急诊体外自动除颤仪频繁电除颤抢救急性心肌梗死后电风暴的干预方法分析

目的:探究急性心肌梗死后电风暴患者采用急诊体外自动除颤仪频繁电除颤抢救的效果。方法:选择2018年1月~2019年1月在本院治疗的30例急性心肌梗死后电风暴患者作为研究对象,均实施体外自动除颤仪频繁电除颤抢救干预措施,比较干预前后患者焦虑、抑郁的情况。结果:干预后患者的HAMA和HAMD评分均低于干预前,差异有统计学意义(P<0.05)。结论:急诊体外自动除颤仪频繁电除颤干预能改善患者抑郁、焦虑情绪,有助于治疗的顺利进行。     

针对性护理在体外自动除颤仪频繁电除颤抢救急性心肌梗死后电风暴患者中的应用

目的 探究针对性护理在体外自动除颤仪频繁电除颤抢救急性心肌梗死后电风暴患者中的应用效果.方法 选取2019年6月至2020年6月天津市第一中心医院收治的45例急性心肌梗死后电风暴患者作为研究对象,所有患者均给予体外自动除颤仪频繁电除颤抢救,并配合针对性护理,比较患者干预前后的汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量...     

急性心肌梗死患者并发电风暴1例的护理

总结对急性心肌梗死并发电风暴的识别、抢救及围手术期康复护理的体会.该文对1例急性心肌梗死并发电风暴的患者进行围手术期护理,尤其是快速除颤、安全转运、心肌缺血的观察等,经过周密护理,患者恢复良好出院.快速识别及时电除颤能够为之后的抢救成功争取时间,减少并发症,提高患者生活质量.     

急性心肌梗死PCI术后患者的血清NT-proBNP、ICTP、MMP-9水平及其临床意义研究

目的分析急性心肌梗死PCI术后患者的血清NT-proBNP、ICTP、MMP-9水平,并分析其临床意义。方法选取2016年2月至2018年8月因急性心肌梗死在本院行PCI手术的300例患者为研究对象,根据术后是否发生心血管不良事件分为发生组和未发生组。比较不同临床特征患者心血管不良事件发生率的差异,分析影响心血管不良事件发生的危险因素。结果 300例急性心肌梗死PCI术后患者发生心血管不良事件的例数为40例,心血管不良事件发生率为13.33%;BMI≥24 kg/m2、合并高脂血症、置入支架数目≥2个、支架直径≥3 mm的急性心肌梗死PCI术后患者发生心血管不良事件发生率较高,发生心血管不良事件的患者NT-proBNP较高、MMP-9水平较低,不同年龄、性别、饮酒史、吸烟史、糖尿病史、卒中史、ICTP水平的患者心血管不良事件发生率差别无统计学意义;将单因素分析有统计学差异的因素作为自变量,将是否发生血栓作为因变量,进行多因素Logistic回归分析,结果显示置入支架数目和MMP-9水平的OR值分别为5.204和4.342。结论置入支架数目和MMP-9水平是影响急性心肌梗死PCI术后患者心血管不良事件发生的独立危险因素,提示临床应早期监测血清MMP-9等指标。     

心血管危重症继发交感风暴37例临床分析

目的:探讨心血管危重症继发交感风暴的病因分布特点和治疗方法.方法:回顾性分析我院2001年-2011年37例心血管危重症继发交感风暴临床资料.结果:37例心血管危重症继发交感风暴患者,其中男性22例,女性15例,年龄55-82岁,平均68.25岁.病因分布为:心肌梗死29例,心衰3例,扩张性心肌病2例,电解质紊乱2例,Brugada综合征1例.治疗方法包括β受体阻滞剂、胺碘酮、利多卡因、电除颤等.其中,17例因反复发作室颤,经抗心律失常药物和电除颤治疗无效死亡,余20例病情得到控制.结论:心血管危重症继发交感风暴临床病因多样,病情凶险,应用β受体阻滞剂及抗心律失常药物,同时积极针对病因及诱因治疗,可以改善临床症状和预后.     

