Biventicular pacing in patients with severe heart failure

According to initial clinical results biventricular pacing seems to be effective in the treatment of patients suffering from drug refractory severe heart failure combined with intraventricular conduction disturbance. Biventricular cardioverter defibrillators and biventricular pacemakers were implanted in patients suffering from drug refractory severe heart failure in 3 and in 2 cases, respectively (follow up > 6 months). NYHA III-IV functional class, low left ventricular ejection fraction (23.2 +/- 5.4%), wide QRS (> 150 ms) with left bundle branch block and lateral dyssynchrony were present in each case. The left ventricle was enlarged in each patient (end-diastolic/end-systolic diameter: 78.6 +/- 9.2/66.2 +/- 8.1 mm). The indications of cardioverter defibrillator implantations were both sustained ventricular tachycardia and ventricular fibrillation, nonsustained ventricular tachycardia combined with syncope in 2 and in 1 case, respectively. The duration of QRS decreased (190 +/- 36 vs. 134 +/- 17 ms, p = 0.012) and wall movement disorder disappeared. At the last follow up every patients were in NYHA II functional class and a decrease in left ventricular diameter could be observed (end-diastolic: 72 +/- 10.4 mm, p = 0.07; end-systolic: 62 +/- 10 mm, p = 0.09). During the follow up period (7.3 +/- 1.7 months) 18 episodes of ventricular arrhythmias could be detected in the same patient. Biventricular pacemakers and cardioverter defibrillators were implanted and applied successfully in the treatment of congestive heart failure for the first time in Hungary. The effect of biventricular pacing on morbidity and mortality, the cost-effectiveness, the exact indication and the combined use with cardioverter defibrillator have yet to be proven in future randomized trials.     

Corticosteroids benefit patients with moderate to severe COPD

Inhaled corticosteroids prevent exacerbations in patients with moderate to severe COPD. The benefit is minor, however, and steroids don't prevent exacerbations in patients with mild COPD. The prevention of exacerbations with steroids must be balanced against the higher rate of fractures and glaucoma.     

高龄老年重症急性心力衰竭的救治

目的 总结高龄老年重症急性心力衰竭的治疗经验.方法 19例平均年龄85.46±5.14岁的高龄老年重症急性左心衰患者,应用利尿剂,血管扩张剂、吗啡、气管插管人工机械辅助呼吸、主动脉内球囊反搏(IABP)及双心室起搏等治疗措施.结果 2例高血压、2例慢性肾衰尿毒症、1例肺部感染、2例陈旧性心肌梗死、2例急性心肌梗死、1例扩张性心肌病患者,经上述药物治疗后重症急性左心衰完全缓解;8例患者因1型呼衰而行气管插管,人工机械辅助呼吸;1例急性心肌梗死因低血压难以纠正行IABP.1例扩张性心肌病因反复心力衰竭行双心室起搏治疗.1例手术后重症急性心力衰竭治疗无效死亡.该19例中,18例存活,1例死亡.结论 本组以利尿剂,血管扩张剂、吗啡为主治疗高龄老年重症急性心力衰竭的疗效较好.     

有创机械通气治疗ICU重症心力衰竭的临床价值及可行性观察

目的对ICU重症心力衰竭患者应用有创机械通气治疗的临床效果进行分析研究。方法将我院ICU重症心力衰竭患者分为两组,一组接受常规治疗,一组在接受常规治疗基础上接受有创机械通气治疗,比较两组患者临床治疗效果。结果治疗组患者的治疗有效率为91.18%,常规组为70.59%,治疗组明显高于常规组患者,P〈0.05;治疗组患者治疗后的HR和R指标均明显低于常规组,SPO2指标明显高于常规组,P〈0.05。结论有创机械通气治疗在重症心力衰竭治疗上是可行的,能够有效改善患者的临床症状,改善其血气分析情况,缓解患者低氧血症,从而有效提高重症心力衰竭的临床治疗效果。     

高龄老年重症急性心力衰竭的救治

目的总结高龄老年重症急性心力衰竭的治疗经验。方法19例平均年龄85.46±5.14岁的高龄老年重症急性左心衰患者,应用利尿剂,血管扩张剂、吗啡、气管插管人工机械辅助呼吸、主动脉内球囊反搏(IABP)及双心室起搏等治疗措施。结果2例高血压、2例慢性肾衰尿毒症、1例肺部感染、2例陈旧性心肌梗死、2例急性心肌梗死、1例扩张性心肌病患者,经上述药物治疗后重症急性左心衰完全缓解;8例患者因1型呼衰而行气管插管,人工机械辅助呼吸;1例急性心肌梗死因低血压难以纠正行IABP,1例扩张性心肌病因反复心力衰竭行双心室起搏治疗。1例手术后重症急性心力衰竭治疗无效死亡。该19例中,18例存活,1例死亡。结论本组以利尿剂,血管扩张剂、吗啡为主治疗高龄老年重症急性心力衰竭的疗效较好。     

