.0 )cm/s ,Vd为 ( 4 7.67± 13 .9)cm/s ,Vd/Vs为 1.2 5± 0 .17,△T1/3d %为 ( 64 .84± 6.2 7) %。总体看 ,后壁各项指标测值较大 ,而室间隔的较小 ;中、上段室壁的收缩和舒张运动较心尖段强。结论　全     

Evidence-based care for the elderly with isolated systolic hypertension

This paper reviews the epidemiology, pathophysiology and clinical significance of isolated systolic hypertension (ISH) in the elderly. Aging is associated with structural and functional changes in the arterial tree. Intimal thickening, migration of small muscle cells to the intima, medial fibrosis, and elastic fiber degeneration result in increased arterial stiffness and ISH. The augmented systemic vascular resistance in the elderly is mediated by increased arterial stiffness. Aging is correlated with overactivity of the sympathetic nervous system, reduced neuronal plasma norepinephrine uptake, and baroreceptor dysfunction. These functional changes all contribute to the development of ISH in elderly persons. Prospective and epidemiological studies have demonstrated that ISH is associated with coronary and cerebrovascular morbidity and mortality. There is good evidence indicating that lifestyle modifications such as weight reduction, increased physical activity, moderation of dietary sodium, and decreased alcohol intake, in combination with pharmacological therapy can effectively reduce blood pressure in elderly individuals with ISH. Primary health care providers can make significant contributions to the care of elderly persons with ISH. These contributions involve educating elderly people to control hypertension through lifestyle modification, monitoring the efficacy of antihypertensive therapy, and preventing complications associated with non-compliance with therapeutic regimens.     

L-肉碱对维持性血液透析患者慢性左心功能不全的疗效观察

目的观察L-肉碱(LC)对伴有左心室收缩功能减退的维持性血液透析(HD)患者的疗效.方法入选患者随机分为贝那普利组(A组)和贝那普利组 LC组(B组),疗程6个月,观察两组治疗前后心脏结构和功能的变化.结果两组治疗前后心脏左心室收缩功能、舒张功能、左心室重量指数都显著性改善,但仅左心室收缩功能在B组比A组显著性提高.结论对伴有左心室收缩功能减退的HD患者补充LC可以提高其左心室收缩功能,而对舒张功能,左心室重量指数无显著性改善.     

普伐他汀治疗老年单纯收缩期高血压的疗效与安全性

目的:研究普伐他汀治疗老年单纯收缩期高血压(ISH)的疗效和安全性.方法:选取老年ISH患者102例,随机分为对照组和治疗组,对照组给予苯磺酸氨氯地平5 mg,每日1次口服,治疗组在此基础上加用普伐他汀20 mg,每晚1次口服,疗程1年.分别在用药前后监测血压、脉压(PP)、血脂、心脑血管事件发生率和不良反应.结果:治疗1年后,两组收缩压(SBP)、舒张压(DBP)及PP与治疗前比较均下降,差异有统计学意义(P＜0.01),治疗组SBP及PP与对照组比较,差异有统计学意义(P＜0.05),DBP差异无统计学意义(P＞0.05);治疗后两组血脂指标比较,差异有统计学意义(P＜0.05);两组1年内心血管病因住院率比较差异有统计学意义(P＜0.05),脑血管病因住院率差异无统计学意义(P＞0.05),总心、脑血管事件发生率差异有统计学意义(P＜ 0.05);对照组出现1例轻微头痛,治疗组出现1例肝功能轻微异常,均未特殊处置.结论:普伐他汀对老年ISH患者有协同降压的作用,可缩小PP、降低血脂,减少心血管事件发生,且不良反应少,安全,可靠.     

长期小剂量利尿剂治疗慢性收缩性心力衰竭的疗效和安全性观察

目的观察长期口服小剂量利尿剂治疗慢性收缩性心力衰竭的疗效和安全性。方法将61例慢性收缩性心力衰竭患者随机分为A（n=31）、B（n=30）2组。在给予ACEI、β受体拮抗剂等治疗的同时,A组给予氢氯噻嗪;B组给予呋塞米。于服药开始及服药后3、6、12个月分别监测左室射血分数（LVEF）、血尿酸、空腹血糖、血肌酐及血清钾等指标,并进行6min步行试验。结果2组治疗6个月后,LVEF、6min步行试验结果与治疗前相比,均显著增加（P〈0．05）;2组治疗前后血尿酸、空腹血糖、血肌酐及血清钾等均无显著改变（P〉0．05）。结论长期口服小剂量利尿剂治疗慢性收缩性心力衰竭的疗效可靠、安全。     

多普勒组织成像评价早期糖尿病心肌病左室收缩功能的实验研究

目的 :利用多普勒组织成像 ( DTI)评价链尿佐 ( STZ)诱导的兔糖尿病 ( DM)早期糖尿病心肌病左室收缩功能障碍出现、发展的过程和规律 ,探讨糖尿病心肌病心脏收缩功能障碍发生的机制。方法 :5 6只实验兔用查表法随机抽出 10只 ,作为第 1组 (正常对照组 ) ,其余 46只进行糖尿病模型复制 ;糖尿病模型复制采用进口药 STZ ( 6 5 mg/ kg) ,耳缘静脉注射药物后 2 4小时内随机血糖高于 340 mg/ 10 0 ml,并能稳定 5天即可为成功模型。模型复制成功后用查表法随机分成 4组 ,即 2周、 4周、 6周、 8周检测组每组在超声检测后处死 ,取心脏送 HE染色光镜检查。超声检测采用 PW- DTI模式分析 DM兔二尖瓣环后间隔和侧壁处的 DTI各指标 :收缩期峰速度 ( Sa)、射血前时间 ( PEP)、局部射血时间 ( ET)、二尖瓣环 4个不同部位平均收缩速度值 Vm。结果 :1.糖尿病心肌病收缩功能障碍出现在模型成功复制 6周 ,表现为 :后间隔和侧壁 Sa显著降低 ( P<0 .0 5 ) ,二尖瓣环水平 4个不同部位平均收缩速度值减小。后间隔处射血前时间在第 8周出现有显著意义的延长 ( P<0 .0 5 ) ,侧壁处局部射血时间在第 8周出现有显著意义的延长 ( P<0 .0 5 )。从而导致左室壁收缩的不同步 ;2 .病理检查发现 :心室肌细胞轻度浊肿 ,胞质内出现空泡 ,心