急性心肌梗死并发室颤多次心脏电除颤3例报告

1　临床资料1 1　一般资料　 3例病人均为男性 ,年龄 42～ 70岁 ,平均5 0 7岁 ,临床诊断均为急性大面积心肌梗死。例 1室颤发生于入院后第 18天 ,例 2室颤发生于急诊中 ,例 3室颤发生于入院途中。 3例病人均未行溶栓治疗。1 2　心脏电除颤　除颤电功率 2 40～ 36 0瓦秒 ,除颤次数 3～ 15次。例 142ｈ内除颤 15次 ,例 2 6ｈ内除颤 8次 ,例 310ｍｉｎ内除颤 3次。1 3　临床及预后　 3例均为有痛性急性心肌梗死 ,经电除颤复律后胸壁有电极板致红斑和 /或灼伤 ,心肌酶明显升高 ,无急性肺水肿、栓塞、窦性静止等电除颤并发症发生。例 1、3为心肺…     

一例青少年扩张型心肌病患者反复电风暴发作的抢救护理与康复

电风暴（electrical storm,ES）指24小时内快速室性心动过速（室速）和（或）心室颤动（室颤）反复发作2次或2次以上[1],又称室速风暴、交感风暴、ICD风暴等,是心源性猝死的重要原因。电风暴发作可导致严重的血流动力学障碍,甚至死亡,若抢救不及时,病死率极高,而且护理质量如何对患者的预后有着直接影响[2]。尽快进行电除颤和电复律是恢复血流动力学稳定的首要措施。我院于2013年10月收治1例青少年扩张型心肌病患者反复发作电风暴,经积极心肺复苏、电复律、维持电解质水平及严密监护和良好护理配合,最后行射频消融术治疗后痊愈出院,跟踪随访与康复指导1年,患者心脏基础疾病较前明显好转,且再无恶性心律失常发生,现将抢救护理和康复指导过程介绍如下。     

直接经皮冠状动脉介入治疗围手术期发生电风暴的危险因素

目的 探讨急性心肌梗死(AMI)患者直接经皮冠状动脉介入治疗(PCI)围手术期发生电风暴的危险因素.方法 对41例AMI患者行直接PCI,将围手术期发生电风暴的患者纳入电风暴组,未发生电风暴的患者纳入对照组.电风暴定义:24h内自发的室性心动过速/心室颤动≥2次,并且不能自行终止,需要紧急治疗者.比较两组患者临床资料的差异.结果 41例行直接PCI患者中发生电风暴7例(电风暴组),发生率17.07％；未发生电风暴34例(对照组).两组收缩压、舒张压、白细胞计数、随机血糖、国际标准化比值、胸痛发作至直接PCI时间比较差异均无统计学意义(P＞0.05).而电风暴组年龄、肌酸激酶同工酶-MB、心肌肌钙蛋白I、梗死相关动脉直径、再灌注心律失常发生率以及病死率明显高于对照组(P＜ 0.05或＜0.01).梗死相关动脉为左主干或两支主要冠状动脉近中段闭塞、右冠状动脉、左前降支和左回旋支的患者在围手术期电风暴发生率分别为66.67％(2/3)、18.75％(3/16)、11.76％( 2/17)和0.结论 直接PCI围手术期发生电风暴最常见于梗死相关动脉为左主干或两支主要冠状动脉近中段闭塞的AMI患者.梗死相关动脉直径、梗死相关动脉开通后TIMI血流分级以及再灌注心律失常是围手术期发生电风暴的主要危险因素.     