重症心力衰竭患者血脂水平的相关性研究

目的 探讨血脂水平对重症心力衰竭患者预后的影响.方法 回顾性分析149例重症心力衰竭患者的临床资料,比较不同病因及不同NYHA心功能分级患者的血脂水平,并比较低血脂水平与非低血脂水平患者预后的差异.结果 不同NYHA心功能分级患者白蛋白(ALB)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平比较差异有统计学意义(P＜0.05),而三酰甘油(TG)水平比较差异无统计学意义(P＞0.05).扩张型心肌病和风湿性心脏病患者TC、HDL-C、LDL-C水平低于冠心病合并高血压及缺血性心肌病患者,差异有统计学意义(P＜0.05).在随访的2年中,低血脂水平患者死亡、病情加重、住院次数＞2次/年及住院时间＞1个月的比例[分别为29.0％(9/31)、25.8％(8/31)、48.4％( 15/31)、61.3％( 19/31)]显著高于非低血脂水平患者[分别为9.3％(11/118)、9.3％(1 1/1 18)、17.8％(21/118)、24.6％(29/118)],差异均有统计学意义(P＜ 0.01或＜0.05).结论 重症心力衰竭患者NYHA心功能分级越高,血脂水平越低.低血脂水平将严重影响患者的预后.     

美托洛尔治疗风湿性心脏病慢性心力衰竭效果研究

目的 探讨美托洛尔对风湿性心脏病慢性心力衰竭患者血压水平及心功能的影响.方法 选取本院2016年3月-2018年4月收治的70例风湿性心脏病慢性心力衰竭患者,随机分为对照组与观察组,各35例.对照组采用常规治疗,在对照组基础上,观察组予以美托洛尔治疗.比较两组临床疗效、血压水平、心功能.结果 对照组治疗总效率为65.7...     

洛汀新治疗高血压并舒张性心力衰竭的疗效

目的评价洛汀新治疗高血压合并舒张性心力衰竭的疗效。方法入选72例高血压患者,经心脏彩色超声心动图证实为左室舒张功能不全,收缩功能正常,采用随机对照的方法,将72例患者随机分为对照组（36例）和治疗组（36例）,对照组予以硝苯地平缓释片、改变生活方式等治疗,治疗组在对照组治疗方案的基础上加用洛汀新治疗。测定治疗前后心功能、血压、心率、左室舒张末期内径（LVDd）、血糖、血脂、心电图等指标。结果治疗2～3周后,治疗组血压、心率、LVDd降低,左室舒张功能明显改善,与对照组比较有显著性差异（P〈0．05）。结论洛汀新是治疗高血压并舒张性心衰较为理想的药物。     

螺内酯治疗冠心病慢性心力衰竭的临床疗效

目的:观察螺内酯对冠心病慢性心力衰竭的临床疗效.方法:冠心病慢性心力衰竭患者80例,随机分为治疗组40例,对照组 40例,对照组选用利尿剂氢氯噻嗪及氨苯喋啶、血管紧张素转换酶( ACE)抑制剂卡托普利、β-受体拮抗 剂倍他乐克,洋地黄制剂地高辛为主要治疗药物.治疗组以螺内酯替代上述氨苯喋啶,其他治疗同对照组,治疗 3个 月后评判疗效.结果:治疗组总有效率达 92.5%,对照组总有效率为 75.0%,两组比较有显著性差异( P<0.05).结 论:螺内酯治疗冠心病慢性心力衰竭可明显提高临床疗效.     

Anti-aldosterone therapy in severe heart failure]

The mortality rate among patients with severe heart failure is still very high despite treatment with loop diuretics and angiotensin-converting enzyme (ACE) inhibitors. The 'randomized aldactone evaluation study' (RALES) has shown that 25 mg spironolactone added to this treatment was safe and reduced all-cause mortality by 30% in patients with severe (previous New York Heart Association (NYHA) functional class IV) heart failure due to systolic left ventricular dysfunction. Blockade of aldosterone in these patients may be necessary to overcome so-called aldosterone escape during chronic ACE-inhibition. The beneficial effects of spironolactone may relate to enhanced diuresis, anti-arrhythmogenic properties and direct effects on the myocardium and blood vessels. At present, addition of spironolactone may be appropriate for patients with severe heart failure, whereas patients with moderate heart failure may benefit more from beta-blockade.     

What to teach to patients with heart failure and why: the role of nurses in heart failure clinics

The most important objective of heart failure (HF) treatment is to reach and preserve patients' clinical stability. Several studies have shown that programs aimed at systematic education, developed by multidisciplinary teams, are positive strategies to work with these patients. Nurses active in HF clinics play a fundamental role in the educational process and continuity of patient care. The objectives of these processes are to teach, reinforce, improve and constantly evaluate patients' self-care abilities, which include weight monitoring, sodium and fluid restrictions, physical activities, regular medication use, monitoring signs and symptoms of disease worsening and early search for medical care. Therefore, education to understand HF and the development of self-care abilities are considered key points to improve adherence, avoid decompensation crises and, consequently, to maintain patients clinically stable. This article presents a careful review of the aspects involved in the patient education process by nurses in the context of HF clinics.     