2例急性心肌梗死合并多次室颤电除颤抢救成功报告分析

目的探讨电除颤对心肌梗死伴有多次室颤的抢救方法。方法对2例心肌梗死伴有多次室颤患者实施电除颤的方法进行急救,并辅助一定的药物治疗,包括心电监护、球囊呼吸复苏仪支持呼吸、纠正水电解质紊乱及酸碱平衡失调,及静滴胺碘酮、多巴胺、肾上腺素等。结果两例患者经多次电除颤抢救成功,病情得到明显的控制和恢复,在随访期间,生命体征稳定,无并发症及后遗症。结论电除颤抢救为急性心肌梗死合并多次室颤的首选治疗策略,治疗过程中,应根据患者个体情况制定针对性的电除颤策略和用药策略,在此基础上,进行密切的心电监护,快速准确的识别心律变化征象,熟练运用电除颤的治疗技巧,是提高抢救成功率的重要保障。     

急性心肌梗死患者医院感染危险因素分析及对策

目的研究急性心肌梗死患者医院感染的流行病学特征,分析其危险因素及预防策略,以期为急性心肌梗死患者医院感染的预防提供参考依据。方法采用横断面研究法,调查2013年12月-2015年9月317例急性心肌梗死住院患者临床资料、医院感染率以及医院感染流行病学特征;根据感染的特点,对多项可能的急性心肌梗死患者医院感染危险因素进行单因素和多因素分析。结果 317例急性心肌梗死患者共发生感染37例、41例次,医院感染率为11.67%;感染部位以呼吸道为主,共发生25例次,占60.98%;单因素分析结果显示,年龄、住院天数、糖尿病、慢性阻塞性肺疾病、心功能等级、预防性应用抗菌药物等是影响患者医院感染的危险因素,经非条件logistic回归分析结果显示,年龄≥60岁、住院天数≥7d、合并糖尿病、合并慢性阻塞性肺疾病、心功能等级Ⅲ~Ⅵ等为急性心肌梗死患者发生医院感染的独立危险因素。结论急性心肌梗死患者医院感染的高危险因素有高龄、合并基础疾病、心功能差等,针对这些人群应提前采取预防措施以降低医院感染的发生率。     

慢性肺源性心脏病患者急性心肌梗死特征及临床分析

目的探索慢性肺源性心脏病患者并发急性心肌梗死的临床特征。方法将笔者所在科室2007年3月～2010年9月期间收治的54例慢性肺源性心脏病伴发AMI患者与48例单纯AMI患者的临床诊疗资料进行回顾性对照分析。结果在室性早搏及传导阻滞方面，慢性肺源性心脏病组较非慢性肺源性心脏病组有着较高的发生率，均P〈0．05；在并发心律失常及心力衰竭方面，慢性肺源性心脏病组的发生率显著高于非慢性肺源性心脏病组，P〈0.05；两组患者在其他并发症的发生率方面比较差异无统计学意义，P〉0．05。结论慢性肺源性心脏病患者突发心律失常、急性左心衰或心源性休克时，应高度重视伴发AMI的可能性。     

Stem cell therapy in cardiovascular diseases

Myocardial infarction is the leading cause of congestive heart failure in the industrialized world. Current treatments fail to address the underlying scarring and cell loss, which are the causes of ischaemic heart failure. Recent interest has focused on stem cells, which are undifferentiated and pluripotent cells that can proliferate, potentially self-renew, and differentiate into cardiomyocytes and endothelial cells. Myocardial regeneration is the most widely studied and debated example of stem cell plasticity. Early reports from animal and clinical investigations disagree on the extent of myocardial renewal in adults, but evidence indicates that cardiomyocytes were generated in what was previously considered a postmitotic organ. So far, candidates for cardiac stem cell therapy have been limited to patients with acute myocardial infarction and chronic ischaemic heart failure. Currently, bone marrow stem cells seem to be the most attractive cell type for these patients. The cells may be delivered by means of direct surgical injection, intracoronary infusion, retrograde venous infusion, and transendocardial infusion. Stem cells may directly increase cardiac contractility or passively limit infarct expansion and remodeling. Early phase I clinical studies indicate that stem cell transplantation is feasible and may have beneficial effects on ventricular remodeling after myocardial infarction. Future randomized clinical trials will establish the magnitude of benefit and the effect on mortality after stem cell therapy.     

The role of aldosterone-antagonists in the treatment of congestive heart failure

The role of aldosterone-antagonists in the treatment of congestive heart failure. Despite the advances of the treatment of congestive heart failure, nearly half of the patients diagnosed with this disease five years ago are alive today. Experimental and human studies have demonstrated, that under special pathologic condition, the heart extracts aldosterone, and aldosterone extraction in the heart stimulates increased collagen turnover culminating in ventricular remodeling. Aldosterone blockade has been shown to be effective in reducing total mortality and hospitalization for heart failure in patients with systolic left ventricular dysfunction due to chronic heart failure (RALES study with spironolactone) and in patients with systolic left ventricular dysfunction post acute myocardial infarction (EPHESUS study with eplerenone). These clinical studies have shown that mineralocorticoid receptor activation remains important despite the use of angiotensin converting enzyme inhibitor or angiotensin receptor blocking agent and a beta blocker. In the ACC/AHA (and in the European and Hungarian) guidelines for the evolution and management of chronic heart failure, the indication of spironolactone was defined of Class Ila, Level of Evidence: B in CHF of stage C. The eplerenone (in US: INSPRA) was approved for the management of CHF patients after myocardial infarction with ejection fraction < 40%. Eplerenone, compared with spironolactone, is associated with a lower incidence of gynecomastia and other sex hormone-related adverse effect (breast pain, menstrual abnormalities). The spironolactone should not be used in patients with a creatinine above 220 mikromol/l. Despite the guidelines recommendation, spironolactone has been widely used in patients without consideration of their functional class or ejection fraction, without optimization of background treatment with ACE inhibitors and beta-blockers.     

Vital epidemiologic clues in heart failure

The epidemiologic investigation of heart failure evolution by the Framingham Heart Study has provided vital clues concerning the pathogenesis, predisposing conditions, other predictive risk factors, and indicators of deteriorating ventricular function related to the disease. This information is important in the early detection of those susceptible to heart failure who are candidates for preventive measures-of importance because the prevalence of the disease has not declined despite the recent therapeutic advances. Epidemiologic investigation has identified useful indicators for the disease including a low or falling vital capacity suggesting diastolic dysfunction, a rapid resting heart rate in compensation for a decreased stroke volume, and cardiomegaly indicating myocardial hypertrophy or dilatation. Hypertension and coronary disease remain the leading causes of the disease, and heart failure due to myocardial infarction has increased in prevalence. Hypertension and coronary disease often coexist in individuals who develop heart failure so that correction and prevention of these conditions deserve a high priority. Early detection and correction of insulin resistance is important because a threefold increase in the prevalence of diabetes in the general population has serious implications for the incidence of heart failure. In patients with hypertension, the occurrence of a myocardial infarction increases the risk of developing heart failure five to sixfold, whereas angina increases it less than twofold. In these patients, the presence of left ventricular hypertrophy increases the risk of developing heart failure two- to threefold. Heart failure-related mortality remains unacceptably high, despite improvements in treatment, indicating a need for early detection and treatment of predisposing conditions.     

法舒地尔对急性心肌梗死合并心力衰竭的疗效分析

目的：观察法舒地尔对急性心肌梗死合并心力衰竭患者心脏功能的影响。方法：选取2011年1月-2013年10月在本院住院的80例急性心肌梗死合并心力衰竭患者,按照随机数字表法将其分为治疗组和对照组各40例,连续治疗15 d,观察治疗前后两组患者的左室收缩末期内径（LVESV）、左室舒张末期内径（LVEDV）、左室射血分数（LVEF）及血清NT-proBNP含量。结果：经治疗后两组LVESD、LVEDD和血清NT-proBNP均有不同程度减少（P〈0.05或P〈0.01）,与对照组相比,治疗组的LVESD、LVEDD和血清NT-proBNP均减少更加明显,差异均有统计学意义（P〈0.01）;两组治疗后的LVEF较治疗前均有不同程度提高,与对照组相比,治疗组的LVEF提高更加显著,差异均有统计学意义（P〈0.01）。结论：法舒地尔在治疗急性心肌梗死合并心力衰竭上有一定疗效,可以改善左室结构及射血分数,值得临床推广应用。     