卡维地洛与美托洛尔治疗慢性心力衰竭的对照研究

目的探讨肛肠源性Fournier坏疽的临床表现及诊疗。方法回顾性分析9例肛肠源性Fournier坏疽患者的临床资料及治疗情况。其中6例并发阴囊坏疽。均行外科清创、引流、抗感染等治疗。7例行高压氧治疗。结果5例经二期缝合痊愈出院，4例因多器官功能衰竭，于术后24h至4周死亡。结论肛肠源性Fournier坏疽预后较差，治疗以早期广泛清创，加强局部引流及应用广谱抗生素为主，有条件者可行高压氧治疗。     

左西孟旦用于严重脓毒血症和脓毒性休克并发心力衰竭患者的Meta分析

目的评价与标准强心剂(多巴酚丁胺类药物)对比,左西孟旦能否取得令临床满意的治疗效果。方法检索2005年1月-2015年12月CNKI、CBM、VIP、万方数据、BioMedCentral、Embase、Pubmed、Central中符合条件的文献;左西孟旦应用于严重脓毒血症和脓毒性休克并发心衰患者且有病死率描述的随机对照试验将被纳入;本研究首要结果是病死率,次要指标为心排血指数(CI)、血清乳酸浓度(LAC)、左心室射血分数(LVEF)、左心室每搏作功指数(LVSWI)、平均动脉压(MAP)。结果共411例患者的11项研究被纳入到本次分析;左西孟旦组病死率为36.8%(77/209),对照组病死率为47.5%(96/202),RR=0.77[0.62,0.95],P=0.02,同质性检验P=0.98,I2=0%;与对照组相比,CI、LVEF、LVSWI升高,LAC降低,MAP差异无统计学意义。结论在严重脓毒血症和脓毒性休克患者中,左西孟旦与标准强心剂治疗相比,可降低病死率。本结论需进行大型多中心随机对照试验验证。     

Treatment of moderate to severe acute hypocalcemia in critically ill trauma patients

BACKGROUND: Our recent data indicate that 21% of critically ill, adult, multiple-trauma patients receiving specialized nutrition support experience hypocalcemia. However, evidence-based methods for the treatment of moderate to severe acute hypocalcemia (ionized calcium concentration [iCa] <1 mmol/L) are lacking. METHODS: The efficacy of an infusion of 4 g of calcium gluconate was evaluated in 20 critically ill, adult, multiple-trauma patients with moderate to severe hypocalcemia (iCa <1 mmol/L). The calcium gluconate was infused at a rate of 1 g/h in a small volume admixture. A serum iCa determination was obtained on the following day. RESULTS: Calcium gluconate infusion significantly increased serum iCa from 0.90 +/- 0.08 mmol/L to 1.16 +/- 0.11 mmol/L (p < .001) on the following day. This dosage regimen was successful for achieving a serum iCa >1 mmol/L for 19 of 20 (95%) hypocalcemic patients and achieved a concentration >1.12 mmol/L in 14 (70%) of the patients. Two patients developed mild hypercalcemia (iCa of 1.34 mmol/L and 1.38 mmol/L) postinfusion. CONCLUSIONS: A short-term infusion of 4 g of intravenous (IV) calcium gluconate for the treatment of moderate to severe hypocalcemia appears to be a promising regimen for critically ill, adult, multiple-trauma patients.     

米力农治疗婴幼儿重症肺炎合并心力衰竭疗效观察

目的:观察米力农治疗婴幼儿重症肺炎合并心力衰竭的疗效及安全性。方法:重症肺炎合并心力衰竭患儿48例,随机分为治疗组与对照组各24例,在常规治疗基础上,治疗组予米力农治疗,对照组予多巴胺治疗。结果:治疗组与对照组有效率分别为95.8%和66.7%,两组间差异有统计学意义(2χ=4.92,P<0.05);治疗组与对照组治疗后心功能指标差异有统计学意义(P<0.05)。两组均未出现不良反应。结论:米力农治疗婴幼儿重症肺炎合并心力衰竭是安全有效的。     

Beta-blocking drugs indicated in patients with heart failure

Until recently, beta-blocking drugs were considered to be contraindicated in patients with chronic heart failure. However, several well-conducted randomised clinical trials have now proven otherwise. Yet, it was still not clear whether nonselective alpha-, beta 1- and beta 2-receptor blockade with carvedilol would be superior to selective beta 1-receptor blockade with metoprolol. One of the studies ('Carvedilol or metoprolol European trial' (COMET)) demonstrated a statistically significant 17% reduction of all-cause mortality with carvedilol. Although striking, the results may have been influenced by differences in blood pressure and heart rate, as well as the short-acting formula of metoprolol that was used. Furthermore, the 'Carvedilol hibernation reversible ischaemia trial; marker of success' (CHRISTMAS) study demonstrated myocardial hibernation in the majority of ischaemic heart-failure patients, and showed beneficial effects on left-ventricle function with carvedilol in both hibernated and non-hibernated patients. Despite this and the rest of the overwhelming evidence, at present only a minority of eligible chronic heart-failure patients are treated with beta-blockers.