Aldosterone antagonism in heart failure

Aldosterone, a neurohormone known to affect electrolytes, has recently been implicated as playing a major role in the progression of heart failure, particularly in patients with systolic dysfunction. Major clinical trials designed to analyze clinical outcomes using an aldosterone antagonist have been done in two groups with heart failure. The first was the Randomized Aldactone Evaluation Study, which was done in symptomatic chronic advanced heart failure patients and showed that an aldosterone antagonist, spironolactone, reduced mortality significantly compared with placebo. Very few of these patients were on standard therapy with beta blockade. Another study, the Eplerenone Post myocardial infarction Heart failure Efficacy and SUrvival Study (EPHESUS), done in post-myocardial infarction patients with heart failure, demonstrated a significant reduction in mortality and hospitalizations for patients randomized to the aldosterone antagonist eplerenone. These trial results provide the background for aldosterone antagonist therapy in chronic advanced heart failure patients as well as post-myocardial infarction heart failure patients with reduced ejection.     

Non-pharmacological treatment of heart failure: implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy

The non-pharmacological therapy of heart failure, in particular an implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy or biventricular stimulation, improves symptoms and survival in patients with heart failure. An ICD is indicated in many patients with heart failure following cardiac arrest unless reversible causes are demonstrable. Selected patients with a left ventricular ejection fraction < or = 35% due to either ischaemic (>40 days after a myocardial infarction) or nonischaemic cardiomyopathy are candidates for ICD implantation as the primary prevention of sudden cardiac death. Patients who continue to have severe symptoms despite maximal pharmacotherapy, with a left ventricular ejection fraction < or = 35% and a wide QRS complex, are candidates for cardiac resynchronisation therapy to improve both symptoms and survival.     

梗死部位对急诊经皮冠状动脉介入治疗患者预后的影响

目的 探讨急性心肌梗死(AMI)行急诊经皮冠状动脉介入(PCI)治疗后梗死部位与预后的关系.方法 入选121例行急诊PCI治疗的ST段抬高心肌梗死患者,根据梗死部位分为前壁组(46例)、下壁组(53例)和下壁合并右室组(22例),分析各组临床表现、ECG、心脏彩色多普勒超声及冠状动脉造影的特点,并进行随访.结果 与下壁组、下壁合并右室组相比,前壁组患者CPK同工酶-MB(CPK-MB)、心肌肌钙蛋白T升高[(387.2±45.7)U/L和(1.9±0.4)ng/L],侧支循环形成少(4.3%),3支病变血管少(13.0%),但ST段回落差,住院期间及出院1年时病死率高;下壁合并右室组患者休克及房室传导阻滞/室性心律失常发生率高(36.4%和50.0%),3支病变血管多(45.5%),血栓形成多(86.4%),因主要心脏不良事件再住院率高.结论 前壁及下壁合并右室心肌梗死是PCI治疗后患者预后差的强烈预测因子.     

血清FGF23水平与心肌梗死后心力衰竭患者心室重构的关系

目的探讨血清FGF23水平与心肌梗死后心力衰竭患者心室重构的关系。方法选择我院心血管内科2012年12月—2015年12月收治的90例慢性心力衰竭患者作为研究对象,根据患者心功能分级结果分为A组(心功能Ⅲ级,n=47)与B组(心功能Ⅳ级,n=43)。对心室重构参数,包括左室舒张末径(LVEDd)、舒张末容积(LVEDV)、室间隔舒张期厚度(IVSd)、左室收缩末容积(LVESV)、左室射血分数(LVEF)、左室后壁厚度(PWT)、左心质量指数(LVMI),行心脏彩超检查确定。并检测尿酸(UA)、血尿素氮(BUN)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)及人成纤维细胞生长因子23(FGF23)。结果A组UA、BUN、LDL、NT-BNP水平均低于B组,HDL高于B组(均P0.05)。两组LVEDd、IVSd、PWT之间的差异无统计学意义(P0.05)。A组LVEF高于B组(P0.05);LVMI与FGF23均低于B组(P0.05)。结论不同心功能分级患者的心室重构程度不同,血清FGF23浓度的改变参与慢性心力衰竭患者心室重构的病理生理过程,可作为慢性心力衰竭患者心室重构程度的生物学评估指标。